Introduction
Health promotion can empower individuals and communities to improve their wellbeing through social and environmental interventions, rather than focusing solely on individual behaviour or curative services,. A setting-based approach, originating from the WHO’s Health for All initiative and the Ottawa Charter, emphasizes community involvement, equity, and systemic collaboration to address multiple risk factors simultaneously. With growing recognition of social determinants of health, community-based health promotion has shown promise as an effective strategy, particularly in underserved populations, by mobilizing local assets and fostering participation, empowerment, and sustainability.
In rural and remote areas, disparities in healthcare access and lower health literacy contribute to poorer outcomes and to challenges navigating healthcare systems. Evidence supports the use of community-based programs that engage local resources and involve populations in health promotion. Interprofessional student-led health promotion efforts may be a flexible and cost-effective approach to addressing such health disparities. Recent studies demonstrate their potential. For instance, motivational interviewing by Australian undergraduates led to sustained behaviour change, while student-led fall-prevention programs reduced risks among older adults. These initiatives highlight the value of students as health promoters, especially in underserved areas where access to services can be limited.
Reach Accès Zhibbi (RAZ) is a student-led not-for-profit in Sudbury, Ontario in Canada. It delivers evidence-based health promotion workshops in collaboration with community agencies, while providing students and professionals with interprofessional experience to challenge their assumptions and perspectives on both the populations they serve and the professionals they work with. Workshops address priority topics identified through a formal needs assessment with the agencies and aim to enhance health literacy and empower participants. At the time of this study, a total of five organizations were partnered with RAZ, ranging from school boards with programming for high-risk youth, addiction recovery and rehabilitation centers to drop-in centres for both youth at risk for or living in homelessness, and for adults with disabilities. Guided by the principles outlined in the Ottawa Charter for Health Promotion and the settings-based approach to health promotion, RAZ fosters supportive environments where participants can learn, share, and apply health knowledge in ways that are meaningful to them.
Numerous studies highlight the effectiveness of student-led clinics in improving healthcare access, managing chronic diseases, and delivering preventive services to underserved populations,. These initiatives provide low-cost or free care, enhance health outcomes, and offer students hands-on, supervised learning opportunities to strengthen skills, interprofessional collaboration, and social accountability. However, research has largely focused on clinical settings, leaving a gap in understanding the impact of student-led efforts in non-clinical health promotion. This study seeks to fill this gap by investigating the outcomes of student-led, community-based health promotion workshops delivered by RAZ volunteers.
Methods
Study design
This cross-sectional mixed-methods study evaluated RAZ workshops at five partnering agencies. A web-based survey (Supplementary material 1) administered via Qualtrics (Qualtrics; https://www.qualtrics.com) was emailed to key contacts at partnering organizations for further distribution to staff at the agency to assess long-term changes in workshop participants. Additionally, a two-part paper-based survey (Supplementary material 2) was administered to workshop participants from September 2023 to April 2024. The first part, completed pre-workshop, gathered baseline data; the second, completed immediately post-workshop, assessed learning, behavioural intent, and perceived workshop value. Surveys were distributed by a research team member not involved in workshop design or delivery to minimize bias or coercion.
Questionnaire development
The survey distributed to partnering organizations assessed workshop familiarity and effectiveness and perceived benefits. Pre- and post-workshop surveys for attendees were based on the Health Behaviour Scale-16 by Chawlowska et al. The pre-workshop survey included demographic questions and four Likert-scale items on confidence in health information and decision-making. The post-workshop survey used a modified Likert scale to assess changes from baseline and included questions on workshop informativeness, helpfulness, and intent to change behaviour. Both surveys were adjusted to a grade 5 literacy level using Microsoft Word’s Readability Statistics tool, ensuring accessibility as recommended by the Centers for Disease Control and Prevention’s Simply Put guide.
Volunteers and workshop development
RAZ volunteers include interprofessional students (eg nursing, kinesiology, medicine, pharmacy) and professionals (eg lawyers, nurses, faculty). Recruitment occurs through presentations at Sudbury-area post-secondary institutions, volunteer fairs, and social media.
