<< Background >>Digital technologies applied to health bring significant advances in self-care, promoting health and preventing illness by facilitating contacts (consultations, medication requests), access to health records, to informative or service provision websites, m-health solutions (e.g. apps) or wearables (e.g. activity tracker, pulse monitoring). The growth of digital health is rapid and brings many advantages, but often exacerbates existing health inequalities, such as those of people with lower levels of literacy, as it became evident during the COVID19 pandemic. People who are digitally health literate are able to achieve healthier lifestyle behaviours; however, people with lower socio-economic backgrounds, experiencing vulnerabilities, or older people may struggle to keep up with technological advancements.The Directorate-General of Health in Portugal recently stated that “The growth of digital health risks widening health inequalities. Specific strategies are needed to address digital health literacy and Portugal is keen to help design and implement evidence-based practice”. A broad health literacy approach can build citizens’ confidence and skills to develop digital skills, and hence benefit from digital technology, and such an approach can reduce, rather than widen, digital inequalities. However, digital health literacy is a growing concept and in the most recent years has been nurtured by a new needed facet – data literacy. In fact, citizens are now asked to share their data, either for research purposes or for integrated care services, but they are now sufficiently aware of how data sharing works or what It means in practice. Even if more perspectives could be added to this ecosystem (media literacy, health systems literacy, etc.), health, digital and data are a sufficient combination to empower citizens to better track, manage and improve their health and well-being through the use of digital tools (approaching the definition of Digital Health as provided by the WHO). There is thus the need to provide citizens with a concerted approach that also includes data literacy. On one side, citizens need to grasp how to navigate in the world of digital health and this requires knowledge, competences and practical skills. Informal educators, such as health care professionals, community associations or municipalities that support citizens in their daily life need a low-threshold tool that they can use to facilitate citizen inclusion. Formal educators can also benefit from costumisable low-threshold learning tools. Finally, policy makers need to advance on citizen access to digital health, to improve quality and efficiency in the health care services.The project partners work in adult education on different perspectives of this trio – health, digital and data – and observe the lack of a combined tool as the one envisioned in TRIO, that could be used by the partnership in their future work. The project “TRIO – Adult education on digital, health and data literacy for citizen empowerment” will thus develop a modular approach to the trio of literacies (digital, health and data), creating and designing a manual, a toolkit for trainers and a Green Paper in co-production with the relevant stakeholders, supported by a platform that ensures customisation of content to different needs. The contents will be designed in three blocks adjusted to different age-ranges (18-35; 36-50; 51+), with special attention to groups at risk of exclusion and/or with physical, cognitive, emotional and cultural challenges and be prepared for diverse modes of delivery (f2f, online, blended).TRIO will create 5 small country pilots, in collaboration with local networks to address the needs of adequate competences and skills on health, digital and data, empowering citizens of all ages and different levels of education to navigate in the eHealth world, and make informed and trusted decisions, thus increasing their well-being, autonomy, inclusion and access to services.<< Objectives >>The project main OBJECTIVES are:1. Increasing health, digital and data literacy of citizens through informal learning strategies and tools, including them in co-developing the knowledge and practices that promote inclusion, access to services and trusted decisions.In the Digital Economy and Society Index (DESI) 2020, Portugal ranks on the 19th position out of the 28 EU Member States. The percentage of the Portuguese population without at least basic digital skills decreased from 50% to 48%. However, about 26% had no digital skills at all. In 2019, Portugal continued implementing the national initiative on digital competencies INCoDe.2030 and other private ventures, such as the Iamdigital Initiative. However, these initiatives are only focused on basic digital skills and thus don’t provide any specific focus on the health needs and data literacy as TRIO predicts. TRIO proposes a concerted upskilling pathway, by improving health, digital and data literacy of citizens in three different age-ranges, promoting adult education through the development of digital readiness, resilience and capacity. 2. Broadening access to knowledge and user-friendly tools co-developed with the target groups to create a step-change in a concerted literacy approach for eHealth via the usage of a digital platform.Literate citizens will have increased access to basic services as well as other forms of adult education, which also facilitates inclusion and diversity in all fields of training. The tailored approach of TRIO will allow that its platform and tools may be easily used by people in disadvantageous situations (economic, social, educational, with mild impairments, etc.) and can be adapted to any EU country.3. Increasing capacity of adult educators to provide low-threshold and highly adaptable training on health, digital and data literacy through the development of a training toolkit adjustable to online, classroom and blended trainings.TRIO will build on collaborative, experiential and interactive learning, based on the exploration and execution of small pilot actions in the five countries involved, using an educational platform to support the development of the competencies defined at the level of the DigComp. 2.0 and the Competence Framework. The Digital Competence Reference Framework (https://www.incode2030.gov.pt/sites/default/files/qdrcd_set2019.pdf), will be used as inspiration to design the learning contents.4. Promote future sustainability and uptake of the TRIO tools and materials, by developing a set of recommendations to policy makers and relevant organisations.European initiatives, such as EuropeHealthNet have publicly recognised the sense of urgency to advance digital health literacy as a means to improve health for all, issuing several recommendations, such as the development of a knowledge hub to share results and facilitate networking and learning; promote technological citizenship and advance critical digital health literacy during the life course; ensure interdisciplinary cooperation, promote digital health literacy at all levels and tailored to the needs of divers groups to avoid widening health inequalities.Overall, the project responds to many of these issues, and TRIO’s Green Paper aims to provide the recommendations together with the release of the tools to implement them in practice. TRIO’s results will be easily adapted to other countries and can thus imply a huge progress for Europe.As a consequence, TRIO’s objective for the consortium members is to obtain a needed package of tools that will broaden their portfolios with new and attractive offers, increase visibility and strengthen local, regional, national and European networks, providing the opportunity to share experiences across borders and hence help them to better fulfil their missions.