Health Literacy in Early Primary Education: A Multimodal Critical Analysis of Greek Grade 1 Textbooks

Background: Early childhood is a key period for the development of health literacy, and school textbooks play an important role in shaping early health-related understandings. Objectives: This study examines how health is represented in Grade 1 primary school textbooks in Greece and how children are positioned in relation to health within the curriculum. Methods: Multimodal critical discourse analysis was conducted on thirteen state-approved Grade 1 textbooks (n = 1.271 pages) published by the Ministry of Education and distributed free-of-charge to all public primary schools in Greece. The dataset covers seven subject areas: Language, English Language, Environmental Studies, Physical Education, Visual Arts, Music and Literature. Analysis was informed by Nutbeam's typology of functional, interactive and critical health literacy. Results: Health-related content appeared across all subject areas but was unevenly framed. Language textbooks and workbooks emphasized prescriptive routines and functional health literacy. Environmental Studies and Literature offered more opportunities for reflective and relational engagement with health. Physical Education and Visual Arts supported well-being through activity and creativity but included limited explicit reflection. Across the curriculum, critical health literacy was minimally represented. Conclusions: Grade 1 textbooks in Greece promote basic health behaviors but provide limited support for the development of critical health literacy in early primary education.