New volunteers complete an orientation covering RAZ’s mission, values, partner organizations, and key concepts from the Canadian Interprofessional Health Collaborative competency framework. They also undergo training in ‘Using a trauma-informed care approach’, developed by a former volunteer and approved by the student-led board of directors, which is supported by a faculty advisor specializing in interprofessional education.
Each partner organization is assigned an ambassador, a student volunteer selected annually who coordinates workshops and conducts needs assessments with their respective organization to tailor topics to their community needs. A master workshop calendar is distributed for volunteer sign-up, offering flexibility for involvement. Outside of signing up for individual workshops, and contributing to development and delivery, there is no long-term commitment for volunteers.
Workshops typically include an icebreaker and evidence-based learning activities, with designs adapted to organizational needs. Ambassadors submit a workshop application form detailing the topic, resources, logistics, and safety considerations. These forms are reviewed and need to be approved by at least five board members, who also ensure content quality and provide feedback for improvement as necessary.
Participants
Staff at the partnering community agencies who were familiar with the workshops delivered by student volunteers were invited to complete the web-based surveys (n=7). An email with a link to the web-based survey for key informants was sent to primary contacts for each agency, with a request for distribution to staff across the respective agencies via email. No direct communication by the research team occurred with the agency staff outside these email chains, which may have contributed to low response rates. All individuals who attended a workshop between September 2023 and April 2024 were invited to fill out the paper-based surveys (n=33) before the start of the workshop, and immediately afterwards.
Data analysis
Responses from key informants at partnering organizations underwent frequency analysis for the first four questions. Three experienced research team members completed blinded cross-triangulation for the qualitative responses.
For workshop participants, the pre-workshop surveys measured baseline knowledge and comfort on a scale from 1 (‘strongly disagree’) to 5 (‘strongly agree’). Post-workshop surveys measured perceived knowledge gain on a scale from 1 (‘a lot less’) to 5 (‘a lot more’). To account for high baseline scores indicating perceived learning, an adjusted change score was calculated as follows:
The numerator adds the post-workshop perceived gain score to the pre-workshop score, minus 1, to centre it as 0. The denominator is the maximum possible gain (ie 5 minus the minimum score of 1). The adjusted change score scales the improvement relative to how much room there was for learning. This way, participants who gave themselves a high pre-workshop score of 5 but still learned ‘a lot more’ have a positive adjusted change score. To analyze whether the adjusted change scores were significantly greater than zero, or if there were significant learning gains, the Wilcoxon Signed-Rank Test using the Statistical Package for Social Sciences v29 (IBM Corp.; https://www.ibm.com/support/pages/downloading-ibm-spss-statistics-29). It is a one-sample non-parametric test used as the data for individual questions did not follow a normal distribution. The null hypothesis (H0) was that the median of the adjusted change scores was equal to 0 (ie there is no knowledge gain), with the alternative hypothesis (H1) being that the median of the adjusted change scores is greater than 0 (ie there is knowledge gain). Missing values were represented by 0 in the analysis.
Ethics approval
This study was reviewed and approved by the Laurentian University Research Ethics Board (REB) on 6 July 2023, under REB file number 6021409.
Results
Key informants
Employees from the five partnering agencies were invited to participate in the study. However, the response rate from agency staff was lower than anticipated, with only seven responses received from staff across three of the five agencies. The exact response rate remains unknown, as the total number of eligible participants invited to respond was not determined.
All respondents reported being familiar with the organization and their health promotion workshops. In response to the question, ‘On a scale of 1 to 10, how effective do you think the health promotion workshops by RAZ are at improving the health outcomes of your clients/students?’, one person rated it a 5, two people rated it a 9, and four people rated it a 10, leading to a mean score of 9. Of the benefit options listed in the survey, respondents found that ‘increase in knowledge and skills’ (57.1%) and ‘improvement in mental wellness’ (42.9%) were the most significant for their members. Options that were not selected included ‘increased health literacy’, ‘improved self-efficacy’, ‘improved physical wellness’, and ‘improved social wellness’.
Thematic analysis of key informant responses revealed three overarching themes: (1) long-term impact of knowledge translation, (2) practical application and (3) mutual collaboration and benefit.
