Involving young people in health promotion, research and policy-making: practical recommendations

Involving young people in health promotion, research and policy-making: practical recommendations Abstract Youth is a dynamic and complex transition period in life where many factors jeopardise its present and future health. Youth involvement enables young people to influence processes and decisions that affect them, leading to changes in themselves and their environment (e.g. peers, services, communities and policies); this strategy could be applied to improve health and prevent diseases. Nonetheless, scientific evidence of involving youth in health-related programmes is scarce. The aim of this paper is to describe youth involvement as a health promotion strategy and to compile practical recommendations for health promoters, researchers and policy-makers interested in successful involvement of young people in health-related programmes. These suggestions aim to encourage a positive working synergy between adults and youth during the development, implementation and evaluation of policies, research and/or health promotion efforts that target adolescents. adolescents health, participation, youth involvement, health promotion Background Youth is one of the most dynamic and complex transition periods in life with a series of turning points that can shape identity and influence development, health and wellbeing [1]. Moreover, half of preventable premature deaths are associated with health risk behaviours developed during youth (e.g. poor dietary and physical activity patterns, alcohol abuse, drug misuse) [2]. Such behaviours can track into adulthood and contribute to the leading causes of non-communicable diseases, mortality and morbidity [3]. The prevalence of health-compromising behaviours that emerge during youth is high enough to classify them as healthcare challenges and high-priority areas for public health research, policy and practice [4, 5]. Furthermore, reducing their cumulative consequences is usually simpler and more cost-effective for societies when addressed during adolescence [5]. The terms ‘youth involvement’ or ‘youth participation’ are generally used interchangeably when addressing the inclusion of young people in matters that affect them, but several definitions exist to explain this concept [6–9]. For instance, the UK’s National Children’s Bureau defines it as ‘the means by which children and adolescents influence decisions that bring about change in them, others, their services and their communities’ [6]. Youth participation has become one of the axioms of effective policy and programming development [10]. However, the effectiveness of this strategy in health-related programmes has not been measured properly since many programmes are constructed using an adult lens and overlooking real-life youth’s experiences [10, 11]. Thus, a participatory strategy is gaining recognition as a viable approach not only to prevent youth health problems, but also to enhance positive development among young people [11]. Nonetheless, ‘there is [still] a need for better and collective understanding of what youth participation involves [and] how it can be implemented’ [12], and scientific evidence-base on the benefits of involving youth in health-related activities is needed; [13, 14] with efforts, underway to address this gap [15, 16]. In this perspective on quality paper, the terms youth and young people are used interchangeably to include children, adolescents and young adults from 10 to 24 years of age. In doing so, we adopted a blanket definition that incorporates a wider age group as identified by reputable stakeholder perspectives, such as that from the World Health Organization (WHO) (10–19) [17], United Nations Convention on the Rights of the Child (UNCRC) (<18) and United Nations (UN) (youth 15–24; young people 10–24) [18]. Our work intends improving participation in this broader group and seeks to provide practical advice that can be tailored to the national or international frameworks. The aim of this perspective on quality paper is to reflect on the concept of youth involvement as a health promotion strategy, and to provide practical recommendations for their successful involvement in health-related activities drawn from a review of existing literature, reputable institutional guidelines and programme toolkits that supported cases for youth involvement as a health promotion strategy. Youth involvement Involvement is as a fundamental right for all people. For youth, this approach exists within the international context of the UNCRC. Specifically, Article 12 states that young people who can form their own views have a right to express them freely in all matters that affect them, assigning a proper weight in accordance to their age and maturity [18]. A direct result of the adoption of the UNCRC has been a change in perspective on their status in society, with children and adolescents now having a say in many aspects of their lives [19, 20]. In addressing health concerns for young people through the adoption of regional strategies like that of the WHO European region, which explicitly seeks to ‘make children’s lives visible’ [21], and the use of adolescent-specific research like the Health Behaviour in School-Children (HBSC) Study [13], policy-makers, advocates and researchers can ensure that youth realities are understood, appreciated and taken into account. The WHO advises that youth needs to be included as active partners in all health-related activity stages, from design through to evaluation, especially for programmes affecting their own health [22, 23]. This goal has been applied under strategies identified as youth engagement (i.e. which identifies youth’s right to participate in decisions that impact them by acknowledging the skills and strengths they add to programmes); [24, 25] youth organising (asset-based approaches, i.e. a youth development and social justice strategy that assists young people in employing skills to alter power relations and create meaningful institutional change in their communities); [26] participatory action research (i.e. giving voice to youth’s concerns, and launching programmes and activities that meet the needs of local youth within a community); [27] youth-driven approaches or youth-adult participation (i.e. includes high-quality youth- adult participation) [28]. Models and typologies of how to involve youth in participatory actions have been described [6, 11, 29, 30]. This participation has also been defined as a theory named ‘youth empowerment’ [4, 31, 32], which can be applied as a framework of public healthcare systems, were adolescents, as both stakeholders and patients, are catalysts in the process of creating patient-centred care [32]. All of these strategies emphasise inclusion and action, offering alternative approaches based on reflection, data collection, and action to improve young people’s health and reduce health inequities. What do adult