© M. Machida et al., Published by EDP Sciences 2025

1 Introduction

Following the Great East Japan Earthquake and Fukushima nuclear disaster in 2011, we observed that many adults in Fukushima remained concerned about children’s health and wellbeing (Ishii K, 2022) . While many studies among children conducted after the 2011 disaster focused on their physical and mental health, the Sendai Framework of Disaster Risk Reduction 2015–2030 stated that, “Children and youth are agents of change and should be given the space and modalities to contribute to disaster risk reduction, in accordance with legislation, national practice and educational curricula.” (UNISDR, 2015). Therefore, children’s ability to act and contribute to their community should be recognized and promoted. Inspired by the “Creative Health” report by the UK All-Party Parliamentary Group on Arts, Health and Wellbeing (All-Party Parliamentary Group on Arts, 2017), we created a participatory school health project called “Creative Health” (Goto A, 2022). The project began with the development and implementation of an “ACT” workshop, based on the participatory theatre approach piloted in Fukushima Prefecture by a UK-based researcher (Lloyd Williams A, 2022), in which children work in groups to exchange opinions about their community, select a topic and develop a short acting scene, and perform it in front of their peers and adults. An evaluation found that not only children but also teachers benefited from these sessions (Goto A, 2020a). Teachers learned how to enhance children’s creativity and capacity to express opinions about their community and became more aware of the importance of children’s voices in community development. Following the successful implementation of the ACT workshop, we added “BODY” and “FOOD” workshops to the program. In BODY, children learn about their own health through exchanging opinions with peers, presenting storyboards about historical figures in medicine, and measuring and graphing their pulse. In FOOD, children learn about the connection between health and food, discovering local foods, cooking and tasting them, and drawing their daily meals. In the ACT component of the three-workshop program, students have the opportunity to express their thoughts about the relationship between food, health, and more widely about their local community.

In 2017, Japan’s Ministry of Education, Culture, Sports, Science and Technology (MEXT) released new guidelines for courses of study to be implemented in schools from 2020 to 2022. Using the slogan “Zest for life,” the goal was to foster children’s ability to think, make judgments, and express themselves (MEXT, n.d.-a). In other words, this promoted the idea that schooling should be less about what teachers teach students and more about what students can do and how they learn (Yamanaka S, 2020). The guidelines also included the development of skills for children to live and interact with others in the community. Our Creative Health project matches these national trends in education policy.

When implementing Creative Health in Fukushima, we valued the right of individual schools to have ownership of their teaching; thus, some schools decided to implement all three workshops, while others chose to conduct only two (in most cases, BODY and FOOD). In this report, we compare the learning outcomes for children in two school groups, participating in two and three workshops, respectively, to gain practical recommendations for future project management.

2 Method

The main activities of Creative Health are shown in Table 1. The project was implemented and evaluated as described above, and the details have been reported previously (Goto A, 2022b). Of note, the original FOOD workshop included a practical cooking activity, but this was substituted with a demonstration of cooking and sampling of cooked food owing to COVID-19-related restrictions (Goto A, 2020a, 2022b).

The workshops for analysis were held in elementary schools in Fukushima Prefecture between 2021 and 2022. Group I comprised 92 children in 5th grade (10-11 y.o.) at one school who participated in three workshops (BODY, FOOD, and ACT), and Group II comprised 125 children in 6th grade (11-12 y.o.) at two schools who participated in two workshops (BODY and FOOD). Of note, the Group I school was located in a municipality with Deliberate Evacuation Areas while the Group II schools were located in a municipality without such areas.

Before and after the workshops, participants were asked to respond to the following questions: “Are you satisfied with your health?” “How do you feel about the place you live?” “How do you feel about the food in your place?” and “Are you willing to help prepare meals at home?”. Answer options used a face-scale adapted for children and ranging from 1 with a neutral expression to 5 with the happiest expression. Stata version 18 (Stata Corp LLC, Texas, USA) was used to perform a two-way mixed-design ANOVA. The between-subject effect was group, and the within-subject factor was time (before and after the workshops). We confirmed the interaction between the two variables.

After the workshops, text-mining analysis of qualitative data in Japanese was conducted to compare the two groups’ learning outcomes, using KH Coder, version 3 (Higuchi K, n.d.). A co-occurrence network was performed to categorize frequently used words.

This study was approved by the Ethics Review Committee of Fukushima Medical University (Fukushima Medical University Ethics Committee Approval No. General 2020-060). This research was funded by the Japan Society for the Promotion of Science Grants in Aid for Scientific Research (No. 19KK0060). Parental written consent and children’s informed assent were obtained for this study.

