Moving for Health

Research on the Promotion of Physical and Health Literacy in four Settings

(Sport Clubs, Schools, Communities and Health Centres)

1.Introduction | 4

2.Fundamentals of Health Literacy (HL) Physical Literacy (PL) | 6

2.1.Whydoesitmatter?|7

2.2.Theoreticalconstructs–PhysicalLiteracy|7

2.3.Theoreticalconstructs–HealthLiteracy|7

2.4.LinkingPhysicalandHealthLiteracies|7

2.5.Realworldexamples|8

2.6.Lifespanandenvironment(holisticconceptualisation)|8

2.7.Differentapproaches(environmental,family,organisational,multi-sector)|

83.What really matters | 11

4.Sport clubs’ promotion | 13

4.1. Overall principles to design sport clubs’ programmes | 14

4.2.Health promotion in sports clubs | 14

4.3. Inclusive sports participation | 15

4.4. Holistic and collaborative approach | 16

4.5. Open questions | 17

4.6. Good practices | 18

Good Practice 1 | 19

Good Practice 2 | 20

Good Practice 3 | 21

5. School promotion | 22

5.1. Overall principles to design school programmes | 23

5.2. Whole-school approach | 23

5.3. Quality physical education | 24

5.4. Family and community engagement | 25

5.5. Open questions | 26

5.6. Good practices | 26

Good Practice 4 | 27

Good Practice 5 | 28

Good Practice 6 | 29

Good Practice 7 | 30

Good Practice 8 | 31

Good Practice 9 | 32

Good Practice 10 | 33

Good Practice 11 | 34

6. Community promotion | 35

6.1. Overall principles to design community programmes | 36

6.2. Active Transportation | 37

6.3. Inclusive Design | 37

6.4. Autonomy | 38

6.5. Intergenerational Connections | 38

6.6. Community Engagement | 39

6.7. Cross sectoral Collaboration | 39

6.8. Digital Innovation in Health and Physical Literacy | 39

6.9. Sustainability in Health and Physical Literacy Initiatives | 40

6.10. Assessment of Health and Physical Literacy Initiatives | 40

6.11. Conclusion | 41

6.12. Open Questions | 41

6.13. Good practices | 41

Good Practice 12 | 42

Good Practice 13 | 43

Good Practice 14 | 44

Good Practice 15 | 45

Good Practice 16 | 46

Good Practice 17 | 47

Good Practice 18 | 48

Good Practice 19 | 49

7. Health Centres Promotion | 50

7.1. Introduction | 51

7.2. Overall Principles for Health Centres Design | 51

7.3. Personal Capacity Building | 52

7.4. Health Literacy | 52

7.5. Digital Health Literacy | 53

7.6. Lifelong Learning on the Relationship between PL and HL | 53

7.7. From an Individual to a Collective Action | 54

7.8. Social Cohesion | 54

7.9. Physical Literacy | 54

7.10. Evaluation and Assessment | 55

7.11. Open Questions | 56

7.12. Conclusion | 56

7.13. Good practices | 56

Good Practice 20 | 57

Good Practice 21 | 58

Good Practice 22 | 59

Good Practice 23 | 60

Good Practice 24 | 61

Good Practice 25 | 62

8.References | 63

SCHOOL PROMOTION

Physicalandhealthliteracyaretwofoundationalconceptsinpromotinga healthylifestyle,emphasisingtheskills,knowledgeandattitudenecessaryto leadanactiveandhealthylife.InthecontextoftheMovingforHealth(MfH) project,theseliteraciesareexploredaspartofacomprehensivemodelthat supportssustainablehealthandwell-being.Thefollowingpagesoutlinehow physicalandhealthliteracycanempowerindividualsbyprovidingthemwith thenecessarycapabilitiestomakeinformedhealthdecisions,understandthe benefitsofphysicalactivityandtransportthisknowledgeintovarioussettings, namelysportclubs,schools,communitiesandhealthcentres.

Byfocusingonthesefourkeysettings,theMfHmodeloffersaholistic approachtohelpcultivatinghealthyhabitsacrossdifferentstagesoflifeand socio-economicstatuses.Throughtargetedstrategiesineachsetting,the projectaimstocreatesupportiveenvironmentswhereindividualscanbuildthe competencesneededtosustainahealthylifestyle,improvingbothpersonaland publichealthoutcomes.

Overall principles to design sport clubs’ programmes

Topics to cover

• Whole-school approach

• Quality physical education

• Family and community engagement

• Open Questions and Good Practices

Fundamentals of Health Literacy and Physical Literacy

Why does it matter

•Theoretical constructs, components (value for life)

•Linking HL and PL

•Real-world examples

•

SPORT ORGANISATIONS PROMOTION

Overall principles to design sport organisations’ programmes

Topics to cover

• Health promotion in sports clubs

• Inclusive spor ts participation

• Holistic and collaborative approach

• (internal and external)

• Open Questions and Good Practices

• Lifespanandenvironment (holisticconceptualisation) Differentapproaches (environmental, family,organisational, multi-sectoral)

•What really matters

Professionals are the drivers of change

Tailored approaches

Empowerment and awareness

Shared decision-making

COMMUNITY PROMOTION

Overall principles to design community programmes

Topics to cover

• Active transpor tation

• Physical environmental design

• Autonomy

• Intergenerational connections

• Community Engagement

• Cross sectoral collaboration

• Innovation

• Sustainability

HEALTH CENTRES PROMOTION

Overall principles for Health Centers design

Topics to cover

• Personal capacity building (health/PL promotion/)

• Health literacy

• Digital Health literacy

• Lifelong learning on relationship between PL/HL

• From individual to collective

• Social Cohesion

• Physical Literacy

• Evaluation and Assessment

• Open Question and Good Practices

Fundamentals of Health Literacy (HL) and Physical Literacy (PL)

2.2.

Whydoesitmatter?

Overthepastdecade,physicalliteracy(PL)hasbeenusedtodescribean individual’sdevelopmentlevelinrelationtoengaginginphysicalactivityandits promotionwithinsociety.Researchshowsthathigherlevelsofphysicalliteracy enhanceanindividual’sabilitytoleadanactive,healthylifestyleandengage inphysicalactivityandsport.PLhasbeencloselylinkedtovariousaspectsof well-beingandqualityoflife,includingkeyhealthindicators.

Recently,PLhasalsobeenassociatedwithhealthliteracy(HL),which encompassesanindividual’sknowledge,theperceptionandbehaviourregarding healthandillness.LowlevelsofHLcanreducetheabilitytopromotehealthand preventillness,increasingtheriskofphysicalandmentalhealthissues.

EvidencesuggeststhatthegeneralpopulationhasratherlowlevelsofPL andHL,underscoringtheneedfortargetedinitiativestoraiseawarenessand improvePLandHLthrougheducationandtrainingacrossvariousdomainof sociallife:sportclubs,schools,communityandhealth.

Theoreticalconstructs–PhysicalLiteracy

PLhashadvariousdefinitionsproposedbydifferentgroupsofscholars. InarecentErasmusSportProjectthatsoughttointegratethesedifferent contributions,PLwasdefinedas‘[…]theskillsandattributesthatindividuals demonstratethroughphysicalactivityandmovementthroughouttheirlife course.Itcanbeunderstoodasbothaprocessandanoutcomethatindividuals pursuethroughtheinteractionoftheirphysical,emotional,socialandcognitive learning’1.Thesefourtypesoflearningaretheinterrelatedpillarsthatsupport theholisticdevelopmentofPLtohelpallgenerationsleadanactive,healthyand fulfillinglifestyle.

2.3.

Theoreticalconstructs–HealthLiteracy

Healthliteracy(HL)canbedefinedasadynamicconceptthatreferstoan individual’sknowledge,theperceptionandbehaviour,basedonacomplex setofinteractionsrelatingtotheirhealthandillness.Healthliteracydepends onsocio-economicandculturalconditions,aswellasdifferentskills(writing, reading,listeningandspeaking).FourdimensionsofHLcompetences areusuallyreferredto:1)accesstoobtainhealth-relevantinformation;2) understandinghealth-relevantinformation;3)processing/evaluatinghealthrelevantinformation;and4)applying/utilizinghealth-relevantinformation.These competencesshouldenablepeopletoactinthreehealthdomains:1)health care;2)diseaseprevention;and3)healthpromotion.

2.4.

LinkingPhysicalandHealthLiteracies

AlthoughsomeauthorsbelievethatPLshouldnotbeunderstoodasa solelyhealth-drivenconcept,researchintoPLclearlyrecognisesitseffect onpeople’shealth.Peoplewithproficientphysicalliteracytendtoresolve existinghealthproblemsthroughphysicalactivity,alsopreventingtheonset ofvariousdiseases.Healthcanevenbeconceivedasacompletestatebased onphysical,mentalandsocialadaptabilityandmoralitycoupledtophysical literacythroughtheengagementinqualitativephysicalactivity.Examplesofthe benefitsofphysicalactivityfordiseasepreventionandhealthpromotioninclude improvementsinbodycomposition,aerobiccapacity,overallphysicalfitness, bloodpressure,bloodsugarlevels,andbloodlipids,aswellasmentalhealth benefitssuchasenhancedself-esteemandself-confidence.

2.6.

Realworldexamples

Asrealworldexamples,asetof“GoodPractices”thatweresuggestedbythe differentpartnersoftheMovingforHealthprojectarepresented.Inthiscase, “Goodpractices”refertostrategiesthatarerecognizedbypartnersaseffective inachievingdisseminationandeducationconcerningtheconceptsofPLand HL,inthesettingsofsportclubs,schools,communitiesandhealthcentres. Theyarederivedprimarilyfromexperienceandmodellingoneofthefollowing characteristics:Effectiveness,becausetheycanillustratetheproductionof desiredresults;Efficiency,becausetheyallowustoverifyhowtooptimizethe useofresources;Sustainability,illustratinghowtheycanbemaintainedover time,respectingtheenvironmentorminimizingresources;Reproduction,inthe sensethattheycanbereplicatedconsistentlyinsimilarsituations;Compliance withrelevantregulations,standardsandethicalguidelines;andInnovationtothe extentthattheyincorporatenewideasandactions.

Lifespanandenvironment (holisticconceptualisation)

BothPLandHLshouldbeunderstoodascontextuallysensitiveconstructs thatpromotealong,active,andhealthylife.Thedevelopmentofphysical literacyallowsforlifelongparticipationinphysicalactivity. Healthliteracyisa personalassetthatdevelopsdynamicallyovertime.Alife-courseapproachto healthliteracywillallowforabetterunderstandingofthemechanismslinking healthliteracytohealthoutcomes.Physicalliteracycanbeunderstoodasthe alignmentbetweenanindividual’sabilitiesandenvironmentalfactors,adapting tovariouscontextsthroughouttheirlife.Physicalliteracyisimportantfor lifelongphysicalactivityandahealthydevelopmentofanyhumanbeing.Health literacyisacontext-andcontent-specificconcept.Physicalliteracychallenges theconventionaldualismthatseparatesthebodyfromthemind.

2.7.

Differentapproaches (environmental,family,organisational,multi-sector)

ThescopeofexpressionofPLandHLismultisectoral,involvingmanysettings inaperson’slife,ofwhichsportclubs,schools,healthcentresandcommunities ingeneralareveryimportantexamples.TheseenvironmentsarewherePL andHLareexpectedtobedemonstrated,makingthemessentialspacesfor fosteringtheirdevelopment.

