The process of student engagement in Health-Promoting Schools: a co-design approach with Youth Engagement Coordinators in Nova Scotia, Canada

Since the advent of the Ottawa Charter for Health Promotion (World Health Organization [WHO], 1986), schools have been viewed as an essential environment where students can develop and engage in healthy habits to build health competence (Langford et al., 2015; Pearson et al., 2015; Penney et al., 2017). Health-Promoting Schools (HPS), also known as Comprehensive School Health (Storey et al., 2016), is a globally recognized, whole-school approach, first championed by the WHO in the 1990s and subsequently adopted in Canada by the Canadian Healthy Schools Alliance and Pan-Canadian Joint Consortium of School Health. HPS approaches aim to create the conditions necessary at the individual, relational and school-level to enhance the health and well-being of children and youth and to support students’ health competence.

HPS approaches comprise of four inter-related pillars: (1) social and physical environments, (2) teaching and learning, (3) school policies and (4) partnerships and services (Joint Consortium for School Health, 2025) and embed principles of participation, empowerment, holism, equity, sustainability and networking (Gugglberger, 2021). Promising outcomes of HPS approaches have been demonstrated, including improvements in physical activity (Fung et al., 2012; Langford et al., 2015), healthy eating (Fung et al., 2012; Langford et al., 2015), personal development skills (Stewart-Brown, 2006), academic achievement (Centeio et al., 2021; Lee et al., 2008), and a decrease in bullying (Langford et al., 2015).

Aligning with the United Nations Convention on the Rights of the Child (UNCRC) (UNICEF, 1989), a critical component of HPS is to engage children and youth (Rowling and Samdal, 2011; Storey et al., 2016). Specifically, Article 12 of the UNCRC refers to the participatory rights of children, their right to express their views and for their views to be considered (Lundy, 2007). There is no single definition of child and youth engagement in the context of schools, but student participation can be considered a partnership or collaboration between students and diverse adult partners (Griebler et al., 2017). Meaningful engagement means moving beyond consultation toward the active involvement of children and youth in school decision-making processes (Rowling and Samdal, 2011). In relation to HPS, student engagement can include active participation in developing inclusive structures, positive relationships, opportunities to expand physical activity and healthy food options, and improving skills and competencies related to health and well-being (Simovska, 2007).

Involving students in HPS has helped to improve their knowledge, competence, motivation and commitments related to health and well-being (Griebler et al., 2017; Simovska and Carlsson, 2012). Further, adults report improved relationships with young people, while organizations and institutions are shown to be more responsive to young people’s needs through more relevant policies, programs and initiatives (Griebler et al., 2017).

Despite the benefits of student engagement in HPS being known, understanding the process of how students are engaged remains unclear (Beck and Reilly, 2017; Griebler et al., 2017; Sprague Martinez et al., 2020). Research from the European Network of HPS has outlined the importance of creating mechanisms that facilitate and support student engagement in HPS to build action competence – the ability for children and youth to initiate and bring about positive change (Bruun Jensen and Simovska, 2005; Jensen, 1997; Simovska, 2007). Recently, two scoping reviews have helped to contextualize factors contributing to student engagement in HPS including Beck and Reilly’s (2017) review on enablers for engagement and our review on the process factors for student engagement in HPS (Kontak et al., 2025). Our review largely found impactful factors related to participatory mechanisms including reflection and visioning, co-determining priorities and action-oriented learning with students (Kontak et al., 2025). Another key finding was that adults who approach engagement as a facilitator can enhance engagement, while those who use authoritative and hierarchical practices negatively impact the process. Although the growing interest to synthesize the evidence on the topic is valuable, understanding the contextual factors within a jurisdiction is also necessary for direct research to practice implications.

