Co-creating health interventions for adolescents: strategies for meaningful involvement.

Review Questions/Objectives The objective of this review is to synthesise the best available evidence on the effectiveness of population based (public health) risk reduction programs and services (interventions) on sexual and reproductive health risk taking among young people (aged 10 to 24 years old) in developing countries (countries with low and middle gross national income (GNI) per capita as defined by World Bank). The specific review questions are: 1. What is the effectiveness of population based (public health) risk reduction programs and services (interventions) on risky sexual behaviors among young people? 2. What are the characteristics of population based interventions that are effective in reducing risky behaviors among young people? 3. What specific outcome measures best assess the impact of interventions that effectively reduce sexual risk taking among adolescents in developing countries? Inclusion Criteria a. Types of Participants The review will consider individuals of ages 10 to 24 years residing in developing countries. b. Types of interventions The review will consider population based (public health) risk reduction programs and services that target young people in developing countries. c. Types of Outcomes Anticipated outcomes related to reduction in risky sexual behavior among young people include the following: Primary outcomes: Abstinence rates, rates of early/premarital sexual initiation, numbers of sexual partners, condom use at first sex, consistent and correct contraceptive (condom) use during sexual encounters among the study population, alcohol and/or substance use prior to or during sexual encounters (short term outcomes). Secondary outcomes: Pregnancies and their outcomes including rates of abortion, births (live and still), etc., STI rates, HIV/AIDS rates, maternal mortality and educational attainment levels of adolescents in the study population (Long term outcomes).

Implementation of digital interventions for sexual health for young people

BackgroundDespite the potential of technology-based mental health interventions for young people, limited uptake and/or adherence is a significant challenge. It is thought that involving young people in the development and delivery of services designed for them leads to better engagement. Further research is required to understand the role of participatory approaches in design of technology-based mental health and well-being interventions for youth.ObjectiveTo investigate consumer involvement processes and associated outcomes from studies using participatory methods in development of technology-based mental health and well-being interventions for youth.MethodsFifteen electronic databases, using both resource-specific subject headings and text words, were searched describing 2 broad concepts-participatory research and mental health/illness. Grey literature was accessed via Google Advanced search, and relevant conference Web sites and reference lists were also searched. A first screening of titles/abstracts eliminated irrelevant citations and documents. The remaining citations were screened by a second reviewer. Full text articles were double screened. All projects employing participatory research processes in development and/or design of (ICT/digital) technology-based youth mental health and well-being interventions were included. No date restrictions were applied; English language only. Data on consumer involvement, research and design process, and outcomes were extracted via framework analysis.ResultsA total of 6210 studies were reviewed, 38 full articles retrieved, and 17 included in this study. It was found that consumer participation was predominantly consultative and consumerist in nature and involved design specification and intervention development, and usability/pilot testing. Sustainable participation was difficult to achieve. Projects reported clear dichotomies around designer/researcher and consumer assumptions of effective and acceptable interventions. It was not possible to determine the impact of participatory research on intervention effectiveness due to lack of outcome data. Planning for or having pre-existing implementation sites assisted implementation. The review also revealed a lack of theory-based design and process evaluation.ConclusionsConsumer consultations helped shape intervention design. However, with little evidence of outcomes and a lack of implementation following piloting, the value of participatory research remains unclear.

When should we intervene in adolescent depression and with whom?

Considering the high prevalence of mental health conditions among young people and the technological advancements of artificial intelligence (AI)-based approaches in health services, mobile health (mHealth) apps for mental health are a promising way for low-threshold and large-scale mental health promotion, prevention, and intervention strategies, especially for young people. However, insufficient evidence on health-promoting effects and deficient user-centric designs emphasize the necessity for participatory methods in the interventions' development processes. This study aimed to explore young people's everyday experiences using an AI-based mHealth app for mental health promotion based on ecological momentary assessments and ecological momentary interventions. Our analysis of qualitative data focused on exploring young people's use patterns in daily life and mental health-promoting effects. We conducted problem-centered interviews and focus groups with a subsample of 27 young people aged 14 to 25 years, who were among the participants of 2 microrandomized trials testing and evaluating an AI-based mHealth app (AI4U training). Our study used a participatory approach, with "co- and peer researchers" from the dialogue population actively engaged in research processes and data analysis. Structural content analysis guided the qualitative analysis. Participants reported enhanced emotional self-awareness and regulation in daily life through the ecological momentary assessments and ecological momentary interventions. Young people appreciated the AI4U training for managing emotions and stress. They had no trust issues regarding disclosing their mental health via the AI4U training in daily life. Some faced challenges integrating it into their daily routines and highlighted the value of autonomy in use decision-making processes. Our findings reveal that young people benefited from enhanced emotional awareness and management through the use of the AI4U training, appreciating its anonymity for facilitating emotional disclosure. The results suggest that enhanced self-directed use may improve daily life integration, although participants noted that they sometimes avoided using the AI4U training during distress despite recognizing its potential benefits. These findings indicate the importance of balancing directed use and autonomy in digital interventions to harmonize compliance with effectiveness in daily life. We highlight the importance of participatory research for tailored digital mental health solutions.