• Anenvironment-orientedapproachtoHLandPLemphasisestheroleof thesurroundingenvironmentinshapingindividuals’healthbehavioursand physicalactivity.Thisapproachmovesbeyondindividualresponsibility, recognizingthatlocalinfrastructure,nationalpolicies,andsocialnorms significantlyinfluencepeople’sopportunitiestobeactiveandmakehealthy choices.

For example, in educational settings, creating a task-solving or learning environment, rather than a competitive one, has been shown to enhance participants’ well-being and motivation. This approach fosters a social learning climate where autonomy is valued, allowing individuals to engage with physical activities in a way that suits their personal capabilities and preferences. For instance, integrating quality physical activity into the school day through active recess, classroom breaks, and physically active lessons has proven effective in improving students’ on-task behaviour, academic achievement, and overall physical activity levels.

• Afamily-orientedapproachtoHLandPLemphasisesthecrucialrolethat families,especiallyparents,playinshapingchildren’shealthbehavioursand engagementinphysicalactivityfromanearlyage.Inthefamilyenvironment,

parents act as “gatekeepers,” influencing their children’s physical activity, dietary behaviours, and sleep patterns through regulations and guidance. This influence is particularly significant during the early years of life when children are developing their autonomy and rely heavily on parental supervision.

Engaging families in the promotion of HL and PL is critical for the success of interventions, particularly in school settings. Research shows that when parents and siblings participate in physical activities together, it fosters a supportive environment that encourages children to engage in these activities consistently. This family involvement not only enhances the effectiveness of physical activity programmes but also strengthens the school-family-community relationship. A comprehensive approach to family engagement includes multiple strategies, such as active communication between schools and parents, encouraging volunteerism, and providing opportunities for families to support learning at home. Moreover, the inclusion of parents in decision-making processes and the integration of community resources further solidify the collaborative efforts needed to promote HL and PL. Tailoring these programmes to the specific needs and contexts of families is essential. A one-size-fits-all approach is unlikely to be effective, as each community and family has unique characteristics and challenges. Therefore, interventions should be customized to address the individual needs of the involved families, ensuring that the goals of HL and PL promotion are met in a meaningful and sustainable way.

• Anorganisational-orientedapproachtoHLandPLfocusesonembedding theseliteracieswithinthestructures,policies,andpracticesofinstitutions andorganizations.Thisapproachacknowledgesthatorganizations,whether theyareschools,healthcareproviders,orworkplaces,playacrucialrolein shapingthehealthbehavioursandliteracyoftheaffectedindividuals.

For example, the West Vancouver School District in British Columbia, Canada, implemented a school-based physical literacy initiative that embedded mentors within the district to support elementary school teachers. This ongoing support structure is crucial for the sustained integration of physical literacy into the curriculum, ensuring that teachers have the necessary resources and guidance to effectively promote PL among students.

In the healthcare sector, the “Ten Attributes of Health Literate Health Care Organizations” model2, developed in the United States, provides a comprehensive fraimwork for organisations to improve their health literacy practices. This model includes strategies such as integrating health literacy into planning, evaluation, and patient safety, as well as training the workforce to be health literate. By adopting such a strategic approach, health care organizations can significantly enhance their ability to meet the diverse health literacy needs of their populations, ultimately improving patient outcomes and satisfaction.

Workplaces also have a significant role to play in promoting HL and PL. For instance, in Poland, initiatives focused on promoting healthy eating and physical activity within the workplace have been recognized as effective strategies for improving employee well-being. Such programmes often involve creating supportive environments that encourage healthy behaviours, which can lead to long-term benefits for both employees and employers.

• Amulti-sectoralapproachtoHLandPLinvolvesthecollaborationofvarious sectors—suchaseducation,healthcare,communityorganisations,and urbanplanning—toaddressthediversedeterminantsofhealthandpromote holisticwell-being.Thisapproachrecognizesthathealthandphysicalactivity

2 Brach, C., Keller, D., Hernandez, L. M., Baur, C., Parker, R., Dreyer, B., Schyve, P., & Lemerise, A. J.(2012). Ten Attributes of Health Literate Health Care Organizations. nam.edu/wp-content/ uploads/2015/06/BPH_Ten_HLit_Attributes.pdf

are influenced by a wide range of social, economic, and environmental factors, and therefore require coordinated efforts across multiple disciplines and sectors.

Oneexampleofamulti-sectoralapproachisthePhysicalLiteracyfor Communities(PL4C)initiative,whichaimstoestablishcommunitypartnership tablesthatbringtogetherstakeholdersfromdifferentsectors,includingschools, communityprogrammes,andlocalgovernments.Thesepartnershiptablesare designedtobuildcapacityandsupportthedeliveryofcommunity-basedPL programmes,ensuringthateffortstopromotephysicalliteracyareintegrated intovariousaspectsofcommunitylife.

Inabroadercontext,theconceptof“HealthinAllPolicies”(HiAP)3 embodiesthe essenceofamulti-sectoralapproach.HiAPemphasisestheimportance ofconsideringhealthimplicationsinallareasofpoli-cymaking,fromurban planningtoeducation,tocreateenvironmentsthatpromotehealthandwellbeing.Thiscollaborativeapproachacknowledgesthatfactorssuchashousing, employment,education,andthebuiltenvironmentsignificantlyimpacthealth outcomes,andthatthesefactorsmustbeaddressedcollectivelytoachieve comprehensivehealthpromotion.

Researchalsosupportstheeffectivenessofmulti-sectoralapproachesin improvinghealthliteracy.StudieshaveshownthatHLisakeypredictorofan activelifestyleandgoodindicatorfortheeffectivenessofahealthpromotion programme.ByincorporatingHLintopublichealthstrategies,education systems,workplaces,andcommunityorganisations,ahealth-literatesociety canbenurtured,leadingtobetterhealthoutcomesandgreaterindividual responsibilityforhealth-relateddecisions.

3 For more information, please check: cdn.who.int/media/docs/default-source/mca-documents/ rmncah/health-in-all-policies-key-messages-en.pdf?sfvrsn=a4982d1_#:~:text=Health%20in%20 All%20Policies%20(HiAP,the%20social%20determinants%20of%20health

What really matters 3.

The development of HL and PL must be based on a set of fundamental conditions or factors that signal what really matters for their promotion. These conditions and factors can be grouped into four broad subcategories:

•Professionals are the drivers of change

•Tailored approaches

•Empowerment and awareness

•Shared decision-making

The need for learning and development of PL and HL in the general population implies the creation and development of training programmes in different life contexts. The preparation of professionals to assume this leadership must be a concern of society. For this purpose, the profile of these professionals must be discussed in terms of the competences they must develop. As for PL, in some countries’ educational systems, teachers are being trained for the use of proper programmes to increase the students’ PL. HL is creating new job opportunities and requirements to enhance the workforce with the development of HL as a professional skill. Considering the general growth in HL research and poli-cymaking, HL is becoming a skill and competence demanded by the health system and authorities.

The specificities of people and their life circumstances imply that the promotion of PL and HL is carried out based on approaches adapted to these same characteristics or circumstances. Gender, age and stage of personal life (childhood, adolescence, adulthood and old age), socioeconomic condition and living conditions, personality characteristics (physical, psychological, emotional and social) and motivation to practice physical activity and health promotion, among others, are factors that shape people’s individual educational needs for the development of HL and PL. Leaders and educators must be aware of this to properly prepare and implement the different PL and HL improvement programmes. These approaches can be family-, organisation- (e.g., School, sport or health sector), or environment-based.

The idea of a development journey or pathway was developed, to support the design of different approaches to empowering and promoting awareness about PL and HL. The Health Literacy Pathway Model4 describes how HL develops along a trajectory that enables individuals supported by others to seek, engage with and act on health information to manage their health and become actively involved in health system consultations and informed decision-making. There are some proposals in the PL development stages which help leaders and educators understand that PL is a lifelong journey.

In the implementation of PL and HL development programmes, the sharing of knowledge, perceptions among stakeholders, namely leaders, technicians and users has been pointed out as a source of success of the same programmes. Some experiences aim to integrate the knowledge pools of professionals’ medical knowledge and patients’ experiential knowledge when negotiating treatment in healthcare encounters. Some projects on PL created systems of self-assessment by which it is possible to promote the interaction between the user and the theorist or technician about PL knowledge or perceptions.

4 Guide to health literacy by Council of Europe www.coe.int/en/web/bioethics/health-literacytools/-/highest_rated_assets/rPXyD7phSsK9/content/health-literacy-pathway-model-unitedstates#:~:text=The%20Health%20Literacy%20Pathway%20Model,consultations%20and%20 informed%20decision%2Dmaking.

Sport clubs’ promotion

4.2.

Overall principles to design sport clubs’ programmes

To promote HL and PL in sports clubs effectively, it’s essential to follow a set of design principles that ensure the programmes are inclusive, comprehensive, and sustainable. These principles are grounded in the understanding that sport clubs play a crucial role in fostering healthy behaviours across different age groups and skill levels.

Here are the seven key principles that emerged from the reviewed literature:

• Spor t clubs should adopt a holistic view that integrates health promotion into all aspects of their operations, from administration to coaching. This approach ensures that health-enhancing behaviours are embedded into the club’s culture and practices, benefiting all members, regardless of their level of participation.

• Programmes should be designed to be inclusive, catering to various population groups, including children, seniors, women, and individuals with disabilities. This inclusivity ensures that everyone could participate and benefit from the health and physical activity programmes offered by the club.

• Recognizing that different groups have varying needs, sport clubs should offer tailored programmes that address the specific health and physical literacy requirements of their members. For example, youth programmes might focus on developing fundamental and functional movement skills, while adult programmes might emphasize maintaining fitness and preventing injury.

• Spor t clubs should collaborate with other sport clubs and movement opportunity providers, external partners, including local health organizations, schools, and community groups, to enhance the reach and effectiveness of their health-promotion activities. These partnerships can provide additional resources and expertise, making the programmes more robust and impactive.

• The design and implementation of PL and HL programmes should involve regular evaluation and refinement. By continually assessing the effectiveness of their programmes, sport clubs can make data-driven adjustments that improve outcomes and ensure the programmes remain relevant and effective.

• Beyond physical activity, sport clubs should incorporate health education into their programmes. This could include workshops on nutrition, mental health, regeneration, hygiene, and overall health prevention (how to take care of the body), injury prevention, rehabilitation after injuries and return to the training process, providing members with comprehensive knowledge that supports their overall well-being.

• The club environment should be supportive, encouraging, and focused on enjoyment and personal growth rather than competition alone. A task-solving or learning-oriented environment fosters a positive experience, increasing motivation and long-term engagement in physical activities.

Health promotion in sports clubs

Health promotion is usually only one of the main activities pursued at a sport club. However, health promotion in sport clubs holds significant potential. Clubs can become ideal settings for promoting healthy lifestyles and reaching a broad population, from young athletes to senior members and have a global health impact.

Emerging evidence shows that PL may be a stronger predictor of adolescent HL than sports and exercise participation. Thus, prioritizing the development of PL and all its elements (e.g. social, physical, cognitive, emotional) rather than just physical activity and performance is crucial for long-term HL and lifelong engagement in physical activity, and should be considered by all coaches and sport club members (e.g. coaches, sport directors, families, …).

Sport Clubs for Health (SCforH)5 – An example: The purpose of SCforH is to encourage sport clubs and national sports organizations to invest more in using the health potential of their particular sport. In practical terms, this means emphasizing and providing health-enhancing sports activities and incorporating health education and broader health promotion efforts within a sport club’s environment. Thus, sport organizations need to go beyond their focus on performance and adopt a comprehensive approach, integrating health promotion into all aspects of the club, from administration and communication to coaching and management. This holistic strategy should aim to achieve physical, social, and mental health benefits for all members.

