Global Health Determinants Perceived and Expressed by Children and Adolescents Between 6 and 17 Years: A Systematic Review of Qualitative Studies

Children's perspectives on health and wellbeing: A concept mapping study

PURPOSE

Children's needs and perspectives regarding health and wellbeing are rarely considered in public health care services. To improve preventive youth health care, the aim of this study was to gain knowledge about children's perspectives on health and wellbeing.

DESIGN AND METHODS

In a concept mapping study, Dutch children, 9-12 years old in primary schools (N = 82), generated ideas regarding health or wellbeing and sorted and rated these ideas on importance. Multidimensional scaling and hierarchical clustering were done in program R. Qualitative analyses determined the final concept maps. Subsequently, we conducted four focus groups about these maps with nurses and physicians.

RESULTS

For the concept "health", children (n = 33) generated 309 statements in 7 themes: 1) healthy living environment, 2) food and drinks, 3) important for a healthy life, 4) leisure time and relaxation, 5) physical diseases and cure, 6) necessities to be healthy, 7) love and affection. For the concept "wellbeing", children (n = 49) generated 435 statements in 9 themes: 1) negative influence on feelings, 2) feeling connected with friends and family, 3) unpleasant feelings, 4) positivity and enjoyable activities, 5) bad experiences and things, 6) problems with friends and family, 7) social media and gaming, 8) puberty and sexuality, 9) tasty food and drinks. Professionals (N = 16) had a more risk-oriented perspective on health and wellbeing than children.

CONCLUSIONS

Children have a wide variety of perceptions of what is important for their health and wellbeing.

PRACTICE IMPLICATIONS

Children's perceptions could inform preventive youth health care services to better adapt to children's needs.

Girl-boy differences in perceptions of health determinants and cancer: a more systemic view of girls as young as 6 years

Introduction

To model and analyze the differences between girls' and boys' conceptions of the determinants of health and cancer, as expressed and perceived by children and adolescents.

Method

A multicentric qualitative study was conducted in five schools (ages 6-11 years), four middle schools (ages 11-15 years), and three high schools (ages 15-18 years). A multi-phase protocol (phase 1 uses the e.Photoexpression© and phase 2 uses the Photonarration) enables children and teenagers to express themselves through photography and storytelling.

Results

A total of 4,174 qualitative productions were produced by 1,068 children, of which 47% were girls and 53% were boys, all in the ages of 6-18 years. From the results of the productions, it can be noticed that children mentioned and were aware of 30 determinants of health and cancer. The three determinants most mentioned were "Consumption of psychotropic drugs", "Diet", and "Harmful environment". Among these 30 determinants, some were mentioned to a greater or lesser extent by girls and boys. These significant gender differences are present for 20 determinants of health and cancer. These differences evolve with age: (1) In elementary school (ages 6-11), girls gave significantly more importance (p < 0.05) to 11 determinants, while boys attached significantly more importance (p < 0.05) to 2 determinants. (2) In middle school (ages 11-16), girls gave significantly (p < 0.05) more importance to 12 determinants, while boys gave significantly (p < 0.05) more importance to one determinant. (3) In high school (ages 15-18 years), girls gave significantly (p < 0.05) more importance to 13 determinants. There was no significant difference (p < 0.05) in favor of boys for high school students. Girls also have a more systemic view of health determinants than boys. The increase in the number of determinants cited by girls is significant (p = 0.017) between the ages of 6-11 and 15-18 years. This gap widens with age (+1.45 determinants) for girls and (+0.68 determinants) for boys between elementary school and high school.

Conclusion

The determinants identified as predominantly female or male, as well as age-related specificities, constitute a resource for effective preventive action, as close as possible to the needs and particularities of a population. This mapping of people's conceptions could provide a decision-making aid in defining the strategic orientations of prevention policies.

Joint Use of e.Photoexpression© and Photonarration: What Methodological Added Value?

Objectives: The objective is to describe the informative value and the added value of a qualitative multiphase methodology in order to investigate the conceptions of children aged 6–11 on the determinants of health and cancer.

Method: This article provides an analysis of the “Determ'Ados” research protocol, a qualitative study in human and social sciences, carried out with children aged 6–11 years. This protocol, organized in three phases, addresses in the first global health with the tool “e.Photoexpression^©,” in the second questions and knowledge around the topic of cancer with the tool “QC” and in the third cancer again with the “Photonarration” tool. The methodology of this innovative, open and exploratory research protocol aims to collect data relating to the experiences, declared practices and knowledge specific to each child who express themselves through photography and storytelling.

Results: The analysis of the Déterm'Ados methodology reveals a density and richness of results among all the children interviewed, even among the youngest: 1,498 productions (4 productions per child) were made by 381 children resulting in a wealth of data available thanks to the multiphase protocol. This massive qualitative survey brings complementarity as the collection phases progress and guarantees continuity in the discourse of each child which allows them to deepen their conceptions and to know how they create or not meaning between the determinants of health and cancer.

Perspectives: The density and quality of the proposals collected from the children reinforce the validity and rigor of the Determ'Ados methodology. Multiphase is the innovative aspect of the tools used. The e.Photoexpression^© and the Photonarration are complementary and inseparable to bring out concepts on health and cancer. These research results, transferable into interventions and current practices, present prevention officers to act more effectively, closer to the conceptions and needs of children.

Modelling the determinants of health and cancers as perceived by children: using imagery as a mediator of expression and narration

OBJECTIVES

To model and analyse conceptions of determinants of health and cancer that are expressed and perceived by school children aged 6-11 based on a multiphase qualitative protocol.

METHODOLOGY

This is a multicentric, qualitative study of human and social sciences conducted among school children aged 6-11 years old. Two different tools were used, e.Photoexpression and Photonarration, in four French schools. This innovative and exploratory method addresses global health during the first phase (e.Photoexpression) and the theme of cancer during the second phase (Photonarration). The children express themselves through photography and narration.

RESULTS

1498 qualitative productions were made by 381 children aged 6-11 years old. The analysis of these productions of expression and narration through images allowed modelling of determinants of health and cancer as perceived by children through 7 fields and 28 categories. The conceptions of determinants of health and child cancer refer to rationalities that are centred on individual determinants (76%), minimise environmental determinants (20%) and conceal the parameters of access to healthcare and social services (3%).

DISCUSSION

These findings provide new data to the international literature on children's perceptions of determinants of health and cancer. These research findings, which can be applied to interventions and current practices, will enable prevention workers to act more effectively, closer to children's perceptions and needs.