Include them and they will tell you: learnings from a participatory process with youth

Drawing a River: Utilizing the Power of Metaphors in Interviews With Children and Young People

In the field of qualitative health research on children, scholars have called for the inclusion of children's perspectives. Still, health care research on children appears to be characterized by an exclusionary approach that stems from a conception of disability and sickness as equivalent to a lack of agency. This article responds to the call to include children's perspectives. It presents the Double-view (Dovi)-river interview, which is a drawing- and metaphor-based interview method that enables ambiguous and multi-layered life course narratives. Based on two steps - (1) a life course interview conducted while drawing a river of the child's life and (2) revisiting and unfolding the child's stories - the method allows for an arts-based, joint exploration of life experiences. Inspired by childhood studies as well as a poststructuralist epistemology, the article discusses and proposes ways to challenge power relations between the adult interviewer and the child interviewee. It is argued that the method can also challenge the predominant deficit view and the dichotomous understanding of children's experiences of their life and capabilities that characterize much health care practice and health research, by focusing both on challenges and opportunities. Doing so enables a more nuanced and appreciative approach to children. We draw on empirical examples from a study with children with disabilities. However, we suggest that the method's potential for enabling articulation of the complex and ambiguous can inspire qualitative research and health care practice more broadly.

Generating youth dialogue through the literary arts: A citywide youth health collaboration in the U.S

A process and outcomes evaluation was conducted of a citywide literary-arts initiative designed to reduce stigma, amplify underrepresented narratives, and generate dialogue about violence. Over 4 months, students in 85 middle schools read a novel addressing mental health and violence-related themes. As a collaboration between a public school district and public library system, the program's classroom activities emphasized dialogue, while coordinated library events supported community engagement. Students completed pre/postsurveys (total n = 1487); school program leaders (n = 39) and public librarians (n = 14) completed postsurveys. Half of student respondents reported personal encounters with violence. Most said the novel influenced their thinking; students with personal experiences of violence reported greater influence than those without. Highest rates of dialogue were seen among students who read the novel in full, and over half of postsurvey respondents wanted more dialogue opportunities. Leaders and librarians indicated that the program was smoothly integrated with existing curricula, but also offered recommendations for improved processes. Findings suggest that this intervention was effective at stimulating dialogue while providing assets-based opportunities for youth to share experiences and concerns. Current program processes indicate promise for further engagement and impact, with some modifications. To this end, authors draw upon evaluation findings and youth development literature to offer recommendations for program development and replication in other regions.

Sexual and reproductive health of Syrian refugee adolescent girls: a qualitative study using focus group discussions in an urban setting in Lebanon

Background

The war in Syria caused the forced displacement of millions of Syrians to neighboring countries. Lebanon is the host country with the largest overall number of Syrian refugees per capita. Adolescent refugee girls experience a unique level of vulnerability during human emergencies and are at increased risk of suffering from poor sexual and reproductive health (SRH) outcomes. We conducted an exploratory qualitative study to learn about the SRH perceptions and experiences of refugee adolescent girls living in Bourj Hammoud, an urban setting in Lebanon.

Methods

We employed a qualitative design with eight focus group discussions (FGDs) conducted with 40 Syrian Arab and Syrian Kurdish adolescent girls between January and March 2020. Every FGD consisted of five participants aged 13 to 17 years. A semi-structured guide was used covering multiple themes: menstruation, puberty, SRH awareness, and sexual harassment. FGDs were transcribed and analyzed using thematic analysis.

Findings

The participants discussed adolescent girls’ health and named six elements of good health, such as healthy activities and self-protection. The majority of the FGD participants reported a lack of awareness about menstruation when they experienced it for the first time and the social stigma associated with menstruation. When defining puberty, they indicated its social link to a girl’s readiness for marriage and her need to become cautious about sexual harassment. Most FGD participants had very poor knowledge of the female reproductive system. Mothers were the most approached persons to receive information on SRH issues; however, the girls indicated a wish to receive advice from specialists in a comfortable and private atmosphere. All the girls reported that either they themselves, or an acquaintance, had experienced some type of sexual harassment. The girls rarely reported those incidents due to fear of being blamed or subjected to mobility restrictions, or forced to drop out of school.

Conclusions

The findings show the refugee girls need for satisfactory knowledge on SRH issues and interventions to prevent sexual and gender-based violence that take into consideration the complexity of urban settings.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12978-021-01178-9.