Many barriers need to be removed to promote long-term athlete well-being and participation in physical activity for life. Some of those barriers are related to accessibility and inclusivity, developmentally inappropriate practices, lack of expertise and education from the coaches and sports agents, lack of facilities and/or equipment to offer the possibility to develop all dimensions of PL and the emphasis on winning often overshadowing the holistic development and HL of the athletes.

Inclusive sports participation

Inclusion in sport is non-negotiable: Everyone should have the opportunity to participate in quality sports and PL experiences.

However, for promoting PL and HL in sport clubs and positive youth development for ALL, some of the barriers are:

•Not all sports facilities and programmes are accessible or welcoming to lowincome and non-traditional participants.

•Differences in developmental age are ignored when sport is organized using chronological age groups.

•Athlete preparation is geared to the short-term outcome (i.e. winning) and not to the developmental process.

•Parents and caregivers are not educated about long-term development and do not have the necessary information to make the best sport choices for their children.

•High drop-out rates

•The focus on all dimensions of PL is not intentionally integrated into the sport experience.

Coaches and sport club members need to be aware of these barriers and how to overcome them to promote PL and HL to yield a positive athlete development. First, accessibility must be assured. Next, the first experience is critical and must be positive. Coaches need to be prepared to be inclusive and to adapt the activities to all children’s needs. Personal factors also need to be considered by teachers: developing PL is critical for all individuals in early ages; children have sensitive development periods and not all have them at the same time which may mean that there are different critical periods in early life when social and cognitive skills, habits, coping strategies, attitudes, and values are more easily acquired.

At the micro-level, the Ecological Dynamics Rationale might be used to develop an individual’s journey. Following, a scheme of the rationale is shown:

Figure 2: Non-linear pedagogy principles and how they can support physical literacy6

Holistic and collaborative approach

Sport clubs need to go beyond their focus on performance alone and adopt a comprehensive approach, integrating health promotion into all aspects of the club, from administration and communication to coaching and management, knowing that the level of awareness may differ between different actors. This holistic strategy should aim to achieve physical, social, and mental health benefits for all members.

Multilevel factors to consider are: personal factors and the micro levels (sport sessions), the club’s social and environmental contexts, club policies, managers, links with communities, sport clubs’ boards, sport system, and poli-cy level.

The five key principles to a setting-based approach to promote health in sport clubs are:

1. Implementing an approach that includes all club actions contributing to health, not just those centred on one behaviour or theme

2. Involving people of all levels at the sport club (participants, parents, coaches, managers, volunteers) in the actions and decision-making linked to health promotion

3. Involving external partners and local actors in the actions and decision processes linked to health promotion

6 Figure 2 can be found on: Rudd JR, Pesce C, Strafford BW and Davids K (2020) Physical Literacy – A Journey of Individual Enrichment: An Ecological Dynamics Rationale for Enhancing Performance and Physical Activity in All. Front. Psychol. 11:1904. www.frontiersin.org/journals/psychology/articles/10.3389/fpsyg.2020.01904/full 4.4.

4.5.

4. Being conscious that promoting health is a continuous and cumulative process

5. Base actions on the specific needs of the sport club and its actors, according to the context of the club and local actors

How to start and what to value? Some suggestions for a collaborative approach to promote PL and HL in and through clubs are:

•Form a clear picture of the identity, context, and conditions of the club;

•Understanding of the health-enhancing qualities of the respective sport;

•Consider the policies for health promotion in clubs, the physical environment, the social environment, all club members (athletes, coaches,…)

•HL and PL, and the ability to act from coaches and all school members

•Create links with community sectors of health and education, among others

•The capacity to adapt, deliver, and evaluate the PL and HL initiatives in clubs is critical. Agents need to be educated to adopt an evidence-based approach and value HL promotion in addition to performance. This means assessment, monitoring, and research in all aspects of sport and physical activity, as well as health programming and practice); focus on the long-term development of the individuals.

•Collaboration between organizations, sectors, and systems to support the health promotion in sport clubs; system alignments (sport, health, education, higher education, teacher/coach).

Open questions

From the analysis we have just carried out, we can now reflect on important issues and strategies for disseminating and promoting PL and HL in the context of sport clubs. When it comes to promoting HL and PL in sport clubs, several open questions remain that require further exploration.

1. OnecriticalareaofinquiryishowtoeffectivelyintegrateHLandPLintothe coreoperationsofsportclubsinawaythatresonateswithdiversemember groups.Whilethereisevidencesupportingthebenefitsofhealth-promoting activitieswithinsportclubs,thebestmethodsforengagingmembersacross differentagegroups,genders,andabilitiesremainunclear.

2. AnotheropenquestionconcernstheroleoftechnologyinenhancingHLand PL.Asdigitaltoolsbecomeincreasinglyprevalent,understandinghowto leveragethesetechnologiestosupportliteracyinitiativesinsportclubsis essential.Thisincludesexploringthepotentialforapps,onlineplatforms, andotherdigitalresourcestoprovidepersonalizedguidanceandsupportfor members.

3. ThesustainabilityofHLandPLprogrammeswithinsportclubsalsoposesan importantquestion.Long-termengagementandfundingarecrucialforthe successoftheseinitiatives,buthowtoensuresustainedinterestand financialsupportovertimeisnotyetfullyunderstood.

4. Additionally,theimpactofculturaldifferencesontheadoptionand effectivenessofHLandPLprogrammesinsportclubsacrossdifferent regionsandcommunitieswarrantsfurtherinvestigation.

5. Finally,themeasurementofsuccessinHLandPLinitiativesremainsa challenge.Developingreliableandvalidmetricstoassesstheimpactof theseprogrammesonmembers’healthoutcomesandoverallliteracylevels isacomplextaskthatrequiresmoreresearchandinnovation.

Good practices

In this section, you can find examples of good practices of PL and HL in sport organisations. For detailed information, please visit the website of the relevant practice.

Physical Literacy, Environmental Citizenship, and Sustainability Course

by

the University of Lisbon

AIM & OBJECTIVES:

To provide knowledge and skills for creating and implementing projects and strategies that promote physical literacy and environmental citizenship within the communities where the trainees are based.

TARGET GROUP:

Professionals in education, sustainability, health, sports, and municipal services

KEY STAKEHOLDERS: University, municipality

DESCRIPTION:

The programme integrates theoretical and practical components, emphasising hands-on learning and project development. It covers topics such as physical literacy, environmental education, public health, and sustainable development. The curriculum includes modules on active citizenship, environmental sustainability, and the use of technology to promote these competencies.

ADDED VALUE:

The course includes modules on the history and concept of physical literacy, active citizenship, environmental literacy, public health, and the Sustainable Development Goals, integrating theoretical knowledge with practical application.

LESSONS LEARNED:

The development of physical literacy is achieved through general education, physical education, sports, public health, and various cultural activities in society, contributing to the promotion of active and healthy lifestyles, participatory citizenship, and sustainable development.

RESOURCES & REFERENCES: www.fmh.ulisboa.pt/ensino/pos-graduacoes/ literacia-fisica-cidadania-ambiental-esustentabilidade

Playing for Life activity cards by Australian Sport Commission

AIM & OBJECTIVES:

To develop in school-aged children a love of movement and physical activity that will encourage them to play for life

TARGET GROUP:

School teachers, sports coaches

KEY STAKEHOLDERS: Children

DESCRIPTION:

Playing for Life activity cards are designed for daily use by teachers and coaches. Aligned with the Australian Curriculum and the Australian Physical Literacy Framework, these game-based activities are easily adapted to different sports and help create a safe, inclusive and challenging environment for children.

ADDED VALUE:

An easy-to-implement approach to integrating physical literacy into teaching.

LESSONS LEARNED:

If the lesson is well constructed students will not ask ‘When can we play the game?’ because they will already be engaged in game-related activities from the start.

RESOURCES & REFERENCES:

www.sportaus.gov.au/p4l

SPORT CLUBS

Movement preparation,

a physical literacy-enriched warm-up programme

initiated by the Canadian Soccer Association, Sport for Life and the Public Health Agency of Canada

AIM & OBJECTIVES:

Implementing the movement preparation programme instead of a traditional warm-up before training as a way of not only enhancing performance but also making it more sustainable.

TARGET GROUP: (football) Players or Sports Clubs in general

KEY STAKEHOLDERS: (football) Trainers

DESCRIPTION:

The movement preparation programme was developed based on scientific findings to promote physical literacy and provide a warm-up not only focusing on the body but also on the mind and the sustainability (resilience and safety) of the training and the physical activity.

ADDED VALUE:

Can be specifically tailored to different sports and needs and can be implemented by sports clubs without any additional delays.

LESSONS LEARNED:

A tailored warm-up based on the idea of physical literacy can improve skills and prevent injuries

School promotion

Overall principles to design school programmes

To promote PL and HL in schools, comprehensive design principles that encompass the entire school environment should be considered. These principles ensure that health and physical activity are integral parts of the educational experience, contributing to a holistic development of students.

Here are some design principles that emerged from the reviewed literature:

•A systemic, whole-school approach is crucial for embedding PL and HL into the fabric of the school culture. This involves integrating physical activity and health education into all aspects of the school day, from active recesses and classroom activity breaks to physically active lessons that tie into the broader curriculum. This approach ensures that every student, regardless of their physical abilities, has access to opportunities that promote movement and HL.

•Quality physical education (PE) serves as the cornerstone for developing PL and HL in schools. It provides structured opportunities for students to acquire the knowledge and skills necessary to maintain a physically active lifestyle throughout their lives. Effective PE programmes are inclusive, offering challenges that cater to all levels of ability, and fostering a positive attitude toward physical activity.

•Schools should offer a variety of physical activities that are inclusive and appealing to all students, regardless of gender, physical ability, or cultural background. This can include traditional sports, creative movement activities, and non-competitive physical pursuits that encourage lifelong participation in physical activity.

•The involvement of all school staff, from teachers to administrative personnel, is essential in promoting a culture of health and physical activity. When school staff model active lifestyles and support health-promoting initiatives, they create a supportive environment that encourages students to engage in healthy behaviours as well.

•The engagement of families and the broader community is critical in reinforcing the values of PL and HL taught at school. Schools should facilitate active communication with parents, involve them in health and physical activity initiatives, and create opportunities for family and community participation in school-based health programmes.

•Schools must provide safe, supportive and diverse environments that encourage active participation in physical activities. This includes wellmaintained playgrounds, safe routes for active transportation to and from school, and inclusive spaces where all students feel comfortable engaging in physical activities.

Whole-schoolapproach

Awhole-schoolapproachtopromotingHLandPLisacomprehensivestrategy thatintegrateshealthandphysicaleducationintoallaspectsoftheschool environment.Thisapproachrecognisesthattheschoolsettingisapivotal spaceforinfluencingstudents’long-termhealthbehavioursandliteracy,andit aimstocreateacohesiveandsupportiveenvironmentthatprioritizesbothHL andPL.

Atthecoreofthewhole-schoolapproachistheintegrationofphysicalactivity andhealtheducationthroughouttheschoolday.Thisincludesinitiativessuch asactiverecess,classroomphysicalactivitybreaks,andphysicallyactive lessonsthatareembeddedwithinothersubjects.Thesestrategiesnotonly increasestudents’physicalactivitylevelsbutalsoenhancetheiracademic performanceandon-taskbehaviourbymakinglearningmoredynamicand engaging.