stakeholders (e.g. health promoters, researchers, policy-makers) and health institutions gain when they embrace youth participation? Professionals who actively listen and involve youth in programmes are more likely to succeed [33] because their actions uphold youth’s rights, promote their protection and fulfil the State’s legal responsibilities [34]. Evidence suggests that young people’s participation in institutional and governmental decisions enhances their credibility in the eyes of society, while improving public services by promoting more transparent actions and participative culture [6, 35–37]. In research, youth involvement is compatible with improved quantitative and qualitative methods, and is a source of innovation that may facilitate the research process [13, 35, 38]. Additionally, researchers gain insight into new domains of enquiry through integrating youth in data generation, analysis, interpretation and dissemination activities [12]. What do youth gain with their participation in health-related activities? The acquisition of new skills, emotional links, knowledge, competences, self-efficacy, self-esteem and confidence, which can foster young people’s autonomy and help them to successfully manage the complex transition to adulthood. This reinforces their sense of control and awareness of their personal, community and environmental decisions. Youth can get confirmation that their views matter and this influence can affect their health [6, 11, 35, 39, 40]. They also learn about addressing structural constraints within institutions that are supposed to serve them, as well as city or state governance affecting their life quality, showing them that they have the opportunity to directly influence both methods and outcomes [11, 35]. Recommendations for youth’s involvement in health-related activities By acknowledging youth’s valuable contribution to health-related activities, both adult stakeholders and young people are benefited. However, if not properly done, youth engagement could result in an unnecessary, burdensome or hazardous experience for participants. Thus, a proper involvement strategy in health activities is necessary, but challenging [35]. A narrative review to identify specific recommendations to promote the design, implementation and evaluation of a successful youth participation was performed based on reputable institutional guidelines and programme toolkits [6, 11, 20, 29, 31, 35, 37, 40–47]. These recommendations have been organised in time-stages associated to the development of health-related activities or programmes (i.e. design, implementation and evaluation) to facilitate youth involvement as a sequential process and to reiterate the importance of coherent and meaningful participation throughout. A schematic overview of all recommendations is presented in Table 1. Table 1 Schematic overview of youth involvements practical recommendations for health promoters, researchers and/or policy-makers During the design of a youth involvement process  During the implementation of a youth involvement process  During the completion of a youth involvement process  Define the purpose of youths’ participation  Introduce all the participants and make them feel part of a team  Incentive  Use an established and reliable methodology  Identify intra-group diversity  Acknowledge youth’s and adult participation  Base the participation on a theoretical framework  Recognise possible stressors and barriers  Assure confidentiality  Choose age-appropriate activities  Set goals  Share experiences  Select a suitable working place and transportation  Remember that youth should collaborate, be involved, but not be solely responsible  Make public resolutions of the process  Provide food if necessary  Think with young people  Make materials available  Consider youth’s participation priorities  Include institutional players  Identify youth’s latest trends  Contemplate diversity  Let young people decide in case of peers’ representation  Minimise pressure  Use everyday language  Collect signed consent by young people and parents/legal guardians  Embrace communication through youth’s usual networks (e.g. social media) as much as young people want  Identify and address any legal concerns  Persuade youth’s creativity  Use of existing research, work and toolkits  During all the youth involvement stages  Guarantee the determination and serious adult commitment Plan and schedule Be open to change Select appropriate participants for partnerships Evaluate the process Motivate Consult young people about their sense of purpose and future Make sure the process’s transparency Participants need to understand limitations and restrictions  During the design of a youth involvement process  During the implementation of a youth involvement process  During the completion of a youth involvement process  Define the purpose of youths’ participation  Introduce all the participants and make them feel part of a team  Incentive  Use an established and reliable methodology  Identify intra-group diversity  Acknowledge youth’s and adult participation  Base the participation on a theoretical framework  Recognise possible stressors and barriers  Assure confidentiality  Choose age-appropriate activities  Set goals  Share experiences  Select a suitable working place and transportation  Remember that youth should collaborate, be involved, but not be solely responsible  Make public resolutions of the process  Provide food if necessary  Think with young people  Make materials available  Consider youth’s participation priorities  Include institutional players  Identify youth’s latest trends  Contemplate diversity  Let young people decide in case of peers’ representation  Minimise pressure  Use everyday language  Collect signed consent by young people and parents/legal guardians  Embrace communication through youth’s usual networks (e.g. social media) as much as young people want  Identify and address any legal concerns  Persuade youth’s creativity  Use of existing research, work and toolkits  During all the youth involvement stages  Guarantee the determination and serious adult commitment Plan and schedule Be open to change Select appropriate participants for partnerships Evaluate the process Motivate Consult young people about their sense of purpose and future Make sure the process’s transparency Participants need to understand limitations and restrictions  Summary of considerations based on reputable international institutional guidelines and programme toolkits for an adequate youth involvement. Table 1 Schematic overview of youth involvements practical recommendations for health promoters, researchers and/or policy-makers During the design of a youth involvement process  During the implementation of a youth involvement process  During the completion of a youth involvement process  Define the purpose of youths’ participation  Introduce all the participants and make them feel part of a team  Incentive  Use an established and