In Nova Scotia, Canada the HPS model has been adopted since 2005, yet over the past 20 years, there has been inconsistency in implementation and a lack of student engagement opportunities (Kontak et al., 2023). A school–community–university partnership, called UpLift (2019–2025) was created to increase the impact of HPS investments, build on local experience and successes and support HPS approaches, with an intentional focus on bolstering student engagement. Targeted strategies in participating school regions included funding for Youth Engagement Coordinators (YECs). These YECs supported student engagement in HPS efforts through working closely with students, school staff and the broader region they served. YECs came from diverse educational backgrounds, yet shared strong competencies in youth engagement, health promotion and HPS. One of their main roles during their affiliation with UpLift was to support schools in accessing a one-time Student Action Grant (SAG) of $5000 CDN to provide students the opportunity to lead a HPS project. Over the six years of UpLift, a total of eight YEC positions supported 163 SAGs that ranged in scope from the development and/or implementation of projects such as school gardens, outdoor classrooms, playground equipment and mental health support rooms. Although findings identified from an evaluation of SAGs showed positive youth outcomes (UpLift Partnership, 2024), there was a gap in understanding what specific process factors might lead to these identified benefits. Thus, the purpose of this study was to interpret the perspectives of YECs on the process of student engagement in HPS through the UpLift partnership. Student perspectives were also collected and are reported in a separate manuscript currently under review.

This research applied a transformative paradigm, an overarching worldview that encapsulates research theories and approaches that prioritize social justice and human rights (Mertens, 2010) and challenge existing power structures (Caraballo et al., 2017). The research team adopted the paradigmatic belief and practical conceptions that align with the integral importance of engaging partners throughout the research to ensure the work conducted is relevant as well as transformative to those involved. Further, this research is part of a doctoral dissertation by J.C.K. (lead author) whose educational and professional background is situated within the field of health promotion. Thus, the lead researcher’s theoretical assumptions are grounded in and emphasize the interconnection and impact the social and physical environment have on an individual’s health behaviors. This dissertation was also embedded within UpLift and most authors (J.C.K, S.O., S.H., C.H.F., S.F.L.K.) were affiliated with the partnership and therefore formed an insider status (Darwin Holmes, 2020) related to the inquiry. This insider status as well as the subjectivity formed from the researchers’ position to the work is a foundational strength and shapes the research inquiry, analysis and results of the study.

A co-design approach was employed to understand the process of student engagement in HPS from the perspectives of YECs. Co-design is an approach to research that collaboratively works with individuals to understand, interpret and address a challenge or opportunity on a certain subject in their present lives by developing and creating spaces, physical products, services, infrastructures or policies, which could lead to a better future reality (Zamenopoulos and Alexiou, 2018). In the case of this research, we aimed to involve YECs in the creation of a process for student engagement in HPS through being part of different stages of the research process.

Specifically, the Generative Co-Design Framework for Healthcare Innovations (Bird et al., 2021) was adapted to guide the co-design. This framework includes seven stages over three different phases: 1) pre-design, 2) co-design and 3) post-design and encourages the use of creative thinking and techniques across the co-design process (Bird et al., 2021).

YECs affiliated with UpLift were recruited for this study based on their designated role to facilitate student engagement in HPS as well as recognition of the importance of adult facilitation for meaningful engagement (Kontak et al., 2025). At the time of the study, there were 8 YECs who were employed across four Regional Centers for Education (RCEs) in NS and the French first language school board, as well as a provincial YEC who supported the work across regions. There were 1–2 regional YECs per region based on region size, resources and capacity. YECs were hired on the basis of their experience working with youth and came from a variety of backgrounds such as teaching, health promotion and education. YECs focused on engaging elementary and middle/junior high school students (grades primary – 9), but some high schools were also engaged in SAGs based on interest. Implementation of SAGs ranged from 8 to 59 (m = 41) per region due to the size, number of participating schools and when UpLift was implemented in the region. A phased approach was taken to implementing UpLift in each school region based on readiness, therefore some regions implemented UpLift for a longer time period than others. All YECs employed at the time were invited via email in the summer of 2023 to be part of the research and six YECs agreed and were available to take part.

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  Contextual inquiry focused on familiarization with the current state of the participant experiences including the usual practices, processes and settings. This involved a review of UpLift internal resources related to YEC responsibilities and practical experience (e.g. job descriptions, yearly evaluation reports, SAG applications), attending monthly meetings with YECs and other affiliated partners to discuss topics related to student engagement in HPS and regular check-in meetings with the UpLift provincial YEC.

