Health Literacy and Youth Empowerment: Investing for Healthier Communities

Cristina Vaz de Almeida

doi:10.20944/preprints202508.0809.v1

Submitted:

08 August 2025

Posted:

12 August 2025

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Abstract

Background: Health literacy is increasingly recognized as a critical factor in promoting youth citizenship, participation, and empowerment in health-related matters. This study examines how health literacy can serve as a strategic driver for engaging young people in decision-making processes, using participatory initiatives developed by the Portuguese Health Literacy Society (SPLS) as case studies. The initiatives include Health Miniassemblies, the Youth Leaders Program, and structured meetings with youth associations within the framework of the National Youth Council. Methods: A qualitative and participatory research design was employed, involving focus groups, interviews, and participatory observation. These methods enabled the collection of proposals from young participants and the evaluation of their involvement and perceived impact on health policies. Ethical principles and informed consent were ensured throughout all activities, although the study was not preregistered. Results: The findings reveal that these participatory initiatives contributed to increased civic awareness, improved communication skills, greater engagement in community health issues, and enhanced advocacy capacity among young participants. Youth expressed a stronger sense of agency and inclusion in health governance. Conclusion: Investing in youth through health literacy fosters democratic participation and strengthens health systems. Comparative analysis with international models confirms the relevance and replicability of this approach in diverse sociopolitical contexts.

Keywords:

health literacy

;

youth citizenship

;

empowerment

;

participation

;

youth

Subject:

Public Health and Healthcare - Other

Introduction

Health literacy is increasingly recognized as a key determinant of individual and public health, influencing health behaviors, service use, and outcomes across the life course (Nutbeam, 2000; Sørensen et al., 2012). Defined by the Portuguese Health Literacy Society (SPLS) as "people's ability to access, understand, evaluate, and apply health information to make informed decisions in their daily lives, promoting autonomy, quality of life, and well-being," health literacy extends beyond clinical settings and into the realm of civic engagement and social participation. It is especially critical during adolescence and early adulthood, when individuals form health behaviors, values, and attitudes that persist into later life (Paakkari & Okan, 2020).

Participatory models, such as Hart’s Ladder of Participation (1992) and Checkoway’s youth empowerment framework (2011), provide valuable guidance for creating authentic spaces of co-decision and shared responsibility between young people and adult-led institutions.

In this context, investing in youth health literacy is not only a matter of disease prevention or health promotion—it is a strategic lever for fostering active citizenship, social inclusion, and more democratic and responsive health systems (Kickbusch et al., 2013; 2024).

The UN definition of ‘youth’ is someone from 15 to 24 years old. There is also a definition for ‘young people’ (10-24 years old) and for ‘adolescents’ (10-19 years old). There is, however, no universal definition (UNESCO, 2019, p. 2).

Young people are often excluded from health decision-making, yet they hold unique insights and are key stakeholders in co-creating future health solutions.

Youth engagement is increasingly recognized as a critical component of democratic governance, sustainable development, and public health promotion. Meaningful youth participation goes beyond symbolic involvement; it is a human right and a fundamental prerequisite for ensuring that young people can exercise agency, co-create policies, and contribute to societal transformation (UNESCO, 2019). Civic space is a right that must be extended to young people. According to the OECD: "Civic space is defined as "the set of legal, political, institutional and practical conditions necessary for non-governmental actors to have access to information, express themselves, associate, organize and participate in public life" (OECD, 2022, p. 16)

According to numerous polls conducted on young people, the lack of political knowledge, competence and literacy, are perceived as the most important barrier to the full and informed participation of youth in democratic processes

In the context of health promotion, communication, and citizenship, youth engagement intersects with the development of health literacy, critical thinking, and life skills essential for navigating modern societies (Vaz de Almeida, 2023).

There is a multidimensional value of investing in youth engagement, particularly through the lens of health literacy and empowerment: it draws on international frameworks, best practices, and theoretical models that position young people not merely as future stakeholders but as active agents of change in the present.

