La Trobe University > Research > Violet Vines Marshman Centre for Rural Health Research > Research > Global Health and Equity Development > Ophelia

Ophelia

Ophelia is a co-design process that uses meaningful engagement with people with lived experience, healthcare providers and stakeholders to develop and implement actions and solutions to optimise health and equity.

Optimising Health Literacy and Access

The voice of people is at the heart of the Ophelia process

The Ophelia process is a product of over 20 years of research and practice. The protocol of the Ophelia process was published in 2014. Since then, the process has been used in over 30 countries around the world.

Ophelia was initially developed by a public health research team led by Professor Richard Osborne, in collaboration with the Victorian Government and nine health and community services in the state of Victoria, Australia in 2014. This initial development included nine test sites that included hospitals, community health services and municipal councils. These were in metropolitan and rural areas. Since this massive development and testing process, Ophelia has been further refined through thoughtful implementation and evaluation in many settings and countries.

The process is recognised in World Health Organisation (WHO) documents as a robust, evidence-based methodology that supports the organisation’s global health literacy agenda. WHO highlights Ophelia as a model of best practice because it provides a structured, participatory process for identifying local health literacy needs and cocreating interventions that advance equity and access. Its prominence in WHO guidance reflects the close alignment between Ophelia’s principles and WHO’s commitment to people centred systems, inclusive communication, and universal health coverage.

The Ophelia process uses meaningful engagement to understand and build on local knowledge and wisdom and international evidence to co-design, develop, and implement health literacy actions that are accessible, sustainable and useful for the people who need them.

Rather than imposing top-down solutions, Ophelia works through co-design with communities and practitioners, ensuring interventions are locally relevant and implementable.

The process of Ophelia

The Ophelia Manual provides a detailed step-by-step method to undertake health literacy development projects.

The approach uses the Health Literacy Questionnaire (HLQ) to identify the needs of community members to then enable generation of tailored strategies to address barriers to understanding and acting on health information and getting equitable access to services.

Ophelia improves the effectiveness of health promotion and strengthens health systems by prioritizing equity as it systematically includes groups who experience disadvantage and are most at risk of poor health outcomes. These people are actively involved in solution design.

The method is adaptable across diverse settings, from hospitals to small community organizations, and has proven to be globally applicable.

Ophelia shifts the paradigm to context-driven action, improving outcomes where they matter most. In short, it turns health literacy from an abstract concept into a practical driver of better health for all.

Ophelia is anchored in health literacy and guided by 8 principles:

  1. Focus on outcomes
  2. Sustainable
  3. Driven by equity
  4. Driven by local wisdom
  5. Diagnosis of local needs
  6. Co-design approach
  7. Responsiveness
  8. Applied across systems

An in depth understanding of people’s health literacy can inform us why people are not responding to current approaches of health interventions. Combining such knowledge with local wisdom from the community, paves the way for responsive solutions. This also forms the framework of the activities of Ophelia process, which includes 3 phases:

  1. Identify strengths, challenges and action ideas
  2. Select, plan and test health literacy-informed actions
  3. Implement, evaluate and improve health literacy actions