Co-creating an action to promote health literacy among parents with immigrant backgrounds

Health literacy is a resource that enables individuals to make health related choices to promote and protect their health and that of those around them. For parents, health literacy is essential to access and use information and services in ways that support their child's health. Immigrant parents may face health literacy challenges due to language barriers, differing approaches to managing child health and parenting, unfamiliar services, and divergent expectations of services and staff. Since parental health literacy is linked to child health outcomes, addressing the needs of immigrant parents may help prevent avoidable inequities in child health. Few studies have developed and tested interventions to promote health literacy among parents with immigrant backgrounds. Based on results from a needs assessment conducted in a culturally and linguistically diverse population in Oslo, Norway, we aimed to co-create an action to promote parental health literacy.

We undertook a two-phase co-creation process drawing on methods from the Optimising Health Literacy and Access (Ophelia) Process and the James Lind Alliance Priority Setting Partnership. In phase one, we collected action ideas from a broad range of stakeholders; analysed and synthesised the ideas; facilitated prioritisation workshops with user representatives; and selected one idea for co-design. In phase two, we co-designed the action with user representatives; and conducted quality-improvement cycles in the clinical setting.

In phase one, 14 immigrant parents and 59 staff from different disciplines generated 302 action ideas. Analysis reduced these to a short-list of 22 ideas which were prioritised by user representatives (parents and staff) resulting in two Top-10 lists. Five priorities overlapped and one of these was selected for development: improving communication on services provided by the family health clinic. In phase two, we operationalised this idea by co-designing short, multilingual, animated videos about follow-up at the clinic. The videos were refined through five iterative quality improvement cycles with input from 43 end users (parents and staff).

We successfully engaged user representatives, stakeholders and end users across multiple stages of co-creation and co-designed a health literacy action. The videos developed were completed to the stage of feasibility testing in the clinical setting.