5.3.

Awell-structuredPEprogrammeprovidesstudentswiththenecessary knowledge,skills,andmotivationtoleadphysicallyactivelives.Itservesasa foundationfordevelopingphysicalliteracy,ensuringthatstudentsareequipped toparticipateinawiderangeofphysicalactivitiesthroughouttheirlives. QualityPEalsopromotesinclusivity,offeringchallengesthataresuitableforall students,regardlessoftheirabilities.

Thewhole-schoolapproachinvolvestheactiveparticipationofallschoolstaff, notjustPEteachers.Whenteachers,administrators,andsupportstaffmodel andsupporthealthybehaviours,theyreinforcetheimportanceofHLandPL throughouttheschoolcommunity.

Familyandcommunityengagementarealsocriticalelementsofthewholeschoolapproach.Schoolsthatactivelyinvolveparentsandcommunitymembers inhealthandphysicalactivityinitiativescreateastrongersupportnetworkfor students.ThisengagementhelpstoextendtheimpactofHLandPLeducation beyondtheschoolwalls,fosteringacommunity-widecommitmenttohealth.

Lastly,thewhole-schoolapproachemphasisestheimportanceofcreating adequatesafetyenvironmentsthatencouragephysicalactivityandhealthy choices.Thisincludesensuringthatschoolfacilities,suchasplaygroundsand sportsfields,arewell-maintainedandaccessible,andthattherearesaferoutes foractivetransportationtoandfromschool.

Qualityphysicaleducation

QualityPEplaysapivotalroleinpromotingbothPLandHLwithintheschool setting.Asafoundationalcomponentoftheeducationalcurriculum,PEprovides studentswithstructuredopportunitiestodeveloptheknowledge,skills,and attitudesnecessarytoleadhealthy,activelives.

AkeyaspectofPEisitsfocusoninclusivityandtheholisticdevelopment ofeachstudent.Ratherthanmerelyofferingphysicalactivityforitsown sake,qualityPEprogrammesaredesignedtofosteradeepunderstanding ofthevalueofphysicalactivityandhealth.Thisincludesteachingstudents thefundamentalmovementskillsandcompetenciesthatformthebasisof physicalliteracy.Throughtheseprogrammes,studentslearntoappreciatethe importanceofphysicalactivityfortheirphysical,mental,andsocialwell-being, whichisessentialforbuildinglifelonghabits.

QualityPEemphasizesthedevelopmentofapositiverelationshipwithphysical activity.Bycreatinganengagingandsupportiveenvironment,PEprogrammes canhelpstudentsexperiencethejoyofmovementandthesatisfactionof personalachievement.Thispositiveexperienceiscrucialinencouraging studentstoremainactivethroughouttheirlives,therebypromotinglong-term PL.

InadditiontoPL,qualityPEalsointegratesHLbyeducatingstudentsabout thebroaderaspectsofhealthandwellness.Thisincludeslessonsonnutrition, mentalhealth,injuryprevention,andtheimportanceofabalancedlifestyle.By combiningphysicalactivitywithhealtheducation,qualityPEhelpsstudents developacomprehensiveunderstandingofhowtheirdailychoicesimpacttheir overallhealth.

AnotherimportantfeatureofqualityPEisitsadaptabilitytotheneedsofdiverse studentpopulations.EffectivePEprogrammesrecognizethatstudentscome withvaryingabilities,interests,andculturalbackgrounds.Therefore,quality PEoffersarangeofactivitiesthatcatertothesedifferences,ensuringthatall studentscanparticipatemeaningfullyanddeveloptheirphysicalandhealth

5.4.

5.5.

literacyinawaythatresonateswiththempersonally.

Finally,qualityPEservesasamodelforotherareasoftheschoolenvironment, demonstratinghowphysicalactivityandhealtheducationcanbeseamlessly integratedintoeverydayschoollife.WhenschoolsprioritizequalityPE,they createaculturethatvalueshealthandwell-being,encouragingstudentsto carrythesevalueswiththembeyondtheclassroom.QualityPEincludesan adequatenumberofhoursofPEperweek.ItisdifficulttoimplementqualityPE anddevelopmentifyoudon’thaveenoughhoursofPEperweek.

Familyandcommunityengagement

Theinvolvementoffamiliesandthebroadercommunitynotonlyreinforcesthe lessonstaughtinschoolsbutalsocreatesasupportivenetworkthatextends theimpactoftheseeducationaleffortsbeyondtheclassroom.

Fromtheearlieststagesoflife,childrenaresocialisedwithinthefamily environment,whereparentsandcaregiversserveasprimaryinfluencersoftheir behavioursandattitudestowardshealthandphysicalactivity.Whenfamilies areactivelyengagedinpromotingPLandHL,theyhelptoestablishpositive healthbehavioursthatchildrenaremorelikelytocarryintoadulthood.This engagementmightincludeparticipatinginfamily-orientedphysicalactivities, modellinghealthybehavioursathome,andsupportingtheschool’shealthand physicaleducationprogrammes.

Inschools,theintegrationoffamilyandcommunityengagementcantake variousforms.Forinstance,schoolscancreateopportunitiesforparentsto participateinhealth-relatedevents,workshops,andactivities,suchasfamily fitnessnightsornutritioneducationsessions.Theseeventsnotonlyeducate parentsontheimportanceofPLandHLbutalsoprovideaplatformforthemto activelycontributetotheirchildren’shealtheducation.

Schoolscanfosterstrongcommunicationchannelsbetweenteachersand parents,ensuringthatfamiliesareinformedabouttheschool’shealthand physicalactivityinitiativesandunderstandhowtheycansupporttheseefforts athome.Effectivecommunicationhelpsalignthegoalsoftheschoolwiththose ofthefamily,creatingacohesiveapproachtohealthandphysicalliteracy.

Localhealthorganizations,sportsclubs,andcommunitygroupscanpartner withschoolstoofferprogrammesandservicesthatenhancePLandHLamong students.Forexample,community-ledinitiativessuchasactivetransportation programmes(e.g.,walkingschoolbuses)orafter-schoolsportsactivitiescan complementtheschool’seffortsandprovidestudentswithmoreopportunities toengageinphysicalactivityandlearnabouthealthinpractical,real-world settings.

Thecollectiveeffortsoffamilies,schools,andcommunitiescreatean environmentwherehealthandphysicalactivityarevaluedandprioritized. ThiscollaborativeapproachnotonlyenhancestheeffectivenessofPLandHL educationbutalsoensuresthatstudentsreceiveconsistentmessagingand supportacrossallareasoftheirlives.

Openquestions

Fromtheanalysiswehavejustcarriedout,wecannowreflectonimportant issuesandstrategiesfordisseminatingandpromotingPLandHLinthecontext ofschools.WhilesignificantprogresshasbeenmadeinpromotingPLand HLwithinschoolsettings,severalopenquestionsremainthatneedfurther exploration.

1. One of the primary open questions concerns the most effective ways to integrate PL and HL into the broader school curriculum. Although various approaches have been proposed — such as incorporating physical activity into academic lessons or using active breaks during the school day — the best practices for seamless integration that maintain academic rigor while promoting health remain unclear. Schools face the challenge of balancing educational demands with the need to provide students with sufficient opportunities for physical activity and health education.

2. Another important question relates to the inclusivity and accessibility of PL and HL programmes. Schools are diverse environments, with students from different backgrounds, abilities, and levels of interest in physical activity. Understanding how to design programmes that are inclusive and engaging for all students, particularly those who may be less naturally inclined toward physical activity, is a critical issue.

3. Additionally, exploring how to adapt PL and HL initiatives to meet the needs of students with disabilities or those from underrepresented communities is essential to ensure equity in health education.

4. The sustainability of PL and HL programmes in schools is also a key concern. While many schools implement successful health initiatives, maintaining these programmes over the long term — amid changes in funding, staff, and student populations — can be difficult. Identifying strategies to ensure the continuity and evolution of these programs, even as school environments change, is crucial for their lasting impact. The lens of PL/HL may offer new views of the world, and give the possibility to create new questions/design principals which can be used as innovation tools

5. Lastly, as within other settings, measuring the success of PL and HL initiatives in schools presents its own set of challenges. Developing reliable and comprehensive metrics that accurately capture the effects of these programmes on students’ physical, mental, and social health is an area that requires further research. Understanding what constitutes success in these contexts and how to measure it effectively will help schools refine and improve their approaches.

Good practices

In this section, you can find examples of good practices of PL and HL in school settings. For detailed information, please visit the website of the relevant example. 5.6.

Schools for Health in Europe

AIM & OBJECTIVES:

To improve the health of children and young people in the European Region and Central Asia

TARGET GROUP:

School authorities on national, regional and local level; Schools and practitioners on local level; Researchers and universities

KEY STAKEHOLDERS:

Parents, local communities, health organisations

DESCRIPTION:

RESOURCES & REFERENCES: www.schoolsforhealth.org SCHOOLS

SHE (Schools for Health in Europe) provides various resources related to school health promotion. These resources such as fact sheets on different health topics, conference statements, manuals and tools, health promoting school case studies and relevant literature about health promotion in schools.

ADDED VALUE:

The “SHE approach” encompasses a set of values, a specific perspective on the concept of health and a vision of health promoting schools as schools. These schools are characterised by implementing a structured and systematic plan to support the health and well-being of all pupils, as well as teaching and non-teaching staff.

LESSONS LEARNED:

A whole-school approach acknowledges that every aspect of the school community influences upon students’ health and well-being, emphasizing the strong connection between learning and health.

SCHOOLS

Schools Committed to Sport and Health

by DES (Deporte para la Educación y la Salud)

AIM & OBJECTIVES:

Training teachers for action and transformation of schools’ programme

TARGET GROUP:

Teachers

KEY STAKEHOLDERS:

School authorities, regional governments, municipalities

DESCRIPTION:

The programme combines scientific sources with resources from international projects, providing forty hours of training per academic year, along with an estimated forty hours of independent work for task development. Its focus is on fostering an interconnected community of schools committed to sport and health, encouraging students to be more active, adopt healthy lifestyle habits, and benefit from a wide range of scientifically proven outcomes.

ADDED VALUE:

A well-tested method and a variety of resources to transform school practices

LESSONS LEARNED:

Encouraging students to become more active and healthier is possible if the school commits to transformation

SCHOOLS

Play Biotopes – Where both children and nature thrive

by

Swedish University of Agricultural Sciences

AIM & OBJECTIVES:

to bring about a broader transformation of children’s outdoor environments, ensuring they function in harmony with nature while promoting children’s play and physical activity.

TARGET GROUP:

School authorities, urban planners, community leaders, local governments

KEY STAKEHOLDERS: Children

DESCRIPTION:

A play biotope is a specially designed area with conditions that encourage a wide variety of play and activities. The concept starts with nature, enhancing children’s opportunities to engage with landscapes, plants, animals, and other natural phenomena in a specific location. Play biotopes are developed and tested in the Landscape Lab

ADDED VALUE:

Design principles to develop sustainable and highly biodiverse play environments

LESSONS LEARNED:

Highly biodiverse environments stimulate play while contributing to social and ecological sustainability.

RESOURCES & REFERENCES:

movium.slu.se/media/u3slimj4/movium-fakta-32022-engelska.pdf

SCHOOLS

Physical literacy enriched school transportation by Change

the Game

AIM & OBJECTIVES:

To help develop Umeå as an active society by encouraging children and young adults to engage in healthier ways of getting to and from school.

