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The cultural challenge of educating Haitian rehabilitation professionals was identified by a Canadian francophone university which collaborated in the implementation and organization of international internships. Ethical cross-border internationalization should ensure reciprocity for partners. With this as a central value and in a context of pedagogical resource scarcity in Haiti, an intercultural educational partnership involved Haitian and Canadian university students situated in their respective countries in a Problem-Based Learning (PBL) course. Teachers and students applied principles of decolonization of health pedagogy principles were applied by teacher and students throughout this cross-border virtual synchronous PBL course. The aim of this study was to determine the feasibility and to identify facilitators and obstacles to conducting a cross-border virtual synchronous PBL course and its perceived benefits in the development of professional competencies. Five Canadian students and five Haitian students, all volunteers, took part in a 3-week cross-border virtual synchronous PBL course. Deductive qualitative content analysis of the transcripts from a 120-minute focus group discussion held one week after the course and a logbook kept during the project was conducted. The criteria deemed important to successfully replicate this project relate to: 1) The attributes of the students and teachers involved; 2) pedagogical preparation activities; and 3) the use of multiple communication strategies and connectivity plans. In addition to the acquisition of course content not readily available in Haiti, the student interactions inherent in the PBL method supported the acquisition of competencies such as collaboration, communication, and change agent advocacy promoted by the Canadian association of occupational therapy which contribute greatly to strengthening the students' professional identity.

Experts in public health and education alike have long advocated for the engagement of youth in nature to foster movement, human-nature connectedness, and mental wellbeing. Physical and health education teachers in school-based programs continue to find a variety of ways to help their students be physically active in the natural environment due to the plethora of positive benefits. This paper describes a unit entitled Nature-Based Physical Activity in Pictures that utilized Photovoice to engage youth and foster human-nature connectedness.

Background: Layperson cardiopulmonary resuscitation (CPR) is an important skill with the potential to save millions of lives. However, CPR courses often require commercial, complicated, and expensive manikins. To increase access to CPR training worldwide at very low costs, Do-It-Yourself (DIY) devices may be a suitable tool for practising compressions. Objective: This scoping review is the first step in scoping and mapping the evidence on the effectiveness of DIY devices for laypersons learning adult CPR, along with defining gaps for future research. Method: This inquiry was structured by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. A systematic search of 14 academic databases and popular media archives, with additional hand searches, identified academic reports and resources describing DIY compression device construction and/or implementation. Research studies were synthesized narratively, and the main characteristics of all resources were presented in a table. Results: Fifteen studies compared learning outcomes of CPR practice either pre-post DIY practice or between DIY and commercial manikins. Studies varied in the intervention (e.g., learning modality, time, manikin) and measurement, which precluded formal meta-analysis. Of the 55 different DIY devices described throughout all resources, 26 (47.3%) used plastic bottles for compression practice. Analysis of the resources revealed gaps in the current evidence base, such as a lack of clear assessment criteria, standardized procedures for comparisons, and sociocultural questions. Conclusion: This scoping review has identified a small number of studies which described different DIY devices for learning basic CPR skills to different extents. While there is a need for a more comprehensive search and full systematic review, the findings serve as a starting point for future investigations and support evidence-based choices regarding DIY manikins for teaching adult CPR.

This action research project is intended to determine the effects of Chromebook technology on student engagement in the secondary classroom. The study involved a classroom of first-year students enrolled in a health course. These students used Chromebooks for the first time as part of the one-to-one (1:1) initiative. Chromebooks were utilized as a part of the curriculum, incorporating daily lessons, teaching tools, applications, and various activities for student learning. Data collection methods included observations, teacher journals, and field notes. On-task and off-task behaviors were noted, and the results of the data analysis showed the level of engagement involved when using Chromebooks in the classroom. Levels of engagement were explored through a six-week study in a 9th-grade classroom comprised of 28 students using Chromebook one-to-one. Engagement included focus, interest, participation in the lesson and activity, and positive social interactions between the teacher and classmates. This action research investigation indicated that incorporating Chromebook technology into lessons effectively increased student engagement and motivation.

Purpose: Countries with unique developmental paths and cultural lineages display significant variations in their out-of-school education systems. In this landscape, Belarus, a vestige of the disbanded Soviet Union, illustrates a distinct out-of-school education system, profoundly shaped by both Soviet and European Union countries' influences. A meticulous examination and scholarly investigation into the Belarusian out-of-school educational framework could enable a more profound comprehension of the metamorphosis and transitions in the out-of-school education systems of nations that surfaced following the dissolution of the Soviet Union. This knowledge could subsequently render a more transparent understanding of the patterns guiding the evolution of global out-of-school educational systems. Design/Approach/Methods: This article focuses on out-of-school education in Belarus and discusses its development status and the following main characteristics: the dimensions of its historical development stage, legislative guarantee, essence and extension, training goals, and typical cases. Findings: Influenced by historical and geopolitical factors, Belarusian out-of-school education is found to embody the characteristics of both the Soviet Union and European countries. National resources are found to play an important role in the development of out-of-school education, effectively reducing the cost of education for families and shaping students' positive values. Originality/Value: This study analyzes both the history and the current situation of out-of-school education in Belarus and summarizes the country's successful experience in the development of out-of-school education. It can provide a positive point of reference for optimizing the public out-of-school education system in China and exert a positive influence on related educational reforms.

The Choose Health Action Teens (CHAT) program of Cornell Cooperative Extension engages teens to teach a nutrition curriculum to younger youth, with the goal of enhancing the leadership skills and health behaviors of the teen teachers. Due to COVID-19, an in-person CHAT program in New York City was converted to virtual and implemented online during Summer 2020. Twelve teens, mentored by eight college interns, taught youth virtually in their homes. Quantitative and qualitative assessments demonstrated improvement in teen leadership and facilitation skills and health behaviors, and suggest that converting this type of programming to a virtual environment can be successful.

4-H academics responded to the COVID pandemic by rapidly adapting CDC and other resources for virtual delivery. A statewide epidemiology project was taught to 48 youth with the goal of minimizing fears and confusion, increasing prevention measures, leveraging current topics for education, and bolstering the social-emotional health of youth participants. Results indicated that youth enjoyed the project and adopted behaviors to reduce the spread of infectious diseases, such as increased mask-wearing.

