Abstract
ABSTRACT 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 ( R 2 = 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.