1. Long-term impact of knowledge translation
The workshops contributed to skill and knowledge development, as evidenced by agency staff observation of clients acquiring valuable skills such as self-defence techniques, conflict resolution skills, and overall enhanced health literacy, among others. As highlighted by the following quote, workshops are not only providing immediate educational benefits, but also serving as catalysts for discussions that continue beyond the workshop's duration.
[The workshops] are often a starting point to open dialogue about health and wellness. This leads to increased knowledge and awareness with the eventual possibility of healthy changes.
One particular shared success story further supports the ongoing dialogue once the workshop is complete:
We had a workshop on smoking/vaping. Several clients afterwards immediately shared that they needed to cut down. Since the workshop, several conversations have occurred about the harmful effects of vaping.
Another respondent touched on observable change in workshop attendees after being empowered with the tools for behavioural changes:
Our clients enjoy workshops that promote health and wellness. We see a huge difference in the members’ activities once they learn the material.
2. Practical application
The practical application of workshop content has been a significant positive outcome, with many clients expressing gratitude for the health promotion resources and techniques provided. The interactive nature of the workshops allows participants to engage with the material in real time, and familiarize themselves with the skills so they are more comfortable applying them afterwards. The following quote reinforces the workshops' role in creating enjoyable and effective learning experiences:
Members have spent time in our kitchen learning healthy eating habits after learning more about the new Canada’s food guide.
3. Mutual collaboration and benefit
The collaborative aspect of the workshops has fostered valuable connections between clients and students delivering the workshops, facilitating knowledge-sharing and discussion not only about the health promotion topic at hand, but also about various academic and career pathways, given the interprofessional background of students delivering the workshops. As highlighted by one of the respondents, this collaboration not only benefits the clients but also enriches the students’ learning experiences, highlighting the workshops’ broader positive impact on the community.
Workshop attendees
During the data collection period, seven workshops were held with 33 survey respondents (n=33). All workshop attendees responded to the survey, resulting in a 100% response rate. Nine of the surveys were partially completed, with missing responses represented by 0 in the data analysis. Table 1 outlines the demographics (age and gender) of participants.
Prior to the workshops, the majority of respondents reported being confident with health literacy (strongly agree 48.5%; agree 30.3%) (Table 2).
Table 1: Demographic data for health literacy workshop attendees (N=33)
| Characteristic | n (%) | |
|---|---|---|
| Age (years) | ||
| 0–15 | 2 (6.1) | |
| 15–30 | 7 (21.2) | |
| 30–45 | 6 (18.2) | |
| 45–60 | 8 (24.2) | |
| ≥60 | 3 (9.1) | |
| Prefer not to answer | 0 (0.0) | |
| (No answer) | 7 (21.2) | |
| Gender | ||
| Woman | 3 (9.1) | |
| Man | 22 (66.7) | |
| Transgender | 0 (0.0) | |
| Non-binary | 0 (0.0) | |
| Prefer not to answer | 0 (0.0) | |
| (No answer) | 8 (24.2) | |
Table 2: Pre-workshop survey responses from health literacy workshop attendees
| Pre-workshop survey statement/question | n (%) | |
|---|---|---|
| 1. I am confident in understanding information about my health. | ||
| Strongly agree | 16 (48.5) | |
| Agree | 10 (30.3) | |
| Neutral | 5 (15.2) | |
| Disagree | 0 (0.0) | |
| Strongly disagree | 1 (3.0) | |
| (No answer) | 1 (3.0) | |
| 2. I am comfortable making decisions about my health. | ||
| Strongly agree | 16 (48.5) | |
| Agree | 8 (24.2) | |
| Neutral | 7 (21.2) | |
| Disagree | 0 (0.0) | |
| Strongly disagree | 1 (3.0) | |
| (No answer) | 1 (3.0) | |
| 3. I know where to find more information if I don%u2019t understand something about my health. | ||
| Strongly agree | 13 (39.4) | |
| Agree | 8 (24.2) | |
| Neutral | 8 (24.2) | |
| Disagree | 2 (6.1) | |
| Strongly disagree | 1 (3.0) | |
| (No answer) | 1 (3.0) | |
| 4. I am aware of ways I can take care of my body. | ||
| Strongly agree | 13 (39.4) | |
| Agree | 10 (30.3) | |
| Neutral | 6 (18.2) | |
| Disagree | 2 (6.1) | |
| Strongly disagree | 1 (3.0) | |
| (No answer) | 1 (3.0) | |
| 5. I am aware of ways I can take care of my mind. | ||
| Strongly agree | 13 (39.4) | |
| Agree | 8 (24.2) | |
| Neutral | 8 (24.2) | |
| Disagree | 2 (6.1) | |
| Strongly disagree | 1 (3.0) | |
| (No answer) | 1 (3.0) | |
Most were also comfortable with health decision-making (strongly agree 48.5%; agree 24.2%) (Table 2). A total of 13 (39.4%) (Table 2) strongly agreed, and eight (24.2%) (Table 2) agreed they knew where to find health information. Over half of respondents reported knowing how to take care of their physical health (strongly agree 39.4%; agree 30.3%) (Table 2) and their mental health (strongly agree 39.4%; agree 24.2%) (Table 2).
