Health literacy in action through community-based participatory research: the ENABLE programme for indigenous older adults in Taiwan

Abstract Background Nutritional status and functional capacity are closely linked and contribute to healthy longevity. Given geographic isolation, Indigenous older adults are more likely to experience limited food diversity and suboptimal diets, increasing cardiometabolic risk in later life. Indigenous Taiwanese communities have distinct cultural identities, lifestyles, and food systems; therefore, health promotion programmes combining professional advice with culturally appropriate approaches are crucial. Methods This community-based participatory research (CBPR), titled ‘Engaging Native Abilities to Boost Lifestyle Enhancement’ (ENABLE), co-created nutrition and cooking workshops with the Indigenous Tsou community in Taiwan. Photovoice-facilitated focus groups were conducted with nine Indigenous older adults to explore dietary patterns before and after the workshops. Post-workshop interviews were conducted with 16 participants, including nine older adults and seven co-organisers. Results The findings reveal that health literacy is constructed and embodied in everyday practices through three interrelated processes shaped by health needs, social roles, and relational responsibility. First, ‘negotiating dietary decisions with health needs’ involves dialogue between traditional and scientific knowledge about food choice transitions. For example, some participants described transitioning from traditional roasted pork to fish in response to changes in chewing ability. Second, ‘engaging place-based adaptive strategies within lifestyles’ supports food access and maintenance of social roles. For example, work is central to Indigenous life, shaping identity, autonomy, and a sense of achievement; participants incorporated dietary portion control into their lifestyles to manage weight while maintaining strength for work. Third, ‘mobilising individual agency for collective well-being’ extends nutritional awareness to family and community members. Conclusions The CBPR approach, grounded in the lived experiences of Indigenous older adults, can shape a tailored dietary intervention. Meaningful engagement in Indigenous health research is strengthened by mutual understanding, shared action, and reflexive dialogue. Health literacy may support the agency of Indigenous older adults and local health sectors; however, its sustained effects in addressing structural barriers and supporting healthy ageing in place warrant further examination. Given the centrality of work in Indigenous life, health promotion activities may benefit from remaining flexible and collaborating with occupational groups to better connect working-aged adults, those transitioning into retirement, and older adults with increasing health needs.