After almost 10 years of war, Syria’s neighboring countries are hosting millions of Syrians who were forcibly displaced. Most prominent among these countries is Lebanon. Adolescent refugee girls are exposed to precarious conditions, which make them more prone to sexual and reproductive health (SRH) problems. This qualitative study was performed in Bourj Hammoud, an urban setting in Lebanon, in order to explore Syrian refugee adolescent girls’ SRH perceptions and experiences. The agenda of the International Conference on Population and Development (ICPD) in addition to the Inter-Agency Field Manual on Reproductive Health in Humanitarian Settings (IAFM) and its Adolescent Sexual and Reproductive Health Toolkit for Humanitarian Settings issued by the Inter-Agency Working Group on Reproductive Health in Crises (IAWG) formed the framework of this study. Focus group discussions were performed with 40 Syrian Arab and Syrian Kurdish adolescent girls, each group consisting of five participants aged 13 to 17 years. Different themes were discussed within the groups including menstruation, puberty, and sexual harassment. The participants talked about the social stigma related to menstruation and the social link between puberty, a girl’s readiness for marriage, and her need to be careful about sexual harassment. Most of the girls had insufficient information about the female reproductive system. The girls consulted their mothers to learn about SRH issues; however, they expressed a wish to receive well-informed advice from specialists in a safe atmosphere. All the girls reported incidents of sexual harassment, which happened either to them or to other girls they know; however, they were discouraged to report them because they feared other consequences, such as being blamed or not being allowed to go to school anymore. The outcomes of the study show the girls’ urgent need to have adequate information about SRH issues and appropriate interventions to prevent sexual and gender-based violence within complex urban settings.

Diabetes Prevention in Adolescents: Co-design Study Using Human-Centered Design Methodologies

BACKGROUND

The rise in pediatric obesity and its accompanying condition, type 2 diabetes (T2D), is a serious public health concern. T2D in adolescents is associated with poor health outcomes and decreased life expectancy. Effective diabetes prevention strategies for high-risk adolescents and their families are urgently needed.

OBJECTIVE

The aim of this study was to co-design a diabetes prevention program for adolescents by using human-centered design methodologies.

METHODS

We partnered with at-risk adolescents, parents, and professionals with expertise in diabetes prevention or those working with adolescents to conduct a series of human-centered design research sessions to co-design a diabetes prevention intervention for youth and their families. In order to do so, we needed to (1) better understand environmental factors that inhibit/promote recommended lifestyle changes to decrease T2D risk, (2) elucidate desired program characteristics, and (3) explore improved activation in diabetes prevention programs.

RESULTS

Financial resources, limited access to healthy foods, safe places for physical activity, and competing priorities pose barriers to adopting lifestyle changes. Adolescents and their parents desire interactive, hands-on learning experiences that incorporate a sense of fun, play, and community in diabetes prevention programs.

CONCLUSIONS

The findings of this study highlight important insights of 3 specific stakeholder groups regarding diabetes prevention and lifestyle changes. The findings of this study demonstrate that, with appropriate methods and facilitation, adolescents, parents, and professionals can be empowered to co-design diabetes prevention programs.

Visual Elicitation: Methods for Enhancing the Quality and Depth of Interview Data in Applied Qualitative Health Research

Generating rich data from interviews for a qualitative study can be difficult to operationalize; especially when difficulties establishing rapport, power imbalances, and participant factors threaten the interview process and quality of data. The aim of this methods article is to (a) discuss the value of incorporating visual elicitation tools or tasks within semistructured or in-depth qualitative interviews to enhance the depth of data generated and (b) provide a specific example of how this is planned and executed within the context of an applied qualitative health research study.

Fierce Autonomy: How Girls and Young Women Impacted by Commercial Sexual Exploitation Perceive Health and Exercise Agency in Health Care Decision-Making

Prior research has examined the high health care needs and vulnerabilities faced by survivors of commercial sexual exploitation (CSE), yet their perspectives are frequently absent. We sought to understand the narratives and views of individuals affected by CSE on their bodies, health, and motivations to seek health care treatment. Twenty-one girls and young women ages 15 to 19 years with self-identified histories of CSE participated in the study. All participants had current or prior involvement in the juvenile justice and/or child welfare systems. Data collection included brief questionnaires, followed by semi-structured individual interviews. The interviews took place between March and July 2017 and were analyzed using iterative and inductive techniques, using the shared decision-making model as a guide. "Fierce Autonomy" emerged as a core theme, depicting how past traumas and absence of control led the girls and young women to exercise agency and reclaim autonomy over decisions affecting their health.

Understanding practitioner perspectives of youth healthcare using thematic and lexical analyses

BACKGROUND

Youth health issues represent a "wicked problem" - they are complex and multifaceted. Furthermore, they are likely to require novel approaches to understand their complexity and develop novel solutions.

OBJECTIVE

Given the importance of youth healthcare, and the need for novel approaches, the aim of this article was to demonstrate the innovative use of two research methods - thematic and lexical analyses - to better understand practitioner perspectives of youth healthcare. It clarifies the factors that shape practitioner ability to support young people and opportunities to improve practice.