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  Preparation included meetings, coordination and planning of the co-design phase. This involved organization of a one-day co-design workshop, and development and distribution of materials. This stage also involved an introductory meeting with each YEC to explain the objective of the co-design process and invite those interested to participate. These meetings further outlined the proposed approach with an opportunity for YECs to provide input into the design, voice their ideas and concerns and adapt the approach to suit their needs.

Co-design included implementation of the workshop held on the local university campus that involved stages 3–5: Framing the Issue, Generative Design and Sharing Ideas. The agenda for the session is outlined in Supplementary Document I.

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  Framing the issue refers to the mutual understanding of lived experiences and challenges faced by participants in the current state, as well as a shared vision of the work. This included the use of a focus group to discuss the work of the YECs, and common factors related to the process of student engagement in HPS. Guiding questions for the focus group are provided in Supplementary Document II.

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  Generative design focused on participants undertaking creative endeavors to reveal practical and latent needs – those that people are not yet aware of in their conscious minds and therefore not readily expressed in words. This stage involved the YECs engaging in a participatory mapping exercise (Denwood et al., 2022) to outline their processes to foster student engagement in HPS. Participatory mapping involves “a multiagent practice, through which citizens are required to communicate their spatial thoughts, feelings, or knowledge in support of a specific research aim or decision-making goal, utilizing a cartographic visualization” (Denwood et al., 2022, p. 2324). The project followed guidance from the toolkit developed by Emmel (2008) that provided steps on how to carry out participatory mapping, such as prompts, pacing, materials and other practical/ethical considerations. YECs were asked to map their steps of the student engagement process in HPS, including obstacles and opportunities for improvement. YECs, working in pairs or alone, were provided sheets of paper and art supplies to help map their thoughts into a tangible process. A graphic illustrator was hired to capture the co-design in real-time. A graphic illustration of the focus group and participatory mapping exercise is presented in Figure 1.

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  Sharing ideas involves discussing the “artefacts” (i.e. items or objects) created by the generative design to allow participants to access and reflect on their experiences in new and creative ways. This stage included YECs providing a narrative description of their participatory map and reflecting on the steps they took in the process of student engagement in HPS with the wider group. After sharing, YECs identified commonalties across their experiences, points of emphasis and the preliminary development of priority areas. YECs were provided with sticky notes to document similar segments and then moved to a prototype exercise where with the help of the graphic illustrator they developed a physical manifestation of the process of student engagement in HPS through theming of common factors. Figure 2 outlines their prototype of the process of student engagement in HPS.

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  Data analysis involved the development of themes from the data gathered at the co-design workshop. Each stage of the co-design workshop was audio-recorded, including the focus group, explanation of the participatory mapping exercise, and group theming exercise. Photographs were captured for materials that were considered data (e.g. participatory maps, graphic illustrations). All audio-recordings were imported, transcribed and de-identified, reviewed by J.C.K. and saved on a private, secure Dalhousie University OneDrive folder. Any additional photos of the process were saved on the OneDrive folder. All data were then imported into NVivo Qualitative Data Software for data management and analysis.

  Braun and Clarke’s (2021) six-phase process for reflexive thematic analysis (RTA) guided further analysis, including familiarization; coding; generating initial themes; reviewing and developing themes; refining, defining and naming themes; and writing up the findings. RTA is a merger of the dataset, the theoretical assumptions of the analysis and the analytical skills/resources of the researcher (Braun and Clarke, 2019). RTA requires an in-depth reflection on the researchers’ positionality and how this reflexivity shapes the research. Although the work was intended to be inductive and semantic, the philosophical positioning of the authors, as well as the beliefs held by the YECs inadvertently impacted the research findings, therefore some critical and latent interpretation was conducted. To facilitate collaborative interpretation, a member reflection meeting (Tracy, 2010) was held with the YECs to provide an overview of the findings and time for reflection, discussion and feedback on the way the data were analyzed and interpreted.