reliable methodology  Identify intra-group diversity  Acknowledge youth’s and adult participation  Base the participation on a theoretical framework  Recognise possible stressors and barriers  Assure confidentiality  Choose age-appropriate activities  Set goals  Share experiences  Select a suitable working place and transportation  Remember that youth should collaborate, be involved, but not be solely responsible  Make public resolutions of the process  Provide food if necessary  Think with young people  Make materials available  Consider youth’s participation priorities  Include institutional players  Identify youth’s latest trends  Contemplate diversity  Let young people decide in case of peers’ representation  Minimise pressure  Use everyday language  Collect signed consent by young people and parents/legal guardians  Embrace communication through youth’s usual networks (e.g. social media) as much as young people want  Identify and address any legal concerns  Persuade youth’s creativity  Use of existing research, work and toolkits  During all the youth involvement stages  Guarantee the determination and serious adult commitment Plan and schedule Be open to change Select appropriate participants for partnerships Evaluate the process Motivate Consult young people about their sense of purpose and future Make sure the process’s transparency Participants need to understand limitations and restrictions  During the design of a youth involvement process  During the implementation of a youth involvement process  During the completion of a youth involvement process  Define the purpose of youths’ participation  Introduce all the participants and make them feel part of a team  Incentive  Use an established and reliable methodology  Identify intra-group diversity  Acknowledge youth’s and adult participation  Base the participation on a theoretical framework  Recognise possible stressors and barriers  Assure confidentiality  Choose age-appropriate activities  Set goals  Share experiences  Select a suitable working place and transportation  Remember that youth should collaborate, be involved, but not be solely responsible  Make public resolutions of the process  Provide food if necessary  Think with young people  Make materials available  Consider youth’s participation priorities  Include institutional players  Identify youth’s latest trends  Contemplate diversity  Let young people decide in case of peers’ representation  Minimise pressure  Use everyday language  Collect signed consent by young people and parents/legal guardians  Embrace communication through youth’s usual networks (e.g. social media) as much as young people want  Identify and address any legal concerns  Persuade youth’s creativity  Use of existing research, work and toolkits  During all the youth involvement stages  Guarantee the determination and serious adult commitment Plan and schedule Be open to change Select appropriate participants for partnerships Evaluate the process Motivate Consult young people about their sense of purpose and future Make sure the process’s transparency Participants need to understand limitations and restrictions  Summary of considerations based on reputable international institutional guidelines and programme toolkits for an adequate youth involvement. During ‘all the involvement stages’, health promoters, researchers and/or policy-makers must consider: Commitment: Adults should be willing to adapt to youth’s necessities [41] and be devoted to the whole process. Planning and schedule: Consider sufficient time for each activity. Schedules should be adapted to the youth’s needs and their other commitments (i.e. school and extra-curricular activities) [35]. Be open to change: Organisers must accept youth’s perspectives and ideas and be willing to adjust rules, which meet their needs [37]. Selectiveness: Choose the appropriate participants for partnerships. Youth vary widely in their level of development and readiness to assume responsibility, and adults vary widely in their degree of commitment and willingness to work with youth [13]. Evaluation: Participants should evaluate the process before, during and after its execution. For this purpose, apply short questions with simple language, avoiding abstract concepts. There are no right or wrong answers, and this message must be reiterated during data collection. Also, ensure to register all kind of answers, even if these are non-verbal methods of communication (e.g. drawings) [6]. Motivation: Ensure participant’s engagement for the whole process [42]. Sense of purpose: Consult youth’s expectations and goals in their healthy lifestyles [10]. Transparency: All the process needs to be clear, providing straightforward data on their right to express views freely [35]. Limitations: Participants need to understand the restrictions that affect the processes [10]. During ‘the design’ of a youth involvement process, health promoters, researchers and/or policy-makers must consider: Purpose: Clearly state the reasons for youth involvement and the expectations of this participation [43]. Established methodology: All the process should be evidence-based, ethical, realistic and properly resourced [6]. There are models described for youth involvement, which could help design a plan [6, 11, 29, 31]. Theoretical framework: Social science theories and conceptual models provide the basis for understanding human behaviours [44]. Theoretical frameworks help monitor both youth and adult involvement in the activities (e.g. empowerment theoretical framework) [31]. Age-appropriate activities: Participation activities need to be meaningful to youth according to their capabilities [20, 35]. Given the formative stage in which they live, activities should consider the integration of learning skills in mathematics, social studies, communications, critical thinking and problem solving [40]. Working place and transportation: Adults are responsible for creating safe environments where youth feel welcome and therefore, willing to share their views [11]. Identify conditions, personal risks and protective factors to create a formal or informal place where involved youth feel safe [40]. If possible, schedule meetings in easily accessible places, considering that youth usually do not have a personal vehicle. Organisers should provide travel vouchers or promptly reimburse youth for transportation costs [37]. Food: Youth rarely have the means to buy meals or dinners outside of their home. When meetings overlap with meal times, consider providing youth with either food or sufficient funds to pay for meals [37]. Materials: The cost of materials and dispensations (cameras, developing, printing, art materials) must be included in project budget and covered by the responsible party. For this reason, it is indispensable to have a list of materials needed for each activity and participant [6]. Institutional players: Adults should seek to integrate institutions within the social environment that influence the