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Thirty years ago, the World Health Organization (WHO) Ottawa Charter for Health Promotion created a paradigm shift in addressing major public health challenges. Traditional approaches to health education focused on personal health 'risks' and lifestyle choices were quickly overshadowed by the attention given to more comprehensive policy and environmental interventions. Since that time health education has evolved in content, media use and sophistication of communication to fulfil a wider range of purposes. The concept of health literacy has been useful in sustaining this change. As the tools for communication have been transformed by digital communication, and the marketplace for communication has become more crowded and complex, health education has continued to evolve to reflect these changes, enabling people to navigate competing sources of information and to engage meaningfully with social and economic determinants of health. Equitable access to quality health education and lifelong learning remain the cornerstones of modern health promotion.

BackgroundLow health literacy is associated with poor health-related knowledge, illness self-management, health service use, health, and survival, and thus addressing issues related to low health literacy has been highlighted as a pressing international priority.ObjectiveTo explore views of a digital health promotion intervention designed to be accessible to people with lower levels of health literacy, in particular examining reactions to the interactive and audiovisual elements of the intervention.MethodsQualitative think-aloud interviews were carried out with 65 adults with type 2 diabetes in the UK, Ireland, USA, Germany, and Austria, with purposive sampling to ensure representation of people with lower levels of health literacy. Inductive thematic analysis was used to identify common themes. We then systematically compared views in subgroups based on country, health literacy level, age, gender, and time since diagnosis.ResultsMost participants from the chosen countries expressed positive views of most elements and features of the intervention. Some interactive and audiovisual elements required modification to increase their usability and perceived credibility and relevance. There were some differences in views based on age and gender, but very few differences relating to health literacy level or time since diagnosis.ConclusionsIn general, participants found the intervention content and format accessible, appropriate, engaging, and motivating. Digital interventions can and should be designed to be accessible and engaging for people with a wide range of health literacy levels.

Background: The HeLP-GP trial aimed to increase the capacity of practice nurses to deliver weight management to overweight and obese patients through an intervention comprising a health check, a lifestyle app and/or telephone coaching. This paper describes implementation through the lens of organisational readiness with emphasis on the role of the practice nurse. Methods: Routinely collected mixed method research data including practice surveys, field notes, and diaries and process data were mapped against the domains: motivation to implement, general capacity and intervention-specific capacity. Results: Organisational readiness varied considerably, particularly the domain of intervention-specific capacity. Practice nurse turnover negatively impacted the implementation, affecting half of the practices. We observed a general lack of practice-based support for intervention delivery, and varying levels of interest, skill and confidence in delivering the intervention. Nurses struggled to complete the research and intervention tasks in a timely way. Conducting risk assessments and referring to coaching were generally not problematic; however, we noted lower confidence levels with the lifestyle app and instructing patients to use it. Conclusions: We found a lack of general 'readiness' inherent in the nursing role, particularly related to their capacity to complete intervention tasks and practice-level support to implement the intervention. For nurses in general practice to fulfil their potential in supporting patients to reduce risk and adopt healthier life choices, our study indicates that more could be done to improve their workforce positioning and remuneration, which may, in turn, improve continuity of care, retention and individual motivation. General practice nurses play a key role in delivering prevention. This paper describes the experience of implementing a nurse-led obesity intervention in Australian general practice through the lens of organisational readiness. Our results suggest that for nurses in general practice to fulfil their potential in supporting patients to reduce risk and adopt healthier life choices, more could be done to improve their workforce positioning and remuneration, which may, in turn, improve continuity of care, retention and individual motivation. [ABSTRACT FROM AUTHOR]

Considered investment in health and medical research (HMR) is critical for fostering a healthcare system that is sustainable, effective, responsive, and innovative. While several tools exist to measure the impact of research, few assess the research environment that nurtures and supports impactful research and the strategic alignment of research with societal needs. This perspective article discusses the limitations of existing assessment tools and presents a novel Research Impact Assessment Framework designed to enable more strategic and targeted investment towards HMR, having the potential for significant public benefit. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study is to explore educational perspectives towards the concept of health promoting schools and its potential benefits for schools in more depth. Design/methodology/approach: This paper presents the results of a qualitative study based on interviews with school staff including principals, and teachers with responsibility for health promotion from 18 primary schools in Sydney, Australia, examining their understanding of the health promoting schools concept, and their perceptions of its advantages for schools. Findings: The study documents the variety of school staff perceptions. Further examination of the data led to the emergence of four broad categories to accommodate diverse perceptions on health promoting schools. The findings point to several challenges that need to be addressed by advocates of the health promoting schools concept, most notably developing a shared understanding between health and education sectors of the practical elements and potential benefits. Practical implications: Sustaining school health interventions, including health promoting schools programs and maintaining their positive outcomes, is likely to be more achievable in circumstances where schools can identify benefits that fit with their core business of education, and their local needs and priorities. Originality/value: This study adds depth to the understanding of the diversity in educational perspectives regarding the meaning and benefits of health promoting schools. This study also revealed an understanding among school leaders that there is scope for realizing both health and educational outcomes from school health promotion programs.