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  Requirement translation involved using the findings from the co-design to identify priorities for a knowledge translation (KT) product. Here, the findings from this study were used to inform the development of a Student Engagement in HPS Roadmap that outlined this process. Roadmap development was led by UpLift and comprised information from the findings, student perspectives, the previously mentioned scoping review (Kontak et al., 2025) and practical information gathered for operational purposes outside this research. To ensure relevant findings were prioritized for the Roadmap, knowledge exchange meetings were held with UpLift staff members including YECs who participated in the study. The roadmap can be viewed on the UpLift website: https://www.upliftns.ca/roadmap/.

Ethics review was provided by the university’s institutional review board. Consent information was shared over email, reviewed and signed prior to the co-design phase. Any expenses, including travel, accommodations and meals, were reimbursed to support participation.

As this form of research promotes collaboration and opportunity for participants to be co-researchers in the work, YECs had an opportunity to consent to have their name publicly credited either through acknowledgement or authorship on research outputs associated with this work. Continual check-in with the YECS was employed for each research output to assess their interest in being publicly credited or if their decision changed over time.

Six YECs diverse in gender, race and ethnicity took part in the co-design study and represented three of the five school regions where UpLift was implemented.

Five themes outlining the process of student engagement in HPS were developed based on the co-design workshop. Although presented in a linear manner, the themes generated did not have an a priori “direction” of implementation, rather they represent five core considerations for engaging students in HPS. Each theme description is also paired with direct extracts from different YECs that were chosen based on how well they represented the shared pattern of meaning across the theme. The five themes were: embodying a youth-engaged position – the values, beliefs and knowledge held by the YECs to guide practice, discovering the layers of the school environment – understanding the history, ethos and culture of the school setting, building trust within the school community – gaining staff and student acceptance through relations, value and reliability, creating a space for exploration on health – expanding the social and physical boundaries to learn about health as an open concept, and Enacting principles of equity – acknowledging student voice and disrupting power dynamics. Figure 3 visually depicts these themes in a nonlinear manner, and each theme is described below.

The theoretical positioning, including the values, and beliefs held by the YECs as they related to student engagement in HPS, was an underlying component of the process that spanned across all themes. Aligning closely with a transformative paradigm and human rights approach, YECs shared a consensual belief that their “way of being”, was grounded in empowerment, advocacy and enabling youth voice. As articulated by one YEC,

This quote encapsulates the ideology that the process is less about the steps taken, and more about how YECs worked to ensure the process enabled students to take the lead over their SAG project.

This form of “being” may look or be defined as simplistic, common and subtle actions, yet the way YECs shifted the norms of the environment, meaningfully engaged students and promoted health, was grounded in entrenched beliefs related to the legitimacy of student voice, advocacy for collaboration and the acceptance of multiple ways of knowing. One YEC expressed that,

This reflects that the process of engagement may feel linear and straightforward, but the underpinnings of how an adult supporter perceived the role and rights of youth was layered beneath the surface and impacted how the process unfolded.

Understanding the school’s position played an essential role in how the process of student engagement unfolded within the school environment. Like the YEC position, this related to how each school context reflected a pre-established set of community values and beliefs that shaped the culture of the school. As shared by one YEC, “What are the conditions? Connecting with existing relationships? … what else is happening in that environment? What’s the history of the place? What was here before? … you’re like … these are important things to know” – YEC 2. With the school consisting of various aspects or “layers” that reflected conditions and constraints, such as resources, the ethos, the history and the existing relationships that formed its culture, the school’s position was complex, yet critical to discover, and “peel back” the layers. Discovering the foundations of the school allowed YECs to understand where the school community was at with student engagement in HPS and where they could push or pause their priorities based on these contextual factors. YECs shared that having knowledge of the background allowed them to understand what was needed prior to beginning the process of student engagement such as financial resources or training, for example.