life of the youth that will participate (e.g. schools, community centres, city councils) [11]. Diversity: Youth participation must aim to include all youth rather than only a few easy to reach potential participants, regardless of their background and without discrimination on any grounds -age, race, sex, language, religion, political, national, ethnic or social origin, disability or other status [34]. Efforts should be made to include adolescents from vulnerable backgrounds [6] (e.g. youth in public care, with learning difficulties, living in low-income communities). Pressure minimisation: Give participants some time to reflect and confirm their commitment to the process [35]. Clarify that youth’s involvement is a voluntary participation, in which no right or wrong answers exist. Signed consent: Information for youth and parents/legal guardians about the process must be provided and it must be clearly explained, including: objectives, description of the process and the roles of each participant, person or institution responsible (include timescale if possible), number of expected participants and their ages, facilitators, logistics and support available [35]. Identify legal concerns: Seek consent to use any material collected during activities (e.g. ideas, pictures, drawings, photographs or other materials created) for reports or dissemination [6]. Also, consider processing the adequate work permits or insurance if youth involved is employed. Existing research and toolkits: Identify similar youth participation models or toolkits in your field. Drawing inspiration from previous successful interventions programme design or research may work as a tool for questioning, understanding, and addressing the issue at hand [39]. During ‘the implementation’ of a youth involvement process, health promoters, researchers and/or policy-makers must consider: Presentation and team formation: Be sure that all participants meet each other, creating a casual atmosphere. Clearly, state the roles and responsibilities of everyone in the process. Each participant will need to agree to the assigned roles and responsibilities [37]. Intra-group diversity: Recognise within the group any age, socioeconomic background, race, colour, sex, language, and religion, political or ethnic origin. Some of these factors may act as constraints in youth’s social interaction [34]. Barriers: Individual and/or group health risks and stressors can be identified in various domains (e.g. family, peers, school, etc.) that can have effects on the individual perspectives [40]. Identify, manage and remove any stressors and/or barriers wherever possible [6]. Goals: Set clear targets with the youth as a common agreement [35]. Collaboration and involvement with no sole responsibility: Aim to create a balance of power between adults and youth during the research and participation process [28]. Remember that it is a partnership; neither the young people nor adults are necessarily subordinate of the other [37]. Lack of adult involvement in youth participation may obstruct rather than encourage optimal adolescent development and empowerment [11]. Brainstorming: Create a co-learning relationship where youth and adults raise the level of collective critical consciousness. Adults can be actively involved in fostering conditions for youth [11], and help them to be more open to learn, engage in critical dialogue and exercise creativity [10]. Priorities: Establish priorities for the process, generating theories of causality, solutions and change [39]. Latest trends: Youth culture evolves so rapidly that by the time older age groups begin to understand it, youth have already adopted a new trend. To create an empathic interaction with youth, be sure that participating adults are updated on the latest tendencies and youth’s preferences [45]. Decision in peers’ representation: Let participants select among themselves those that will represent them [35]. Everyday language: The participatory process should include a language with which youth are familiar. Avoid labels or nicknaming among youth without their approval [43]. Communication: Nowadays, youth communicate to a larger extent via social media applications and services. As such, it should be considered as a practical tool in youth involvement. Social media allows interaction outside the confines of physical proximity, which could benefit the involvement procedure beyond face-to-face interactions [46]. Creativity: Allow youth to express themselves in a way that others may appreciate what they hear. Be sure to encourage creativity during the process [47]. During ‘the evaluation’ of a youth involvement process, health promoters, researchers and/or policy-makers must consider: Incentive or rewarding participation: This does not necessarily mean an economic or tangible reward. Ensure participation ends in a meaningful way, e.g. evaluate satisfaction, pride or incentives [11]. Acknowledging: Recognise all the participants’ contributions in the process, both youth and adults [10, 34]. Confidentiality: Youth participants should afford the same degree of protection regarding confidentiality, anonymity and data protection as adult participants [6]. Communication: Support youth’s share their experiences, which can have a powerful impact on audiences of all ages [35]. Resolutions: Identify power differentials between participants. Move toward change strategies on these levels that mediate power by improving conditions for youth, ensuring that the results from this collaboration are translated into actions. In addition, findings should be accessible to the general audience to raise awareness [6, 29]. Discussion Youth involvement in health-related programmes can make a difference in programme success [10, 37, 48]. There is evidence to suggest that participatory approaches to health add value to programmes [10, 33]. In many ways, however, it is as much about changing cultures [24] as it is about changing processes. For this reason, youth involvement as a health promotion strategy has the potential to promote health by satisfying youth’s developmental needs in a positive manner [11]. Youth involvement is not a traditional risk-factor based public health approach; it provides a new focus on the assets that youth inherently possess, adopts them while also eliciting changes in youth themselves. However, the best frameworks may include elements of both approaches (public health and youth development) working together [48–50]. Some successful health-related programmes have reported the use of youth involvement as a fundamental strategy (Table 2) [24, 48, 51–53]. For instance, the Spanish participation at the European Youth Tackling Obesity (EYTO) project, (implemented as a randomised controlled trial) significantly increased daily fruit consumption and daily physical activity practice in adolescent’ participants. This positive result is attributable to the youth being involved in the design and implementation stages of