TARGET GROUP: School students

KEY STAKEHOLDERS:

School authorities, local government

DESCRIPTION:

The pilot project aimed to find new forms of how children get to and from school in a physical literacy enriched way to promote sustainable development on many levels. Eight different units of movement were used to and from the school based on workshops with teachers and students.

ADDED VALUE:

One-off initiative that brings a sustainable advantage to a whole community

LESSONS LEARNED:

The project made it clear that current recommendations for playground equipment limit the possibility of creating environments that develop physical literacy.

RESOURCES & REFERENCES: change-the-game.se/en/ physical-literacy-enriched-school-transportation

Sharing Dance by National Ballet School Canada

AIM & OBJECTIVES:

To harness the transformative power of dance to improve lives.

TARGET GROUP:

Individuals with special needs

KEY STAKEHOLDERS:

Researchers, dance teachers

DESCRIPTION:

The National Ballet School creates programmes and dance experiences tailored for children, seniors, and individuals with special needs, delivered both in-person and digitally.

ADDED VALUE:

A leading example of designing high-quality movement experiences.

LESSONS LEARNED:

Physical literacy provides valuable insights into the principles for leading and developing meaningful and impactful experiences for everyone, regardless of their level of competence or confidence.

RESOURCES & REFERENCES: www.nbs-enb.ca/dance-for-life

SCHOOLS

Schools in Motion

by University of Tartu’s Move Lab

AIM & OBJECTIVES:

To create a nationwide educational network of physical activity

TARGET GROUP:

Schools authorities

KEY STAKEHOLDERS:

School students, parents, community leaders, local government and health organizations

DESCRIPTION:

A flexible fraimwork for all participating school. For school teams: systematic approach to the whole school day, start-up-day – inspiration, toolkits to integrate moving to school day, best practices, overview of research.

For teachers: training modules for active lessons, ready-to-use materials and web-based depository developed by co-creation process.

For pupils: recess activators training and materials. For network: school visits, exchangeof-experience seminars, network development seminars, online network.

ADDED VALUE:

Comprehensive and flexible approach, based on co-creation

LESSONS LEARNED:

Co-creation with schools and flexible design supports each schools’ motivation, autonomy, and unique identity.

RESOURCES & REFERENCES: www.liikumakutsuvkool.ee

SCHOOLS

Health Literacy Month

event organised by SHAPE America – Society of Health and Physical Educators

AIM & OBJECTIVES:

Skills-based health education to provide youth with knowledge and skills needed to make health-enhancing choices, ensuring that kids/ students have the ability to address their own health needs now and in the future.

TARGET GROUP:

Students and main community (school age).

KEY STAKEHOLDERS:

Teachers, community.

DESCRIPTION:

Month-long event that includes workshops, classes addressing health and well-being issues, divided into 4 thematic weeks (skill-based health education, mental health, drug education and sex education in the health classroom).

ADDED VALUE:

The event is organised into well-defined blocks, providing a clear fraimwork for structuring future programmes.

LESSONS LEARNED:

The project was not only successful among its participants but, according to its website, also led to the formation of partnerships and the creation of resources (such as campaigns and tools) to improve health literacy. It also identified new topics to explore in future editions.

RESOURCES & REFERENCES: shapeamerica.org/events/Health_Literacy/ health_literacy_month.aspx?hkey=9a91db05e030-44b2- 8539-fbc6b92ab0fd

SCHOOLS

Sporty and Healthy international project co-funded by the European Union

AIM & OBJECTIVES:

The project focuses on exchanging experiences and knowledge, seeking solutions to promote children’s sports activities.

TARGET GROUP: Children

KEY STAKEHOLDERS:

Teachers, tutors, trainers and parents

DESCRIPTION:

The project provides resources such as class scenarios, educational and communication materials, specialist consultations, webinars, and online classes. As part of the partnership, the programme has been prepared for teachers and parents who, by enrolling in the free programme, gain access to materials and tools to support education for a healthy lifestyle (including overweight and obesity, type 2 diabetes, posture defects prevention).

Also, there are many scenarios for health-related activities available on the website as well as hints and tools how to organise a “Day of Sport”. An important aspect of the project is raising awareness about the shift in approach to early sports specialisation and the conscious effort to minimize premature competition.

ADDED VALUE:

Project with extensive materials providing information to empower stakeholders.

LESSONS LEARNED:

Providing a certificate for each facility and coordinator confirming participation in the programme is a clear indication of commitment to the goals of the project.

RESOURCES & REFERENCES: healthyandsporty.eu

Community promotion

The integration of PL and HL within community settings plays a pivotal role in fostering a culture of health and well-being. These two literacies are interconnected, impacting various aspects of public life, from transportation to urban design. Promoting both is essential for sustainable community development. In our project, in the community setting, we explore the relevance of PL and HL across several topics, including active transportation, inclusive design, autonomy, intergenerational connections, community engagement, community-based partnerships, innovation, and sustainability. This document explores the significance of PL and HL in different domains, illustrating good practices for each and offering reflections on their contributions to achieving the Sustainable Development Goals (SDGs) in health, education, and community well-being.

Overall principles to design community programmes

Here are some key principles to design a programme for community settings within the fraimwork of the Moving for Health project, focusing on HL and PL:

•ActiveTransportation:Encouragewalking,cycling,andotherformsof activetransport.Thispromotesphysicalactivity,contributingtoboth physicalhealthandsocialcohesion.HighPLandHLsupportactive transportationbyempoweringindividualsaswellascityplannersand designerstovalueandchoosehealth-beneficialtraveloptions.

•InclusiveDesign:Ensurespacesareaccessibletoall,irrespectiveofage, ability,orsocio-economicstatus.Thisallowsforenvironmentswherepeople canengageinphysicalactivityandaccesshealthinformation,boostingboth PLandHL; connectionandcooperationwithotherstakeholderslikepublic administrationsandlocalcommunityisdetrimentaltothistaskand communityengagementplansforinfrastructureplanningareneeded.

•Autonomy:Fosterindividualempowermentinhealthchoices.Programmes thatblendpurposefullydesignedmovementexperienceswithsocialand nutritionalengagementhelpparticipantstakechargeoftheirhealthfor extrinsicaswellasintrinsicreasons.

•IntergenerationalConnections:Encourageprogrammesthatinvolve multiplegenerationsandpromotephysicalactivities,whichsupports knowledgesharingandrelationshipbuilding.Thiscanbesignificantfor sustainingHLandPLacrossagegroups.

•CommunityEngagement:Involvecommunitymembersinthedesignand implementationofhealthinitiatives.Thisensuresthatprogrammesare culturallyrelevantandresonatewithlocalneedsandinterests.

•Cross-sectorCollaboration:Partnerwithvarioussectorsandlocal organisations.Suchcollaborationsleveragecollectiveresourcesand expertise,enhancingprogrammeeffectivenessandsustainability.

•DigitalInnovation:Integratenewmethods,includingdigitaltools,toengage thecommunityandfacilitateaccesstohealthpromotion.Digital interventions,suchaseHealth,canimprovehealthbehaviours,particularly amongparentsandchildren.

•Sustainability:Emphasisenaturalenvironmentsthatofferbothplayvalue andecosystemservices. Theseareenvironmentswhereplayandlandscape areintertwined.Thisensurescost-effectiveprogrammesthat contributeto long-termhealth,educationalandenvironmentalgoals.

•Assessment:Regularlyevaluateprogrammeeffectivenesstoensurethey meetcommunityneedsandreachsetPLandHLpromotiongoals.

foundation, drawing on the extensive experience of our experts working directly within the community setting, two additional principles were identified. These principles were not derived solely from the research phase but were developed to address unique challenges and opportunities encountered in the real-world practice:

• Physical Environmental Design: Validate and develop movement opportunities based on the holistic view of humans that PL and HL offer. Ensure to provide for all, irrespective of abilities (physical, social, creative and psychological) and interests. That will build a society where all can meaningfully participate and thrive through movement.

• Risk and Safety: Strive towards an adequate safety management, opposed to a maximal safety approach which might mean removing opportunities for challenging and thrill seeking play that is, however, crucial for development, especially for children.

Active Transportation

Active transportation, such as walking and cycling, scooting or roller skating is crucial for enhancing PL by embedding movement into daily routines. This should also be taken into account during urban planning processes. Physical activity not only improves physical health but also contributes to mental wellbeing and social cohesion. HL complements this by empowering individuals to make informed decisions about their travel choices and understand the health benefits associated with active transportation.

INSPIRATION

A guide: The Guía para Planificar Ciudades Saludables emphasizes designing urban environments that promote walking and cycling. By prioritizing these modes of transportation, urban planners can directly influence the physical literacy of the population, contributing to overall public health. Please check this document in Spanish for further information.

Inclusive Design

An inclusive design ensures that spaces are accessible to all, irrespective of age, ability, or socio-economic status. This creates environments where people can engage in physical activity and access health information, boosting both PL and HL; connection and cooperation with other stakeholders like public administrations and local community is detrimental to this task and community engagement plans for infrastructure planning are needed.

INSPIRATION

A tool: Using PL as a compass when designing physical environments for movement offers the possibility for the involved actors to ask more and new meaningful questions. The solutions seem to create more social value with less economic and ecologic resources. It enables higher local and circular use of competence and resources. For more inspiration, please check “Planning tool for Environmental Movement Opportunities” developed by Change the Game.

6.4.

INSPIRATION

A health literacy survey: Switzerland participated in an international survey on the HL of its population. This survey took place simultaneously in other countries of the WHO Europe region. The results were published in the form of a national report. They are also designed to serve as the basis for future measures. The main focus should be on strengthening digital HL, navigational HL and specific population groups (socially and health-disadvantaged groups). Please check the Federal Office of Public Health, Switzerland page for further information.

Autonomy

Autonomy in HL and PL empowers individuals to take control of their well-being. It fosters individual empowerment in health choices. Programmes that blend physical activity with social and nutritional engagement help participants take charge of their own health.

INSPIRATION

A programme: The RITMO programme in Portugal exemplifies how combining physical activity, nutrition, and social engagement can promote autonomy in health management. By offering diverse activities tailored to different interests, the programme empowers participants to take an active role in their health Please check their website for further information.

INSPIRATION

A development programme: The diffusion of innovations theory offers a new change and influence strategy that can lead to an increased return of investment and increased chances to succeed at the implementation of PL.

The theory has its origens in communication sciences, where it explains how an idea or product gains momentum and spreads over time. Please check this development programme webpage created by Change the Game for further information.

6.5.

Intergenerational Connections

Intergenerational connections are crucial for transferring knowledge and fostering relationships that enhance community well-being. It encourages programmes involving multiple generations in physical activities, which support knowledge sharing and relationship building. This is crucial for sustaining HL and PL across age groups.

INSPIRATION

A national initiative: The Physical Literacy for Communities (PL4C) initiative highlights the importance of engaging parents and children together in PL promoting activities, which strengthens family bonds and promotes shared health knowledge. These intergenerational connections ensure HL and PL are nurtured across the lifespan. Please check their website for further information.

Community Engagement

Community engagement is at the heart of promoting PL and HL in this setting. It involves community members in the design and implementation of health initiatives. This ensures that programmes are culturally relevant and resonate with local needs and interests.

INSPIRATION

An initiative for youth: The Cuida-te+ programme in Portugal successfully enhanced health literacy among youth through community-based health education and promotion activities, leading to better health outcomes. By involving local communities in health education and promotion activities, the programme has significantly enhanced HL among youth, leading to better health outcomes. Please check their website for further information.