There has been marked progress in access to education, representation of women in leadership, sexual reproductive health, and gender-based violence as a result of gender equality initiatives. However, there is still a strong focus on interventions targeting girls only. Through the adolescents' lens, this study sought to establish if there is a preference for interventions targeting girls compared to boys in two urban informal settlements; and what benefits were realized from programming for both adolescent boys and girls enrolled in an after-school support program. We employed a thematic analysis approach to answer the research questions. Results showed that most interventions at the community and school levels tended to favor girls over boys despite both facing similar challenges. Some of the benefits of programming for both sexes included sharing academic knowledge; boys gaining knowledge and skills to enable them to be future champions of change; enhanced ability for the adolescents to keep away from social ills; better gains for the society; breaking the gender inequality cycle; and enhanced social-emotional skills. Evidence from this paper highlights that there is a need for program and policy stakeholders to consider gender-transformative approaches and interventions targeting both sexes to maximize gains in education, health, and well-being.

This study investigates the patterns of promoting physical activity among residents in Mueang District, Mahasarakham Province, Thailand. It explores the impact of contemporary societal shifts, such as increased reliance on technology and decreased physical labor, on public health. The research identifies the rise of chronic diseases due to lifestyle changes and the need for preventive strategies emphasizing physical activity. Utilizing a questionnaire, the study analyzes residents' knowledge, awareness, motivation, and practices regarding health promotion through physical exercise. The findings reveal high general knowledge and awareness of health benefits but low levels of physical activity practice, influenced by lifestyle and societal changes. The study emphasizes the importance of tailored health promotion strategies and the role of digital platforms in enhancing physical activity awareness and participation. This research contributes to understanding effective methods to promote physical activity and addresses the health challenges faced by the local population, promoting sustainable physical and mental health.

There is a high prevalence of adolescent girls with ovulatory menstrual (OM) dysfunction, which is associated with school absenteeism and mental health challenges. Low menstrual health literacy among this group has evoked calls to review OM health education. This qualitative study sought to explore gaps in current OM health education and to validate a holistic school-based OM health literacy program named "My Vital Cycles"®. Findings are based on 19 written reflections, six focus group discussions and three interviews conducted with 28 girls aged 14-18 years from 11 schools, and five mothers. Six themes compared current OM health education with "My Vital Cycles"®: understating health, comprehensiveness, resources, teaching, parents and cycle tracking. Future refinements to the program comprised: inclusion of the complete reproductive lifespan, use of visual media and developing a mobile application. These findings inform future research in a whole school approach, strengths-based teaching and changes in the health curriculum.

Background: In 2013, the Chicago Public Schools (CPS) district passed a policy requiring schools to deliver comprehensive sexual health education (SHE) to all K-12th grade students. A performance improvement case study was conducted in the 2019-2020 school year to evaluate the implementation of the policy and identify lessons learned to support implementation in schools. Methods: Key informant interviews were conducted with 11 school principals and 29 teachers to discuss SHE implementation at their school. Interviews were recorded, transcribed, and analyzed to assess school and classroom factors that affect implementation. Themes that cut across these factors were then identified and summarized by 2 evaluators. Results: The following themes were identified across key informant interviews: (a) principal prioritization of SHE helps ensure SHE is implemented, (b) the expansion of school and teacher capacity facilitates SHE implementation, and (c) the creation of accountability mechanisms in classrooms and schools fosters adherence to SHE policy. Conclusions: Principals play a crucial role in building capacity to deliver SHE and ensuring SHE accountability mechanisms are implemented in their school. CPS is using these findings to adjust technical assistance and resources provided to principals and SHE instructors.

Background: Despite emerging evidence for the effectiveness of school-based suicide prevention programmes worldwide, there are few being implemented in the United Kingdom, and their social validity (i.e., the feasibility, acceptability, and utility) is not yet known. Aims: We aimed to conduct a scoping study to determine: (1) the social validity and potential benefits of school-based suicide prevention interventions, (2) the perceived need for such interventions, and (3) barriers and facilitators to implementation. Sample and Methods: A total of 46 participants took part. Semi-structured interviews were conducted with mental health professionals (N = 8), school staff (N = 8), and parents whose children had experienced suicidal ideation/behaviours (N = 3) in England. Focus groups were also completed with children and young people (N = 27) aged 15-18 across three state secondary schools. Data were analysed using thematic framework analysis. Results: Three themes were identified: (1) the need for and importance of suicide prevention in children and young people, (2) schools as a setting for delivery, and (3) key components of suicide prevention programmes. Conclusions: Participants overwhelmingly agreed that there is a need for a greater and more consistent emphasis on school-based suicide prevention. School appears to be an acceptable location for suicide prevention, and participants felt discussions about suicide should begin at the start of secondary school. However, there are potential barriers that need to be considered, including tailoring for neurodiversity, challenging cultural/family beliefs and stigma, managing personal experiences of suicidal thoughts or previous bereavement from suicide, and a lack of existing training for school staff.

Despite research indicating evidence-based sexual health education results improved student outcomes, students with intellectual and developmental disabilities (I/DD) do not typically receive sexual health education. While school psychologists possess skills that could contribute to sexual health education for students with I/DD, there is no existing research on this topic. To address this, we conducted a survey of school psychologists in a state in the Southeastern United States regarding their attitudes, perceptions of social norm and self-efficacy, and training and familiarity in regard to sexual health education for students with I/DD. The survey's focus and design were guided by the Reasoned Action Approach. Data collection and analyzes addressed (a) the underlying structure and internal consistency of our survey's scales; (b) school psychologists' level of training, knowledge, and beliefs about implementing sexual health education programs with students with I/DD; and (c) the relationship between school psychologists' previous training, knowledge, and beliefs and their implementation of and advocacy for sexual health education for students with I/DD. Descriptive statistics, principal component analyzes, and multiple regression were used to summarize the data and address the research questions. Data from the multiple regression analysis indicated that a significant amount of the variance in participants' implementation/advocacy scores was explained by attitude, social norms, behavioral control/self-efficacy, and training/familiarity. Our findings suggest that school psychologists' engagement in implementation of and advocacy for sexual health education for students with I/DD can be influenced by level of training and knowledge and perceived capability and behavioral control.

