Conceptualizing Youth Participation in Children's Health Research: Insights from a Youth-Driven Process for Developing a Youth Advisory Council

Environmental health perceptions of urban youth from low-income communities: A qualitative photovoice study and framework

BACKGROUND

Children are amongst the most susceptible groups to environmental exposures, for both immediate and life-course health outcomes. Despite their increased susceptibility, children's knowledge, experiences and voices are understudied. A deeper understanding of children's environmental health perceptions has the potential to better inform policy, develop targeted interventions and improve public health outcomes.

METHODS

In this study, our community-academic partnership used the Photovoice research method to examine how urban children from low-income communities perceive environmental influences on their health. Twenty children, ages 10-12, took photographs and participated in focus group interviews regarding their perspectives on how the environment influences their health.

RESULTS

Qualitative analyses revealed five major thematic categories: environmental exposures, environmental health sentiments, environmental health outcomes, interest in environmental health and environmental health solutions. We used the findings to develop an environmental health perspective theoretical framework that can inform future work designed to promote the environmental health and well-being of children from low-income communities in urban communities.

CONCLUSION

Photovoice enabled children from low-income communities to capture and communicate their environmental health perceptions. These findings have the potential to inform and identify potential targets and opportunities for environmental health interventions and promotion in their communities.

PATIENT OR PUBLIC CONTRIBUTION

Partnerships with community-based organizations were central to the present study. By design, these community-based partners were involved in the conduct and procedures of the study.

'Just because we're younger doesn't mean our opinions should be any less valued': A qualitative study of youth perspectives on a Youth Advisory Council in a mental healthcare context

INTRODUCTION

Recognition of the importance of youth engagement in youth mental health and/or addiction (MHA) service design and delivery is increasing. Youth Advisory Councils embedded in MHA organizations represent one strategy that allows youth to be involved in MHA at the individual, organization and systemic levels. This level of involvement can facilitate positive outcomes for both the youth and the organization. As these councils become more common, it is important that organizations are prepared to partner with the participating youth. This study uses a descriptive qualitative approach to understand the motivations and expectations of youth with lived experience with MHA concerns who were beginning to work on a Youth Advisory Council in an MHA setting in the Greater Toronto Area.

METHODS

Semistructured interviews were conducted with each youth, ages 16-26, on the advisory council (N = 8) to understand their motivations, expectations and goals coming into the work. Interviews were transcribed verbatim and analysed using a reflexive thematic analysis.

RESULTS

Analysis resulted in five overarching themes: providing opportunities for youth learning and growth, platforming youth, empowering youth, embracing youth leadership and promoting youth-driven change. The findings illustrate that these youth came into the Youth Advisory Council motivated to create positive change in the mental health system, take on leadership roles and had high expectations for organizational support. Our analyses provide insight for organizations planning and implementing Youth Advisory Councils in the MHA sector with the goal of best supporting youth in driving positive change across the system.

CONCLUSION

Youth want to be provided authentic opportunities for their engagement to make a difference. MHA organizations must embrace youth leadership and move towards listening to youth experience and acting on youth recommendations to enhance service design and implementation to improve access and to better meet the needs of youth utilizing these services.

PATIENT OR PUBLIC CONTRIBUTIONS

This study incorporated service users, including youth ages 16-26 with lived experience of MHA concerns who served on the Youth Advisory Council at the Family Navigation Project, Sunnybrook. Youth Advisory Council members contributed to two relevant research activities: (1) youth reviewed the draft interview guide before data collection, and their feedback was prioritized in the final version and (2) youth contributed to knowledge translation through contributing to academic conference presentations.

Involving adolescents in the design, implementation, evaluation and dissemination of health research: an umbrella review protocol

INTRODUCTION

A lack of awareness on how to engage adolescents in research has been reported as one of the barriers to meaningful youth involvement in health research. Currently, available guidelines on youth involvement are limited in terms of the scope (e.g., focused on limited health research areas), content (e.g., include broad principles) and context (e.g., most guidelines are from high-income countries) for which the guidelines are applicable. To address this, we will develop a set of comprehensive guidelines based on consolidated evidence on youth involvement in health research. To inform these guidelines, we are first conducting an umbrella review to (1) summarise and synthesise findings from reviews on involving adolescents in health research, (2) consolidate the challenges experienced in youth involvement and the recommendations to mitigate these challenges, (3) identify best practices and (4) identify gaps and methodological weaknesses in the extant literature on involving adolescents in health research.