This study evaluated the six-phase Global Youth Voices model (EIPARS) for engaging youth in community health promotion in the Middle East: 1) engagement, 2) issue identification, 3) planning, 4) action, 5) Rs; research, reflect, reward and 6) sustainability. 20 Grade 9 students (10 boys, 10 girls) from two Bedouin communities: 10 from Tuba-Zangaria in North Israel; 10 from Segev Shalom in the Negev--South Israel. Using low-end (photo-voice, photography) and high-end internet-based technology, youth identified and documented the strengths and weaknesses of their communities, and then undertook a community action project focusing on one important issue. Workbooks including process guides and tools for each step of the EIPARS model are available online at: http://www.globalyouthvoices.org/resources.html. Similar issues were identified in each community: e.g., smoking, injuries, friendships, Bedouin culture. Unique issues identified were suicide at Tuba and industrial pollution at Segev Shalom. Students at Tuba selected Suicide Prevention for a community project and prepared a PowerPoint presentation for educating their peers, teachers and parents. Youth from Segev Shalom created a video and photo exhibit on Violence Prevention. Photo-essays and their action projects were uploaded to the Global Youth Voices website for virtual discussion and sharing with youth globally (www.globalyouthvoices.org/middle-east/greetings-en.html). This project demonstrated that the EIPARS model can be used successfully for engaging youth and creating youth-driven community action in the Middle East. This public health intervention provides a positive approach for building cooperation in conflicted regions.

Reports of acute hepatitis C in young persons in the United States have increased. We examined data from national surveillance and supplemental case follow-up at selected jurisdictions to describe the US epidemiology of hepatitis C virus (HCV) infection among young persons (aged ≤30 years). We examined trends in incidence of acute hepatitis C among young persons reported to the Centers for Disease Control and Prevention (CDC) during 2006-2012 by state, county, and urbanicity. Sociodemographic and behavioral characteristics of HCV-infected young persons newly reported from 2011 to 2012 were analyzed from case interviews and provider follow-up at 6 jurisdictions. From 2006 to 2012, reported incidence of acute hepatitis C increased significantly in young persons-13% annually in nonurban counties (P = .003) vs 5% annually in urban counties (P = .028). Thirty (88%) of 34 reporting states observed higher incidence in 2012 than 2006, most noticeably in nonurban counties east of the Mississippi River. Of 1202 newly reported HCV-infected young persons, 52% were female and 85% were white. In 635 interviews, 75% of respondents reported injection drug use. Of respondents reporting drug use, 75% had abused prescription opioids, with first use on average 2.0 years before heroin. These data indicate an emerging US epidemic of HCV infection among young nonurban persons of predominantly white race. Reported incidence was higher in 2012 than 2006 in at least 30 states, with largest increases in nonurban counties east of the Mississippi River. Prescription opioid abuse at an early age was commonly reported and should be a focus for medical and public health intervention.

A Public Health Reset Through Contractualism

Beginning to hope: Aligning psychiatric care provision to needs of vulnerable children and young people.

