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Article History

Received: 18 November 2022

Accepted: 12 September 2023

First Online: 26 September 2023

Competing interests

: The authors declare no competing interests.

: The study was approved by the School of Medicine, Dentistry and Biomedical Sciences Ethics Committee at Queen’s University Belfast on September 21, 2018 (ref. 18:43) and by the Research Ethics Committee at the University of Los Andes on July 30, 2018 (ref. 937/2018). This study complies with all relevant ethical regulations. All study procedures were carried out in accordance with institutional guidelines for research involving human participants and with the Declaration of Helsinki.

: Written, informed consent was obtained for all participants. Prior to the baseline assessment, each school was provided with Teacher information sheets, Pupil information sheets, Parent/guardian information sheets, Pupil consent forms, and Parent/guardian opt-out forms. All pupils were required to complete written consent forms indicating whether they agreed or declined to participate. Parents/guardians who did not wish their child to take part were asked to return completed opt-out forms. The experimental protocol, and all data collection procedures, were carried out in accordance with institutional guidelines for research involving human participants and with the Declaration of Helsinki.