METHODS AND ANALYSIS

We will include review articles exploring adolescents' involvement in studies aiming to improve their physical or mental health. Databases to be searched include Cochrane Database of Systematic Reviews, Medical Literature Analysis and Retrieval System Online (MEDLINE), Scopus, Embase, PsycINFO, PsycArticles, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Epistemonikos and Health Systems Evidence. A grey literature search will be conducted in Web of Science, ProQuest, Google Scholar and PROSPERO, supplemented by a handsearch of the reference lists of eligible reviews, relevant journals, websites of related organisations and input from experts. Data will be analysed using narrative synthesis.

ETHICS AND DISSEMINATION

Ethical approval is not required as we are not collecting participant data as part of this review. The findings of this umbrella review will be disseminated through peer-reviewed publications, participatory workshops and academic conferences.

PROSPERO REGISTRATION NUMBER

CRD42021287467.

An emerging youth-centered model of community resilience in communities impacted by gun violence: Power through Black Community and Unity

Studies commonly examine resilience as an outcome by way of measuring the degree to which protective factors maintain individuals' well-being despite the presence of significant risk. In this study, we developed a model of community resilience that centered the voices of Black youth. Using data collected as part of a 3-year, youth participatory action research project, we developed a model that focuses on what 11 Black youth perceive and believe contributes to community resilience through their investigation of problems and solutions related to community gun violence. Findings from a constructivist grounded theory analysis of multiple data sources (e.g., field notes, transcribed group discussions, youth photovoice activities) revealed our developing model of community resilience: Power through Black Community and Unity. Specifically, Power through Black Community and Unity was a core category that reflected the importance of care, support, and safety as strengths in the community's current response and resilience to gun violence, and future aspects the community could develop to increase community resilience to gun violence. This core category emerged in three subsequent ways: Collective Care, "Seeing Beyond the Bad," and Supportive Teen Spaces. This study illustrates potential pathways that youth service agencies and community practitioners can consider enhancing in their programming to promote resilience in their communities.

Children and adolescents' mental health during the COVID-19 pandemic: A qualitative study of their experiences

TOPIC

Public health measures implemented in response to the COVID-19 pandemic severely disrupted children and adolescents' (C&A) lives, affecting their sense of structure, predictability, and security.

PURPOSE

To examine C&A' experiences during the COVID-19 pandemic to better understand how this context and its associated public health measures affected them and their mental health, and to identify helpful coping strategies.

SOURCES USED

The study was guided by a participatory hermeneutic framework. Semistructured interviews were conducted with 25 C&A aged 6-17 years during the first and second pandemic waves. Participants' interviews were analyzed following a narrative synthesis approach, through which C&A' experiences were contrasted and contextualized to highlight relevant themes.

CONCLUSIONS

Participants described a distinct pattern related to their mental health as the pandemic unfolded, which followed the severity of the pandemic in the province. Negative repercussions on their mental health were linked to the loss of social activities, imposed public health measures, transition to online learning, and challenges with family relationships. Certain youth shared positive societal and moral reflections triggered by the pandemic context. Coping strategies reported include: having a variety of hobbies; expressing their emotions; and accessing financial and material resources. This study highlights the importance of supporting C&A' mental health during crisis situations such as a pandemic. Their perspectives are vital for clinical practice and policy improvement, particularly to find means for social engagement while maintaining safety.

A scoping review of youth advisory structures in the United States: Applications, outcomes, and best practices

Although youth advisory structures (YASs) have proliferated internationally to facilitate the voice of young people, little is known about the practices of such groups, especially in the United States. To address this gap of knowledge, this study describes the findings of a scoping review of scholarly research on YAS in the United States. The review found that although the use of YAS is increasing, current scholarship offers little information about YAS processes or how youth are engaged. Most YAS in the review partnered with marginalized young people to inform research and programming around sensitive health topics, such as human immunodeficiency virus prevention. Youth who participated in YAS experienced positive outcomes such as leadership and skill development, healthier decision-making, and confidence. Although most studies involved youth in minimal ways, there is a growing body of literature where youth are engaged in long-term partnerships that support positive youth development. This review details other key characteristics of YAS and provides recommendations for best practices, such as building consensus around terms used to refer to YAS and promoting the dissemination of process details around YAS facilitation.