More and more we have evidence of the role of health literacy in promoting youth empowerment and civic engagement through participatory practices (Youthforum, n.d.) . It focuses on a set of innovative initiatives led by the Portuguese Health Literacy Society (SPLS), including:

Health Miniassemblies, which bring together secondary school students to discuss topics such as mental health and nutrition using the nominal group technique, generating policy-relevant proposals;
The SPLS Youth Leaders Program, which empowers young people through training in health communication, leadership, and digital campaigning, enabling them to design and implement health promotion activities;
Collaborations with the National Youth Council, where SPLS facilitates dialogue between youth associations and health policymakers to identify health priorities from the youth perspective;
Creative interventions and public events, such as the “RITMO” project, which links artistic expression with health literacy, and youth-led health screenings that foster direct community engagement.

Table 1. content of interventions with groups of Youth and self perceptions.

Health Miniassemblies 2023, 2024
WHITE PAPER - MINI-ASSEMBLIES OF HEALTH" "THE VOICE OF THE CITIZEN" A constructive and dynamic form of community participation for the creation of better public policies ISBN 978-989-35724-0-5 Quote Vaz de Almeida, C, Nunes, C., Lima, V., & Keller, F. (2024). Livro branco Miniassembleias da saúde. A voz do cidadão. Uma forma construtiva e dinâmica de participação comunitária para a criação de melhores políticas públicas. Sociedade Portuguesa de Literacia em saúde. ISBN In these "Health Mini-Assemblies", health and well-being issues were debated with the health literacy matrix, that is, focusing on the dimensions of access, understanding and use of health resources, navigability in the system, health decision-making in the continuum of life and well-being of these populations represented here. The increase in the dimensions of health literacy, and the subsequent action of decisions taken in a more responsible, conscious and participatory way, are the basic proposals of these "Mini-Health Assemblies". With its realization, its promoters – SPLS and Municipalities, it is intended that these "Health Mini-Assemblies" that replicate the public space for debate, are activators of greater participatory civism, involving the human dimensions of social connection, fostering multiculturalism, inter and multidisciplinary vision and the promotion of healthier communities.
The SPLS Youth Leaders Program 2022-2025
Young Leaders Program returns to SPLS The Portuguese Society for Health Literacy (SPLS) presents the 2nd of the leadership course "What does it take to be a young leader in health?"element. The project brings together young leaders from different areas of health and each session has the participation of a prominent personality in the area of young leaders. The program takes place online, via Zoom. It is aimed at students and early career professionals who seek to develop their leadership skills and drive positive changes in health in Portugal. The leadership program aims to provide a space for learning and exchanging experiences for young leaders in the health area. I had the pleasure of participating in the Leadership Program "What does it take to be a young leader in health?" provided by the Portuguese Society of Health Literacy – SPLS with an introduction by Dr. Tiago Pereira and the Leadership course given by Sérgio Alves, so rich and inspiring not only for young leaders, but for all people who aspire to leadership, and for those who are part, or not, of teams. I would like to thank Dr. Cristina Vaz de Almeida for the kindness and moderation of the Program, and all the people who participated in this session. Catarina Mendes Source: https://splsportugal.com/events/spls-lanca-curso-de-lideranca-para-jovens-dirigentes-na-saude-inscreva-se-aqui/
Collaborations with the National Youth Council 2023- 2024
Launnch of e-book YOUNG PEOPLE'S HEALTH CHOICES THE VOICE OF YOUNG LEADERS Suggested citation: Vaz de Almeida, C., Marques-Pinto, A., Matos, M. G., & Lima, V. (2024). Young people's options for health. The voice of young leaders. 2nd Meeting. Portuguese Society for Health Literacy. ISBN 978-989-35724-1-2; From the book, Excerpt: Vania Lima, Youth Diretor of Health Communication “we urgently need to look at the communication technology used by our national health service and move forward with the digital transition that we've been talking about for so many years and which, by the time it's actually implemented, will be obsolete again. We need an omnichannel strategy, i.e. one that integrates all communication channels, so that health communication is effective. Moving on to organisational communication in healthcare, which refers to all the dynamics of interaction that take place in the internal and external environment of healthcare organisations, we highlight the following: - The importance of reinforcing the communication