Empowering Children: Co-Design Boosts Health Literacy and Learning Outcomes in primary school

Abstract Background Research underscores the primary school's pivotal role in educating children on managing health information. To enhance the effectiveness of interventions, relevance for the children and engagement of children in learning activities co-design is a promising participatory method. It fosters empowerment and ownership among young learners which is needed for active involvement in learning health literacy (HL) skills. Methods Four steps of design-based research were used to design and evaluate HL learning activities with children. In the first two steps HL learning activities were co-designed in groups of 6-9 children and 2 researchers in 3 schools in the Netherlands. In the third step the co-design group and their peers tested the activities in school. For the evaluation children's HL was measured at T0, T1, T2 with HLS-Child-Q15-NL, learning outcomes (LO) were measured subjectively based on the HL skills in the learning activity at T1 and T2. The effect on HL and LO for testing and co-designing the activities was analysed for differences within and between the co-design group and the peers who only tested the activity. Results 66 Children participated in this study (n = 24 in co-design group, n = 42 in test group. The mean age was 10.8 and 62% were girls. In the co-design group HL scores increased significantly over time. The group of peers had a significantly increased learning outcomes scores after testing the learning activity. However, the co-design group started with a significantly higher learning outcomes score than the peers group before the test. Conclusions Co-designing the activity significantly increased HL and showed significantly higher LO scores, suggesting that co-designing an HL learning activity is more beneficial than experiencing it. Engaging in the design process contributed to a deeper understanding of HL and LO, which highlights the importance of an active role in learning processes.