"We don't know how to talk": Adolescent meaning making and experiences of participating in research on violence in Romania, South Africa, and the Philippines

BACKGROUND

Current evidence on adolescent participation in violence research has primarily measured distress, harm or upset using quantitative methods. There are relatively few studies which have employed qualitative methods to understand adolescent emotional experiences, and to articulate the experiences of participation from their own perspective.

OBJECTIVE

This study aimed to assess adolescents' experiences of participating in research on violence in different contexts, namely Romania, South Africa, and the Philippines.

METHODS

A purposive sample of adolescents (N = 53, 51 % female) were recruited from rural, urban, and peri-urban areas in Romania, the Eastern Cape Province of South Africa, and Metro Manila, Philippines. Semi-structured one-on-one in-depth interviews and drawings sought adolescent perspectives on their experiences of participation, including the emotions they felt, and their perceptions of research on violence.

RESULTS

Drawing on analysis of interviews and drawings, adolescents reported a layered emotional experience, ranging from sadness, anger, apprehension, and upset, to joy, relief, and laughter. Their emotional experiences were driven by participation as a relational encounter, both with the researchers involved, as well as with other children and young people they encountered. Adolescents emphasized participation as enabling disclosure of difficult experiences, and the creation of awareness of violence.

CONCLUSIONS

Adolescent perspectives of participation in research on violence are nuanced and encompass their lived experience as well as the fundamentally relational nature of participation. Adolescents experienced increased awareness of topics in violence and perceived research participation as enabling disclosure and possible help-seeking. Measures of participation impact developed along with adolescents, which reflect this complexity, are needed.

Obtaining Consent for Research on Risky Behaviours Among Adolescents in Canada: A Scoping Review

This scoping review explores current practices for obtaining consent in research on risky behaviours among adolescents in Canada. The JBI methodology for scoping reviews was used. The database search was conducted in August 2021 and updated in November 2022. Papers published in 2010 or later were included. Extracted data included study characteristics, sample characteristics, and consent procedures. The review included 83 reports covering 57 studies. Nearly 60% of studies relied on adolescent self-consent for participation. Adolescent self-consent was more common than parental/guardian consent for studies using in-person research methods, older adolescent groups, and particularly vulnerable populations. Parental/guardian consent was more common for studies using younger age groups and general population samples. Adolescent self-consent was more common than parental/guardian consent for most risky behaviours covered by this review. These results provide insight into current consent practices in this area and offer guidance to researchers and institutional review boards in Canada.

An Exploration of Satisfaction with Mental Health Counseling Services in Western Australia Among Sexuality and Gender Diverse Youth

Clinically significant psychological distress affects approximately 29.3% of Australian adolescents and 80.6% of sexuality and/or gender diverse youth (SGD-Y). Often, SGD-Y experience inadequate access and lower satisfaction with mental health services, stemming from age- and sexuality and/or gender diversity-status. Accordingly, exploration of factors affecting SGD-Y's access to, and satisfaction with, mental health services is critical. Using a social constructionist lens, we explored factors supporting SGD-Y's satisfaction with mental health services, and how these needs are or could be met. Seven LGBTQA+ youth aged 15 to 21 who received counseling in Western Australia in the last year, recruited via a university student participant pool and community organizations, participated in semi-structured interviews via video-conference, phone call, or SMS. Reflexive thematic analysis was inductively applied to participants' verbatim accounts. Satisfaction was tied to participants' sense of control over their healthcare-system experiences, shaped by four themes: person-centered support during the service-access process, resources to guide the search for services, confidence in therapists, and healthcare-system organization. Practices and policies supporting SGD-Y's self-determination during their service access may allow for empowering and personally meaningful therapeutic experiences. Developers of policies and initiatives may need to adopt a systems approach to foster SGD-Y's self-determination as they access services.