Background: Women with learning disabilities are less likely to access cervical and breast cancer screening when compared to the general population. The Social Ecological Model (SEM) was used to examine the inequalities faced by women with learning disabilities in accessing cervical and breast cancer screening in England, UK. Methods: The findings from a qualitative systematic review and a Q methodology study were triangulated. Framework analysis, in line with the SEM, was used to develop an integrated set of findings. Findings: Women with learning disabilities may lack knowledge of cancer symptoms, and cancer screening, as well as being scared about the process and getting the results. The attitudes of family and paid carers towards screening may influence women with learning disabilities' decisions as to whether screening is seen as favourable; support and training may ensure unbiased perspectives. Barriers were also associated with how cancer screening programmes are designed, such as postal invitations which assumes an ability to read. In addition, screening staff need to be aware of the general needs of people with learning disabilities, such as the benefits of easy-to-read documents. Lastly, multidisciplinary working is required so reasonable adjustments can be embedded into cancer screening pathways. Conclusion: This article highlights multiple methods to reduce the inequalities faced by women with learning disabilities, which can be achieved through reasonable adjustments. Embedding reasonable adjustments can support women with learning disabilities in making an informed decision and accessing screening if they choose to. This may result in women with learning disabilities getting a timely cancer diagnosis.

Background: Across the life course, women and girls with learning disabilities and their carers report difficulties in accessing information and support with menstruation, yet their experiences are often overlooked in initiatives to improve menstrual health and wellbeing. Our aim was to collaborate with women with learning disabilities to co-produce future research priorities in a UK context. Methods: We undertook a two-part scoping exercise to explore what is known about this topic from a life course perspective, beginning pre-menarche and extending to post-menopause support. This combined a rapid scoping review of the literature since 1980 with a stakeholder consultation where people with learning disabilities, family carers, advocacy groups and staff working across education, health and social care were invited to share their experiences of menstruation support. Findings: UK and international literature provided insight across five narrative themes. Seventy stakeholders took part in our consultation, enabling the identification of five key themes. Findings across both highlight examples of supportive practice and valued resources alongside enduring health inequalities and barriers to menstruation support faced by women and girls with learning disabilities across the life course. Conclusion: Our scoping exercise identified multiple gaps in research and practice, ongoing reproductive health inequalities and a need for improved access to peer support, resources and training that take a life course approach. The scoping exercise indicates the need for further empirical research on menstruation and learning disability, with a particular focus on collating people's lived experiences.

Objective: Using the FAST (Face, Arms, Speech, Time) Heroes educational programme, this intervention sought to educate residents in a nursing home to recognise and recall the three main stroke symptoms and prepare them to act in an appropriate way, in the event of a stroke emergency. Design: Participatory action research. Setting: A nursing home in Northern Greece. Method: Fifteen residents (n = 15, aged 78-92, mean age = 86.6 ± 4.4) were enrolled and educated through a series of FAST Heroes activities, specially tailored for this new target population. Stroke awareness was measured before, after and 3 weeks post-programme implementation. Fourteen residents completed the programme. Results: Participants demonstrated significant increases in stroke definition, stroke symptom knowledge, appropriate course of action and emergency number knowledge after completing the programme. Notably, 64.3% of participants could accurately identify stroke symptoms, and all participants (100%) correctly knew to call an ambulance in case of witnessing a stroke; 78.6% of the participants correctly identified the European emergency number 112. In the follow-up period, knowledge gain was retained as residents scored significantly higher in three out of four sections of the questionnaire. Conclusion: This study is the first attempt to utilise the FAST Heroes educational intervention in target populations which hitherto have had limited or no access to such educational programmes. This initial intervention showed promising results and could form the basis for extension to a wider population.

Objective: Crack cocaine use has increased rapidly throughout Mexico, along with rising HIV and hepatitis C virus (HCV) infections among vulnerable groups. The Tirando Esquina: Interviniendo Muros de Salud (TE:IMS) project uses projection-mapping technology and is the first of its kind to reach and provide health education at an individual and community level to at-risk crack smoking populations in Mexico City. Setting: This intervention project took place in Mexico City. Design: A single-arm design was utilised. Method: The TE:IMS intervention used projection mapping, a community-based art form wherein 3-dimensional (3-D) images, videos and graphics are projected onto buildings in the community. A total of nine projection mapping episodes were projected and health promoters engaged individuals on the street to reinforce messaging and distribute safer crack kits. A sample of persons who use crack (n = 58) were recruited prior to the intervention to complete pretest-posttest evaluation questionnaires. Results: Findings provide evidence of initial effectiveness. Decreases pre- to posttest were found in weekly crack use (p < 0.05), sharing of paraphernalia (p = 0.002) and use of cans as pipes (p = 0.008), while increases were observed in the usage of Pyrex pipes (p = 0.002). While quantitative HIV knowledge assessments did not increase significantly, qualitative data suggest the intervention made a substantial impact on perceptions and knowledge of HIV among those who interacted with the health promoters and saw the projections. Conclusions: TE: IMS was successful in providing health education and harm reduction strategies at a community level to at-risk crack smoking populations in Mexico City. These findings provide evidence for the initial effectiveness of innovative education and harm reduction efforts in this population.

Objectives: Increasing childhood health literacy (HL) is a crucial means of improving health outcomes and reducing preventable deaths globally. Understanding how to best support children's HL development in schools is essential. However, identifying pedagogical strategies that develop children's HL relies on a fit-for-purpose measure. Currently, no universally accepted approach for measuring HL among children exists. The purpose of this paper was to propose and discuss how a curricular approach to assessing children's HL could provide a means to overcoming the challenges with existing children HL measures. Design/Methods: The discussion is framed by the key components of assessment -- outcome of interest, and collection, analysis and interpretation of data -- and is underpinned by contemporary HL and educational research. Setting: The Australian Curriculum is used to discuss the approach in practice. Results: A curricular approach to HL assessment suggests that HL assessment may work best when it is relevant to the child and their context, is integrated with other areas of the curriculum, allows children to demonstrate a wide range of HL skills and contains an element of open-endedness. Measurement could be guided by a rubric (underpinned by a taxonomy), and interpretation of scores consistently aligned with the learning intentions outlined in the curriculum. Conclusion: A curricular approach provides a contextually adaptive framework from which HL assessment tools for children can be developed

Objectives: Among Aboriginal children, the year between birth and 1 year of age has the highest mortality rate compared with any other age. Prompt administration of cardiopulmonary resuscitation (CPR) leads to better outcomes and a lower likelihood of ongoing sequalae. Current education on infant CPR is not provided to parents except in certain circumstances in a neonatal intensive care unit. Currently, there are no identified CPR education courses specifically available for Aboriginal or Torres Strait Islander people, meaning that current infant CPR education courses are not culturally responsive. Design: Partnering with an Aboriginal community from the Bindjareb region of the Western Australian Noongar nation, the researchers used a co-design approach and an Aboriginal Participatory Action Research (APAR) design to explore how to deliver culturally safe and responsive infant CPR community education. This resulted in the development of the Koolangka Infant Life Saving Education Framework (KILSEF), which can be used to guide future planning and delivery of culturally safe and responsive community level infant CPR education. Results: The study findings identified that members of the Aboriginal community were very interested in receiving infant CPR education, but the barriers identified from mainstream CPR course delivery need to be removed for the community to benefit from culturally responsive ways of learning. Culturally responsive community CPR education should be provided in culturally safe places and the focus of learning should be on the practical applications of CPR and less on the academic pre-reading and written requirements. Explanations should be provided in lay terms and patience is required to communicate ideas in ways that facilitate understanding, and the course may need to be delivered over several days to accommodate community participant availability. Conclusion: Addressing Aboriginal community concerns and barriers allowed for the implementation of culturally responsive infant resuscitation education which was highly valued by community members and led to increased community confidence and participation in CPR education.

