Strengthening climate-health literacy through sustainability education among dental students: a quasi-experimental evaluation

Introduction: Health systems both face escalating climate risks and contribute to emissions. Dentistry can mitigate impacts via prevention-oriented, low-carbon, and resilient practice, yet climate-health literacy is inconsistently taught. We evaluated whether a curriculum-embedded sustainability module improves climate-health literacy and action readiness among dental students. Methods: We conducted a quasi-experimental, two-site, parallel-group evaluation with pre- and post-testing in Türkiye (spring 2023–2024). Fourth-year students at Selcuk University (intervention; 14-week sustainability module) and Izmir Democracy University (control; standard curriculum) completed surveys at baseline (week 0) and post-teaching (weeks 14–15). Primary outcomes were the Climate Change Perceptions Scale for Health and Related Professionals and Students (CCPS-HARPS) total and subscales: Awareness & Consciousness, Health & Climate Change, and Advocacy & Experience. Study-specific Oral Health and Willingness-to-Act scales captured discipline-specific perceptions and readiness. Analyses included within-group paired tests, ANCOVA of post-test scores adjusted for baseline (and GPA), assumption checks with interaction probing via estimated marginal means, reliability (Cronbach’s α), and multivariable linear regression with demographic covariates. Results: Baseline included 67 control and 83 intervention students (post-test n = 65 and n = 75, respectively). Internal consistency was acceptable-to-excellent (α = 0.64–0.89 pre; 0.79–0.92 post). In the control group, Awareness (Δ=−0.17, p=0.017), Advocacy (Δ=−0.44, p<0.001), and CCPS Total (Δ=−0.16, p=0.004) declined. The intervention group improved in Health & Climate (Δ=+0.20, p=0.002), CCPS Total (Δ=+0.12, p=0.025), and Willingness-to-Act (Δ=+0.18, p=0.009), with a borderline increase in Oral Health (Δ=+0.12, p=0.061). Adjusted post-tests favored the intervention for Awareness (p=0.025; η²ₚ=0.036), Health & Climate (p=0.001; 0.075), Advocacy (p=0.002; 0.066), CCPS Total (p<0.001; 0.091), and Willingness-to-Act (p=0.006; 0.053); Oral Health was not significant (p=0.190; 0.013). Slope non-homogeneity for Health & Climate and CCPS Total showed larger benefits at lower baselines (e.g., CCPS Total difference 0.37 at 25th percentile, p<0.001), indicating gap-narrowing effects. Conclusions: A semester-long, curriculum-embedded sustainability module produced small-to-moderate gains in climate-health literacy and action readiness among dental students, with the greatest benefits for those starting lower. Findings support integrating assessed, discipline-specific sustainability learning across dental curricula to enable climate-smart, prevention-oriented oral healthcare.