DESIGN AND SETTING

Focus groups and interviews were conducted with 37 youth health practitioners. They represented government and non-government services; hospital and community services; and metropolitan and regional services.

RESULTS

Thematic analysis highlighted the complexity of participants' work and the judgements made as they negotiated relationships with young people and ancillary services. Lexical analysis revealed two hitherto neglected dimensions of the complexity of youth healthcare - uncertainty and corporeality.

DISCUSSION

In addition to affirming the complexities of youth healthcare, this study revealed how practitioners (can) negotiate these complexities. These findings were only possible because of the innovative use of the two research methods.

CONCLUSIONS

This study has important theoretical, methodological and practical implications. Theoretically, it is the first to view the complexities of youth healthcare through the wicked problem lens. Methodologically, it highlights the complementary value of thematic and lexical analyses. Practically, it reinforces the importance of policy support and professional development to enable practitioners to grasp the complexities of their work.

Adaptation, Implementation, and Evaluation of a Public Health Research Methods Training for Youth

Purpose: To adapt, implement, and evaluate a public health research methods training program for youth. The Community Research Fellows Training Program is an evidence-based public health research methods training program for adults (18 years and older). The Youth Research Fellows Training (YRFT) is an adaptation of this program for youth.

Methods: University faculty facilitate didactic training sessions and experiential small group activities in biweekly sessions conducted as part of an existing 4-week summer camp. Participants were African American girls (n=11) ranging from ages 10 to 14 years (most recent grade completed 4th–8th). To evaluate participant knowledge gain and satisfaction pre-tests were administered before each session, and post-test and evaluations were administered after each session. In addition, faculty completed web-based evaluation surveys on their experience teaching in the program.

Results: Mean and median post-test scores were higher than pre-test scores for most (6 of the 7) of the training sessions; one session had no difference in scores. Participants rated the sessions well, on average overall session ratings of 4.3–4.8 on a 5-point Likert scale. Faculty rated their experience teaching in the program as excellent or very good and would be willing to teach in the program again (n=7; 100%).

Conclusion: This pilot implementation of the YRFT program proved highly successful in terms of participant and faculty experience. The program evaluation demonstrates increased knowledge of public health research methods. This program has the potential to prepare youth to engage in public health research as partners not just participants.

Body Mapping as a Youth Sexual Health Intervention and Data Collection Tool

In this article, we describe and evaluate body mapping as (a) an arts-based activity within Fostering Open eXpression Among Youth (FOXY), an educational intervention targeting Northwest Territories (NWT) youth, and (b) a research data collection tool. Data included individual interviews with 41 female participants (aged 13-17 years) who attended FOXY body mapping workshops in six communities in 2013, field notes taken by the researcher during the workshops and interviews, and written reflections from seven FOXY facilitators on the body mapping process (from 2013 to 2016). Thematic analysis explored the utility of body mapping using a developmental evaluation methodology. The results show body mapping is an intervention tool that supports and encourages participant self-reflection, introspection, personal connectedness, and processing difficult emotions. Body mapping is also a data collection catalyst that enables trust and youth voice in research, reduces verbal communication barriers, and facilitates the collection of rich data regarding personal experiences.

Photovoice: A Strategy to Better Understand the Reproductive and Sexual Health Needs of Young Mothers

STUDY OBJECTIVE

Adolescent women face significant sexual and reproductive health challenges and are more vulnerable than their male peers. Photovoice methodology might allow them to provide more meaningful and accurate representations of the health challenges they encounter. Our objectives were to: (1) use Photovoice to understand how young mothers frame reproductive and sexual health within the context of their lives; (2) explore how they define reproductive and sexual health; (3) identify youth perspectives on how their life situations influence their ability to affect their health; and (4) connect their perspectives to social determinants of health framework to facilitate implementation of effective programs and policies to address their needs. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: This was a prospective qualitative community-based participatory research study involving young women (ages 15-25 years) recruited from a local youth outreach center. A 9-step validated qualitative participatory approach that combined documentary photography with focus groups was used. Qualitative analysis was conducted with NVivo version 10 software (QSR International Inc., Burlington, MA, USA). Data were coded and themes were developed.

RESULTS

Thirty women were recruited and nine women completed the study. Key themes included: personal sexual health practices and coping skills, influence of poverty, physical environments, community resources and sexual health services, education, and stigma of pregnancy. Participating in community-based participatory research empowered participants to advocate for their own health.

CONCLUSION

Photovoice methodology contributes to understanding complex factors influencing sexual and reproductive health of young mothers. This participatory-based methodology highlights their individual situations, allowing us to seek connections, create analytical perspectives from which to relate their situations to root causes, and consider strategies for change.