3 Result

For Group I (Table 2), the scores for two evaluation indicators increased following attendance at all three workshops: satisfaction with your own health (3.36 to 3.85) and feelings about your community (3.72 to 3.95). Likewise, in Group II, the scores of two evaluation indicators increased: satisfaction with your own health (3.52 to 3.83) and feelings about the food where you live (3.92 to 4.05). The interaction (group x time) was statistically significant (p = 0.033) for the feelings about your community. A simple effect test showed a significant difference between pre- and post-workshop scores for Group I (p = 0.019). There were no significant interactions for health, food in their community, and helping with meals (p > 0.05). Significant increases from pre- to post-workshops were found for health (p < 0.001) and food in their community (p = 0.007).

The results of the text mining of the children’s free written opinions after participation are visualized in Figure 1. Words used among both groups were “anemia” and “vitamin C and iron.” The words that appeared only in Group I were “taking care of my health,” “communication,” “move,” and “movement.” Those that appeared only in Group II were “blood, heart, and lungs.”

Fig. 1 (1-1) Cooccurrence Network after FOOD, BODY and ACT workshops.

4 Discussion

Children in Group II only became more positive about their own health and the food in their community, while children in Group I who experienced all three workshops became more positive about their community overall, as well as their own health and the food in their community. This is a marked observation, especially given the relatively younger age of Group I, who were presumed to have poorer comprehension of the same learning content. It is possible that ACT provided an opportunity for children to think more deeply about food and health in their community by discussing and performing among peers. Notably, there was no observed change in children’s confidence in preparing meals at home; this might be due to COVID-19 restrictions for FOOD that resulted in cooking activities being replaced with tasting.

Regarding free written opinions, words related to communication, active movement, and taking responsibility for one’s own health appeared only in Group I. This suggests that ACT was clearly linked with thepromotion of agency, and effective in empowering children in health promotion through promoted critical thinking by communicating and collaborating with their peers. For Group II, group-specific words were organ-related, indicating that the workshop was useful for knowledge retention.

The Creative Health workshops are conducted in collaboration with schoolteachers. As described above, ACT in particular makes teachers aware of their children’s agency in the community. Since the school that conducted the ACT was located in a municipality with relatively higher levels of environmental radiation contamination and had deliberate evacuation areas, it is possible that the teachers were more interested in our project aimed at better community development with children. The teachers’ enthusiasm may have created a positive iterative interaction with their students. Nevertheless, we observed similar effects of ACT in another project site outside Japan (Lloyd Williams A et al., 2023). ACT is potentially effective regardless of a disaster’s impact, yet it plays an essential role in the recovery of disaster-affected areas, where its need has increased.

The new education guidelines in Japan⁷ aim to develop children’s active and interactive learning skills. The guidelines further state the importance of linking “play” with education: “ensure that the things developed through play as spontaneous activities in early childhood are smoothly connected to learning in all subjects” (MEXT, n.d.-b). Our Creative Health workshops provide children with a safe space and tools to explore and learn on their own. The skills of critical thinking, decision-making, and self-expression that are listed in the guidelines are included in the workshops, most explicitly in ACT. More than a decade after the Fukushima nuclear disaster, it is our hope that the implementation of Creative Health will promote creative and independent learning among schoolchildren, expand their capacity as independent citizens, and create resilience in their communities.

Fig. 1 (1-2) Cooccurrence Network after FOOD, BODY and ACT workshops.

Acknowledgments

The authors thank Satsuki Katsumi and Shigeru Nakano (former school principals in Date City) for their contribution towards implementing the project.

Funding

This research was funded by the Japan Society for the Promotion of Science Grants in Aid for Scientific Research (No. 19KK0060 and 23KK0045).

Conflicts of interest

The authors declare no conflict of interest.

Data availability statement

The data are not publicly available due to the nature of this research that students and parents did not agree for their data to be publicly shared.

Author contribution statement

ALW, KEN, and SO developed the workshops and YY contributed to developing the teaching tools. AG obtained funding, developed the research plan, and supervised the implementation at schools. MM (first author) analyzed the data and drafted the manuscript, and MM (sixth author) contributed to data interpretation. All authors contributed to revising the manuscript.

Ethics approval

This study was approved by the Ethics Review Committee of Fukushima Medical University (Fukushima Medical University Ethics Committee Approval No. General 2020-060).

Informed consent

Parental written consent and children’s informed assent were obtained for this study.

References

All Tables

All Figures

	Fig. 1 (1-1) Cooccurrence Network after FOOD, BODY and ACT workshops.
In the text

	Fig. 1 (1-2) Cooccurrence Network after FOOD, BODY and ACT workshops.
In the text