Author Identifier (ORCID)
Elizabeth J. Cook's ORCID record 
Eleanor K. O'Brien's ORCID record
Leesa N Costello's ORCID record
Abstract
Early childhood offers an important opportunity to lay the foundations for lifelong health literacy. The Little Aussie Bugs (LAB) dialogic book series and online professional development (PD) course were designed to support Early Childhood Education and Care (ECEC) educators to embed health literacy concepts, including hygiene, healthy eating, and oral health, into everyday learning routines. This mixed methods study evaluated the course pilot and examined its contribution through the lens of the Ottawa Charter for Health Promotion—a framework comprising five interrelated action areas: building healthy public policy; creating supportive environments; strengthening community action; developing personal skills; and reorienting health services. Quantitative findings demonstrated statistically significant improvements in educators’ overall health literacy scores and confidence using dialogic reading to deliver health messages. Educators reported enhanced capability to support children’s understanding of health behaviors. Qualitative findings revealed educators’ experiences embedding learning and LAB resources into daily routines, strengthening their confidence, supporting communications with families, and aligning practice with policy and accreditation expectations. Applying the Charter sharpened research insights into how the intervention developed personal skills and created supportive environments, while also illuminating structural gaps in policy alignment, educator training, and equitable implementation. This evaluation demonstrates how applying the Charter can support analysis of digital, early-years health promotion initiatives and help identify system-level supports for their sustainability. It also shows the course is an accessible and scalable approach to embed health literacy across ECEC settings. Implications for early-years PD and health literacy practice are discussed through the lens of the Charter.
Keywords
health literacy, early childhood education and care, dialogic reading, Ottawa Charter for Health Promotion, professional development, supportive environments, mixed methods evaluation
Document Type
Journal Article
Date of Publication
7-6-2026
ISSN
1460-2245
Volume
41
Issue
4
Publication Title
Health Promotion International
Publisher
Oxford Academic
School
School of Medical and Health Sciences / School of Education / Centre for Precision Health / Nutrition & Health Innovation Research Institute
Funding Information
This work was supported by Edith Cowan University’s Academic Staff Association’s “Solidarity Research Fund,” grant number G1006992_SUB/110689.
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.
Included in
Community Health and Preventive Medicine Commons, Early Childhood Education Commons, Educational Psychology Commons, Public Health Education and Promotion Commons, Teacher Education and Professional Development Commons
Comments
Ruscoe, A., Cook, E.J., O’Brien, E.K., Costello, L., Kirk, G., Sambell, R., Rayfield, T., Devine, A., & Wallace, R. (2026). Applying the Ottawa Charter to evaluate health literacy outcomes of the Little Aussie Bugs course for Australian early childhood educators, Health Promotion International, 41(4), https://doi.org/10.1093/heapro/daag087.