Unpacking the school setting also helped YECs understand where the school was positioned within the system, referred to by YECs as the “container” of possibilities when considering the reality of working within system restrictions. This “container” connected to two specific influencers identified as time constraints of teachers and school staff, and systemic barriers that went beyond the scope of the work a YEC could complete. For example, the availability of potable water in the school community or government policy restrictions during COVID-19. Consideration of the wider system challenges that impacted the school community allowed YECs to navigate school contexts, while also respecting the time it can take to implement new initiatives within a traditional school system. This understanding reflected the reality of what could be done within the resources available to the YEC compared to larger system issues, described by one YEC as,

In practice, discovering the layers of the school environment was an ongoing process, and a tangible tool used by the YECs was a HPS environmental assessment tool that helped to capture the school needs, barriers and facilitators to engage in HPS initiatives, from both the perspectives of the students and staff.

The YECs, who were hosted externally from the school communities they worked with, faced the obstacle of gaining acceptance from school members. This involved YECs receiving buy-in from the school staff, teachers and students that they could be trusted as a valuable resource to the school. Building relationships and sharing the value of their role helped the YECs gain acceptance from teachers and school staff, while for students, building trust meant being reliable. Cultivating these relationships within the school community was referenced as an integral part of the process where relationships were infused across all components of the school and continually nurtured. One YEC referred to relationship building as, “… you’re doing that at every step you’re … it’s not step one it is all the steps; it is also step one but it’s also step two, three and four” – YEC 1. In practice, this translated to YECs building interpersonal relationships with adults within the school system who were considered “champions” of HPS. Further, building an understanding of the innate importance of the YEC role was identified as a main precursor to building trust with teachers and school staff. This related to various facets, including YECs highlighting their extensive background in student engagement and HPS principles, their ability to operationalize and support student-led projects, and their capacity to engage students.

In relation to building trust, the consistency and sustainability of the YEC position helped create acceptance from students. YECs acknowledged that there was constant staff turnover, and this could inhibit and impact the completion of a student engagement project from beginning to end. Referencing a student’s perspective, one YEC stated,

This example of perceived student frustration is an ongoing issue related to staff turnover and a lack of sustainability within designated roles for HPS in school communities. Despite these challenges, YECs shared strategies they embedded to help combat student’s concerns around reliability. YECs suggested that engaging students or implementing changes in small ways could build momentum and trust with youth that adults would deliver on the promises made to listen and action student voice. As one YEC shared,

YECs also indicated that they engaged students in other projects beyond the SAG, to help embed the engagement process across different parts of the school environment. For instance, one YEC shared how they worked with students on a small referendum to have the right to a wear a hat in class, which provided students the opportunity to understand different parts of the engagement process beyond an idea.

Expanding the social and physical boundaries of the school to embrace different ways of learning was an essential component in the process of student engagement. This was viewed as the act of YECs creating space, socially and physically, to explore health concepts and the role of student engagement within it. Socially, space was created for students to explore health as an open concept rather than a predefined term that might be commonly located within a health curriculum or bounded by adult-centric decision-making. YECs expressed that this was done through creating space to ensure that students felt that they had the power to construct the engagement process in ways that would work for them, be that through different conversations, thinking or time. This was described by one YEC as,

Further, it was thought that an open and fluid approach to learning was more specific to student engagement in the health realm compared to other subjects that may require a more concrete structure or outcome. This was described by a YEC as, “… I think in health promotion, the fact that we can’t go without any expectation of what the end goal is going to be because we really got to get the students from where they are …” – YEC 4. As health is different for everyone it is important that, through student engagement, the definition of health be open for interpretation and defined by the students involved.

Creating space for exploration also involved adapting physical constraints of the school. For example, the structured placement of chairs and tables to promote physical movement over sedentary behaviors like sitting at desks. YECs shared that they focused on ensuring movement was embedded into their student engagement process to make the planning playful and fun, or in simple terms, “making it not suck”. This fundamental act of implementing physical activity into engagement helped to promote the normalization of learning through movement. In practice, this took various approaches, including different forms of “energizers” to engage the students through interactive play or adapting paper-based activities into movement such as the environmental assessment that YECs conducted at the beginning of each engagement process.

Ensuring principles of equity were enacted throughout the process was seen as crucial for students to foster competencies on how these principles directly related to their health and the health of the school community. As one YEC described, “… yes, I want you to show me your school, I also want you to put yourself in the shoes of someone who’s not here and talk to us about it in that sense” – YEC 1. This process included introducing students to democratic processes that helped them to compromise, understand diverse perspectives and comprehend gaps within the environment, learn skills such as consensus building or needs assessments and recruit a diverse student group, with YECs actively embedding equity principles throughout the process. Conceptually, these principles included shifting power dynamics, acknowledging youth voice as worthy and working toward infusing approaches to health equity across the school community.