the activities [48, 51–53]. In the referenced examples, youth involvement supported the creation of a collective critical consciousness [11], not only by creating a work synergy with adults, but also raising awareness among peers and their communities. However, youth participation can pose a challenge to health promoters, researchers and policy-makers as they balance the importance of involving end-users to increase uptake of effective interventions, programmes and policies [47] and the feasibility of those approaches in light of resource limitations or knowledge constraints that may dissuade them from engaging. Essentially, the main challenge is how to effectively involve youth to create a working synergy that improves policies and programmes worldwide. For this reason, and for a proper evaluation of this strategy, health programmes that include youth should put this strategy into practice. Table 2 Examples of youth involvement as a health promotion strategy Project Name  Country  Description  Website  The Students Commission  Canada  Founded in 1991 to help young people put their ideas for improving themselves, their communities and their world into action. In 2000, it became the lead of The Centre of Excellence for Youth Engagement, which networks academics, youth organisations and young people together to provide research and training to improve youth programmes and youth engagement in Canada. The Commission works with the Health Behaviour in School-aged Children (HBSC), a WHO Collaborative Study, in Canada team to develop and carry out their youth participation efforts. For an example of their work [10].  www.studentscommission.ca/  The Dream Teens Project  Portugal  In 2013 was launched in Portugal to give voice to young people in matters that affect them. Participants (under-18) were actively involved in the elaboration of research instruments and group debates on issues such as mental health, sexuality, substance consumption, self-harm, interpersonal violence, academic success and expectations, family support, social support networks, leisure, among others. Young people have identified emerging problems, gaps and solution trajectories [51].  www.dreamteens-en.aventurasocial.com/  The European Youth Tackling Obesity (EYTO) Project  UK, Portugal, Czech Republic, Spain  In 2014 was launched to create a multicentre project. Five selected adolescents (in each country) were tasked with designing and implementing youth-led social marketing approach to promote healthy eating and physical activity and to stem the rise in obesity amongst young people aged between 13 and 18 years old living in low socioeconomic areas [47, 50].  http://www.eyto.org.uk/  Project Name  Country  Description  Website  The Students Commission  Canada  Founded in 1991 to help young people put their ideas for improving themselves, their communities and their world into action. In 2000, it became the lead of The Centre of Excellence for Youth Engagement, which networks academics, youth organisations and young people together to provide research and training to improve youth programmes and youth engagement in Canada. The Commission works with the Health Behaviour in School-aged Children (HBSC), a WHO Collaborative Study, in Canada team to develop and carry out their youth participation efforts. For an example of their work [10].  www.studentscommission.ca/  The Dream Teens Project  Portugal  In 2013 was launched in Portugal to give voice to young people in matters that affect them. Participants (under-18) were actively involved in the elaboration of research instruments and group debates on issues such as mental health, sexuality, substance consumption, self-harm, interpersonal violence, academic success and expectations, family support, social support networks, leisure, among others. Young people have identified emerging problems, gaps and solution trajectories [51].  www.dreamteens-en.aventurasocial.com/  The European Youth Tackling Obesity (EYTO) Project  UK, Portugal, Czech Republic, Spain  In 2014 was launched to create a multicentre project. Five selected adolescents (in each country) were tasked with designing and implementing youth-led social marketing approach to promote healthy eating and physical activity and to stem the rise in obesity amongst young people aged between 13 and 18 years old living in low socioeconomic areas [47, 50].  http://www.eyto.org.uk/  Table 2 Examples of youth involvement as a health promotion strategy Project Name  Country  Description  Website  The Students Commission  Canada  Founded in 1991 to help young people put their ideas for improving themselves, their communities and their world into action. In 2000, it became the lead of The Centre of Excellence for Youth Engagement, which networks academics, youth organisations and young people together to provide research and training to improve youth programmes and youth engagement in Canada. The Commission works with the Health Behaviour in School-aged Children (HBSC), a WHO Collaborative Study, in Canada team to develop and carry out their youth participation efforts. For an example of their work [10].  www.studentscommission.ca/  The Dream Teens Project  Portugal  In 2013 was launched in Portugal to give voice to young people in matters that affect them. Participants (under-18) were actively involved in the elaboration of research instruments and group debates on issues such as mental health, sexuality, substance consumption, self-harm, interpersonal violence, academic success and expectations, family support, social support networks, leisure, among others. Young people have identified emerging problems, gaps and solution trajectories [51].  www.dreamteens-en.aventurasocial.com/  The European Youth Tackling Obesity (EYTO) Project  UK, Portugal, Czech Republic, Spain  In 2014 was launched to create a multicentre project. Five selected adolescents (in each country) were tasked with designing and implementing youth-led social marketing approach to promote healthy eating and physical activity and to stem the rise in obesity amongst young people aged between 13 and 18 years old living in low socioeconomic areas [47, 50].  http://www.eyto.org.uk/  Project Name  Country  Description  Website  The Students Commission  Canada  Founded in 1991 to help young people put their ideas for improving themselves, their communities and their world into action. In 2000, it became the lead of The Centre of Excellence for Youth Engagement, which networks academics, youth organisations and young people together to provide research and training to improve youth programmes and youth engagement in Canada. The Commission works with the Health Behaviour in School-aged Children (HBSC), a WHO Collaborative Study, in Canada team to develop and carry out their youth participation efforts. For an example of their work [10].  