Development of an adolescent advisory group to inform sexual and reproductive health research for first- and second-generation immigrant adolescents in Canada: A community-based participatory action research study

BACKGROUND

Despite the growing evidence supporting the benefit of engaging adolescents in research, the active engagement of immigrant adolescents in research is limited. Further, when exploring the sexual and reproductive health (SRH) needs of immigrant adolescents, utilization of adolescent advisory groups is finite. This study aimed to train and evaluate engagement of an adolescent advisory group (AAG) to inform SRH needs of immigrant adolescents in Canada.

METHODS

Using purposive sampling, 13 AAG members were recruited into this study. Members were trained in content related to SRH needs of adolescents and various research methodologies such as conducting a scoping review and qualitative interviews with adolescent participants. After 10 months of member engagement, their experiences were evaluated to identify areas of success and areas for improvement. These data were collected using the Public and Patient Engagement Evaluation Tool, which consisted of a Likert survey and open-ended questions, and analyzed in accordance to the Patient Engagement in Research (PEIR) framework.

FINDINGS

Ten members completed the evaluation survey. Likert survey responses were primarily positive. Majority of members showed positive demonstrations regarding various components of the PEIR framework, including contributions, support, research environment, and feeling valued.

CONCLUSION

Findings illustrated that immigrant AAGs are constructive to informing SRH research. Not only can research teams benefit, but members are also empowered. This study provided the foundation for future immigrant adolescent engagement in research and knowledge translation, and effective means of evaluating engagement by utilizing the PEIR framework.

The generative potential of mess in community-based participatory research with young people who use(d) drugs in Vancouver

Community-based participatory research (CBPR) is increasingly standard practice for critical qualitative health research with young people who use(d) drugs in Vancouver, Canada. One aim of CBPR in this context is to redress the essentialization, erasure, and exploitation of people who use(d) drugs in health research. In this paper, we reflect on a partnership that began in 2018 between three university researchers and roughly ten young people (ages 17–28) who have current or past experience with drug use and homelessness in Greater Vancouver. We focus on moments when our guiding principles of shared leadership, safety, and inclusion became fraught in practice, forcing us in some cases to re-imagine these principles, and in others to accept that certain ethical dilemmas in research can never be fully resolved. We argue that this messiness can be traced to the complex and diverse positionalities of each person on our team, including young people. As such, creating space for mess was ethically necessary and empirically valuable for our CBPR project.

The mental well-being and coping strategies of Canadian adolescents during the COVID-19 pandemic: a qualitative, cross-sectional study

BACKGROUND

Qualitative research is lacking on the mental well-being of adolescents during the COVID-19 pandemic. The aim of this study was to explore the feelings and emotions adolescents experienced during the first wave of the COVID-19 pandemic and the coping strategies they identified and employed to manage those emotions.

METHODS

Participants living in Canada aged 13-19 years were recruited through social media platforms and youth-serving organizations. Qualitative data were gathered from 2 open-ended questions included in a youth-informed cross-sectional online survey: "What feelings and emotions have you experienced around the pandemic?" and "What coping strategies have you used during the pandemic?" We collected data from June 2020 to September 2020. A summative content analysis was undertaken to analyze survey responses inductively.

RESULTS

A total of 1164 open-ended responses from Canadian adolescents (n = 851; mean age 15.6, standard deviation 1.7, yr) were analyzed. We identified 3 major themes within the category of feelings and emotions associated with the pandemic: sociospatial and temporal disconnections, emotional toll of the pandemic and positives amid the pandemic. Within the category of coping strategies used during the pandemic, 2 major themes were identified: connecting online and outdoors, and leisure and health-promoting activities.

INTERPRETATION

Although the emotional toll of the first wave of the COVID-19 pandemic is evident, participants in our study adopted various positive coping strategies to mitigate their distress, including physical activity, safe peer interactions and hobbies. The results have important implications for public health policy and practice during pandemic times, emphasizing the importance of accessible mental health resources for those experiencing psychological distress.