Views and experiences of young women from a migrant or refugee background regarding the contraceptive implant in Australia

Young people comprise a significant proportion of migrants and refugees in Australia. Many encounter challenges in accessing contraception information and services. This study explored the views and experiences of young women from migrant and/or refugee backgrounds regarding the contraceptive implant and related decision-making. Interviews were conducted with 33 women, aged 15-24, living in New South Wales, Australia, who spoke a language other than English and had some experience of the implant. Three themes were developed from the data as follows: 'Finding your own path': contraception decision-making (in which participants described sex and contraception as being taboo in their community, yet still made independent contraceptive choices); Accessing 'trustworthy' contraception information and navigating services (in which participants consulted online resources and social media for contraception information, and preferred discussions with healthcare providers from outside their community); and Views and experiences of the contraceptive implant (while the implant was described as a 'Western' method, most participants regarded it as an acceptable, convenient, cost-effective, and confidential means of contraception). Decision-making regarding the implant is influenced by many factors which must be considered in health promotion efforts and when providing clinical care. Consideration of more informative health promotion resources, peer education strategies, and healthcare provider training is warranted to support contraception decision-making and choice.

Adolescents' Experiences of Participating in Sensitive Research: A Scoping Review of Qualitative Studies

Despite an increasing emphasis on adolescents' participation rights, there are concerns about their participation in research on sensitive topics, such as trauma and violence. This review reports findings of a scoping review that examined the nature and extent of qualitative studies conducted with adolescents about their experiences of participating in research on sensitive topics. Studies were identified by searching electronic databases and grey literature and reported on qualitative and mixed-methods studies eliciting adolescents' experiences of participating in research on sensitive topics. Seventeen (17) studies were included after screening 4426 records. The scoping review revealed significant adolescent benefits from participation, relating to positive emotions, skill acquisition and enhanced self-efficacy and interpersonal relationships. To a lesser extent, participants also experienced burdens relating to negative emotions, concerns about confidentiality and privacy and inconvenience of participation, which were mitigated by careful attention to research design and researcher engagement and training. Participants shared insights into their motivation to participate, and factors that impacted their experiences of research, such as ethical considerations, including consent procedures, safety and connection in research, study procedures and documentation and researcher characteristics. There were tangible benefits and some burdens involved in adolescents' participation in sensitive research. This review considers implications for research and practice, such as the need to regularly publish findings of consultations, assessing caregiver consent requirements, obtaining adolescent views on study documents and measures and building on existing research, differentiated by age, gender and dis/ability status, especially in diverse and under-represented regions.

Engagement and outcomes of marginalised young people in an early intervention youth alcohol and other drug program: The Street Universities model

BACKGROUND

Early intervention alcohol and drug (AOD) programs for disadvantaged young people have the potential to substantially decrease the need for future intervention, however there is little research about how young people use these programs or the substance use and other outcomes of such programs. This paper uses data from an Australian AOD early intervention program, The Street Universities, to: describe young people's participation; examine changes in substance use and wellbeing over 90 days; and assess which young people are most positively impacted.

METHODS

Data come from a prospective study of new attendees, measuring retention in and attendance patterns in an 'engagement' program focussed on arts and lifestyle activities (n = 95), and a routine service dataset collected from seven years of therapeutic intervention (n = 3,893), measuring substance dependence (SDS), psychological distress (K10) and quality of life (EQoL).

RESULTS

Analysis reveals that young people were retained in the program at high proportion (63% at six months) and more than half of these returned at a frequency of weekly or more often. Young people participating in the therapeutic component of the program reported significant improvements in all key wellbeing indicators with SDS, K10 and EQoL scores significantly improving (at p < .001). These improvements occurred rapidly, within the first 30 days, and were maintained over the 90 day study period. Moreover, young people with the highest SDS and K10 scores and lowest quality of life at baseline experienced the most positive changes.

CONCLUSION

Aligning engagement program with therapeutic intervention can provide comprehensive support to disadvantaged young people, producing substantial improvements in AOD use, distress and wellbeing.