www.studentscommission.ca/  The Dream Teens Project  Portugal  In 2013 was launched in Portugal to give voice to young people in matters that affect them. Participants (under-18) were actively involved in the elaboration of research instruments and group debates on issues such as mental health, sexuality, substance consumption, self-harm, interpersonal violence, academic success and expectations, family support, social support networks, leisure, among others. Young people have identified emerging problems, gaps and solution trajectories [51].  www.dreamteens-en.aventurasocial.com/  The European Youth Tackling Obesity (EYTO) Project  UK, Portugal, Czech Republic, Spain  In 2014 was launched to create a multicentre project. Five selected adolescents (in each country) were tasked with designing and implementing youth-led social marketing approach to promote healthy eating and physical activity and to stem the rise in obesity amongst young people aged between 13 and 18 years old living in low socioeconomic areas [47, 50].  http://www.eyto.org.uk/  The youth involvement recommendations in this manuscript are not checklists to follow, but aim to facilitate a process that reflects a true partnership between youth and adults in a professional setting, integrating the perspectives and skills of youth with the experience of adults [10]. These recommendations stem from evidence of what works and may be useful along health promotion efforts and future youth research. The practical suggestions seek to contribute towards the development of evidence-base on health promotion, research and policy-making and practice around youth participation while also reducing the gap between stakeholder intent and understanding of youth participation in health-related activities. Conclusion Youth involvement in health-related activities needs to be a carefully planned process that, at every stage, encourages synergy between youth and relevant adult stakeholders such as health promoters, researchers or policy-makers. Thoughtfully implementing youth participation as a health promotion strategy will help all involved stakeholders achieve health and wellbeing goals. This synergy should catalyse joint efforts aimed at the improvement of young people’s health. Acknowledgements The authors would like to thank Professor Candace Currie for her insight in writing this paper, and for giving MA-M the opportunity to work at the WHO Collaborative Centre for International Child and Adolescent Health Policy, and Child and Adolescent Health Research Unit from the University of St Andrews and Dr Jo Inchley for her valuable comments in developing this manuscript. Funding This review had no specific support or funding. References 1 Adolescence: a period needing special attention - recognizing-adolescence. World Health Organization (WHO). http://apps.who.int/adolescent/second-decade/section2/page1/recognizing-adolescence.html (24 June 2017, date last accessed). 2 Maharaj RG, Nunes P, Renwick S. Health risk behaviours among adolescents in the English-speaking Caribbean: a review. Child Adolesc Psychiatry Ment Health  2009; 3: 10. Google Scholar CrossRef Search ADS PubMed  3 Catalano RF, Fagan AA, Gavin LE et al.  . Worldwide application of prevention science in adolescent health. Lancet  2012; 379: 1653– 64. Google Scholar CrossRef Search ADS PubMed  4 Adrian M, Charlesworth-Attie S, Vander Stoep A et al.  . Health promotion behaviors in adolescents: prevalence and association with mental health status in a statewide sample. J Behav Health Serv Res  2014; 41: 140– 52. Google Scholar CrossRef Search ADS PubMed  5 Naudeau S, Cunningham W, Lundberg MK et al.  . Programs and policies that promote positive youth development and prevent risky behaviors: An international perspective. New Dir Child Adolesc Dev  2008; 122: 75– 87. Google Scholar CrossRef Search ADS   6 National Children’s Bureau. Guidelines for research with children and young people . London: National Children’s Bureau, 2011. London: National Children’s Bureau Research Centre. 7 Marx M, Finger W, Mahler H Youth participation guide: assessment planning and implementation. Arlington, Virginia. 2005 8 Participation Models Citizens, Youth, Online. Creative Commons. Demokratie & Dialog website. http://www.demokratie-dialog.de/work/Participation-Models20110703.pdf (7 March 2017, date last accessed). 9 Rajani R. The participation rights of adolescents: A strategic approach . New York: UNICEF, 2001: 1– 67. 10 Cook P. Understanding the effects of adolescent participation in health programmes. Int J Children’s Rights  2008; 16: 121– 39. Google Scholar CrossRef Search ADS   11 Wong NT, Zimmerman MA, Parker EA. A typology of youth participation and empowerment for child and adolescent health promotion. Am J Community Psychol  2010; 46: 100– 14. Google Scholar CrossRef Search ADS PubMed  12 Youth Participation Fact Sheet. United Nations and the Focal Point on Youth Web site http://www.un.org/esa/socdev/documents/youth/fact-sheets/youth-participation.pdf (23 August 2016, date last accessed). 13 Inchley J, Currie D. Growing up unequal: gender and socioeconomic differences in young people’s health and well-being. Health Behaviour in School-aged Children (HBSC) study: international report from the, 2014. Health Policy for Children and Adolescents, No. 7 . Copenhaghen: World Health Organization, 2013. 14 Patton GC, Sawyer SM, Santelli JS et al.  . Our future: a Lancet commission on adolescent health and wellbeing. Lancet  2016; 387: 2423– 78. Google Scholar CrossRef Search ADS PubMed  15 Gavine A, Morgan A, Aleman-Diaz AY et al.   The benefits of involving young people in the health development process: protocol for a systematic review. (Under review for publication). 16 Gavine A, Aleman-Diaz AY, Currie C et al.   The engagement of young people in the development and implementation of programmes to secure health: a systematic review. St Andrews: St Andrews Medical School (Under review for publication). 17 Adolescent Health, World Health Organization, 2018. Adolescent health. http://www.who.int/maternal_child_adolescent/adolescence/en/ (19 January 2017, date last accessed). 18 United Nations Convention on the Rights of the Child ( 1989) (UNCRC) ‘Your rights under the UNCRC’ United Nations Children’s Fund (UNICEF) Youth Voice website: https://downloads.unicef.org.uk/wpcontent/uploads/2010/05/UNCRC_united_nations_convention_on_the_rights_of_the_child.pdf (16 January 2017, date last accessed). 19 UNCRC General Comment No.19 on Public Budgeting for the Realization of Children’s Rights: 29 launches contributing to awareness, partnerships, children’s voices and pledges on investment in children. UNCRC. The Child Rights Connect Working Group on Investment in Children Website: http://eurochild.org/fileadmin/public/05_Library/Thematic_priorities/01_Childrens_Rights/Other/GC_No._19_launch_results.pdf (7 January 2017, date last accessed). 20 Alderson P, Morrow V. Ethics, Social Research and Consulting with Children and Young People . Ilford: Barnardo’s, 2004. 