This paper reports on the design of a multimodal metalanguage developed by teacher education researchers to support pre-service teachers' understandings of critical literacy and critical health literacies in a changing communication landscape. The design of metalanguage constitutes the first stage of an ongoing transdisciplinary project, Multiliteracies Across Teaching Areas (MATA), which aims to design and implement cohesive disciplinary multiliteracies pedagogies across teaching areas of an initial teacher education (ITE) programme. The focus on metalanguage design is motivated by concerns shared by critical literacy scholars and scholars in health literacy to balance deconstruction of texts with actionable response through the 'deep moral grammar of narrative' Kindenberg and Freebody ("Australian Journal of Language and Literacy, 44"(2), 90-99, 2021). Such concerns also align with recent World Health Organisation calls for the use of solution-oriented literacies to empower communities. These sociocultural understandings of critical literacy and Kindenberg and Freebody's ("Australian Journal of Language and Literacy, 44"(2), 90-99, 2021) call to balance 'the analytical' and the narrative' in critical literacy practice provide the starting point for designing metalanguage for transdisciplinary research in Health and Physical Education (HPE) and English. We firstly review relevant models of the critical informing both subject areas to establish synergous understandings and then analyse expectations of critical practice in descriptions and elaborations of the HPE and English curricula. We provide an overview of the semiotic resources available for transdisciplinary conversations within the English curriculum with clarifying 'bridging' terminology informed by social semiotic descriptions. Through close analysis of four representative texts selected for critical literacy practice by English and HPE teacher educators in the MATA project, we demonstrate how such metalanguage was shared to build understandings of both critical analysis and actionable response. Along with analytical features to build and analyse issues according to disciplinary criteria, we show how stories are used to build rapport with their diverse audiences and to motivate their peers to take positive health action.

Smoking poses a significant threat to adolescent health because of its immediate and long-term detrimental health effects. Smoking refusal self-efficacy predicts smoking behavior in adolescence. In adolescents' health education, digital interventions are potential tools to support smoking refusal self-efficacy. The aim of this two-arm cluster randomized controlled trial was to evaluate the effectiveness of a digital health game intervention compared with a no-intervention control group on smoking refusal self-efficacy in 10- to 13-year-old Finnish early adolescents. The early adolescents (n = 781) were randomized to the control group (n = 394) and the health game intervention group (n = 387). Smoking refusal self-efficacy, sources of smoking and snus refusal self-efficacy, and motivation to decline smoking and snus use in the future were measured at baseline, 2-week postintervention, and 3-month follow-up. Data were analyzed using linear mixed model and Wilcoxon rank-based test for clustered data. According to the results, the intervention group made improvements in sources of smoking and snus refusal self-efficacy between baseline and postintervention, and in sources of snus refusal self-efficacy between baseline and follow-up, compared with the control group. The intervention group showed improvements in smoking refusal self-efficacy among 12-year-olds between baseline and follow-up, and postintervention and follow-up compared with the control group. Similar improvements were also found among those with a smoking friend or a smoking parent between postintervention and follow-up. The results were promising for the use of digital health game interventions to promote early adolescent smoking refusal self-efficacy and preventing smoking experimentation. Further research can evaluate the long-term effects for adolescents.

Effective collaboration and teamwork skills are critical in high-risk sectors, as deficiencies in these areas can result in injuries and risk of death. To foster the growth of these vital skills, immersive learning spaces have been created to simulate real-world scenarios, enabling students to safely improve their teamwork abilities. In such learning environments, multiple dialogue segments can occur concurrently as students independently organise themselves to tackle tasks in parallel across diverse spatial locations. This complex situation creates challenges for educators in assessing teamwork and for students in reflecting on their performance, especially considering the importance of effective communication in embodied teamwork. To address this, we propose an automated approach for generating teamwork analytics based on spatial and speech data. We illustrate this approach within a dynamic, immersive healthcare learning environment centred on embodied teamwork. Moreover, we evaluated whether the automated approach can produce transcriptions and epistemic networks of spatially distributed dialogue segments with a quality comparable to those generated manually for research objectives. This paper makes two key contributions: (1) it proposes an approach that integrates automated speech recognition and natural language processing techniques to automate the transcription and coding of team communication and generate analytics; and (2) it provides analyses of the errors in outputs generated by those techniques, offering insights for researchers and practitioners involved in the design of similar systems.

Health professions educators often use social media to share knowledge; however, it is unclear what specific dissemination and knowledge translation (KT) processes are occurring and the implications of this sharing for health professions education (HPE). This study explored how educators have used social media as a mechanism of dissemination and KT in the literature. A critical scoping review methodology, informed by Engeström's Activity Theory, was employed. Twelve databases were searched and studies that: (a) addressed health professions educators; (b) described the use of social media for dissemination or KT; (c) focused on a regulated health profession; (d) focused on undergraduate or graduate education; and (e) were published in English or French between 2011 and 2021 were included. Data were analyzed using numerical and qualitative content analyses. Of the 4859 articles screened, 37 were eligible for inclusion. Social media may facilitate knowledge sharing in HPE, but there is a lack of conceptual clarity on what is meant by 'dissemination' and 'KT'. Who is responsible for sharing knowledge, what knowledge is being shared, and the target audiences are not always clear. Multiple factors (e.g., affordances, opportunity costs) influence how social media is used as a mechanism of dissemination, and it remains unclear whether and how it is used as a mechanism of KT. Concepts like KT and dissemination, which are often borrowed from other disciplines, must be critically evaluated for their relevance and suitability if they are to be appropriately applied to HPE and in particular to social media. Educators looking to use social media to teach students about KT should consider whether this use of technology truly aligns with their stated learning outcomes.