Guidelines and Recommendations for Training Ethical Alcohol Researchers

Research on alcohol use presents several ethical challenges, and therefore, training of ethical alcohol researchers is particularly important. While the Helsinki Declaration (World Medical Association, 2001), Belmont Report (National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, 1978), and American Psychological Association's (APA) Ethics Code (2002) provide ethical guidelines and aspirational principles for researchers, there are a number of areas in which these principles allow for judgment. For trainees in particular, this ambiguity may be disconcerting. Along with these broader principles, there are also specific considerations for training alcohol researchers in the responsible conduct of research, which may further complicate matters for trainees. Although alcohol research is an important avenue for understanding a large public health concern and investigating risk and protective factors associated with use, it also presents a number of ethical and legal challenges for researchers. Working with high-risk drinking populations presents unique ethical and legal challenges in the areas of informed consent, confidentiality, compensation, and risk-benefit ratios. Additionally, alcohol administration studies present challenges for those supervising, as well as conducting, such experiments. New technology, such as the use of ecological momentary assessment (EMA) or other ambulatory assessment methods to examine risky and illegal behaviors, also presents new ethical challenges that are likely to continue to evolve in the coming years for trainees. Specific recommendations for handling a variety of concerns that may arise when conducting alcohol research are provided. Additionally, suggestions for improving the training of ethical alcohol researchers are discussed.

Ethical considerations for conducting sexual and reproductive health research with female adolescents engaged in high-risk behaviours in China

BACKGROUND

Chinese female adolescents engaged in sex trade and substance use are often criminalized and stigmatized. As a result of these cultural, legal and political constraints, ethical concerns can discourage investigators from engaging these adolescents in research. This paper aims to address the ethical tensions between protection and inclusion in conducting sexual and reproductive health (SRH) research with adolescents engaged in high-risk behaviours. Processes of moral reasoning, and examples and practical mechanisms in managing such ethical challenges were presented in the hope of advancing the research ethics policies and practice with adolescents.

METHODS

We extracted ethical issues from three previously conducted SRH studies involving 517 Chinese female adolescents. Utilizing the principles of justice, beneficence, and respect for persons as articulated in the Belmont Report as a framework, we thematically summarised the key ethical considerations regarding inclusion and protection, then examine the ethical tensions and solutions within the local context.

RESULTS

Findings suggest that the balance between protection and inclusion can be achieved by both considering the evolving decision-making capacity of adolescents as well as the level of risk. A community-based participatory approach shows promise in advancing adolescent engagement and empowerment. Ethically robust approaches contribute to the greater relevance and validity of the findings.

CONCLUSIONS

Our studies suggest that it is crucial to achieve adolescents' meaningful involvement in all levels of research and interventions, researchers need to shift their perspectives of the target population from subjects to key stakeholders in design and implementation of research.

Students', parents' and teachers' views about the resources required by school nurses in Perth, Western Australia

Background

Nurses play a significant role in promoting health in schools; however, they are often poorly resourced to do so.

Aims

The aim of the study was to identify the perceptions of students, parents and teachers regarding the resources school nurses require in order to practise effectively in the secondary school environment in Perth, Western Australia.

Methods

One-on-one interviews were conducted with parents, teachers, nurses, school principals and school counsellors. Focus groups were conducted at three schools with students in years 10, 11 and 12, parents and teachers. Interviews and focus group data were analysed using thematic analysis.

Results

It was acknowledged that nurses in all schools were under-resourced, with large student numbers contributing to high workloads. The importance of privacy during a visit to the school nurse was highlighted by students. All stakeholders discussed the advantages of nurses completing extra qualifications, in addition to an undergraduate degree. Appropriate support and supervision were also highlighted.

Conclusions

School nurses need to thoroughly document and describe the work that they do and collaborate within the school community to advocate for increased resources. There is a great need for further research regarding the school nurse role involving the whole school community, and most importantly the students.

Developing a framework for community-based sexual health interventions for youth in the rural setting: protocol for a participatory action research study

INTRODUCTION

There is limited research examining community-based or multilevel interventions that address the sexual health of young people in the rural Australian context. This paper describes the Participatory Action Research (PAR) project that will develop and validate a framework that is effective for planning, implementing and evaluating multilevel community-based sexual health interventions for young people aged 16-24 years in the Australian rural setting.