departments of the new Local Health Units, with a sufficient number of professionals with different technical skills dedicated to internal and external communication, guaranteeing their training and updating, as well as the technological means necessary to carry out their duties. Having communications departments that serve an entire Local Health Unit with one or two communications professionals who work on internal communications, health campaigns for the population, relations with the media, creating communications materials is like having one doctor who has to attend to all the specialities. It doesn't work.” We cannot ignore the role that artificial intelligence will play in the exponential increase in content creation, particularly health content. This increase can be very positive for health communication, but it can also represent an uncontrollable source of dissemination of false health information, which is increasingly difficult to detect. That's why we need to take a fresh look at the role of the Media Regulatory Authority, considering extending its actions to people or organisations with a high level of public awareness or with a considerable presence and audience on social media that could contribute to the population's misinformation about health.
RITMO” a sensorial project
RITMO is an event with "EXPERIMENTATION", which stimulates memory and behavioral intention, physical activity, values and respect for the life of the other person, learning to save lives (basic life support), appealing to the participation of the various audiences, specially for young people, for the prevention of disease and health promotion by bringing together the factors of behavior change EMOTION + REASON. The combination of movement, food, health, well-being through art (music, dance, painting, theater) promotes better memories, motivates and awakens to change throughout the life cycle. Physical activity promotes well-being. Healthy eating is essential to health and well-being Art helps create environments of well-being and promotes change. Social connection allows for the development of stronger and healthier relationships between people. Health and well-being better understood and based on practices that stimulate motivation and learning. Young people also learn by modeling, by "copying" – offering good examples through gamification allows them to increase their skills, respect and citizenship. RITMO is a health literacy event that also contributes to improving awareness of the prevention of cardiovascular diseases and chronic diseases, the fight against obesity and sedentary lifestyle, and the stimulation of mental health. Source: https://splsportugal.com/events/ritmo-uma-experiencia-sensorial-na-atividade-fisica-alimentacao-e-bem-estar/
Screening projects in Portugal with health students associations (2022- 2025)
Case study: May 2025, the Portuguese Society for Health Literacy (SPLS), in collaboration with the Portuguese Association of Pharmacy Students (APEF) and the Senior University of Coimbra, organized a training and health screening session, with the aim of promoting health literacy among the community and training future professionals in the pharmaceutical area. The training was coordinated and promoted by nurse Ana Veiga, who led a session focused on crucial topics such as diabetes, cardiovascular diseases and the importance of effective communication with users. The practical component of the session included simulations of pharmaceutical care, with the aim of preparing students to carry out screenings in a real and community context. The training culminated with the application of screenings to the University's seniors, creating moments of health education and promoting intergenerational proximity. The session was also attended by the President of APEF, Afonso Garcia, reinforcing the association's commitment to the empowerment of students and its active intervention in the community. Source: https://splsportugal.com/events/spls-apef-e-universidade-senior-de-coimbra-promovem-sessao-de-capacitacao-e-rastreios-em-saude/ case study 2: comments from the President of Portuguese Health Literacy Society June 2024) Nurse. Ana Veiga, National Coordinator of Screenings of this scientific society, was in Évora to coordinate another health prevention project. The Portuguese Association of Pharmacy Students (APEF) contributed to making this possible. "Nurse. Ana Veiga has been a true vehicle of health literacy. Thanks to her contributions, the Portuguese Society for Health Literacy has repeatedly promoted good prevention practices, through screenings and lectures coordinated by this excellent professional", explains the President of SPLS, "We hope to be able to continue to count on the commitment and dedication of Enf. Ana Veiga, who has been one of the most important arms in the dissemination of reliable information in the health area. Their work with the population is fundamental for the country" President of SPLS https://splsportugal.com/events/enf-ana-veiga-coordena-rastreios-em-evora/

