Improving health literacy in co-creation with the community: a process evaluation

Global socioeconomic health inequalities are persistent and increasing. Although health literacy is linked to these inequalities, many interventions fail to meet the needs of individuals with limited health literacy. This study evaluated experiences with the community-based intervention 'Healthy and Well Together', aimed at improving health literacy and language proficiency among people with limited health literacy. Participants ( n = 24; mean age = 56.8 ± 19.0 years; range: 31–88 years) were included from five municipalities in the Netherlands of whom 16 completed the full intervention. Using a multi-method approach, questionnaires assessed changes in participants' basic psychological needs and satisfaction with the intervention, while semi-structured interviews explored participants’, coaches’, and other involved professionals’ experiences. Participants rated the intervention as a whole with an 8.2 ( SD = 2.0; scale: 1–10; n = 15), valued the coach’s support and personal approach and enjoyed peer interaction. Following reflexive thematic analysis, four key themes for further development were identified: the power of acknowledgment, a tailored approach, awareness as a motivator for change and challenges in participant engagement. These findings highlight the importance of tailored interventions that address community needs, emphasizing the role of personal coaching and supportive group environments. Future research should test the intervention with a larger sample and consider an extended time frame to enhance engagement with the study population.