Background: Return to school supports are recommended to facilitate adolescents' re-entry to school following a concussion. However, little is known as to what school stakeholders prefer for a return-to-school process. This study sought to describe the preferences of high school students, parents, and educators for a Return-to-School Framework for adolescents following a concussion. Methods: We conducted qualitative semi-structured, 1-on-1 or group interviews with high school students (n = 6), parents (n = 5), and educators (n = 15) from Calgary, Canada. Interviews aimed to describe participants' preferences for a Return-to-School Framework for students following a concussion. Interviews were analyzed using conventional content analysis. Results: We organized the data into 4 main themes: (1) purpose of the Return-to-School Framework; (2) format and operation of the Return-to-School Framework; (3) communication about a student's concussion; and (4) necessity of concussion education for students and educators. Implications for School Health Policy, Practice, and Equity: A Return-to-School Framework following concussion should be developed in consultation with families, educators, and students and supports should be tailored to each student. Conclusions: Participants preferred a standardized and consistent Return-to-School Framework including ongoing communication between stakeholders as well as feasible and individualized school supports.

Background: As summarized in this article, the widespread implementation of modern school health education (SHE) could become one of the most effective means available to improve the well-being of people in the United States and in other nations. However, the development and evolution of SHE largely remains unorganized, underdeveloped, and neglected by health and education agencies, policymakers, and the public. Methods: Essential to the development of any scientific discipline, scientists today use the word ontology to refer to efforts to organize knowledge in particular domains. A useful working definition of a scientific ontology is an explicit, formal specification of a shared conceptualization--a systematic set of shared terms and an explication of their interrelationships. Nine interdependent questions are outlined to help guide the development of an initial, broad, and actionable scientific ontology for SHE. Results: Whether and how we respond to these questions arguably will determine the future of SHE research, policy, practice, and equity in the United States. Conclusions: An initial ontology might help conceptualize, inform, and facilitate more systematic and strategic local, state, national, and international deliberations and actions to improve SHE.

Background: Pedagogical approaches that support young people's well-being and maximize their potential are among the "Journal of School Health" research priorities. A unique form of observational learning called biblioguidance could be a pedagogical approach. Methods: We, a team of researchers and teachers, implemented biblioguidance book clubs with 10th-grade health education students. While the initial focus was health literacy skills, we also aimed to generate psychosocial benefits. Those benefits are the focus of the current descriptive phenomenological research. A final book club reflection captured the benefits students received and documented their transformation. We randomly selected 42 reflections from the sample pool (n = 168) and coded them via descriptive document analysis. Results: The results indicate that the book clubs provided psychosocial benefits. Students identified with the stories and characters, gained insight into others' perspectives, lived experiences, and "ways of the world," and were, in many ways, transformed. Some students even experienced catharsis, citing hope, validation, and feeling less alone. Implications for School Health Policy, Practice, and Equity: Biblioguidance book clubs could offer an innovative pedagogical approach to advance students' psychosocial well-being and engage them as active participants in their own learning and health.

Objective: This paper forms part of a DigihealthPE project in which we have been working with physical education (PE) teachers to co-create critical and embodied digital health pedagogies. As part of the project, we invited PE teachers to mind map their personal engagements with digital health technologies. We aimed to explore the potential openings and opportunities (and limitations) within these maps for critical thinking and action. Method: Data were generated during a workshop with 12 PE teachers in Scotland. Informed by new materialism, we focus on the human and non-human factors and intra-actions evident within six narrative portraits generated from teachers' mind maps. Results: Our findings suggest that teachers were engaging complexly and extensively with digital health technologies, which we considered an opening for further critical work. Importantly, experiences of strong (negative) affect had the potential to transform engagements with digital health technologies. Conclusion: We conclude by exploring how the process of mind mapping helped us to see further opportunities for supporting teachers to engage critically with digital health technologies. We also argue that new materialist-informed critical practices in education may have transformative potential for helping teachers and pupils to engage critically with the moving body, technology and health.

Objective: The goal of this study was to report on the development and early usability of a new interactive mHealth app for reducing cardiovascular risk in primary care patients of low socioeconomic status attending clinics in Chile. Design: Mixed-methods design with qualitative and quantitative components. Setting: Three Chilean primary care clinics located in one urban (Santiago) and two rural areas (San Clemente and Chiguayante). Each clinic serves a population of about 24,000 people of generally low socioeconomic status with an average of 8.5 years of education. Methods: A qualitative co-design participatory framework was used to develop the "Mi Salud-APS" mHealth app. Three iterations of virtual workshops were held with healthcare providers and patient participants to develop the new app. Once developed, the usability phase identified, invited and followed up for 3 months a sample of primary care patients with moderate (N = 119) or high (N = 329) cardiovascular risk. Results: A total of 24 healthcare providers and 24 patients participated in the developmental workshops. Three emergent categories represented the core attributes for the mHealth app design: 'Friendly', 'Interactive' and 'Pertinent'. In the usability phase of the sample of 448 patients, 98% downloaded the app, and 64.6% of them logged in and used it for an average of 1.46 (0.5-10) times weekly. Conclusion: Findings suggest that patient and healthcare provider contributions to the development of the mHealth app accurately reflect the interests and experiences of both groups and together helped achieve the high usability levels observed among primary care patients enrolled in clinics in underserved communities.

Objective: This paper examines the ways in which young people in Eastern Canada learn about menstruation and construct personal period pedagogies through embodied experiences and encounters with digital and social media. Design: A qualitative exploratory approach was undertaken to elicit the stories and voices of young people who menstruate. Menstruation is conceptualised as a deeply bio-social phenomenon and knowledge was understood as created, contested and negotiated across settings and contexts. Methods: Semi-structured interviews were conducted with nine university students (ages 19-23 years) in Eastern Canada as part of a pilot project informing a broader study about menstruation education and menstrual experiences. To be eligible for inclusion, participants were required to have experienced one menstrual cycle in the past 6 months and engaged with social media at least once per week. Setting: This project was conducted in a small University town in Maritime Canada. Results: Young people interviewed learned about menstruation through knowledges assembled from conversations family members and peers, educational and medical settings and content encountered on social and digital media. Three themes were developed from the analysis. The first two capture how young people actively try to 'Fill in the Gaps' left by conventional menstrual education approaches and therefore turn to informal and narrative knowledges circulating on social media in efforts to answer the question 'Am I normal'. The third theme describes how participants actively 'Balance Authority and Intimacy' when seeking menstrual information that resonates with their embodied experiences. Conclusion: Substantial gaps exist in the menstrual knowledges available to young people, particularly in relation to the embodied and emotional dimensions of having and managing a period. Digital and social media have the capacity to contribute to personal period pedagogies by acknowledging and exploring aspects of menstruation not adequately addressed in other contexts.

