Background: Health literacy impacts children’s health and educational attainment, therefore determining the most appropriate pedagogical design is critical. The long-term health benefits of health literacy for each child’s life-course further justifies this imperative. School-based health literacy programs are of interest internationally.

Methods: Authors brainstormed the search terms and established inclusion/exclusion criteria for the systematised review. Two databases (CINAHL, ERIC) were searched following PRISMA guidelines. Three authors screened and sorted the findings.

Results: Twenty one relevant studies were identified from 629. Few (6/21) studies were situated in the primary school setting.

Discussion: This review found a variety of project designs, evaluation methods, and conceptual models. Descriptive analysis of the final 21 papers highlighted the importance of multicomponent design (whole-of-school and curriculum), cross-curricula integration, professional development for teachers, age of children, role of parents, and role of community. The results of this analysis may usefully inform primary school program design in the future.

Conclusion: Schools provide a logical setting for health literacy development. Despite the evidence that adolescence is too late, few studies have been situated in primary schools. Teachers lack confidence to teach health and need ongoing professional development. Parent, child and community voices are essential for sustained engagement and program success.