After the workshops, 19 (57.6%) (Table 3) of respondents felt they were leaving the workshop more confident about understanding health information, and 17 (51.5%) (Table 3) felt more comfortable making decisions about their health.
When asked about change in their knowledge on where to seek health information, 16 (48.5%) (Table 3) felt they knew more after the workshop, while 9 (27.3%) (Table 3) stated there was no change. Of the 33 participants, 19 (57.6%) (Table 3) left the workshops knowing more about caring for their physical health while 16 (48.5%) (Table 3) reported knowing more about their mental health.
The Wilcoxon signed-rank test on the adjusted change score for individual questions showed a statistically significant increase in perceived knowledge and comfort levels (Table 4), even with high baseline knowledge, following the health promotion workshops.
For each question, responses for all 33 participants were analyzed (n=33). The adjusted change scores revealed a mean score ranging from 1.583 to 1.705 (Table 4), with all scores reflecting improvements in participants’ perceived knowledge. The test statistic (W) was consistently 561 (Table 4) for all questions, indicating a strong positive shift. The Z-value ranged from 5.030 to 5.060 (Table 4), all resulting in p-values less than 0.001 (Table 4), demonstrating statistically significant increases in knowledge.
The majority (69.7%) (Table 5) of workshop participants found the workshop informative and helpful, while 57.6% (Table 5) said they see themselves making changes based on what they learned from the workshop.
Table 3: Post-workshop survey responses from health literacy workshop attendees
| Post-workshop survey statement/question | n (%) | |
|---|---|---|
| 1. After the workshop, I am ______ confident in understanding information about my health. | ||
| A lot more | 5 (15.2) | |
| More | 19 (57.6) | |
| No change | 7 (21.2) | |
| Less | 0 (0.0) | |
| A lot less | 0 (0.0) | |
| (No answer) | 2 (6.1) | |
| 2. After the workshop, I am ______ comfortable making decisions about my health. | ||
| A lot more | 5 (15.2) | |
| More | 16 (48.5) | |
| No change | 9 (27.3) | |
| Less | 1 (3.0) | |
| A lot less | 0 (0.0) | |
| (No answer) | 2 (6.1) | |
| 3. After the workshop, I know ______ about where to find more information if I don%u2019t understand something about my health. | ||
| A lot more | 4 (12.1) | |
| More | 17 (51.5) | |
| No change | 9 (27.3) | |
| Less | 1 (3.0) | |
| A lot less | 0 (0.0) | |
| (No answer) | 2 (6.1) | |
| 4. After the workshop, I am aware of ______ ways I can take care of my body. | ||
| A lot more | 4 (12.1) | |
| More | 19 (57.6) | |
| No change | 7 (21.2) | |
| Less | 1 (3.0) | |
| A lot less | 0 (0.0) | |
| (No answer) | 2 (6.1) | |
| 5. After the workshop, I am aware of ______ ways I can take care of my mind. | ||
| A lot more | 5 (15.2) | |
| More | 16 (48.5) | |
| No change | 8 (24.2) | |
| Less | 1 (3.0) | |
| A lot less | 1 (3.0) | |
| (No answer) | 2 (6.1) | |
Table 4: One-sample Wilcoxon signed rank test for adjusted change scores evaluating knowledge gains from health literacy workshops
| Question number | N | Min. | Max. | Mean | Standard deviation | W† | Standard error | Z¶ | p-value |
|---|---|---|---|---|---|---|---|---|---|
| 1 | 33 | 0.75 | 2.25 | 1.705 | 0.397 | 561 | 55.44 | 5.060 | <0.001*** |
| 2 | 33 | 0.75 | 2.25 | 1.659 | 0.441 | 561 | 55.77 | 5.030 | <0.001*** |
| 3 | 33 | 0.50 | 2.25 | 1.591 | 0.450 | 561 | 55.71 | 5.035 | <0.001*** |
| 4 | 33 | 0.75 | 2.25 | 1.621 | 0.415 | 561 | 55.62 | 5.044 | <0.001*** |
| 5 | 33 | 0.75 | 2.25 | 1.583 | 0.436 | 561 | 55.73 | 5.034 | <0.001*** |
*p<0.05, **p<0.01, ***p<0.001
† Test statistic for Wilcoxon signed-rank test.