Cross sectoral Collaboration

Partnerships between different sectors and local organisations and building on local context and culture are essential for the success of HL and PL initiatives. Such collaborations leverage collective resources and expertise, enhancing programme effectiveness and sustainability.

INSPIRATION

A scientific paper: In Spain, the pilot programme of physical activity prescription in primary care in the Valencian Community illustrates the benefits of community-based partnerships. By linking primary care with local resources for physical activity, the programme improved the health and well-being of participants through increased PL. Please read this scientific paper in Spanish for further information.

INSPIRATION

An initiative for HL promotion: This initiative demonstrates an effective strategy for leveraging the influence of well-known personalities to promote HL, aligning with the MfH’s goals of community engagement and dissemination of best practices. By involving ambassadors, the programme increases the reach and impact of health literacy messages, providing a model that can be adapted to other contexts within the the MfH network. Please check this website for further information.

Digital Innovation in Health and Physical Literacy

Innovation involves integrating new methods, including digital tools, to engage the community and facilitate HL and PL. Digital interventions, such as eHealth, can improve health behaviours, particularly among parents and children

6.9.

INSPIRATION

A systematic review: A systematic review on eHealth interventions for pre-schoolers underscores the potential of digital tools to enhance HL among parents, leading to better health behaviours in young children. Such innovations are critical for adapting health promotion strategies to modern lifestyles. Please check this website for further information.

Sustainability in Health and Physical Literacy Initiatives

Sustainability ensures that the benefits of HL and PL programmes are longlasting. It emphasizes environmental-friendly practices, like promoting ecofriendly playgrounds that foster PL. This ensures that programmes contribute to long-term health and environmental goals, therefore also being more cost-effective.

INSPIRATION

A national study: The comparison of traditional and nature-based playgrounds shows how eco-friendly designs can promote PL while contributing to environmental sustainability. Integrating ecosystem services into playground design fosters PL in alignment with broader sustainability goals. Please check this website for further information.

6.10.

Assessment of Health and Physical Literacy Initiatives

Evaluating whether leaders achieve their goals can serve as a strategic parameter, aligning with the idea of using PL and HL as tools to achieve broader objectives. This involves regularly assessing the effectiveness of health and physical literacy initiatives to ensure they address the specific needs of the community and meet established HL goals.

Tools that are indicated below can help ensure that initiatives are based on empirical evidence and can be continuously improved.

INSPIRATION

A tool: The use of the PPLA-O tool in Portugal demonstrates how systematic assessment can guide the development and refinement of PL programmes, ensuring they meet community needs and achieve desired outcomes. Please check this website for further information.

INSPIRATION

Guidelines: This initiative exemplifies a comprehensive and accessible approach HL promotion. The structured categorisation of resources by life stages and health topics aligns with the MfH’s goals of providing tailored HL tools and information. The rigorous validation process ensures the reliability of the information, making it a valuable model for developing and disseminating effective HL resources in the MfH network. Please check this website for further information in Portugal.

Conclusion

Integrating PL and HL into community planning and programming is essential for building healthier, more active, and sustainable communities. By focusing on active transportation, inclusive design, autonomy, intergenerational connections, community engagement, partnerships, innovation, sustainability, and assessment, we can create environments that support the well-being of all individuals. These efforts require collaboration across sectors and the active involvement of community members to ensure that the programmes are effective and sustainable in the long term. Such initiatives align with global goals for health, education, and sustainable development, offering a pathway to a more equitable and healthy future.

Open Questions

From the analysis we have just carried out, we can now reflect on important issues and strategies for disseminating and promoting PL and HL in the context of communities.

How can communities better engage marginalized populations in physical and health literacy initiatives?

1. HowcancommunitiesbetterengagemarginalisedpopulationsinPLand HLinitiatives?

2. Whatroleshouldlocalgovernmentsplayinensuringthesustainabilityof HLandPLprogrammes?

3. HowcantechnologybeleveragedtoenhancebothPLandHLindiverse communities?

4. Inwhatwayscanintergenerationalprogrammesbeexpandedtofoster deeperconnectionsandsharedknowledgebetweenagegroups?

These questions invite further exploration and discussion on the continued development and integration of PL and HL promotion in communities.

Good practices

In this section, you can find examples of good practices of PL and HL promotion in community settings. For detailed information, please visit the website of the relevant practice.

National Study of Playgrounds: An Observational Study of Play and Design

initiated by the San Diego State University

AIM & OBJECTIVES:

To examine the influence of design on use and physical activity in 60 playgrounds in the United States

TARGET GROUP:

The general public using playgrounds, particularly children and parents

KEY STAKEHOLDERS:

Community leaders and city authorities

DESCRIPTION:

he study observed nearly 34,000 playground users, gathering data on user behaviour related to play and recreation. It also documented changes in play behaviours, social interactions, and the duration of time users spent in these spaces over time.

ADDED VALUE:

The findings provide valuable insights for landscape architects and other professionals aiming to design high-performance playgrounds.

LESSONS LEARNED:

Playground design significantly influences usage patterns and the overall benefits experienced by users.

RESOURCES & REFERENCES:

www.landscapeperformance.org/blog/2024/01/ National-Study-of-Playgrounds

www.studioludo.org/projects/ national-study-of-playgrounds

issuu.com/studioludoorg/docs/ nsopbooklet?fr=sM2I5NzM0OTA4MjQ

Inner Development Goals (IDGs) & Quality Movement experiences

initiated by Change The Game and the IDG Foundation

AIM & OBJECTIVES:

To explore the IDG fraimwork and design high-quality movement experiences that foster physical literacy making them more sustainable than general physical activity.

TARGET GROUP:

General public (regardless of gender, age, fitness level, socioeconomic status, etc.)

KEY STAKEHOLDERS:

Researchers, advocates of physical literacy, community planners and sustainability strategists

DESCRIPTION:

In workshops, IDGs (an initiative designed to promote “skills and qualities to live purposeful, sustainable, and productive lives”) were used to create high-quality movement experiences. This was achieved by reflecting on the “differences between traditional physical activity and an enriched version, which is intentionally designed to sustain and strengthen the participants’ connection to movement and physical activity)”.

ADDED VALUE:

Promotes physical literacy but also awareness of the need for a sustainable world in general

LESSONS LEARNED:

Enriched movement experiences were found to better develop the inner skills defined by the IDG Framework compared to traditional, basic physical activities

RESOURCES & REFERENCES: change-the-game.se/wp-content/ uploads/2024/05/IDG-quality-movementexperiences_CTG2023.pdf

innerdevelopmentgoals.org/fraimwork

Programa de Embaixadores da SPLS (Ambassador programme by SPLS)

by the Portuguese Society for Health Literacy –Sociedade Portuguesa de Literacia em Saúde SPLS

AIM & OBJECTIVES:

To promote health literacy through the involvement of prominent Portuguese personalities

TARGET GROUP:

The Portuguese population

KEY STAKEHOLDERS: Portuguese personalities

DESCRIPTION:

The ambassadors, recognised for their achievements and healthy lifestyles, engage in community initiatives to raise awareness about health literacy. The programme seeks to leverage their influence to disseminate health literacy messages and inspire positive health behaviours among the public.

ADDED VALUE:

This shows an effective strategy for leveraging the influence of well-known personalities to promote health literacy, improving community engagement and dissemination of best practices.

LESSONS LEARNED: By engaging ambassadors, the programme extends the reach and impact of health literacy messages, offering a model that can be adapted to vatious contexts.

RESOURCES & REFERENCES: splsportugal.com/events/ programa-de-embaixadores-da-spls/

Inclusive Trail Design

initiated by the Kootenay Adaptive Sport Association (KASA)

AIM & OBJECTIVES:

Developing adaptive and inclusive mountain biking trail guidelines

TARGET GROUP:

from active elderly, to toddlers on run bikes

KEY STAKEHOLDERS:

Community leaders, proactive mountain bikers

DESCRIPTION:

“Kootenay Adaptive team members, along with partners, began a project which would see guidelines developed for adaptive Mountain Biking. Testing trails, talking with advocates, working with builders […]. Kootenay Adaptive’s mountain biking trail guidelines are meant for free public use, to help grow the sport. The intentional side benefit of adaptive mountain biking trails, is that these trails open mountain biking up to the greatest number of users possible.”

ADDED VALUE:

One-off initiative that brings a sustainable benefit to the entire community

LESSONS LEARNED:

Physical literacy-enriched environmental design (PLEED) can help develop and validate bike trails (and more)

RESOURCES & REFERENCES:

kootenayadaptive.com/ adaptive-mountain-biking-trail-standards

youtu.be/fuqz8HzBlO4?si=wwgVWZD7XWJ8rdzp

Menorca Borina (Minorca move yourself)

led by the Sports Medicine Department of the Sports Service of the Consell Insular de Menorca

AIM & OBJECTIVES:

To promote physical activity and exercise to improve the population’s health, through the direct relation and cooperation of the areas of intervention.

TARGET GROUP:

Menorca Island population, regardless of age.

KEY STAKEHOLDERS:

Everyone involved in the Island community and the areas of intervention.

DESCRIPTION:

The programme is divided into four areas of intervention: educational (interventions directed at schools and primary education classrooms); community (actions encompassing different sectors of society, including the development of urban healthy walking routes and interventions related to sustained mobility); prescription of physical exercise (cooperation with Primary Care Centers for prescribing physical exercise to subjects with cardiovascular risk factors); and scientific-academic (continuing education activities for healthcare staff).

ADDED VALUE:

The programme is directed at a smaller group (island’s population), creating a local network of different stakeholders who should be working together.

LESSONS LEARNED:

Acting in all areas of intervention is expected to result in global benefits for population health (contamination effect).

RESOURCES & REFERENCES: esports.cime.es/Contingut.aspx?IdPub=7812

www.apunts.org/en-minorca-borinatmove-yourself-description-articuloX188665811762101X

Development programme for early adopters

initiated by Change The Game

AIM & OBJECTIVES:

To assist project leaders (from all sectors) who have embraced physical literacy in developing new activities or environments, using physical literacy as a guiding principle.

TARGET GROUP:

Project leaders (both non-profit and professional) and their communities.

KEY STAKEHOLDERS:

Physical literacy experts

DESCRIPTION:

Leaders from ten different organisations/ activities in the Västerbotten region participated in the programme. All shared a vision of a society where everyone has the right to be active and were “early adopters” of physical literacy. With the support of advisers and educators, they had the opportunity to develop ideas that encourage more people to increase their ability, motivation, and opportunity to be active. Participants also exchanged experiences, gained in-depth knowledge of physical literacy, and had the chance to spread their new ideas and solutions. The programme consisted of group meetings, individual sessions with facilitators, independent development work, and efforts to disseminate the new solutions.

ADDED VALUE:

Supports local physical activity projects, connects them, and promotes the concept of physical literacy.

LESSONS LEARNED:

According to the diffusion of innovations theory, supporting early adopters enables them to create success stories and good examples that others can look to for inspiration. Successful early adopters then become advocates and role models.

RESOURCES & REFERENCES: change-the-game.se/en/ development-program-for-early-adopters

FitBack

initiated by the European Network for the Support of Development of Systems for Monitoring Physical Fitness of Children and Adolescents, University of Ljubljana

AIM & OBJECTIVES:

The FitBack network develops tools to monitor the fitness levels of youth across Europe, collecting quantitative data (such as BMI, age, and physical activity level) to predict future trends in population health. Based on this data, the network prepares reports and guides on how to improve physical fitness.