Youth Perspectives on Sexual Health Workshops: Informing Future Practice

Newcomer and street-involved youth provided their perspective on the design and content of a sexual education workshop. Following the workshop, focus group discussions were held with 80 youth from four youth-serving agencies. Youth expressed increased levels of confidence and empowerment, consistent with recent criticism that a focus on specific behaviors as intervention outcome measures may miss important psychosocial changes in participants. Some youth views on cultural adaptation of workshops were not consistent with current views expressed by some adult educators, highlighting the need to ensure a youth perspective is captured during intervention development. Finally, the dichotomous views that youth expressed regarding workshop activities emphasizes a research gap related to how best to adapt interventions to different cognitive capacities, literacy levels, and learning styles. Information of this kind is relevant in terms of knowledge translation from youth to program planners and educators.

Ensuring youth's right to participation and promotion of youth leadership in the development of sexual and reproductive health policies and programs

The purpose of this article was to reflect on the concepts of adolescence and youth, summarize models and frameworks developed to conceptualize youth participation, and assess research that has attempted to evaluate the implementation and impact of youth participation in the field of sexual and reproductive health and rights (SRHR). We searched and critically reviewed relevant published reports and "gray literature" from the period 2000-2013. "Young people" are commonly defined as those between the ages of 10 and 24 years, but what it means to be a young person varies largely across cultures and depends on a range of socioeconomic factors. Several conceptual frameworks have been developed to better understand youth participation, and some frameworks are designed to monitor youth development programs that have youth participation as a key component. Although none of them are SRHR specific, they have the potential to be adapted and applied also for adolescents' SRHR programs. The most monitored and evaluated intervention type is peer education programs, but the effectiveness of the approach is questioned. There are few attempts to systematically evaluate youth participation, and clear indicators and better methodologies still need to be developed. More research and documentation as well as the adoption of innovative practices for involving youth in sexual and reproductive health programs are needed. Participation is a right and should not only be evaluated in terms of effectiveness and impact. Youth participation in program and policy development should still be a priority.

Novel methods to collect meaningful data from adolescents for the development of health interventions

Health interventions are increasingly focused on young adolescents, and as a result, discussions with this population have become a popular method in qualitative research. Traditional methods used to engage adults in discussions do not translate well to this population, who may have difficulty conceptualizing abstract thoughts and opinions and communicating them to others. As part of a larger project to develop and evaluate a video game for risk reduction and HIV prevention in young adolescents, we were seeking information and ideas from the priority audience that would help us create authentic story lines and character development in the video game. To accomplish this authenticity, we conducted in-depth interviews and focus groups with young adolescents aged 10 to 15 years and employed three novel methods: Storytelling Using Graphic Illustration, My Life, and Photo Feedback Project. These methods helped provide a thorough understanding of the adolescents' experiences and perspectives regarding their environment and future aspirations, which we translated into active components of the video game intervention. This article describes the processes we used and the valuable data we generated using these three engaging methods. These three activities are effective tools for eliciting meaningful data from young adolescents for the development of health interventions.

Promoting an equal and healthy environment: Swedish students' views of daily life at school

Education is an important factor in health equity, but many students still do not complete high school. A focus on the school context rather than on individual problems might help to create a supportive environment for health and learning. In this study we explored factors that promote health and learning from the perspective of vocational and low-achieving high school students in Sweden. We used grounded theory with a constructivist orientation, informed and sensitized by the concept of salutogenesis. Students from a school in a mid-sized municipality in Sweden participated, and we collected data using the photovoice method and interviews. Students identified general factors as significant to their well-being and success in school. The main theme, "promoting driving forces for health and learning," emerged from the categories "longing to be seen by teachers," "longing for support," and "longing for recuperation."

Youth researching youth: benefits, limitations and ethical considerations within a participatory research process

Objectives

To examine the benefits, limitations and ethical issues associated with conducting participatory research on tobacco use using youth to research other youth.

Study design

Community-based participatory research.

Methods

Research on tobacco use was conducted with students in the K’àlemì Dene School and Kaw Tay Whee School in the Northwest Territories, Canada, using PhotoVoice. The Grade 9–12 students acted as researchers. Researcher reflections and observations were assessed using “member checking,” whereby students, teachers and community partners could agree or disagree with the researcher's interpretation. The students and teachers were further asked informally to share their own reflections and observations on this process.

Results and conclusions

Using youth to research other youth within a participatory research framework had many benefits for the quality of the research, the youth researchers and the community. The research was perceived by the researchers and participants to be more valid and credible. The approach was more appropriate for the students, and the youth researchers gained valuable research experience and a sense of ownership of both the research process and results. Viewing smoking through their children's eyes was seen by the community to be a powerful and effective means of creating awareness of the community environment. Limitations of the approach were residual response bias of participants, the short period of time to conduct the research and failure to fully explore student motivations to smoke or not to smoke. Ethical considerations included conducting research with minors, difficulties in obtaining written parental consent, decisions on cameras (disposable versus digital) and representation of all participants in the final research product.