Background: Applying information from health checkup reports is important for the self-management of health. Students in Japan undergo regular health checkups until they graduate from senior high schools. Therefore, it is essential to provide health education through senior high school, in order to improve student's ability to comprehend and apply health checkup reports. However, this ability has yet to be assessed in elementary, junior, and senior high schools in Japan.

Objective: The aims of this study were to examine students' ability to comprehend and apply health checkup reports and the differences between schools and between genders, and to identify intervening factors between the comprehension and application of health checkup reports.

Methods: An anonymous, self-administered questionnaire survey was conducted in 2019 among 328 fifth-grade elementary school students, 173 second-grade junior high school students and 273 second-grade senior high school students. The survey assessed “comprehension of health status based on a health checkup report”(2 questions, multiple answers), “recognition of illness risk” (4 questions), “motivation for carrying out preventive behavior” (7 questions) and “usual application of health checkup reports” (7 questions).

Results: ⑴ Junior high school students' scores on “comprehension of health status based on a health checkup report” and “recognition of illness risk” were significantly higher than those of elementary school students. Specifically, students in higher grades obtained higher scores for the items pertaining to effectiveness of preventive measures (“recognition of illness risk”), the items pertaining to motivation for searching for information and treatment options (“motivation for carrying out preventive behavior”), and the items on making decisions about preventive measures (“application of health checkup reports”). Students in the lower grades obtained higher scores on the items pertaining to recognition of the seriousness of one's health status (“recognition of illness risk”), those pertaining to motivation for making lifestyle modifications and preparing for the next health checkup (“motivation for preventive behavior”), and those on talking with parents and following the advice in the report (“application of health checkup reports”).

⑵ Compared with boys, girls scored significantly higher on the comprehension and application of school health checkup reports.

⑶ The instruction process model from “comprehension of health status based on a health checkup report” to “application of health checkup reports,” which was mediated by “recognition of illness risk” and “motivation for preventive behavior” showed acceptable goodness of fit.

Conclusion: The comprehension and application of school health checkup reports, and the motivation for preventive behavior were significantly better among girls, and these abilities varied according to grade. This study suggests that an instruction process model for application improvement should include comprehension of health status, recognition of illness risk, and motivation for preventive behavior.