A systematic review of environmental health literacy toolkits: Examining key components and data collection methods for effectiveness

Educators often hand out resources to help people protect themselves from things in their environment, like strong sun or chemicals at home. But what should a good resource include, and how can you tell if it works?

The researchers searched for trials that tested environmental health "toolkits," meaning packages of resources meant to share knowledge and change habits. They found 17 trials that met their quality standards, published between 1994 and 2020. Together the trials involved about 11,000 people, mostly in the United States and Canada.

Most of the toolkits focused on sun safety. Others covered hygiene, lead in the home, and air pollution and chemicals. The trials reached preschool staff, schoolchildren, families, farmers, postal workers and parents at ski resorts.

The researchers identified seven features. Two were core building blocks:

1. Short, simple, repeated messages. Three toolkits used plain, age-appropriate material and frequent reminders, sometimes by text message.
2. Appealing to looks as well as health. In one trial, 11th graders who watched a five-minute video on how sun ages skin used sunscreen more often than students who watched a video on skin cancer. Both groups learned the same amount.

Five features made toolkits more engaging:

3. Hands-on activities. About half used games, role-play, group discussion or question-and-answer time.
4. A mix of media. Seven combined things like workbooks, slides, videos, text reminders and online games.
5. Easy access. Seven made materials easy to reach. One example was an online video people could watch as often as they liked.
6. Personal feedback. Three gave people advice based on their own risk.
7. Small rewards. One school program gave children achievement certificates.

Strong programs often combined several of these features. A school program in Turkey used a guidebook, posters, puzzles, a Frisbee game that changes color in sunlight, videos, reminders and certificates. Six months and a year later, children in the program scored higher on sun protection than children who did not take part.

To check whether toolkits worked, most trials asked people what they knew, believed and actually did, both before and after the program. They usually did this with short questionnaires or diaries. One trial measured lead levels in babies' blood.

What this means for your practice:

• Keep messages short and repeat them. Use plain language suited to your audience, and follow up with reminders after the program ends.
• Make it hands-on. Build in games, discussion, role-play or time for questions, rather than relying on a handout alone.
• Mix your media. Pair print materials with a short video, slides or an online game.
• Make it easy to come back to. Put materials where people can revisit them, whether online or during class time, so learners don't have to find them on their own.
• Connect to what people care about. Health is not the only reason people change habits. Think about what matters to your audience, like how they look, and speak to that as well.
• Personalize where you can. Help learners see their own situation, for example by giving feedback on their own risk.
• Recognize effort. Certificates or other small rewards can motivate learners to finish.
• Measure what changes. Ask simple before-and-after questions about knowledge, beliefs and actions. This shows whether your resource changes what people do, not just what they know.