Background: The UNGASS target to reduce HIV prevalence by 25% among 15-25 year olds living in the most affected countries by 2005 has not been met. In the absence of a vaccine or cure, behavioural interventions are the main strategy for HIV control. The ability of specific behaviour change interventions to reduce HIV/STI incidence and unplanned pregnancies in young people remains unproven. Methods: Since January 1999, an adolescent sexual and reproductive health (SRH) intervention has been implemented in 10 randomly selected intervention communities in rural Tanzania, within a community randomised trial. The intervention consisted of teacher-led, peer-assisted in school education, youth-friendly health services, community activities and youth condom promotion and distribution. Process evaluation in 1999-2002 showed high intervention quality and coverage. From June 2007 to July 2008, in the specific research reported in this thesis, the long-term impact of the intervention was evaluated among 13,814 young people aged 17-27 years who had attended trial schools between 1999 and 2002. Findings: Prevalences of HIV and HSV2 were 1.8% and 25.9% in males and 4.0% and 41.4% in females, respectively. The intervention did not significantly reduce risk of HIV (males adjusted prevalence ratio(aPR)=0.91; 95%CI:0.50-1.65; females aPR=1.07; 95%CI:0.68-1.67) or HSV2 (males aPR=0.94;95%CI:0.77-1.15; females aPR=0.96; 95%CI:0.87-1.06). The intervention was associated with a reduction in number of lifetime sexual partners reported by males (aPR=0.87; 95%CI:0.78-0.97) and an increase in reported condom use at last sex with a non-regular partner among females (aPR=1.34; 95%CI:1.07-1.69). There was a clear and consistent beneficial impact on knowledge, but no significant impact on reported attitudes to sexual risk, reported pregnancies or other reported sexual behaviours. Interpretation: SRH knowledge can be improved and retained long-term, but this intervention had little effect on reported behaviour or HIV/STI prevalence. Youth interventions integrated within intensive, community-wide risk reduction programmes may be more successful and should be evaluated.

BackgroundDespite increased focus on adolescence, young people’s voices are often undervalued and underrepresented in inequalities research. Through exploring young people’s perceptions of health and inequality, we may begin to understand...

BackgroundGreater interest is being shown in participatory approaches, especially in research on interventions that concern children and young people’s health and well-being. Although participatory approaches have user involvement in common, they differ in terms of the explicit guidance on how to actually involve and engage children and young people in health research. The aim of this scoping review was to systematically map recent research involving children and young people in the development of interventions targeting issues of health and well-being.MethodsAn interpretative scoping literature review based on: a scientific literature search in (health and social science) databases, reference lists, a manual search in key journals and contact with existing networks was conducted. A total of 4458 references were identified through the literature search, of which 41 studies published between 2000 and 2017 were included in the review. The target population was children and young people under 25 years old. Level of participation was categorized according to Shier’s Pathways to Participation Model.ResultsThe review showed that participatory approaches were most often used in the development of interventions in school settings and in community and healthcare settings and on issues concerning support in lifestyle or in managing illness or disease. The level of participation varied from children and young people taking part just as active informants, through stages of greater participation both in quantitative and qualitative terms, to children and young people becoming an active agent involved as a co-researcher where the research process was shaped by views of a higher level of mutuality. Most of the studies were categorised at a medium level and only three studies were judged to involve the children and young people at the highest level.ConclusionsThis scoping review showed that work remains in enabling children and young people to influence the development of interventions targeting health and well-being. In relation to level of sustainability in the interventions, it is relevant that goals, strategies and processes are formulated by those who can gain from the interventions. Participatory approaches aiming for a higher level of participation where children and young people work together with the researchers in partnerships are thus warranted.