Objective: This study aimed to evaluate how health educators use emotional appeals on the social media site TikTok to promote well-being, engage audiences and reduce mental health stigma. Design/Method: Our research team conducted a quantitative content analysis of 400 TikTok videos centred on health education. We evaluated the frequency of mental health content compared with general health education content and associated views, engagement and use of emotional appeals. Results: Mental health content frequently appeared in #EduTok health videos and earned significantly greater reach than general health content. However, videos discussing mental health earned less engagement and relied less on emotional appeals. Mental health content mainly relied on affiliation, hope and sorrow message appeals, although the presence of these appeals did not significantly affect engagement. General health content utilised personal stories, expert credentials and emotional appeals more frequently than mental health content. Conclusion: Evidence from this research suggests that mental health educational content underperforms general health videos and underutilises emotional appeals on TikTok. Health educators must critically analyse and adjust message strategies to enhance audience reception, taking note of success across health topics. We discuss the implications for how practitioners can use TikTok to reduce stigma and promote positive mental health with emotionally engaging content, especially among young audiences.

Anatomy has been integral to medical and health education for centuries, it has also had a significant role in wider public life, as an educational resource, a link to their health, and also as a darker deterrent. Historically, public engagement in anatomy is hallmarked by public dissections of convicted criminals across the globe. Artists, specifically non-medical men, such as Leonardo da Vinci, are reported to have participated in public dissection. Dissection would later rekindle public interest in anatomy as graverobbing led to the reform and regulation of anatomy in many countries. In recent years, there has been growing interest from the public in learning more about their bodies as health and well-being become of paramount importance, particularly following the COVID-19 pandemic. Anatomy sits in a prime position to direct and instigate conversations around health, well-being, and body image. Every human on earth possesses a perfect resource to look at and learn about. Models, art-based anatomical activities, and crafts provide active learning opportunities for the wider public around anatomy. Most recently, apps, games, and extended reality provide novel and insightful learning opportunities for the public relating to the body. Finally, training and resources must also be made available from institutions and professional bodies to anatomists to enable them to deliver engagement in an already congested and educationally heavy schedule. This resurgence of interest in anatomical public engagement sees anatomy re-enter the public spotlight, with more appropriate resources and educational settings to offer engagement with the aim of benefiting the public.

To date, no evidence-based practices are identified for working with students who are deafblind (DB). No evidence-based practices have been identified for teaching basic self-help skills such as dressing. The present study examined the efficacy of an intervention package including the system of least prompts (SLP; i.e., SLP and least-to-most prompting), visual cues, and reinforcement to teach three self-help skills (i.e., wash hands, dry hands, entry routine) to four participants, ages 3-5 years, with vision and hearing impairments and multiple disabilities. A multiple probe across behaviors design, replicated across participants, was used to evaluate the effectiveness of an intervention package including SLP to teach self-help skills. Three of four participants increased their independence for all targeted self-help skills. A functional relation is indicated for three of four participants and provides promising evidence for use of SLP in teaching individuals with multiple disabilities that include DB.

LGBTQ+ communities experience significant healthcare and academic success disparities due to barriers in care, negative attitudes towards them, and lack of awareness among healthcare providers and educators. Addressing the unique health and wellbeing concerns of LGBTQ+ individuals in the classroom and clinic requires cultural competency among educators and health professionals, yet knowledge and training in this content is lacking. Thus, we created, piloted, and assessed a six-month interdisciplinary professional development program to enhance knowledge, attitudes, awareness, and cultural humility around LGBTQ+ health for educators, administrators, and clinicians in higher education. Participants were surveyed with standardized assessments pre- and post-program to measure their knowledge, skills, and readiness to teach these topics and incorporate them into their curricula and practice. Participants (n = 33) completed LGBTQ+ inclusivity training including six structured learning sessions, small group mentoring meetings, and a virtual visit to an LGBTQ+ community center. Participants consistently displayed interest and engaged actively in training sessions. In a follow-up survey seven months post-intervention, respondents reported changes in their practice to create inclusive environments. Data analysis demonstrated improved knowledge and comfort with LGBTQ+ care and readiness and willingness to integrate LGBTQ+ care into their curricula and interactions with students. These findings suggest that this interdisciplinary professional development pilot offers a useful program to enable educators and clinicians to support the unique needs of LGBTQ+ communities.

US Latine adults who prefer the Spanish language for healthcare encounter communication have high risk of health disparitiesm in part from low organizational health literacy, mental health stigma and discrimination. Organizational health literacy includes the provision of culturally responsive, language concordant health information, which supports good comprehension and usefulness and could mitigate some health disparities. We conducted a pilot study to assess commonly provided patient health information handouts about depression treatment and antidepressant consumer medication information sheets. Thirty Latine adults with a Spanish language preference and a history of depression and antidepressant use participated in one phone interview. Descriptive statistics and thematic analysis were used to assess comprehension and usefulness of selected sections extracted verbatim from these documents. Overall, 83% (n = 25) participants reported that all sections were easy to understand, and 97% (n = 29) said that they were useful. Yet, responses to open-ended questions for 53% (n = 16) of participants revealed 'confusing' terminology in at least one section, and 10% (n = 3) expressed concerns about or misunderstood an idiomatic phrase as reinforcing mental health stigma. The seriousness of the organizational health literacy-based issues identified in this and previous studies require that government and health service organizations make necessary and timely revisions to address them.

This paper evaluates the effectiveness of an educational intervention based on the transtheoretical model aimed at increasing physical activity (PA) participation among female employees in Bandar Abbas city (Iran) healthcare centers in December 2017 and August 2018. Using a semi-experimental interventional study design with a randomized and multi-stage method, 100 participants were included in both the intervention (n = 50) and control groups (n = 50). Data collection involved questionnaires assessing demographic information (age, gender, marital status and education), stages of change in PA behavior, Perceived Benefits, Barriers and Self-efficacy. The data were analyzed using SPSS-16, employing both descriptive (mean, SD, frequency, percentage) and inferential statistics (t-tests, chi-squared tests, etc.). Prior to the educational intervention, 19 participants (0.38%) in the intervention group engaged consistently in PA (stages 4-5). After 3 and 6 months of intervention, these numbers increased to 29 (0.58%) and 25 (0.50%), respectively. This improvement was statistically significant compared to the pre-intervention stage (P < 0.001). The findings highlight the importance of theory-based behavior change models and health education programs in promoting PA and combating sedentary lifestyles. Although focused on a specific population in Bandar Abbas, the intervention can serve as a model for similar programs targeting diverse social classes and populations.