To mitigate power dynamics, YECs shared that they aimed to dismiss typical hierarchical positions through working with students in more of a peer or team member role. Although many adults outside of a YEC role hold similar values, it can be difficult for teachers or staff that occupy traditional positions of power to switch into roles that engage students in a more collaborative manner. A YEC articulated this challenge as,

Beyond sharing power with students, actively engaging students in opportunities to understand the importance of their voice to promote health equity was pivotal. This went beyond the YECs own positionality, and required them to intentionally build agency, ownership and pride in youth to know that their voices mattered. As put by a YEC, “let’s acknowledge for them or like help them acknowledge what they’ve accomplished and that this is an important cool thing” – YEC 2.

Building time into the process for reflection and celebration was shared as essential for the youth to recognize that their voices were important. Although the recognition of the work varied across projects such as presentations of youth work, certificates of completion or a celebratory party, the common thread was for students to recognize the importance of the process beyond the product.

Lastly, an important equity principle identified was ensuring that the process of engagement considered the greater impact on the school community. As shared by a YEC in relation to planning a SAG project, “… there’s a lot of great ideas on how we can make the space better, but what’s going to have … the most impact for the most people or what will have a great impact for people who are being underserved in this community …” – YEC 1. For example, SAGs were established to develop school gardens, outdoor classrooms and quiet rooms to support mental health of the school community. YECs indicated that ensuring the projects took a population health approach to enhancing the school community was an ongoing consideration to ensure SAG projects were focused on benefiting the whole school, not just a small portion of students. For example, a YEC discussed how they worked to develop a “Caring Closet” that provided items that might be needed by students to support their well-being.

The purpose of this qualitative exploratory research was to understand the process of student engagement in HPS in Nova Scotia, Canada through interpreting the perspectives of YECs. These designated roles sought to engage youth in HPS initiatives developed through the UpLift Partnership, a school-community-university partnership that aimed to catalyze HPS within the province. Through a co-design workshop in collaboration with the research team, the YECs were engaged in a co-design project to collect, analyze and interpret their perspectives on the process of student engagement in HPS. Five themes were generated from the analysis: (1) Embodying a youth-engaged position, (2) Discovering the layers of the school environment, (3) Building trust with the school community, (4) Creating a space for exploration on health and (5) Enacting principles of equity.

Student engagement is acknowledged as one of the core conditions necessary for HPS success (Sprague Martinez et al., 2020; Storey et al., 2016), yet our understanding of the factors that lead to best practice is limited (Griebler et al., 2017). Our findings build upon recent research on student engagement and provide contextual insights into different process factors that can enhance meaningful engagement of students in HPS. Of note, our findings specifically emphasize the groundwork needed prior to implementing practical engagement mechanisms. This includes a focus on understanding the school environment, ensuring time for adults to identify student and school values and cultivating relationships with students and school staff to enhance trust for student engagement in HPS.

This research expands on prior research related to the subject. Previous research emphasizes the importance of the school environment on the process of student engagement in HPS, including the overall culture, ethos and policies (Carlsson and Simovska, 2012; Sprague Martinez et al., 2020), while a focus on the social position of individuals who support this work is less evident. Our study highlights the significant need for individuals working in this field, like the YECs who participated in this study, to reflect on their position as it relates to student engagement, and work toward embodying a worldview that genuinely promotes and supports the inclusion of youth voices in decision-making practices. This was discussed in our study as placing emphasis on the way we support student engagement in HPS rather than what the steps may be. This result relates to the wider literature, in that without a robust understanding of the underlying principles needed to enact meaningful facilitation practices, engagement can become tokenistic, or the steps can act as a checklist rather than being embodied as guiding principles (Bruun Jensen and Simovska, 2005; Heath and Walker, 2012).