Source: SPLS reports.

These initiatives demonstrate how structured participation, when grounded in health literacy, can enhance young people’s sense of agency, strengthen advocacy skills, and contribute to more inclusive health governance. To contextualize these Portuguese cases, the study also draws comparisons with international programs—such as the Young Health Programme (Canada), JuLii (Germany), HealthLit4Kids (Australia), and the Youth Health Assembly (UK)—which similarly emphasize peer education, creative methods, and youth-led engagement (Bröder et al., 2017; Abel & Benkert, 2019; Dadaczynski et al., 2020).

The aim of this work is to analyze how participatory health literacy initiatives can empower young people and integrate their voices into health-related decision-making. By reflecting on both national and international practices, the study highlights the broader significance of youth health literacy as a driver of equity, citizenship, and system transformation

Table 2. Summary of best practice cases in Portuguese Society of Health Literacy, Portugal, and the international comparisons.

Case	Description	Key Strategies / Outcomes
Health Miniassemblies (Portugal)	Organized by the Portuguese Health Literacy Society (SPLS), these bring together high school students to discuss health topics (e.g., mental health, nutrition, access to care) using the nominal group technique.	Youth generate proposals that are later reviewed by policymakers, enhancing civic engagement and participatory decision-making.
SPLS Youth Leaders Program (Portugal)	A training and mentoring program focused on youth leadership, health communication, and project development.	Participants lead community interventions promoting healthy behaviors.
Participation in the National Youth Council (Portugal)	SPLS partnered with the National Youth Council (CNJ) to host meetings with youth associations on health priorities.	Strengthens the connection between youth voices and public health policy development.
Events and Interventions (Portugal)	Youth-led activities such as health screenings and the RITMO project, which integrates arts and health literacy.	Encourages creative engagement, health promotion, and community visibility for youth efforts with health professionals supervision
International Comparative Cases	- Young Health Programme (Canada) - JuLii (Germany) - HealthLit4Kids (Australia) - Youth Health Assembly (UK)	These programs use peer education, creative workshops, political engagement, and communication skills development to empower youth in health contexts. They align with SPLS strategies and confirm the global relevance of youth-focused health literacy initiatives.

Methodology

The study adopted a participatory methodology centered on youth engagement, grounded in principles of inclusion, active listening, equity, and youth protagonism. A combination of qualitative and collaborative methods was used to capture young people's perceptions, experiences, and proposals regarding health literacy, citizenship, and empowerment.

The Nominal Group Technique was applied during the Health Miniassemblies organized by the Portuguese Health Literacy Society (SPLS), enabling collective idea generation and democratic prioritization of proposals. This technique ensured equitable participation and fostered group cohesion, allowing for the emergence of shared health priorities (Van de Ven & Delbecq, 1972).

In addition, co-creative workshops were conducted with youth leaders to develop reflective and practical work on the challenges of health communication and the role of youth as agents of change. These workshops supported the production of digital content (videos, podcasts, campaigns) aimed at promoting peer-to-peer health literacy.

Semi-structured interviews with participating youth and facilitators provided deeper insights into motivations, expectations, and perceived outcomes. These interviews helped to unpack the lived experiences of empowerment and the specific contexts in which the young people operated.

Furthermore, focus groups were held with educators, NGO representatives, and policy-makers to triangulate perspectives on the impact of the interventions and to validate the relevance and feasibility of the youth-generated proposals within the community.

Lastly, a content analysis was carried out on youth proposals and digital outputs produced within the SPLS programs. This analysis identified patterns of critical health literacy, creativity, argumentation, and active citizenship. Abel and Benkert (2022) identify Critical health literacy “as the ability to reflect upon health determining factors and processes and to apply the results of the reflection into individual or collective actions for health in any given context”..

The methodology adhered to strict ethical standards, including informed consent and the safeguarding of participants' rights and confidentiality. This participatory approach aligns with the framework proposed by Rowe and Frewer (2005), who advocate for structured citizen engagement mechanisms in public health decision-making processes.

Discussion of Results

For UNESCO we need a meaningfully engaging with youth (2025). UNESCO relates that 70% of young people feel they do not have enough space to express themselves in public debates nor can voice their concerns and ideas (UN campaign Be Seen Be Heard).

SPLS aligns with this World wide organization (UNESCO, 2025) and also are convinced that engaging young people in decisions that affect them is not just a matter of right, it is a matter of principle (UNESCO 2025) As innovators and knowledge creators, they have proven time and again how crucial they are to social change. In view of the difficult challenges our societies and humanity face, this is now needed more than ever.

Youth engagement is a strategic investment in health literacy and social transformation.

The Sociedade Portuguesa de Literacia em Saúde (SPLS) aligns its strategic priorities with the frameworks established by international organizations, notably the United Nations Educational, Scientific and Cultural Organization (UNESCO, 2025). Youth participation in decision-making processes is increasingly recognized as a fundamental human right and a necessary principle for sustainable development and democratic governance (UNESCO, 2025; Checkoway, 2011; Lansdown, 2011). Rather than passive recipients of policies and programs, young people are active contributors to knowledge, innovation, and transformative social change (UNDP, 2016).