¶ Standardized test statistic.
Table 5: Responses on health literacy workshop informativeness and potential behavioural changes
| Survey question | n (%) | |
|---|---|---|
| Did you find the workshop to be informative and helpful? | ||
| Yes | 23 (69.7) | |
| No | 0 (0.0) | |
| Not sure | 7 (21.2) | |
| No answer | 3 (9.1) | |
| Do you see yourself making changes based on what you learned today? | ||
| Yes | 19 (57.6) | |
| No | 3 (9.1) | |
| Maybe | 8 (24.2) | |
| No answer | 3 (9.1) | |
Discussion
This study evaluated the impact of RAZ’s student-led, community-based health promotion workshops on health literacy, empowerment, and knowledge of participants. Results demonstrated significant improvements (Table 4) in perceived knowledge and comfort levels of workshop attendees, particularly in understanding health information and making health-related decisions. Participants reported greater awareness of health resources (Table 4) and improved understanding of physical and mental health care (Table 4). These findings align with previous studies that emphasize the effectiveness of student-led, community-based health promotion interventions,,.
Key informant responses from partner organizations highlighted three themes: ‘long-term impact of knowledge translation’, ‘practical application’, and ‘mutual collaboration and benefit’. These themes emphasize the workshops’ potential for lasting change through knowledge-sharing, skill application, and strengthened community partnerships. The workshops effectively addressed gaps in health literacy by providing participants with the tools and knowledge necessary to make informed health decisions. The success of these workshops mirrors the outcomes seen in other studies where student-led interventions contributed to sustained behaviour changes and improved health outcomes. The emphasis on practical application and active participation in the workshops aligns with the principles of adult learning, which suggest that hands-on, experiential learning is more effective in promoting lasting knowledge and behaviour change,. These findings are particularly important when considering the rural context, where healthcare providers and access to health care are often limited, and health literacy is often lower. Interprofessional student-led workshops can play a vital role in delivering health education and promotion in rural and remote communities. This study has demonstrated such efforts as a scalable approach to health promotion that leverages local partnerships and community engagement. By addressing the unique needs of rural populations, such initiatives can help fill critical gaps in health outreach and empower individuals in underserved areas to take control of their health, while fostering a sense of community engagement among student volunteers.
Unlike student-led clinics focused on healthcare delivery, RAZ’s interprofessional student-led workshops prioritize education, empowerment, and community engagement, which are crucial for sustained behaviour change and improved health outcomes. The workshops’ interactive and practical nature likely contributed to the significant perceived learning gains among participants. The hands-on approach allows community members to engage actively with the material, enhancing their ability to apply the knowledge and skills in their daily lives. For practical application in the rural setting, a hands-on approach might not always be feasible given geographical and resource barriers, but minor modifications could easily adapt to a virtual yet interactive approach, to overcome such challenges.
