Freire used very specific materials in culture circles to support an empowering process that allowed learners to define the content and outcome of their own learning. However, the materials themselves were carefully crafted and developed by Freire and his co-workers. This article focuses on an extension of Freire's problem-posing educational methods to include participant involvement in the development and production of their own learning materials. Four linked case examples, one in literacy and three in health education, illustrate the process of participatory materials development and we discuss some issues for facilitators and learners. The production process can be an empowering experience and the product stands as testimony to the participants as self-conscious agents and critical thinkers capable of transforming their world. The resultant materials, geared to a particular locale and reflective of the people and language in the community, can provide a powerful model for those who may not have been involved in the process, but who can identify with the friends and neighbors who developed the materials. Participatory materials development is suggested as a supplement to problem-posing educational experiences and is particularly well suited for community programs.

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BackgroundPeople with low literacy and low health literacy have poorer health outcomes. Literacy and health literacy are distinct but overlapping constructs that impact wellbeing. Interventions that target both could improve health outcomes.Methods/designThis is a cluster randomised controlled trial with a qualitative component. Participants are 300 adults enrolled in basic language, literacy and numeracy programs at adult education colleges across New South Wales, Australia. Each adult education institute (regional administrative centre) contributes (at least) two classes matched for student demographics, which may be at the same or different campuses. Classes (clusters) are randomly allocated to receive either the health literacy intervention (an 18-week program with health knowledge and skills embedded in language, literacy, and numeracy training (LLN)), or the standard Language Literacy and Numeracy (LLN) program (usual LLN classes, specifically excluding health content).The primary outcome is functional health literacy skills – knowing how to use a thermometer, and read and interpret food and medicine labels. The secondary outcomes are self-reported confidence, more advanced health literacy skills; shared decision making skills, patient activation, health knowledge and self-reported health behaviour. Data is collected at baseline, and immediately and 6 months post intervention. A sample of participating teachers, students, and community health workers will be interviewed in-depth about their experiences with the program to better understand implementation issues and to strengthen the potential for scaling up the program.DiscussionOutcomes will provide evidence regarding real-world implementation of a health literacy training program with health worker involvement in an Australian adult education setting. The evaluation trial will provide insight into translating and scaling up health literacy education for vulnerable populations with low literacy.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN12616000213448.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-3034-9) contains supplementary material, which is available to authorized users.

BackgroundAdult education institutions have been identified as potential settings to improve health literacy and address the health inequalities that stem from limited health literacy. However, few health literacy interventions have been tested in this setting.MethodsFeasibility study for an RCT of the UK Skilled for Health Program adapted for implementation in Australian adult education settings. Implementation at two sites with mixed methods evaluation to examine feasibility, test for change in participants’ health literacy and pilot test health literacy measures.ResultsTwenty-two socially disadvantaged adults with low literacy participated in the program and received 80–90 hours of health literacy instruction. The program received institutional support from Australia’s largest provider of vocational education and training and was feasible to implement (100 % participation; >90 % completion; high teacher satisfaction). Quantitative results showed improvements in participants’ health literacy skills and confidence, with no change on a generic measure of health literacy. Qualitative analysis identified positive student and teacher engagement with course content and self-reported improvements in health knowledge, attitudes, and communication with healthcare professionals.ConclusionsPositive feasibility results support a larger RCT of the health literacy program. However, there is a need to identify better, multi-dimensional measures of health literacy in order to be able to quantify change in a larger trial. This feasibility study represents the first step in providing the high quality evidence needed to understand the way in which health literacy can be improved and health inequalities reduced through Australian adult education programs.Electronic supplementary materialThe online version of this article (doi:10.1186/s12939-016-0373-1) contains supplementary material, which is available to authorized users.

Health psychology has the potential to contribute meaningfully to our understanding of the concept, processes, and outcomes of health literacy. Three areas for discussion are presented here: (1) health literacy as a multimodal concept; (2) the role of the health-care system, the professional, and tools of the trade; and (3) the relevance of social context, participation, and empowerment. The three levels of health literacy proposed by Nutbeam are mapped onto the four evolving approaches in health psychology proposed by Marks to explore the synergy between these research areas. It is hoped that this Special Section on Health Literacy will generate more discussion and activity among health psychologists into health literacy research and practice.