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Limited health literacy and access to engaging, relevant, understandable health promotion and disease prevention materials are barriers to achieving and maintaining health. The We-Engage-4-Health program co-created the graphic-style story "Foamy Soap Fun" with community members to reinforce the importance of the primary preventive strategy--handwashing--in limiting spread of COVID-19. Pre/postsurveys were administered, and a modified focus group was conducted to learn community participants' preferences for reading stories (aloud together and/or silently to themselves), versus reading typical health promotion information sheets. Three themes were identified related to reading the story aloud: increased enthusiasm, increased attentiveness, and improved interpretation skills, vocabulary, and information processing skills. Educational constructs included: empathy with the story's characters, engagement with previous health experiences, enthusiasm with sharing health information, and explanation of complex health topics. This study supports the value of graphic-style stories in helping communities to better understand the science behind health topics.

Determining the factors that influence implementation of school-based wellbeing and health programs is essential for achieving desired program effects. Using a convergent mixed-methods, multiple informant design, this study considered factors that influence implementation of health programs for ninth grade students and in what ways implementation is differentially perceived by multiple informants (i.e., participants, instructors, and independent observers). Two types of programs--mindfulness and health education--were implemented with ninth graders (N = 70) in three schools situated in low-resourced urban neighborhoods. Study outcomes were derived from four data sources: (1) focus group participants (N = 45); (2) program instructor fidelity ratings; (3) independent observer fidelity ratings and notes; and (4) instructor open-ended session responses. Using thematic and mixed methods integration analyses, we identified themes related to implementation promoting or challenging factors. Theme names differed when data sources were separately analyzed by informant. Mixed methods integration analysis indicated that four themes were common across all informant groups: (1) competent, attentive, and engaging instructors are essential; (2) programs should involve interactive components (e.g., physical activities, applied learning opportunities); (3) adequate time for program delivery is key for student exposure and engagement; and (4) students' availability and preferences should guide program scheduling. A fifth theme, unique to instructor and observer perspectives, was that program implementation was negatively impacted by distractions from multiple sources, including instructors, students, and settings. Recommendations from students, instructors, and observers for implementation optimization are discussed.