<< Implementation >>TRIO activities will be divided in 3 areas:Project Results: PR1 Manual on digital, health and data literacy”: This Project Result is based on the concept of Health 2.0, as a conceptual approach that places the citizen at the center of the healthcare pathway, going beyond the sole use of pervasive social networking technology. It is based on patient empowerment, communication and collaboration between patients, their caregivers, citizens and health care professionals, seeing citizens as co-producers of their care. However, this demands for strong literacy in the health, digital and data domains require to make a meaningful use of the available health apps. This is the conceptual basis of the Manual that will be edited as online publication and contribution to public awareness-raising, and it will serve as a basis for PR2. PR2 Educational platform: The Educational platform will create a simple and attractive interface that combines tools with training contents and gamification strategies to enhance literacy, including a library and materials for adult educators, (workshop curriculum, toolkit for professionals and template for certificates), and policy recommendations for stakeholders at political level. These materials will be developed jointly with citizens, to gain access to the experiences and views of the people concerned and experience and test options for low-threshold learning. After the translation of requirements into technical qualification, the beta version of the platform will be tested and probed in local workshops with representatives of the group of future learners. PR3 Toolkit for professionals and workshop methodology: Although PR2 can be used as an independent outcome, the impacts of the learning platform will increase when embedded in a workshop. Therefore, a toolkit for trainers will be developed. A specific section will deal with needs of different stakeholders to conduct workshops for the target groups. Like the beta version of the platform, PR3 will be tested during local workshops in small national experiments and adapted where necessary. PR4 Recommendations for policy-makers: Lobby groups and associations in health, digital health, data sharing, digital and socio-political fields are elementary to spread knowledge about the existence of this learning opportunity and to foster its implementation. A Green Paper with recommendations on how to enhance the trio of literacies and to facilitate the usage of the platform will sustain the outcomes. Multiplier events at national and European level will also serve to inform relevant stakeholders and provide them with the Paper.Events:Five national multiplier events will involve at least 30 people per country and the International multiplier event in Porto also at least 20 participants. This will amount to at least 170 multiplier event participants in total.TRIO will have five transnational partner meetings to discuss the achieved results and prepare the next working steps as well as for quality management and sharing and promotion. In line with eco-friendly practices, in two of the partner meetings only one person per organization will attend physically and the other one will attend online. Moreover, train trips will be privileged, when the trip duration does not go over one working day. The responsibility for hosting will be shared by five of the six partners. The selection of the locations is also oriented at time and cost-effectiveness of the travel.Horizontal tasks:Project management and coordination at European level and communication with the National Agency will be assumed by the European coordinator who will be supported content-wise by the leaders of the PRs. Sharing and promotion will be led by SHINE and Quality and Risks management led by CETEM with support from ISIS. Sustainability will be a leading task for INESC TEC but strongly endorsed by all partners.<< Results >>Based o the assumption that most citizens are now more open to learn and change their behaviour towards digital health use and data sharing patterns, TRIO aims to design a platform targeted at increasing their literacy on the referred areas, costumised to three main age ranges.TRIO plans for significant contributions to the mission of the Berlin Declaration on Digital Society and Value-based Digital Government, addressing and strengthening digital participation and digital inclusion in our societies. The fact is that this was already a challenge, but the COVID-19 pandemic increased poverty rates and will further grow the wealth gap, which raises obvious worries on the potential exclusion of those more in need of digital services. More than just a wish list, the Declaration brings a set of actionable measures that will be put in place to ensure these extremely important priorities: social participation and digital inclusion, empowerment and digital literacy, trust, and human-centred systems. Fully in line with this context, the project will deliver four main results:• In PR1 (leader AFE), it will develop a Manual, including interviews with experts and citizens to create a concerted approach of the combined literacy needs and gaps on health, digital and data. The aim is to create 3 knowledge blocks for people within the following age ranges – 18-35; 36-50; 51+. • Based on these outcomes, PR2 (leader INESC TEC) will build an interactive learning platform to enhance literacy through gamification techniques. Features and materials will be developed jointly with citizens from the 3 learner groups. The aim is to gain access to the experiences and views of the people concerned and experience and test options for low threshold learning, allowing the learner to move freely in the platform and explore the different contents.• With the Manual and educational platform being established, PR3 (leader ISIS) will develop a toolkit for professionals to accompany the learning platform, containing background knowledge and workshop concepts for the 3 learning blocks, being also a guide for adult educators. It will be tested in small pilot experiments in all countries of the partnership.• Last but not least, in PR4 (leader SHINE) a set of policy recommendations will be addressed to the EU, Member States, relevant organisations and policy makers, with guidelines for action on this innovative concerted approach and further data for using the full training toolkit at scale.From the very beginning, the outreach and impact of the project results are considered important. High quality of the project results is a precondition for successful sharing, promotion and sustainability. During the lifetime of the project, stakeholders at local, regional, national and European level will have been regularly informed in a targeted way by newsletters, leaflets and personal consultations. The broad public is targeted via social media and press publications. At the end of the project, 75 to 100 representatives of the target groups in five countries will have been involved in the development of the curriculum, platform tools and methods, through interviews or workshop attendance. At least 180 stakeholders (policy makers, national and European representatives from health, digital or data related initiatives) will be directly targeted and involved in multiplier events and workshops. As a result of the efforts to raise awareness about the learning platform, it is expected that 200 people will have used the platform during the two months between the multiplier events and the completion of the project.Last but not least, by developing new practices and methods, the TRIO consortium partners along with their local network members will have strengthened their links at European level, introduced their staff to transnational work experiences, and broadened their expertise and range of services by another attractive educational offer.