METHODS AND ANALYSIS

To develop a framework for sexual health interventions with stakeholders, PAR will be used. Three PAR cycles will be conducted, using semistructured one-on-one interviews, focus groups, community mapping and photovoice to inform the development of a draft framework. Cycle 2 and Cycle 3 will use targeted Delphi studies to gather evaluation and feedback on the developed draft framework. All data collected will be reviewed and analysed in detail and coded as concepts become apparent at each stage of the process.

ETHICS AND DISSEMINATION

This protocol describes a supervised doctoral research project. This project seeks to contribute to the literature regarding PAR in the rural setting and the use of the Delphi technique within PAR projects. The developed framework as a result of the project will provide a foundation for further research testing the application of the framework in other settings and health areas. This research has received ethics approval from the Curtin University Human Research and Ethics Committee (HR96/2015).

An Alternative Technique for Youth Risk Surveillance Outside of the School System

PURPOSE

When school districts choose not to participate in adolescent health behavior surveys, tracking adolescent health indicators can be challenging. We conducted a countywide youth behavior survey outside of the school system. Our purpose is to describe alternative methods used for gathering these data reliably and ethically.

METHODS

We implemented two parallel surveys with youth ages 14-19 residing in a mid-sized county with urban, suburban, and rural neighborhoods. An anonymous phone-based survey used computer-assisted telephone interviewing with a live interviewer in conjunction with an interactive voice response system to survey youth via random digit dialing of landlines and cell phones. A concurrent in-person anonymous survey was conducted with marginalized youth (from juvenile detention centers, shelters, and residential facilities), using audio computer-assisted self-interviewing technology. The survey measures included the Centers for Disease Control Youth Risk Behavior Surveillance System and additional questions about social supports, neighborhood, and adverse childhood experiences.

RESULTS

Data were collected between February and December 2014. The phone-based sample recruited 1813 participants; the marginalized sample included 262 youth. Several strategies ensured anonymity and reduced coercion. The final phone-based sample was similar to demographics of the county population. The marginalized youth sample captured out-of-home youth who may have been missed with phone-based sampling alone.

CONCLUSIONS

We review alternative strategies for obtaining population-based adolescent health data without the cooperation of schools. These techniques can provide a basis to collect data that may help direct resources and policies relevant to needs of local youth.

Potential and Challenges in Collecting Social and Behavioral Data on Adolescent Alcohol Norms: Comparing Respondent-Driven Sampling and Web-Based Respondent-Driven Sampling

Background

Respondent-driven sampling (RDS) is a method successfully used to research hard-to-access populations. Few studies have explored the use of the Internet and social media with RDS, known as Web-based RDS (WebRDS). This study explored the use of combining both “traditional” RDS and WebRDS to examine the influences on adolescent alcohol use.

Objective

This paper reports on the recruitment processes and the challenges and enablers of both RDS and WebRDS. It details comparative recruitment data and provides a summary of the utility of both methods for recruiting adolescents to participate in an online survey investigating youth alcohol norms.

Methods

Process evaluation data collected from research staff throughout the study were used to assess the challenges and solutions of RDS and WebRDS. Pearson chi-square test (Fisher’s exact test if applicable) was used to compare the differences in sociodemographics and drinking behavior between data collected by RDS and WebRDS.

Results

Of the total sample (N=1012), 232 adolescents were recruited by RDS and 780 by WebRDS. A significantly larger proportion of Aboriginal or Torres Strait Islander (P<.001) participants who spoke English as their main language at home (P=.03), and of middle and lower socioeconomic status (P<.001) was found in the RDS sample. The RDS sample was also found to have a higher occurrence of past 7-day drinking (P<.001) and past 7-day risky drinking (P=.004). No significant differences in gender, age, past month alcohol use, and lifetime alcohol use were observed between the RDS and WebRDS samples. This study revealed RDS and WebRDS used similar lengths of chains for recruiting participants; however, WebRDS conducted a faster rate of recruitment at a lower average cost per participant compared to RDS.

Conclusions

Using WebRDS resulted in significant improvements in the recruitment rate and was a more effective and efficient use of resources than the traditional RDS method. However, WebRDS resulted in partially different sample characteristics to traditional RDS. This potential effect should be considered when selecting the most appropriate data collection method.