This intervention study aimed to assess mothers' knowledge of iron-deficiency anemia (IDA). It also measured the impact of a health education program on their level of knowledge and their infants' IDA rates in rural areas of Nablus Governorate. Using a randomized pretest--posttest control group design, the efficacy of 3 months' education program was examined against control group. Assessments were made at baseline and after 3 months of conducting the intervention. A structured interviewing questionnaire was used to assess the knowledge about IDA, and blood samples were collected from infants in both groups. Only 1.9% of mothers in the intervention group and 3.5% of mothers in the control group had good level of knowledge at baseline. After the educational intervention, a significant statistical difference was observed in the mean total knowledge score between the intervention and control groups (33.68 + 5.366 versus 26.12 + 5.243), and the intervention group was seven times more likely to have good knowledge (relative risk = 7.332). Regarding IDA rate, there was a decrease in the infants with IDA in the intervention group (relative risk = 0.671) compared to infants in the control group. The planned health education program was effective in improving mothers' knowledge and reducing the risk of IDA among their infants.

This article reports on a 3-year longitudinal study focused on the impact of cross-sector, collective impact approaches to creating cultures of campus health. The study sought to understand the integration of health and well-being concepts into university operations, including business practices and policies, as well as the contribution of public health initiatives focused on health-promoting universities to creating cultures of campus health for students, staff, and faculty. Research was carried out from spring 2018 to spring 2020 via focus group data collection and rapid qualitative analysis involving template and matrix analysis. A total of 18 focus groups were conducted across the 3-year study, six with students, eight with staff, and four with faculty. The initial cohort included 70 participants: 26 students, 31 staff, and 13 faculty. Qualitative analysis findings indicate a general pattern of change over time from a primary focus on well-being characterized by programs and services (e.g., fitness classes) to policy and structural-level interventions (e.g., stairwell beautification and hydration stations) promoting well-being for all. Grass-top and grassroots leadership and action were instrumental to changes in working and learning environments, policies, and campus environment/infrastructure. This work contributes to the growing literature on health-promoting universities and colleges and demonstrates the critical role of both top-down and ground-up approaches and leadership efforts to create more equitable and sustainable cultures of campus health and well-being.

Culturally-adapted evidence-based programs (EBPs) are needed to promote healthy behaviors among Native teens and young adults. Little is known about the facilitators and barriers of implementing and sustaining EBPs in Native communities. This paper aims to identify those factors described by educators who implemented the Native Students Together Against Negative Decisions (STAND) curriculum. Methods: We conducted qualitative, semi-structured interviews with 44 Native STAND educators from 48 sites throughout the United States. We used a modified grounded theory approach to explore barriers, facilitators, and sustainability factors related to implementing Native STAND. Results: We learned that disruptions to staffing, coordination, and organizational factors were the most common barriers. Factors that improved implementation success included: tailoring the program to local needs/constraints, having a supportive Project Manager, improved fidelity due to check-in calls, and participation in summer training. Factors that improved sustainability included: access to needed infrastructure, administrative support, community support, and student interest. Discussion: The delivery of Native STAND was further improved by person-to-person communication and resource sharing across sites. Sustaining EBPs in AI/AN settings requires culturally-tailored technical assistance, sufficient implementation funds for materials and staffing, and a community of peer educators to inspire forward progress. Conclusion: EBPs that reflect the needs and experiences of American Indian and Alaska Native (AI/AN) youth are necessary to address systemic inequities in adolescent health outcomes. The Native STAND Dissemination and Implementation study is among the first to assess facilitators and barriers to program delivery in diverse AI/AN settings.

Background: While vaccines have reduced the incidence of vaccine-preventable diseases, vaccine hesitancy threatens the re-emergence of childhood infectious diseases. Purpose: This randomized controlled study evaluated an online vaccine education program to advance vaccine acceptance among middle-school students. Methodology: Study participants were randomly assigned to an intervention group who viewed the VEP videos or to a comparison group who viewed a science-based video unrelated to vaccines. Results: Knowledge scores improved in both groups and more favorable shifts in vaccine-related beliefs and attitudes occurred in the intervention than in the comparison group. Conclusions: This program can be feasibly delivered via an online platform to middle school students, resulting in shifts in vaccine-related knowledge, beliefs and attitudes. Implications: Delivering evidence-based content to instruct about vaccine effectiveness and safety is an area in which school nurses have demonstrated an important role as a resource for patient education to promote vaccine advocacy.

Black and Latinx adolescents in urban schools can derive numerous benefits from tailored career and health education. However, many factors may prevent schools and teachers from offering such programing. To address the need for career and health education, we prototyped Caduceus Quest, a theory-based, digital role-playing game designed to provide information on health and biomedical science careers and sexual health (specifically HIV) for Black and Latinx adolescents. Forty high-school-aged adolescents participated in small group sessions to playtest the prototype. Post-intervention, adolescents reported increased interest in health and biomedical science careers, as well as HIV knowledge and PrEP awareness.

We offered an enrichment program for high school students with the theme, "The Environment, Health, and You" during the Summer of 2022 and the Spring of 2023. We developed several educational modules for high school students that provided them with an opportunity to learn and explore the foundations of physiological systems, nutrient needs to maintain health, and the impact that environmental factors can have on them. The modules included videos, discussion boards, games, readings, and labs. These modules were integrated into the first session: Your Body and Health. On "day 1," the first module explored the basic physiology and anatomy of the body with respect to the organization of cells into organ systems. Additionally, the educational content included information on macro- and micronutrients and their impact on body development, nutrition, and metabolism. The nutrition module explored nutrition concepts and various factors that can impact healthy eating patterns, such as food insecurity issues and the consumption of ultraprocessed foods. A lab activity on label reading was included to help empower students to make healthy choices. A total of 43 high school students participated in the program. Overall, the quality of the educational content in the modules was rated highly by the students, and they indicated that the educational experience inspired them to learn more about the physiology and nutrition concepts associated with human metabolism, and the importance of healthy food choices to maintain health.