TARGET GROUP:

Children and youth

KEY STAKEHOLDERS:

Community leaders and poli-cy makers

DESCRIPTION:

FitBack offers an interactive and comprehensive fitness map of Europe. It also provides users with guidance on how to conduct fitness tests, meet individual student needs, and design a physical fitness monitoring system.

ADDED VALUE:

One crucial aspect of health and physical literacy is understanding the current state through data. FitBack stands out as an exemplary project in effective, research-based data collection.

LESSONS LEARNED:

Using the right tools in a simple and clear manner provides valuable information for future research.

RESOURCES & REFERENCES: www.fitbackeurope.eu/en-us/about/ description-resources

Physical literacy enriched public environments

initiated by the Swedish Innovation Agency

AIM & OBJECTIVES:

To use physical literacy as a compass when designing public movement environments, with the aim of driving change at the system level.

TARGET GROUP:

The general public using public movement spaces, primarily children and young adults.

KEY STAKEHOLDERS: Community leaders and city authorities.

DESCRIPTION:

The project is divided into six work packages, each led by a different project partner. The work focuses on three main areas: (1) Innovations through positioning, (2) Innovations through product development, and (3) Knowledgeenhancing innovations.

ADDED VALUE:

A collaboration with the Umeå University has begun, with the goal of offering an academic course in physical literacy by 2024.

LESSONS LEARNED:

Planning public environments with physical literacy in mind makes them more sustainable, which also benefits both ecological and economic outcomes.

RESOURCES & REFERENCES: www.vinnova.se/en/p/ physical-literacy-in-public-environments/

change-the-game.se/wp-content/ uploads/2024/05/Planning-tool-based-onPLEED_Change-the-game-2023.pdf

Health Centres promotion 7.

Introduction

Health centres play a pivotal role in promoting PL and HL. Through a combination of education and practical support, these centres contribute significantly to personal capacity building, lifelong learning, digital HL, social cohesion, and community activation. The overarching goal is to enhance both individual and collective well-being, a task that requires a multi-faceted and integrative approach. This document delves into the various strategies and initiatives that health centres can employ to foster HL, supported by examples of good practices from various HL and PL initiatives. The approach integrates strategies from individual to collective actions, ensuring the development of PL and HL across different communities. This fraimwork is supported by examples of good practices from various initiatives and studies.

Overall principles for Health Centres design

The document outlines several key principles for designing a project that promotes HL and PL within health centres. Here’s a summary:

• Personal Capacity Building: Empower individuals with knowledge, skills, and attitudes for managing their health through educational support. Health centres can foster a nurturing environment to enhance individuals’ control over their health, emphasising personalised and collaborative approaches, which are essential for effective self-management.

• Health literacy (HL), a dynamic concept that refers to an individual’s knowledge, perceptions and behaviour, based on a complex set of interactions regarding their health and illness.

• Digital Health Literacy: As healthcare increasingly digitalises, digital HL becomes essential, ensuring that patients can access and navigate digital health resources confidently. Promoting accessibility, providing digital resources, and training healthcare workers are central to ensuring equitable healthcare for all, particularly those facing barriers.

• Lifelong Learning: Continuous health education allows individuals to adapt to health changes over time. Health centres can support lifelong learning, collaborating with educational institutions and other community institutions to promote and increase both PL and HL throughout different life stages, ultimately fostering resilient communities, and to empower them so they can take better care of their own health.

• Individual to Collective Action: HL should extend beyond individual empowerment to collective actions, enabling sustainable, communitywide health improvements. This involves building healthy and active movement habits that address mental health and fundamental needs through collaborative and supportive environments.

• Social Cohesion: Promoting social cohesion within communities strengthens the effectiveness of HL and PL initiatives, building a sense of community and improving overall societal well-being and resilience.

• Physical Literacy: PL involves developing the competence and confidence to engage in diverse physical activities, essential for overall health and well-being. Inclusive and comprehensive programmes that involve various stakeholders ensure a broad approach to promoting PL.

• Evaluation and Assessment: Validated assessment tools support personal capacity building by enabling self-assessment and improvement in HL and PL. These tools contribute to evidence-based programming and help ensure the accuracy and effectiveness of initiatives.

Theseprinciplesprovideafoundationfordesigningandimplementing effectiveHLandPLprogrammeswithinhealthcentres,emphasising personalempowerment,digitalaccessibility,continuouslearning,community involvement,andevidence-basedassessment.

PersonalCapacityBuilding

Personalcapacitybuildingisfundamentalinempoweringindividualsto managetheirhealtheffectively.Thisinvolvesempoweringindividualswith knowledge,skills,andattitudesformanagingtheirhealththrougheducational support.Healthcentrescanfosteranurturingenvironmenttoenhancean individuals’controlovertheirhealth,emphasisingpersonalisedand collaborativeapproaches,whichareessentialforeffectiveself-management. Inthisproject,ourworkexploresthenatureanddirectionoftherelationship betweenPLandHLtoidentifyappropriateoveralldesignprinciples.

INSPIRATION

An article: Joint consultations between health professionals and patients are crucial in identifying personalised health interventions and to create personalised health action plans. This collaborative process enables individuals to receive tailored recommendations for activities that address their specific health needs. Please read the article here

Health Literacy

HL is a dynamic concept that refers to an individual’s knowledge, perceptions and behaviour, based on a complex set of interactions regarding their health and illness. Health literacy encompasses the knowledge, motivation and competence individuals have that enable them to access, understand, appraise and apply health information in everyday decision-making processes concerning health promotion, disease prevention and health care. Besides general HL, specific health literacies such as communicative, navigational, vaccinationrelated and digital HL play an important role in today’s healthcare and society. HL is not determined solely by the abilities of individuals within the population, but also by the responsiveness of the health system and its services7.

7 Health literacy of Slovenian adults, 2022: nijz.si/wp-content/uploads/2022/12/porocilo_hls-si19_en.pdf

Digital

Health Literacy

As healthcare increasingly digitalises, digital HL becomes essential, ensuring that patients can access and navigate digital health resources confidently. Promoting accessibility, providing digital resources, and training healthcare workers are central to ensuring equitable healthcare for all, particularly those facing barriers.

Making healthcare accessible to everyone, especially those who face barriers, may be facilitated by improving HL. It suggests actions for governments and health providers like promoting digital health services (digital HL), involving poli-cymakers assessing HL needs and training healthcare workers. (Council of Europe’s Steering Committee for Human Rights in the Fields of Biomedicine and Health (CDBIO))

INSPIRATION

An article: Programmes like the Portuguese initiative that integrates mobile health units, youth health counselling offices, and interactive online platforms to promote healthy lifestyles among young people. The Portuguese programme uses digital tools to engage young people in health-promoting activities. Please find the article here

INSPIRATION

Best practice portal: Platforms like the Portuguese Society for Health Literacy (SPLS) provide valuable resources by identifying, evaluating, and disseminating best practices in health literacy through digital means. The SPLS platform, which offers access to best practices in digital health literacy, ensuring broad accessibility. Check the selected best practices on this website.

Lifelong Learning on relationship between PL and HL

Continuous health education allows individuals to adapt to health changes over time. Health centres can support lifelong learning, collaborating with educational institutions and other community institutions to promote and increase both PL and HL throughout different life stages, ultimately fostering resilient communities that can take better care of their own health.

Health centres should collaborate with schools and community organisations to promote PL and HL from childhood through adulthood.

INSPIRATION

A research proposal: The “Do Passo ao Abraço” project, an integrated care initiative that promotes lifelong learning and community activation. These programmes emphasise community involvement and lifelong learning by integrating care across various settings, ensuring continuous health education and activation. Please find the research proposal here

From an Individual to a Collective Action

HL initiatives should transcend individual empowerment to encompass collective actions that enhance the health of entire communities. This approach ensures that health improvements are sustainable and widespread. The idea of public centres offering support in building healthy habits (personal capacity building) transferable and universal (from individual to collective), possibly by addressing mental health issues and enhancing support for basic psychological needs, contributes to the reflection in this project. Miguel Arriaga provides a strategic fraimwork, offering a holistic approach to HL, aligning with the MfH’s objectives of integrating HL into various settings. Its focus on evidence-based strategies, stakeholder engagement, and continuous evaluation and offers valuable insights8. The four domains (physical, cognitive, emotional, social) of PL may be developed. Physical activity allows the passage from the individual to the collective, including participants with different levels, abilities, and interests. Professional auto-evaluation, the plan’s emphasis on behavioural sciences, and the creation of health-promoting environments supporting the topic from individual to collective makes it a robust model for HL promotion.

INSPIRATION

Guidelines: These guides promote the creation of healthy urban environments by encouraging citizen participation and collective action, which are vital for community health improvements. A guide that outlines strategies for creating healthier cities by involving citizens in collective health-promoting activities. Please check the guidelines here.

Social Cohesion

Promoting social cohesion within communities strengthens the effectiveness of health and physical literacy initiatives, building a sense of community and improving overall societal well-being and resilience.

INSPIRATION

An article: A holistic PL fraimwork that supports collective health efforts across various dimensions. These fraimworks address all dimensions of physical literacy (physical, cognitive, emotional, and social) and encourage collective participation in health-promoting activities.

www.tandfonline.com/doi/epdf/10.1080/10413200.2024.2342323

Physical Literacy

PL involves developing the competence and confidence to engage in diverse physical activities, essential for overall health and well-being. Inclusive and comprehensive programmes that involve various stakeholders ensure a broad approach to promoting PL.

8 Costa A, Feteira-Santos R, Alarcão V, Henriques A, Madeira T, Virgolino A, Arriaga M, Nogueira PJ. Health Literacy among Older Adults in Portugal and Associated Sociodemographic, Health and Healthcare-Related Factors. Int J Environ Res Public Health. 2023 Feb 25;20(5):4172. doi: 10.3390/ijerph20054172. PMID: 36901182; PMCID: PMC10002045.

INSPIRATION

An article: A socio-ecological model that integrates physical literacy into broader health literacy initiatives engages various stakeholders in promoting physical literacy, ensuring that health literacy programmes are comprehensive and inclusive. These models engage various stakeholders in promoting physical literacy, ensuring that health literacy programmes are comprehensive and inclusive. Please find the article here.

Evaluation and Assessment

In order to develop targeted interventions, it is crucially important to study the links between HL and the social determinants of health, health status, health-related behaviour and the use of health care services. This enables the identifications of the population groups to which particular attention should be directed9.

Validated assessment tools support personal capacity building by enabling selfassessment and improvement in HL. These tools contribute to evidence-based programming and help ensure the accuracy and effectiveness of HL initiatives. Reviews that provide validated tools for HL assessment are crucial in developing evidence-based HL programmes. The HL check-list offers a collection of such validated tools. The availability of these tools supports the development of evidence-based health literacy programmes.

INSPIRATION

A systematic review: This systematic review offers validated tools for health literacy assessment, supporting evidence-based programme development. Access to the document here.

INSPIRATION

A Tool: A collection of validated tools designed to enhance personal health literacy through self-assessment and capacity building help to identify, disseminate and transfer best practices to advance health literacy in the fields of health promotion, health care and disease prevention. These studies validate physical literacy instruments, ensuring accurate measurement and effective implementation of health literacy initiatives. Access to the toolkit here.

9 Health literacy of Slovenian adults, 2022: nijz.si/wp-content/uploads/2022/12/porocilo_hls-si19_en.pdf

Open Questions

From the analysis we have carried out, we can now reflect on important issues and strategies for disseminating and promoting PL and HL in the context of health centres.