Moreover, while previous research emphasizes the importance of adult approaches to student engagement in HPS, the focus has largely been on the actions associated with practice, rather than the philosophical underpinnings that ground the work (Bruun Jensen and Simovska, 2005). For example, the IVAC model (Investigation, Vision, Action, Change) provides a theoretically sound and directive process on how to support student engagement in HPS initiatives. This approach includes guidance on how to investigate different health issues that affect students, create visions about desirable changes and action those visions into change (Bruun Jensen and Simovska, 2005). These components are all essential, and align with our findings, yet the effective implementation of these principles is in fact a by-product of individual beliefs, suggesting that a potential missing step in this approach is a reflection on individual worldviews. Regardless of a focus on more philosophical underpinnings or more action-oriented approaches, it is vital for individuals supporting these engagement practices to participate in adequate capacity-building to ensure they have the competencies necessary to meaningfully engage in this work (Boonekamp et al., 2022; Bruun Jensen and Simovska, 2005).

The literature also identifies student motivation as an influential factor for sustained student involvement in HPS (Garnett et al., 2019; Sprague Martinez et al., 2020). Research largely relates this to student feelings of ownership, fostered through involvement in understanding their own data (Garnett et al., 2019; Sprague Martinez et al., 2020) or peer-to-peer support (Boonekamp et al., 2022; Fletcher et al., 2015). Although our findings did not fully align with these specific examples, they did highlight the value of recognizing student work through celebrations or building awareness of their motivations for participation. This finding reflects the overarching purpose of the IVAC model to foster the action competence of students in ways that build their ability to bring about positive change through motivation, interest and a desire for action (Bruun Jensen and Simovska, 2005).

Lastly, our research connects to ongoing dialogue around how student engagement in HPS not only contributes to greater personal development in areas of leadership, motivation and confidence (Griebler et al., 2017) but also fosters overall health and well-being of individuals, society and the environment (Griebler et al., 2017; Sprague Martinez et al., 2020). Aligned with past literature (Clausen et al., 2019; Danielsen et al., 2017), our results suggest that this is enacted by providing students with space to envision, brainstorm and decide which facets of health are important to them. One related example is from the work of Clausen et al. (2019), who elicited reflections from children on their health and well-being through three stages (Critical Phase, Visionary Phase and Realistic Phase). Their approach emphasizes expression, brainstorming and time to envision actions for realistic change. Offering students autonomy to define their own health interests through student-led projects aids in building ownership, interest and competencies related to health and well-being (Garnett et al., 2019; Griebler et al., 2017). Furthermore, building student competencies in health promotion principles allows students to understand the impact they can have beyond individual behavior change and toward changing the wider school community (Bruun Jensen and Simovska, 2005; Jensen, 1997). This was a key finding in understanding how student engagement and HPS are interchangeable concepts that are mutually beneficial to enhance student engagement and support the HPS model.

This research provides significant implications for both research and practice in three realms. First, this research provides in-depth analysis on the factors that influence the student engagement process. This interpretation goes beyond surface-level analysis and instead unpacks and interprets the conceptual underpinnings and nuances of the principles necessary to guide student engagement in HPS. Samdal and Rowling’s (2011) work that outlines theoretical and empirically based components necessary for HPS effectiveness emphasizes the importance of moving beyond “what” to “why”. By providing educators and practitioners with further context on “why” components for HPS implementation are important can enhance knowledge users’ competencies and implementation effectiveness through further articulation of the theoretical basis (Rowling and Samdal, 2011). We adopted this thought process to critically interpret how the engagement process can accelerate positive health and developmental outcomes in children and youth. In practice, these findings may serve as tangible principles for educators and professionals when developing, implementing and evaluating student engagement in HPS initiatives. Specifically in Nova Scotia, Canada these findings informed a Student Engagement in HPS Roadmap that can be viewed on the UpLift website. This Roadmap along with affiliated published articles that informed the work have been disseminated to UpLift partners and staff including YECs. Recently, a HPS research showcase was held in Nova Scotia, Canada to outline how the research informed the development of the Roadmap to interested parties. This contribution to practice is particularly timely as the YEC positions have recently been permanently funded and expanded across the provincial health system (Nova Scotia Health, 2024), a key outcome of the UpLift Partnership.