How Do Urban Environments Affect Young People's Mental Health? A Novel Conceptual Framework to Bridge Public Health, Planning, and Neurourbanism

Childhood and adolescence are crucial periods for mental and social development. Currently, mental illness among young people is a global epidemic, and rates of disorders such as depression and anxiety are rising. Urban living, compared with rural living, is linked with a higher risk of serious mental illness, which is important because the world is urbanizing faster than ever before. Urban environments and their landscapes, designs, and features influence mental health and well-being. However, no conceptual frameworks to date have detailed the effect of urban environments on young people's mental health, and few studies have considered the growing role of digital and social media in this relationship, leading to calls for the development of holistic approaches to describe this relationship. This article synthesizes existing knowledge on urban places (both built and natural environments) and mental health in the public health and urban planning literature and examines the emerging field of neurourbanism (a multidisciplinary study of the effect of urban environments on mental health and brain activity) to enhance current practice and research. We developed 2 novel conceptual frameworks (1 research-oriented, 1 practice-oriented), adapted from Bronfenbrenner's socioecological model, that focus on the relationship between urban environments and young people's mental health. We added a digital and social media contextual level to the socioecological model, and we applied a multilayer concept to highlight potential cross-field interactions and collaborations. The proposed frameworks can help to guide future practice and research in this area.

Sharing personal health record data elements in protective custody: youth and stakeholder perspectives

OBJECTIVE

The study sought to develop the necessary elements for a personalized health record (PHR) for youth emancipating from child protective custody (eg, foster care) by collecting thoughts and ideas from current and former foster youth and community stakeholders who have a significant amount of experience working with emancipating young people.

MATERIALS AND METHODS

We employed a mixed methods, participatory research design using concept mapping to identify key features for PHR across stakeholders.

RESULTS

In the clusters, common themes for necessary elements for a PHR included health education, health tips, medication instructions, diagnoses including severity, and website resources that could be trusted to provide reliable information, and addressed data privacy issues such as the primary user being able to choose what diagnoses to share with their trusted adult and the ability to assign a trusted adult to view a part of the record.

DISCUSSION

By directly involving youth in the design of the PHR, we are able to ensure we included the necessary health and life skills elements that they require. As a PHR is created for foster youth, it is important to consider the multiple uses that the data may have for emancipated youth.

CONCLUSION

A PHR for foster youth needs to include an appropriate combination of information and education for a vulnerable population. In addition to providing some of their basic health and custody information, a PHR provides an opportunity to give them information that can be trusted to explain common diagnoses, medications, and family health history risks.

Physical activity and social connectedness interventions in outdoor spaces among children and youth: a rapid review

INTRODUCTION

The rise in sedentary behaviour, coupled with the decline in overall mental health among Canadian children and youth in recent decades, demonstrates a clear need for applied research that focusses on developing and evaluating cross-disciplinary interventions. Outdoor spaces provide opportunities for physical activity and social connectedness, making them an ideal setting to address these critical health concerns among children and youth.

METHODS

We conducted a rapid review of peer-reviewed (n = 3096) and grey literature (n = 7) to identify physical activity and/or social connectedness outdoor space interventions targeted at children and youth (19 years and under) in Australia and New Zealand, Canada, Europe and the United States. We determined if interventions were effective by analyzing their research design, confidence intervals and reported limitations, and then conducted a narrative synthesis of the effective interventions.

RESULTS

We found 104 unique studies, of which 70 (67%) were determined to be effective. Overall, 55 interventions targeted physical activity outcomes, 10 targeted social connectedness outcomes and 5 targeted both. Play (n = 47) and contact with nature (n = 25) were dominant themes across interventions, with most taking place in a school or park. We report on the identifying features, limitations and implications of these interventions.

CONCLUSION

The incorporation of natural and play-focussed elements into outdoor spaces may be effective ways to improve physical activity and social connectedness. There is a considerable need for more Canadian-specific research. Novel methods, such as incorporating smartphone technology into the design and evaluation of these interventions, warrant consideration.

Development of a Teen-Informed Coding Tool to Measure the Power of Food Advertisements

The food-related information environment, comprised of food and beverage advertising within one’s surroundings, is a growing concern for adolescent health given that food marketing disproportionately targets adolescents. Despite strong public interest concerning the effects of food marketing on child health, there is limited evidence focused on outdoor food advertising in relation to teenage diets, food purchasing, and perceptions. Further, limited research has considered both the exposure to and influence of such advertisements. This study used a novel multi-method approach to identify and quantify the features of outdoor food and beverage advertisements that are most effective at drawing teenagers into retail food establishments. An environmental audit of outdoor advertisements and consultations with youth were used to: (1) identify teen-directed food marketing techniques; (2) validate and weigh the power of individual advertising elements; and, (3) develop a teen-informed coding tool to measure the power of food-related advertisements. Results indicate that marketing power is a function of the presence and size of teen-directed advertisement features, and the relative nature of each feature is an important consideration. This study offers a quantitative measurement tool for food environment research and urges policymakers to consider teen-directed marketing when creating healthy communities.