Introduction: The development of knowledge and understanding in relation to movement and health is a basic requirement to facilitate lifelong engagement in physical activity with its accompanying possible health benefits. To train teachers in applying adequate strategies, implementation studies have often shown little acceptance of traditional top-down approaches. Thus, the purpose of the Health.edu project was to develop, implement and evaluate effective and feasible measures addressing students' health-related knowledge and understanding (HKU) in physical education (PE) via a participatory approach. Materials and Methods: For evaluation, a controlled pre-post-test study with 233 students from eight different secondary schools in Germany was carried out. Four schools (with two PE teachers at each school) comprised the intervention group and they participated in a 1-year participatory planning process to conceptualize and implement evidence-based PE lessons addressing students' HKU. Control schools carried out their regular PE lessons. Evaluation followed a mixed-methods research design, assessing program implementation via written documentary technique as well as program effectiveness using a standardized questionnaire. Results: Results show a significant intervention effect on students' HKU with a medium effect size. However, due to the participatory process, there were considerable differences between the intervention schools that were involved. Student's HKU improved most in schools where program implementation corresponded to relevant principles of fostering HKU. Discussion: The present study purposefully dispensed with any structured intervention programs for PE teachers to follow. The results show the potential effects of this participatory approach to strengthen student's HKU. However, the participatory planning does not always work in the intended manner, emphasizing that numerous contextual factors influence the implementation process.

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The purpose of the Health.edu project was to develop, implement and evaluate effective and feasible measures addressing students' health-related knowledge and understanding (HKU) in physical education (PE) with a specific focus on a co-creation approach (Cooperative Planning). The general procedure was identical in the four intervention schools involved; however, effectiveness (i.e. an increase in HKU) differed. Therefore, the present study investigated how different contextual factors supported or hindered the Cooperative Planning approach (evaluation of program implementation). To consider different perspectives in the analysis, we used data triangulation. On the one hand, written protocols (N = 19) document relevant statements and decisions in each planning group meeting (scientific perspective). On the other hand, we captured the participating PE teachers’ (N = 8) individual attitudes after the Cooperative Planning process through semi-structured interviews (teachers’ perspective). Data were analysed via qualitative content analysis. We identified three relevant factors with influence on the Cooperative Planning approach. First, the Cooperative Planning intervention worked if teachers saw a benefit in providing evidence-based knowledge, reflected their teaching practices and made an effort to implement new teaching strategies. Second, it was beneficial to have students represented as partners in the decision-making process. Third, support from the principal appeared to be helpful but not mandatory for implementing progressive pedagogical concepts. Continuous monitoring and reflection on those factors by the leading project team might help facilitate subsequent interventions using Cooperative Planning.

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