<![CDATA[Modern science education increasingly demands an instructional paradigm shift that bridges classroom concepts with authentic, real-life contexts, particularly concerning critical health decision-making among adolescents. However, a comprehensive structural mapping of how health literacy is systemically integrated into science instructional designs remains scarce. [Objective] This systematic review aims to comprehensively synthesize the instructional strategies, integrated science topics, and pedagogical outcomes of embedding health literacy within the school science curriculum. [Method] Adopting the PRISMA 2020 protocol integrated with the qualitative-sensitive SPIDER framework, 30 empirical articles published between 2017 and 2026 were rigorously screened and extracted from Scopus, ERIC, and SINTA databases. [Results] The thematic synthesis reveals that health literacy integration is predominantly implemented at the secondary school level using mixed-methods and quasi-experimental designs. Prominent instructional approaches include project-based learning, inquiry-based models, and advanced digital media interventions (such as virtual reality, educational websites, and social media platforms) applied across critical topics like nutrition, reproductive health, mental well-being, and infectious disease prevention. While these socio-scientific instructional designs consistently yield profound advancements in students' health-related knowledge and critical awareness, achieving sustainable, long-term health behavior changes remains a pervasive challenge. [Conclusion] This study concludes that effective health integration requires a transition from temporary pedagogical interventions to permanent, curriculum-wide instructional models. Future research must prioritize the validation of standardized K–12 health literacy assessment instruments and longitudinal investigations in resource-limited educational settings]]>
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