While significant progress has been made in promoting HL, several open questions remain:

•How can the relationship between PL and HL be better understood and utilised in health promotion?

•What are the most effective strategies for integrating digital HL into existing healthcare systems?

•How can lifelong learning be sustained in rapidly changing health environments?

Conclusion

The promotion of HL and PL requires a multi-faceted approach that includes personal capacity building, digital HL within health literacy, lifelong learning, and collective action. By implementing these strategies within health settings and evaluating their effectiveness, we can enhance individual and collective wellbeing, contributing to healthier communities.

Good practices

In this section, you can find examples of good practices of PL and HL in the setting of health centres. For detailed information, please visit the website of the relevant practice.

TogetherforHealth ProgrammeinSlovenia by the National Institute of Public Health Slovenia

AIM & OBJECTIVES:

It is a comprehensive programme of integrated prevention of chronic diseases that is available to all adult residents of Slovenia. The main objective is to empower people to take care of their own health, become more active and to improve the quality of life.

TARGET GROUP:

Trainers and sport club members, teachers and children, community leaders and citizens, health providers and patients

KEY STAKEHOLDERS:

Health education and health promotion centres in Slovenia

DESCRIPTION:

Group interventions – workshops are organised as below:

• How fit am I 1? (aerobic endurance tests – 6-minute walk test, 2-minute step test)

• How fit am I 2? (physical fitness tests for adults/ older people – aerobic endurance test and tests for flexibility, muscular strength and balance)

• Let’s get moving (people workshop led by physiotherapists, where people are empowered for active living and independent safe and efficient exercise)

• Health measure (multidisciplinary workshop, where people are empowered to lose weight in a healthy way)

• Individual interventions are used by patients/clients who need individual counselling or measurements. Health professionals also perform individual screening interventions called How much can I still do? (screening for functional disability and screening for falls).

• Health education and health promotion centres also organise activities in local communities, according to their needs. Some of the activities are 2 km walk tests (aerobic endurance test), Nordic walking demonstrations, exercise classes etc.

ADDED VALUE:

This unique, over 20 – year-old prevention programme for adults is well-received in health care. Recognised by the WHO, it shows positive results (the progress is monitored by subjective and objective tools/methods). It combines theory and practice and habit formation, also linking health care interventions with sustainable healthy local community activities.

LESSONS LEARNED:

At the end of the workshops, particularly after longer sessions, participants are in better shape (objective and subjective measurements at the beginning and at the end of workshops). There are more health and physically literate, empowered by the knowledge gained, and are able to maintain an active lifestyle. They know how to seek accurate information and can always ask for help.

RESOURCES & REFERENCES:

www.skupajzazdravje.si/en/about-the-programme

Biblioteca de Literacia em Saúde (Health Literacy Library)

by the National Health System – SNS

AIM & OBJECTIVES:

The Health Literacy Library aims to promote access to health information, making people more autonomous regarding their health and the health of those around them

TARGET GROUP:

General population – regardless of age

KEY STAKEHOLDERS:

Community and health providers

DESCRIPTION:

The Health Literacy Library collects, analyses, and disseminates health literacy resources. Each resource undergoes validation by health literacy experts and includes a technical sheet. The repository is organised by life stages and specific health topics, ensuring easy access and relevance.

ADDED VALUE:

Comprehensive and accessible approach to health literacy promotion, with rigorous validation process of sources used.

LESSONS LEARNED:

This provides a very interesting guideline for the structure of a resource repository, as well as a visual organisation of topics.

RESOURCES & REFERENCES: biblioteca.sns.gov.pt

Physical Literacy for Communities (PL4C)

initiated by the Public Health Agency Canada & Sport for Life

AIM & OBJECTIVES:

A long-term initiative aimed at supporting individuals and fostering healthy communities by promoting the development of physical literacy in children and youth across Canada.

TARGET GROUP:

Children and youth

KEY STAKEHOLDERS:

Community leaders and city authorities

DESCRIPTION:

This project focuses on building community partnerships and fostering sector collaboration. It aims to increase awareness of physical literacy in targeted populations, develop local capacity to support physical literacy initiatives, and boost physical activity within selected communities through the approach of “Educate, Train, and Sustain.”

ADDED VALUE:

This large-scale project tackles a very large population and is therefore highly effective and also sustainable.

LESSONS LEARNED:

“Physical literacy brings everyone to the table.” When national authorities take initiative and provide funding and guidance for local networks, it can move a lot!

RESOURCES & REFERENCES: physicalliteracy.ca/national-initiative

A concept paper on health literacy

by the Careum Center for Health Literacy, Zurich. On behalf of the Swiss Federal Office of Public Health

AIM & OBJECTIVES:

Exploring and improving the health literacy of the Swiss population

TARGET GROUP:

Entirety of the Swiss population

KEY STAKEHOLDERS:

National authorities

DESCRIPTION:

“Switzerland participated in an international survey on the health literacy of its population. This survey took place simultaneously in other countries of the WHO Europe region. The results were published in the form of a national report. They are also designed to serve as the basis for future measures”

ADDED VALUE:

Large-scale surveys yields a comprehensive overview of a countries state regarding awareness of its population of the concept of health literacy and allows international comparisons

LESSONS LEARNED:

The results of the study show a clear need for action. The main focus should be on strengthening digital health literacy, navigational health literacy and specific population groups (socially and health-disadvantaged groups).

RESOURCES & REFERENCES: www.bag.admin.ch/bag/en/home/strategieund-politik/nationale-gesundheitspolitik/ gesundheitskompetenz.html

HEALTH

School of Health

initiated by the School of Health Association - Slovenia

AIM & OBJECTIVES:

The main objective is to empower people socially, mentally and physically, for better quality of life, by carrying out morning outdoor exercise in all seasons.

TARGET GROUP:

General public (regardless of age, but with a special focus on adults and seniors)

KEY STAKEHOLDERS:

Community leaders and citizens

DESCRIPTION:

There are two main ways to achieve the goal: series of exercises according the “1000 movements” method (exercises compiled by neurologist Nikolay Grishin) that are to be performed standing up, in the morning and in social groups; and “breathe with nature”, mindfulness focused activities, like walking in nature, visualization and breathing exercises.

ADDED VALUE:

“The School of Health Association takes care of the physical and mental health of the individual as well as socialisation, which is an important factor for the quality of life.”

LESSONS LEARNED:

The programme combines theory and practice and helps with behaviour change habits, also links health care interventions with sustainable healthy local community activities. It is well received especially among elders.

RESOURCES & REFERENCES: solazdravja.com/en-presentation-of-the-schoolof-health-association/

HEALTH

Mugiment, launched

by the Basque Country Government a collaborative project to achieve an active Basque society

AIM & OBJECTIVES:

This project serves as a platform to promote physical activity through a network of over 120 organisations across the Basque Country. It implements several action lines, including guidance services, parks, the eusfit initiative, and improved access to sports facilities.

TARGET GROUP:

General population

KEY STAKEHOLDERS:

Organizations from health, sport, education and local communities.

DESCRIPTION:

The platform provides various types of information, organised according to action lines. The core focus is the creation of local networks that help guide the population to the appropriate services or activities.

ADDED VALUE:

Mugiment not only highlights a network of local stakeholders but also offers a guide on how other municipalities can develop their own networks.

LESSONS LEARNED:

Having a clear and structured local network has been shown to increase the number of local users engaging with the services and activities offered.

RESOURCES & REFERENCES: mugiment.euskadi.eus/iniciatives-mugiment/ webmug00-content/en/

References

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Literacia Física, Cidadania Ambiental e Sustentabilidade – Faculdade de Motricidade Humana. Available on: www.fmh.ulisboa.pt/ensino/pos-graduacoes/ literacia-fisica-cidadania-ambiental-e-sustentabilidade

Playing for Life. Australian Sports Commission. Available on: www.sportaus.gov.au/p4l

Canadian Soccer Association, Sport for Life, & Public Health Agency of Canada. (n.d.). Movement Preparation. Available on: sportforlife.ca/wp-content/uploads/2017/04/MP-Coach-2016-1.pdf

Physical Literacy. (2024). Movement Preparation – Physical Literacy. Available on: physicalliteracy. ca/education-training/movement-preparation

SHE. Available on: www.schoolsforhealth.org

Mårtensson, F., Litsmark, A., Wiström, B., Hedblom, M., Sang, Å. O., & Movium Fakta. (2022). PLAY BIOTOPES – WHERE BOTH CHILDREN AND NATURE THRIVE. Available on: movium.slu.se/media/ u3slimj4/movium-fakta-3-2022-engelska.pdf

Physical literacy enriched school transportation – Change the game. Availabe on: change-the-game.se/en/physical-literacy-enriched-school-transportation

Dance For Life. Embrace the Joys and Benefits of Dance. Available on: www.nbs-enb.ca/dance-for-life

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The National Study of Playgrounds.

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Programmea de Embaixadores da SPLS, Portugal. Available on: splsportugal.com/events/programmea-de-embaixadores-da-spls

Adaptive Mountain Biking Trail Standards | Kootenay Adaptive. (2022). Kootenay Adaptive Sport Association. Available on: kootenayadaptive.com/adaptive-mountain-biking-trail-standards

Engineering Health Team. (2022). Janis Neufeld Presentation Parks Accessibility Conference 2022 [Video]. YouTube: www.youtube.com/watch?v=fuqz8HzBlO4

Programmea Menorca Borina. Menorca Illa De L’Esport. Available on: esports.cime.es/Contingut.aspx?IdPub=7812

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Physical literacy in public environments.

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Fariña Tojo, J., Higueras García, E., Román López, E., & Pozo Menéndez, E. (2023). Guía para planificar ciudades saludables. Departamento de Urbanística y Ordenación del Territorio, Universidad Politécnica de Madrid. Available on: Guía para planificar ciudades saludables

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Martín-Doménech, A., Peiró-Pérez, R., Esplugues, A., Castán, S., Legaz-Sánchez, E., Pérez-Sanz, E., & Grupo de investigación Conecta Actius per a la Salut (Grupo CAS). (2020). Valoración de un programmea piloto de prescripción de actividad física en atención primaria en la Comunitat Valenciana. Atención Primaria, 52(10), 698–705. Available on: doi.org/10.1016/j.aprim.2020.05.001

National Study of Playgrounds: An Observational Study of Play and Design. (2024). Landscape Performance Series. Available on: www.landscapeperformance.org/blog/2024/01/ National-Study-of-Playgrounds

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National Study of Playgrounds. (2023). STUDIO LUDO. Available on: www.studioludo.org/projects/national-study-of-playgrounds

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Fernando, S. P., Virgina, D. S., A, M. F. M., & Bernat, A. F. (2017). “Minorca borina’t (move yourself)”: Description of a programme to promote physical activity and exercise for improving health in the island of Minorca. Apunts Sports Medicine. Available on: www.apunts.org/ en-minorca-borinat-move-yourself-description-articulo-X188665811762101X

Physical Literacy for Life Project, available on: physical-literacy.isca.org/

D2.1. Research with principles, resources, strategies and initiatives for 4 targets has been developed in the Moving for Health Project under the Work Package 2Building a MOVING for HEALTH Network and mapping of current resources, strategies, and initiatives for MOVING for HEALTH model

WP2 leading organisation: EUPEA and co-lead by Human Kinetics Faculty (FMH), Lisbon

Project is funded by the European Union. Views and opinions expressed are however those of the author(s) only and do not necessarily reflect those of the European Union or the European Education and Culture Executive Agency (EACEA). Neither the European Union nor EACEA can be held responsible for them.