21 Investing in children: The European child and adolescent health strategy 2015–2020. WHO Regional Office for Europe Website. http://www.euro.who.int/en/healthtopics/Life-stages/child-and-adolescent-health/policy/investing-in-children-theeuropean-child-and-adolescent-health-strategy-20152020 7 March 2017, date last accessed). 22 World Health Organization. Programming for Adolescent Health and Development . Geneva: World Health Organization, 2001. PubMed PubMed  23 Jensen BB, Simovska V, Larsen N et al.  . Young people want to be part of the answer . Copenhagen: WHO Regional Office for Europe. Copenhagen, 2005. 24 Pan Canadian Joint Consortium for School Health’s (JCSH) Youth Engagement (YE) Toolkit. Pan Canadian Joint Consortium for School Health’s (JCSH) Website. http://www.jcsh-cces.ca/ye-book/ (15 March 2017, date last accessed). 25 Scheve JA, Perkins DF, Mincemoyer CC, Welsh JA. Say YES to youth: Youth engagement strategies . University Park, PA: The Pennsylvania State University, 2005. 26 Christens BD, Kirshner B. Taking stock of youth organizing: an interdisciplinary perspective. In Flanagan CA, Christens BD (Eds.), Youth civic development: work at the cutting edge. New Dir Child Adolesc Dev  2011; 134: 27– 41. Google Scholar CrossRef Search ADS   27 Foster-Fishman PG, Law KM, Lichty LF, Aoun C. Youth ReACT for Social Change: a method for youth participatory action research. Am J Community Psychol  2010; 46: 67– 83. Google Scholar CrossRef Search ADS PubMed  28 Larson R, Walker K, Pearce N. A comparison of youthQdriven and adultQdriven youth programs: balancing inputs from youth and adults. J Community Psychol  2005; 33: 57– 74. Google Scholar CrossRef Search ADS   29 Hart R. Children’s participation: From tokenism to citizenship (no. 4) . Florence: UNICEF International Child Development Centre, 1992. 30 Shier H. Pathways to participation: openings, opportunities, and obligations. Children and Society. Child Soc  2001; 15: 107– 17. Google Scholar CrossRef Search ADS   31 Jennings LB, Parra-Medina DM, Hilfinger-Messias DK, McLoughlin K. Toward a critical social theory of youth empowerment. J Comm Pract  2006; 14: 31– 55. Google Scholar CrossRef Search ADS   32 Klaus H. Youth empowerment to achieve patient engagement. N C Med J  2015; 76: 187– 8. Google Scholar PubMed  33 Morgan A, Aleman-Diaz AY Measuring what matters for young people’s health and well-being: an asset approach. Learning for Well-being Magazine. Bloemendaal, The Netherlands. 2016. 34 Farthing R. Why youth participation? Some justifications and critiques of youth participation using New Labour’s youth policies as a case study. Youth Policy  2012; 109: 71– 97. 35 Children’s participation in public decision-making. Why should I involve children?  Brussels: Jeunesse de la Fédération Wallonie-Bruxelles, 2014. 36 Ott MA, Rosenberger JG, McBride KR, Woodcox SG. How do adolescents view health? Implications for state health policy. J Adolesc Health  2011; 48: 398– 403. Google Scholar CrossRef Search ADS PubMed  37 Klindera K, Menderweld J. Youth involvement in prevention programming . Washington, D.C.: Advocates for Youth, 2001. 38 Janina B, Lobo R, Hallett J, Brown G, Maycock B. My-Peer Toolkit [1.0] Developing an online resource for planning and evaluating peer-based youth programs. Youth Stud Aust  2012; 31: 53. 39 Zimmerman MA. Psychological empowerment: issues and illustrations. Am J Community Psychol  1995; 23: 581– 99. Google Scholar CrossRef Search ADS PubMed  40 Berg M, Coman E, Schensul JJ. Youth action research for prevention: a multi-level intervention designed to increase efficacy and empowerment among urban youth. Am J Community Psychol  2009; 43: 345– 59. Google Scholar CrossRef Search ADS PubMed  41 Dotterweich J Practice Matters—Strengthening Youth Involvement. New York City: ACT for Youth Center of Excellence, Cornell University, University of Rochester, the New York State Center for School Safety, and Cornell Cooperative Extension of New York City. 2014 42 Luciana M, Collins PF. Incentive motivation, cognitive control, and the adolescent brain: is it time for a paradigm shift? Child Dev Perspect  2012; 6: 392– 9. Google Scholar PubMed  43 Millstein SG, Petersen AC, Nightingale EO. Adolescent health promotion: Rationale, goals, and objectives. Promoting the health of adolescents: New directions for the twenty-first century . Oxford: Oxford University Press, 1993. 44 Baranowski T, Cullen KW, Nicklas T, Thompson D, Baranowski J. Are current health behavioral change models helpful in guiding prevention of weight gain efforts? Obes Res  2003; 11: 23S– 43S. Google Scholar CrossRef Search ADS PubMed  45 Willis PE, Jones S, Canaan J, Hurd G. Common culture: Symbolic work at play in the everyday cultures of the young . Milton Keynes: Open University Press, 1990. 46 McBride DL. Risks and benefits of social media for children and adolescents. J Pediatr Nurs  2011; 26: 498– 9. Google Scholar CrossRef Search ADS PubMed  47 Resnick MD, Catalano RF, Sawyer SM, Viner R, Patton GC. Seizing the opportunities of adolescent health. Lancet  2012; 379: 1564– 7. Google Scholar CrossRef Search ADS PubMed  48 Aceves-Martins M, Llauradó E, Tarro L et al.  . School-based, peer-led, social marketing intervention to engage Spanish adolescents in a healthy lifestyle (‘We Are Cool’-Som la Pera Study): a parallel-cluster randomized controlled study. Child Obes  2017; 13: 300– 13. Google Scholar CrossRef Search ADS PubMed  49 Birkhead GS, Riser MH, Mesler K, Tallon TC, Klein SJ. Youth development is a public health approach. Introduction. J Public Health Manag Pract  2006; 12: S1– 3. Google Scholar CrossRef Search ADS   50 Mokwena S. Putting youth engagement into practice: A toolkit for action. Commonwealth Youth and Development . London: Commonwealth for action, 2007. 51 Llauradó E, Aceves-Martins M, Tarro L et al.  . A youth-led social marketing intervention to encourage healthy lifestyles, the EYTO (European Youth Tackling Obesity) project: a cluster randomised controlled trial in Catalonia, Spain. BMC Public Health  2015; 15: 607. Google Scholar CrossRef Search ADS PubMed  52 Frasquilho D, Ozer EJ, Ozer EM et al.  . Dream teens: adolescents-led participatory project in Portugal in the context of the economic recession. Health Promot Pract  2016; 19: 51– 9. Google Scholar CrossRef Search ADS PubMed  53 Matos MG, Simões C. From positive youth development to youth’s engagement: the dream teens. Int J Emot Educ  2016; 8: 4– 18. © The Author(s) 2018. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/about_us/legal/notices) http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png International Journal for Quality in Health Care Oxford University Press

Involving young people in health promotion, research and policy-making: practical recommendations

Loading next page...
 
/lp/ou_press/involving-young-people-in-health-promotion-research-and-policy-making-gLH6iUCwcn
Publisher
Oxford University Press
Copyright
© The Author(s) 2018. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com
ISSN
1353-4505
eISSN
1464-3677
D.O.I.