The findings from this study have important implications for health promotion practice. First, they support the idea that interprofessional student-led health promotion workshops are a viable and effective strategy for improving health literacy and empowering individuals in underserved communities. The success of these workshops demonstrates the potential for similar initiatives to be scaled up and adapted to different community settings, particularly in lower resourced, rural communities. Second, the study highlights the importance of collaboration between interprofessional student volunteers and community organizations in delivering health promotion interventions. The partnerships formed through these workshops facilitated knowledge-sharing and mutual benefit, with students and community members gaining valuable insights and skills. This collaborative approach can serve as a model for future health promotion programs, encouraging a more integrated and community-centred approach to public health. Finally, the practical application of workshop content, as evidenced by participants’ reported intent for behaviour change, underscores the need for health promotion programs to be interactive and engaging. By involving participants in hands-on activities and providing them with practical tools and strategies, these workshops made health information more accessible and relevant, leading to greater uptake and potential for sustained behaviour change.
Strengths and limitations
This study has several strengths, including its use of a mixed-methods design, which provided both quantitative and qualitative insights to the effectiveness of the workshops. The involvement of a variety of community partners also allowed for a broader understanding of the impact of workshops across different settings. Additionally, the focus on an underserved community with diverse health literacy levels adds to the relevance and applicability of the findings.
There are some limitations to consider. The small sample size, particularly in the key informant survey, may limit the generalizability of the findings. Additionally, the reliance on self-reported data introduces the potential for response bias, as participants may have over- or under-reported their knowledge gains and intent of behavioural changes. The study's cross-sectional design also limited the ability to assess the long-term impact of the workshops on health outcomes. While this study adjusted for high baseline knowledge scores, the use of perceived change as an outcome measure may not fully capture the actual impact of the workshops on participants’ knowledge and behaviours.
Recommendations for future research
Future research should focus on several key areas. First, longitudinal studies are needed to assess the long-term impact of interprofessional, student-led health promotion workshops on health behaviours and outcomes. Second, exploring the impact of different types of health promotion content (eg mental health, chronic disease management, nutrition) and delivery methods could provide insights into the most impactful interventions. Additionally, investigating the use of digital tools could expand the reach of these interventions and offer new opportunities for engaging participants. Third, further research should explore the adaptability of these workshops to rural contexts, where healthcare access and literacy are often limited.
Finally, exploring students’ experiences in delivering health promotion workshops could offer valuable insights into their learning, professional growth, and the role of community-based initiatives in their education.
Conclusion
This study demonstrates the effectiveness of interprofessional, student-led, community-based health promotion workshops in enhancing health literacy and empowering participants in underserved communities. The significant improvements in participants' perceived knowledge and confidence, coupled with the positive feedback from key informants, suggests that these workshops are a valuable tool for addressing health disparities and promoting health equity. The findings also highlight the potential for interprofessional, student-led initiatives to be widespread and adapted to different community settings, providing a scalable and sustainable model for health promotion. This is especially important for rural and remote communities where health promotion resources may be limited. Future research should continue to explore the long-term impact of these workshops and identify ways to further enhance their effectiveness and reach.
Acknowledgements
A special thank you to Nina Jodko for her contribution to the literature review and Andrée-Michelle O’Connor for survey distribution. We also thank the partnering agencies of RAZ that continue to support community members in need. We also acknowledge the health promotion volunteers of RAZ who put the time and effort into design and delivery of the workshops themselves.
Funding
No funding was received by any of the authors or contributors to this study.
Conflicts of interest
All members of the research group are current volunteers of the student-led health promotion organization included in this study.
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Catherine O'Connor1,2 Senior Director of Research
Alyssa Labelle1,2 Senior Director of Research
Tyler Pretty1,2 Research Assistant
Kayla Katerynuk1 RN, Research Assistant
Gayle Adams-Carpino1,3 Faculty Advisor
1 Reach Accès Zhibbi (RAZ), Sudbury, Ontario, Canada
2 Division of Medical Sciences, Northern Ontario School of Medicine University, Sudbury, Ontario, Canada
3 Division of Human Sciences, Northern Ontario School of Medicine University, Sudbury, Ontario, Canada
© 2025. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.
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; Labelle, Alyssa; Pretty, Tyler; Katerynuk, Kayla; Adams-Carpino, Gayle