Purpose: The purpose of this study is to examine characteristics of resilience among Australian adolescents, the extent to which resilience might be strengthened through participation in a dance/drama competition, the Rock Eisteddfod Challenge (REC), and the impact participation may have on health related behaviour. Design/methodology/approach: Students completed questionnaires at the commencement of the REC planning and rehearsals in schools. The survey was repeated immediately after completion of the competition. Three groups of students were compared comprised students engaged in the REC (participants), students from Rock Eisteddfod schools who did not participate in the Rock Eisteddfod Challenge (REC school non-participants) and students from schools that did not participate in the Rock Eisteddfod Challenge (control school students). The questionnaire was designed to measure changes to key modifiable elements of resiliency and selected health behaviours. Findings: The majority of participants in the REC were girls, and the analysis of results was restricted to a matched group of girls from Year 9 (age 13-14) and above. Girls in this group from REC schools scored significantly higher in measures of overall resiliency during the rehearsal period than students from control schools. Within REC schools, participants scored higher for a combined measure of resiliency than non-participants. High scores for resiliency were consistently associated with lower prevalence of reported substance misuse across the whole sample. In general, increases in substance use observed over the time period from baseline to follow up was less in the REC group than the control group. Research limitations/implications: Several methodological problems were encountered in this study, including identification of adequate measures of personal skills and characteristics, difficulty in obtaining a true pre-intervention point to commence the study; and in identifying a large balanced sample of students that would allow for meaningful analysis of results; as well as the normal difficulties of identifying and maintaining contact with a large cohort of students in many different sites. For these reasons, the results need to be treated cautiously, and "causal" conclusions about the intervention could only be preliminary. Practical implications: The study indicates the potential benefits of participation in programmes like the REC, and the results are consistent with other studies indicating positive associations between participation in the REC and a range of positive personal, social and behavioural outcomes. Originality/value: The paper highlights some of the methodological challenges in conducting a prospective assessment of the effects of participation in a health oriented dance/drama event. It indicates the potential of this type of activity as a vehicle for the communication of health messages, and the possibility of a more direct influence on personal skills and health related behaviour. (Contains 1 figure and 3 tables.)

Background: Health literacy interventions and research outcomes are not routinely or systematically implemented within healthcare systems. Co‐creation with stakeholders is a potential vehicle through which to accelerate and scale up the implementation of innovation from research. Methods: This narrative case study describes an example of the application of a co‐creation approach to improve health literacy in an Australian public health system that provides hospital and community health services to one million people from socioeconomically and culturally diverse backgrounds. We provide a detailed overview of the value co‐creation stages and strategies used to build a practical and sustainable working relationship between a University‐based academic research group and the local health district focussed on improving health literacy. Results: Insights from our experience over a 5‐year period informed the development of a revised model of co‐creation. The model incorporates a practical focus on the structural enablers of co‐creation, including the development of a Community of Practice, co‐created strategic direction and shared management systems. The model also includes a spectrum of partnership modalities (spanning relationship‐building, partnering and co‐creating), acknowledging the evolving nature of research partnerships and reinforcing the flexibility and commitment required to achieve meaningful co‐creation in research. Four key facilitators of health literacy co‐creation are identified: (i) local champions, (ii) co‐generated resources, (iii) evolving capability and understanding and (iv) increasing trust and partnership synergy. Conclusion: Our case study and co‐creation model provide insights into mechanisms to create effective and collaborative ways of working in health literacy which may be transferable to other health fields in Australia and beyond. Patient and Public Contribution: Our co‐creation approach brought together a community of practice of consumers, healthcare professionals and researchers as equal partners. [ABSTRACT FROM AUTHOR]

Eight papers on Australia's school health programs discuss: creating health promoting schools in the United States; intersectoral collaboration for developing a national framework for health promoting schools; school-based health promotion nationwide; auditing health promoting schools policy documentation; the nature of health service/school links; research; the impact of Australia's national health promoting schools initiative; and secondary HIV/AIDS education. (SM)

Discusses the need to promote health literacy. Such efforts can be achieved through more personal forms of communication and through community-based educational outreach. (Adjunct ERIC Clearinghouse for ESL Literacy Education) (Author/VWL)