Empirical research and global policy reports have consistently demonstrated that engaging youth in the co-creation of solutions leads to better outcomes across health, education, environmental sustainability, and civic engagement (Wilkinson et al., 2021; WHO, 2022).

Particularly in the field of health literacy, youth involvement promotes not only individual empowerment but also collective resilience and systems improvement (Paakkari & Okan, 2020; Abel & Benkert, 2019).

Given the urgency of addressing complex societal challenges—such as climate change, mental health crises, and health inequities—youth engagement has never been more critical (UNICEF, 2021). The SPLS advocates for youth participation as a cross-cutting lever with direct impact in three key domains: youth empowerment, societal innovation, and institutional effectiveness.

Table 3. Strategic Dimensions of Youth Engagement.

Domain	Strategic Objective
1. Youth	Promote the fulfillment of young people's rights and support their holistic development and agency.
2. Society	Leverage youth-led, creative, and bold solutions to address urgent and systemic societal challenges.
3. Institutions	Improve the relevance, responsiveness, and effectiveness of institutions working with and for young people.

Source:_ UNESCO 2025.

This multidimensional investment approach aligns with the European Youth Strategy (European Commission, 2018), which emphasizes youth empowerment, engagement, and connectivity. It also reflects the Health in All Policies (HiAP) framework promoted by the World Health Organization, which recognizes young people as critical stakeholders in shaping health-promoting environments (WHO, 2023).

According to Checkoway (2011), Youth participation is important, because when young people participate, it draws upon their expertise, exercise their rights as citizens, and contributes to a more democratic society, promotes their personal development, and provides them with substantive knowledge and practical skills.

The initiatives of SPLS demonstrated a positive impact on the development of health communication skills, the reinforcement of citizenship, and the ability to influence decisions. Comparison with international models reinforces the importance of youth involvement in diverse contexts. In the Canadian Young Health Programme, an effective link between youth and health systems was observed (Aston et al., 2022). In Portugal, the miniassemblies generated concrete proposals for local and regional policymakers, with a high degree of ownership by young people. The existence of a structured program like Youth Leaders promotes the development of sustainable youth leadership, replicated in several regions of the country.

In Germany, the JuLii project empowered migrant youth to co-create culturally appropriate health campaigns, strengthening social cohesion. In Australia, HealthLit4Kids connected schools and families to promote early health literacy and long-term community well-being. In the United Kingdom, the Youth Health Assembly involved youth in national consultations, producing policy-relevant recommendations. These examples underline that when given the opportunity, young people show commitment, creativity, and civic responsibility.

The research further highlights the relevance of linking health literacy with cultural expression, as seen in participatory artistic events that enhance message reach and strengthen community identity. International comparisons suggest that youth involvement should not be peripheral but central to the formulation of health policies and interventions.

Conclusion

Health literacy is a driver of citizenship and youth empowerment, based on participatory experiences developed in Portugal by the Portuguese Health Literacy Society (SPLS). Initiatives such as Health Miniassemblies, the Youth Leaders Program, and meetings with youth associations within the scope of the National Youth Council are very important strategies to give voice to young people in an organized way, generating confidence and taking steps towards a more consistent future for public health policies. Giving voice to youth through health literacy is a transformative investment. The experiences analyzed show that, when properly involved, young people have the skills and vision to contribute to more effective and equitable public policies.

Through a qualitative and participatory methodology, it was possible to collect proposals and assess the impact of young people's voices in health decisions. The results show an increase in civic awareness, community engagement, and advocacy capacity. This model is compared with international programs, demonstrating that investment in youth is essential for more democratic and effective health systems.

The best practices described are replicable in other communities and can be integrated into local, regional, and national health promotion strategies

No Conflict of Interest

The author declare no conflict of interest." Any role of the funding sponsors in the design of the study; in the collection, analyses or interpretation of data; in the writing of the manuscript, or in the decision to publish the results must be declared in this section.

Support ON AI

During the preparation of this manuscript, the author(s) used Chat GPT for the purposes of sistematize the article in terms of organizations, example – the creation of correspondent tables based on previous text . The author have reviewed and edited the output and take full responsibility for the content of this publication.

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