Background: Electronic portfolios (e-portfolios) are valuable tools to scaffold workplace learning. Feedback is an essential element of the learning process, but it often lacks quality when incorporated in ePortfolios, while research on how to incorporate feedback into an ePortfolio design is scarce. Objectives: To compare the ease of use, usefulness and attitude among three feedback formats integrated in an ePortfolio: open-text feedback, structured-text feedback and speech-to-text feedback. Methods: In a mixed method designed experiment, we tested with 85 participants from different healthcare disciplines, three feedback formats in an ePortfolio prototype. Participants provided feedback on students' behaviour after observing video-recorded simulation scenarios. After this, participants completed a questionnaire derived from the Technology Acceptance Model (TAM). The experiment ended with a semi-structured interview. Results: Structured-text feedback received highest scores on perceived ease of use, usefulness, and attitude. This type of feedback was preferred above open-text feedback (currently the standard), and speech-to-text feedback. However, qualitative research results indicated that speech-to-text feedback is potentially valuable for feedback input on-premise. Respondents would use it to record short feedback immediately after an incident as a reminder for more expanded written feedback later or to record oral feedback to a student. Implications: Structured-text feedback was recommended over open-text feedback. The quality of the speech-to-text technology used in this experiment, was insufficient to use in a professional ePortfolio but holds the potential to improve the feedback process and should be considered when designing new versions of ePortfolios for healthcare education.

Background: In this paper, we explore the role digital health education can play in physical education. We argue that the use of digital media and technologies has been accompanied by fundamental changes in basic sports pedagogical categories such as body, movement and experience. In doing so, we advance the thesis that increasing digitalisation offers multi-layered and partly paradoxical opportunities and risks for health education, which have not yet been sufficiently discussed from a sports pedagogical perspective in a digitalised world. Objective: To develop a deeper understanding of these changes, we aim to analyse the mechanisms, opportunities and challenges created by digital health education in physical education, with a focus on the use of tools such as wearables. Method: We draw on a Bildung-oriented perspective rooted in German-speaking pedagogy. With this in mind, we first look at the possibilities and limits for digital health education in physical education at the surface level, before we offer a deeper investigation of body, movement and experience in a digitalised world. This leads us to critical reflection at a structural level. Results and Conclusion: Supposedly clear distinctions between 'virtual' and 'real', and 'digital' and 'analogue', are increasingly untenable. On the one hand, the use of digital technologies can convey reductionist images of humankind and a narrow understanding of education. On the other hand, students can experience differences between supposedly objective and subjective views of their bodies and their movement behaviour using digital technologies. This can lead to Bildung processes in which the relationship between oneself and the world is questioned, which in a sense constitutes a form of Bildung-oriented digital health education.

Healthcare in Aotearoa New Zealand is changing with the aim of becoming truly universal. Development of a new curriculum model in the education of health professionals can aid this goal through increased focus on community needs and flexibility for multiple health professional registrations. Universal healthcare and disability support are promoted as a defining feature of Aotearoa New Zealand, yet inequities are blatantly evident, with increasing calls for equity. Complexity of the issue and the multitude of stakeholders favour action research founded on Vision Matauranga, a problem-solving philosophy which embraces the potential for innovation of Maori -- people, knowledge and resources. Action research embraces collaboration with stakeholders to identify and implement solutions. Government ministries determine policy, with Responsible Authorities accrediting educational institutions, which in turn provide educational programs. Changing what and how students learn can increase their understanding of equity and community needs when they become practitioners, with the voice of service users being paramount.

The COVID-19 pandemic has amplified preexisting challenges for educators as manifested in high rates of work-related stress and burnout, and educators leaving the profession in higher numbers than ever before. In this article, we highlight the urgency for work-related well-being supports for educators, with a particular focus on system changes. Individual self-care is necessary, yet insufficient. To this end, we recommend the use of a multitiered system of support framework to promote a supportive and balanced work environment for all educators, tailored to local needs. We provide a rationale for the use of a tiered model and give specific recommendations for implementation and sustainability of a continuum of supports for school-wide educator well-being.

The impact of community-wide teen pregnancy prevention initiatives (CWIs) on local U.S. birth rates among adolescents aged 15 to 19 years was examined using synthetic control methodology within a quasi-experimental design. CWIs were implemented in 10 U.S. communities from 2010 to 2015. Each initiative implemented evidence-based teen pregnancy prevention interventions at local organizations and enhanced best practices in adolescent reproductive health care at local health centers, while engaging diverse community sectors. The synthetic control method was used to estimate the impact of each CWI on overall and race- and ethnicity-specific teen births relative to rates in synthetic control communities. Additionally, we estimated the overall effect of CWIs across communities by pooling results from the 10 synthetic control case studies using the mean percentile rank. Pooled data across all 10 communities indicated an estimated average of 6.6 fewer births per 1000 teens per year overall during the initiative relative to each community's synthetic control (p = 0.001). By race and ethnicity, there were an estimated average of 6.4 fewer births per 1000 teens per year among Black teens (p = 0.03), 10.7 fewer births among Hispanic teens (p = 0.03), and 4.2 fewer births (p = 0.10) among White teens. Results from individual communities indicated an intervention effect on overall and/or race/ethnicity-specific teen birth rates in five communities. This study demonstrates the value of synthetic control methods in evaluating community-level outcomes of programmatic efforts. Findings indicate the CWIs had a positive impact on teen birth rates and have the potential to address racial and ethnic disparities in those rates.

Objectives: This study evaluated the effects of reading different versions of a fotonovela about diabetes in resource-poor settings in South Africa. Design: An experimental study was conducted with 411 participants, comparing a fotonovela with a younger protagonist, a similar fotonovela version with an older protagonist and a no message control condition. Differences between the two fotonovela versions were analysed for two age groups of readers (25-49 years, and 50 years and older). Setting: Community centres in vulnerable communities in the South African provinces of the Western Cape, the Northern Cape and Gauteng. Method: In the experimental conditions, participants completed a questionnaire after reading one of the fotonovela versions. Participants in the control condition answered similar questions without having read a fotonovela. Results: Both fotonovela versions resulted in more diabetes knowledge than the control condition. Limited positive effects were found for attitudes and behavioural intentions. In the younger participant group, age similarity between the protagonist and readers resulted in knowledge gain, while in the older participant group, no such effect was found. In both age groups, no age similarity effects were found for attitudes or behavioural intentions. Conclusion: This study confirms that fotonovelas can be an effective means of health communication. Furthermore, for a narrative on a health topic for which age is relevant, it can be beneficial to choose a young protagonist. For readers from the same age group, the impact of the story on knowledge acquisition may then be greatest, while for older readers, the age of the protagonist does not seem to influence the knowledge effects of the story.