The mental health and wellbeing of young people is at the forefront of mental health policy in Australia, with significant recent investment in initiatives for those aged 12-25 years. This is a welcome outcome from over 15 years of sustained advocacy. Mental health was recognised as a health priority area in 1996 and, since then, increasing awareness of the burden of mental disorder in adolescence and young adulthood has sharpened the focus on this stage of the lifespan. The most recent Australian data from the National Survey of Mental Health and Wellbeing revealed that one in four young people will experience an affective, anxiety or substance use disorder in a 12-month period. This parallels data from the large US comorbidity study, which showed that three-quarters of mental disorders emerge before the age of 25 years and half before the age of 14.The National Action Plan for Promotion, Prevention and Early Intervention for Mental Health in 2000 emphasised the need to focus on the teenage and early adult years, and many of its directions were taken up and have significantly advanced. The Plan provided strong conceptual support to intervene early in the developmental trajectory of mental disorder, aiming to prevent the development of disorder where possible and, where this was not possible, to mitigate the impact of disorder on the individual, their family and the community. It is particularly important to reduce the impact of mental health problems on adolescents and young adults as they are in the process of accomplishing essential developmental tasks that if not achieved, interfere with their transition to adulthood and can have a lifelong negative impact. All young people need support to develop their identity and independence, belong and connect with relevant social groups including family, and to attain educational and vocational goals. Young people experiencing mental health problems need even greater support to achieve these outcomes.This special issue of Advances in Mental Health (ISSN 1837-4905), 'Promoting Youth Mental Health through Early Intervention' also released as a reader (ISBN 978-1-921729-30-0), presents a range of original research, conceptual and descriptive articles that consider some recent initiatives in promoting youth mental health through early intervention. The first paper (Catania, Hetrick, Newman & Purcell, 2011) sets the groundwork by examining whether there are evidence-based models of care for prevention and early intervention for mental health problems for those aged up to 25 years. Importantly, evidence for childhood interventions is covered as well as that relevant in adolescence and early adulthood. This acknowledges that the childhood and preteen years are also vital for early intervention for mental health. Catania et al. (2011) argue that there is a pressing need to develop better models of care to ensure greater access to appropriate early intervention services, and that evidence for the value of collaborative and integrated service systems is growing.The next three papers (Collin et al., 2011; Howe, Batchelor, & Bochynska, 2011; Wilson, Rickwood, Bushnell, Caputi, & Thomas, 2011) consider different aspects of promoting effective help-seeking and service use by young people. The strong current focus on youth help-seeking is in response to the low rate of professional service use evident at this stage of life - a clear mismatch with the high level of need. Effective youth participation is essential to developing services that young people are prepared to use, and the paper entitled 'Finding our way' (Howe et al., 2011) describes how youth participation was incorporated within the development and promotion of youth mental health services in the Central Coast. The next article considers two factors that have been argued to signifi- cantly impact on young people's reluctance to use professional services - need for autonomy and preference for seeking help from informal sources - and their infl uence is shown to be not quite as expected (Wilson et al. …

The capability approach provides a broad evaluative space for making funding decisions for health and care interventions, with capability wellbeing as the outcome of value. A range of capability measures have been developed for the economic evaluation of health and care interventions for adults. However, such measures have not been previously developed for children and young people for this purpose and may be valuable. This study aimed to identify important capabilities for children and young people aged 11–15, and to develop these into attributes for an economic measure that can inform funding decisions. Thirty-three qualitative in-depth interviews were undertaken with children and young people aged 11–15 (n = 19) and parents (n = 14) in urban and rural areas of England between September 2019 and November 2021. Purposeful maximum variation sampling ensured representation from different backgrounds. Children and young people were asked to think of things important to them and place these on sticky notes around a drawing/photograph of themselves; the interview asked them about these important things. Parents were asked to identify factors that enhanced and negatively impacted their child's quality of life. Analysis using constant comparison facilitated exploration of similarities and differences in important capabilities. A second phase of semi-structured interviews with children and young people (n = 15) explored how these attributes should be expressed in a meaningful way. Eight overarching capability wellbeing themes were identified, with some variation across children and young people, and parent groups: Fun and enjoyment; Learning and experiencing; Attachment; Emotional security andsupport; Achievement; Identity and choice; Physical safety; Aspiration. Potentially, this information will help to provide an alternative approach to the measurement of benefits to children and young people for economic evaluation of health and care interventions, one that will be better able to capture benefits associated with interventions to improve the social determinants of health.

BackgroundDespite increased focus on adolescence, young people’s voices are often undervalued and underrepresented in health inequalities research and policy. Through exploring young people’s priorities for their health and their community, we may begin to understand how public health interventions and policies can be more effective and equitable. Engaging with youth using art enables empowerment and self-expression on these complex topics.MethodsCreative workshops, co-produced with a young artist, were delivered at three youth centres to participants aged 11–18 years (n = 30) in disadvantaged areas of Bristol, UK. Participants engaged in art and were guided by a semi-structured topic guide through focus group discussion. Thematic analysis, supported by the young artist, was used to distil key policy priorities for young people to be delivered to the local authority.ResultsThe young people identified a list of key priorities. These were: (1) mental health, (2) feeling ‘forgotten’ as an age group and having safe city spaces to socialise, (3) the need for greater support for their education and career aspirations. I provide a brief summary of these priorities, but the focus of this article is on the critical reflections on this innovative way of engaging with young people about local policy. I provide key learning points for researchers looking to do creative public health work in community settings and involve marginalised young people.ConclusionsArt is a promising way of engaging with young people in community settings and elevating marginalised voices. Co-producing with a local young artist enriched the project and partially alleviated power imbalances. This approach has potential for involving different groups within local policymaking and priority setting around health inequalities.