Perceptions of School-Based Health-Preserving Practices and Health-Related Learning Engagement Among Primary School Students in Kazakhstan

The school period is critical for developing health-related knowledge, attitudes and behaviours. However, evidence on primary school students' perceptions of school-based health-preserving practices and engagement with health-related educational content remains limited in Kazakhstan. This cross-sectional survey of 1750 primary school students aged 6–12 years in Kazakhstan assessed perceived health awareness, attitudes, perceived cognitive impact and health-related learning engagement. Psychometric properties were evaluated using reliability and factor analyses, and associations were examined using correlation, regression and cross-sectional path analyses. The hypothesized four-factor model showed strong incremental and residual fit (CFI = 0.972, TLI = 0.964, SRMR = 0.034), although RMSEA was elevated (0.087) and discriminant separation was incomplete for selected domains. Health-related learning engagement was positively associated with perceived health awareness, attitudes and perceived cognitive impact, with the multivariable model explaining 60.6% of its variance (R2 = 0.606, p < 0.001). Language of instruction and grade level were also associated with engagement through direct and indirect statistical pathways. Overall, the findings support a four-dimensional framework of closely related health-related perceptions and educational engagement among primary school students. The instrument assesses self-reported perceptions and engagement rather than objective health knowledge or actual health behaviours, warranting cautious interpretation and further validation.