Second, the methods in this research engage YECs as both partners and participants in the study by using co-design methods. Rightfully, the importance of engaging knowledge users throughout the research process to ensure it is relevant, manageable and sustainable, has gained traction over the past 2 decades (Gagliardi et al., 2016). As it relates to HPS, it is critical to engage people who have specific context and expertise to understand the challenges and opportunities they encounter (McIsaac et al., 2018). Having HPS knowledge users involved throughout the research process adds credibility to the findings. Further, using a co-design approach to collaborate with knowledge users may also contribute to a paradigm shift from a positivist ideology that typically considers researchers as the sole proprietors of knowledge, toward the belief that those with lived experience hold contextual, and practical experience that brings value to research. This is relevant for research on population health approaches like HPS that aim to make sense of a real-word application where theoretical assumptions can differ from what happens in practice (Samdal and Rowling, 2011).

Third, it is widely known that HPS relies heavily on adequate implementation for its success (Samdal and Rowling, 2011; Storey et al., 2016). The focus on implementation rather than outcomes contributes to a wider body of research committed to developing evidence-based strategies in conjunction with examining evidence-based outcomes. This requires greater emphasis on implementation science questions that examine what process strategies, factors and principles are essential for an outcome to be achieved (Bauer and Kirchner, 2020). This research study does so by unpacking the “black box” of HPS implementation (Rowling and Samdal, 2011) with specific focus on student engagement.

The major strength of this research study is in its methods of engaging YECs throughout the research process. By using a co-design approach, we involved YECs in parts of the planning, data collection and analysis of the work. Further, YECs had the opportunity to be involved in knowledge mobilization activities including contribution to the Student Engagement in HPS Roadmap, conference abstracts and the manuscript. Applying the Generative Co-Design Framework for Health Care Innovations (Bird et al., 2021) provided a practical structure to carry out the work with flexibility for adaptation based on the context of the research. Further, the framework encouraged the use of art-based approaches for data collection that supported interpretation of the perspectives of YECs as they shared and analyzed their experiences. Yet, limitations come with this movement toward more creative mechanisms for qualitative data collection, as art-based and participatory methods have been critiqued as less rigorous, because they may lack the maturity and systematic processes associated with more traditional methods. We sought to mitigate this limitation by using a variety of data collection techniques throughout our co-design approach and providing a detailed description of each stage of the process. Further, although we recruited an appropriate participant group for our study based on the methodological and analytical approach, we recognize that not all the YECs could participate, therefore there was a lack of representation from all participating school regions, nor did the study recruit other adults in the school system such as teachers, principals and other that supported student engagement in HPS. We acknowledge that gathering multiple perspectives from different interest groups is important and suggest future research expand the participant pool. Of note, students who were involved in UpLift were engaged in a similar co-design process with the methods and findings published separately. Also, due to the risk of breaching confidentiality, based on the small number of adults in a YEC role, we did not gather demographic information, yet recognize this information could be useful for interpreting and contextualizing the findings.

Lastly, the co-design workshop was intended to be two days but due to time constraints experienced by YECs it was condensed into a one-day event. Although we gathered in-depth data over this day, ensuring there is ample time for connecting and sharing perspectives within a participatory approach is valuable. A longer period to engage the participants in data collection and analysis may have enhanced the depth of the research findings.

With increasing recognition that student engagement is a crucial, yet under-studied component of an effective HPS model, this exploratory research contributes to unpacking the factors necessary for meaningful engagement practices. These findings will have direct impact on advancing student engagement in HPS across Nova Scotia, Canada, while providing key considerations that could be adapted or used in other jurisdictions.

The authors would like to thank the funding agencies and the UpLift Partnership, Healthy Populations Institute, Dalhousie University for their support. The authors would also like to sincerely thank the regional Youth Engagement Coordinators and the past Provincial Youth Engagement Coordinator for participating in the study. We would also like to acknowledge Caitlyn Macrae, Research Assistant, UpLift Partnership for her help in supporting the project.

The supplementary material for this article can be found online.