10.1093/intqhc/mzy113
Publisher site
See Article on Publisher Site

Abstract

Abstract Youth is a dynamic and complex transition period in life where many factors jeopardise its present and future health. Youth involvement enables young people to influence processes and decisions that affect them, leading to changes in themselves and their environment (e.g. peers, services, communities and policies); this strategy could be applied to improve health and prevent diseases. Nonetheless, scientific evidence of involving youth in health-related programmes is scarce. The aim of this paper is to describe youth involvement as a health promotion strategy and to compile practical recommendations for health promoters, researchers and policy-makers interested in successful involvement of young people in health-related programmes. These suggestions aim to encourage a positive working synergy between adults and youth during the development, implementation and evaluation of policies, research and/or health promotion efforts that target adolescents. adolescents health, participation, youth involvement, health promotion Background Youth is one of the most dynamic and complex transition periods in life with a series of turning points that can shape identity and influence development, health and wellbeing [1]. Moreover, half of preventable premature deaths are associated with health risk behaviours developed during youth (e.g. poor dietary and physical activity patterns, alcohol abuse, drug misuse) [2]. Such behaviours can track into adulthood and contribute to the leading causes of non-communicable diseases, mortality and morbidity [3]. The prevalence of health-compromising behaviours that emerge during youth is high enough to classify them as healthcare challenges and high-priority areas for public health research, policy and practice [4, 5]. Furthermore, reducing their cumulative consequences is usually simpler and more cost-effective for societies when addressed during adolescence [5]. The terms ‘youth involvement’ or ‘youth participation’ are generally used interchangeably when addressing the inclusion of young people in matters that affect them, but several definitions exist to explain this concept [6–9]. For instance, the UK’s National Children’s Bureau defines it as ‘the means by which children and adolescents influence decisions that bring about change in them, others, their services and their communities’ [6]. Youth participation has become one of the axioms of effective policy and programming development [10]. However, the effectiveness of this strategy in health-related programmes has not been measured properly since many programmes are constructed using an adult lens and overlooking real-life youth’s experiences [10, 11]. Thus, a participatory strategy is gaining recognition as a viable approach not only to prevent youth health problems, but also to enhance positive development among young people [11]. Nonetheless, ‘there is [still] a need for better and collective understanding of what youth participation involves [and] how it can be implemented’ [12], and scientific evidence-base on the benefits of involving youth in health-related activities is needed; [13, 14] with efforts, underway to address this gap [15, 16]. In this perspective on quality paper, the terms youth and young people are used interchangeably to include children, adolescents and young adults from 10 to 24 years of age. In doing so, we adopted a blanket definition that incorporates a wider age group as identified by reputable stakeholder perspectives, such as that from the World Health Organization (WHO) (10–19) [17], United Nations Convention on the Rights of the Child (UNCRC) (<18) and United Nations (UN) (youth 15–24; young people 10–24) [18]. Our work intends improving participation in this broader group and seeks to provide practical advice that can be tailored to the national or international frameworks. The aim of this perspective on quality paper is to reflect on the concept of youth involvement as a health promotion strategy, and to provide practical recommendations for their successful involvement in health-related activities drawn from a review of existing literature, reputable institutional guidelines and programme toolkits that supported cases for youth involvement as a health promotion strategy. Youth involvement Involvement is as a fundamental right for all people. For youth, this approach exists within the international context of the UNCRC. Specifically, Article 12 states that young people who can form their own views have a right to express them freely in all matters that affect them, assigning a proper weight in accordance to their age and maturity [18]. A direct result of the adoption of the UNCRC has been a change in perspective on their status in society, with children and adolescents now having a say in many aspects of their lives [19, 20]. In addressing health concerns for young people through the adoption of regional strategies like that of the WHO European region, which explicitly seeks to ‘make children’s lives visible’ [21], and the use of adolescent-specific research like the Health Behaviour in School-Children (HBSC) Study [13], policy-makers, advocates and researchers can ensure that youth realities are understood, appreciated and taken into account. The WHO advises that youth needs to be included as active partners in all health-related activity stages, from design through to evaluation, especially for programmes affecting their own health [22, 23]. This goal has been applied under strategies identified as youth engagement (i.e. which identifies youth’s right to participate in decisions that impact them by acknowledging the skills and strengths they add to programmes); [24, 25] youth organising (asset-based approaches, i.e. a youth development and social justice strategy that assists young people in employing skills to alter power relations and create meaningful institutional change in their communities); [26] participatory action research (i.e. giving voice to youth’s concerns, and launching programmes and activities that meet the needs of local youth within a community); [27] youth-driven approaches or youth-adult participation (i.e. includes high-quality youth- adult participation) [28]. Models and typologies of how to involve youth in participatory actions have been described [6, 11, 29, 30]. This participation has also been defined as a theory named ‘youth empowerment’ [4, 31, 32], which can be applied as a framework of public healthcare systems, were adolescents, as both stakeholders and patients, are catalysts in the process of creating patient-centred care [32]. All of these strategies emphasise inclusion and action, offering alternative approaches based on reflection, data collection, and action to improve young people’s health and reduce health inequities. What do adult stakeholders (e.g. health promoters, researchers, policy-makers) and health institutions gain when they embrace youth participation? Professionals who actively listen and involve youth in programmes are more likely to succeed [33] because their actions uphold youth’s rights, promote their protection and fulfil the State’s legal responsibilities [34]. Evidence suggests that young people’s participation in institutional and governmental decisions enhances their credibility in the eyes of society, while improving public services by promoting more transparent actions and participative culture [6, 35–37]. In research, youth involvement is compatible with improved quantitative and qualitative methods, and is a source of innovation that may facilitate the research process [13, 35, 38]. Additionally, researchers gain insight into new domains of enquiry through integrating youth in data generation, analysis, interpretation and dissemination activities [12]. What do youth gain with their participation in health-related activities? The acquisition of new skills, emotional links, knowledge, competences, self-efficacy, self-esteem and confidence, which can foster young people’s autonomy and help them to successfully manage the complex transition to adulthood. This reinforces their sense of control and awareness of their personal, community and environmental decisions. Youth can get confirmation that their views matter and this influence can affect their health [6, 11, 35, 39, 40]. They also learn about addressing structural constraints within institutions that are supposed to serve them, as well as city or state governance affecting their life quality, showing them that they have the opportunity to directly influence both methods and outcomes [11, 35]. Recommendations for youth’s involvement in health-related activities By acknowledging youth’s valuable contribution to health-related activities, both adult stakeholders and young people are benefited. However, if not properly done, youth engagement could result in an unnecessary, burdensome or hazardous experience for participants. Thus, a proper involvement strategy in health activities is necessary, but challenging [35]. A narrative review to identify specific recommendations to promote the design, implementation and evaluation of a successful youth participation was performed based on reputable institutional guidelines and programme toolkits [6, 11, 20, 29, 31, 35, 37, 40–47]. These recommendations have been organised in time-stages associated to the development of health-related activities or programmes (i.e. design, implementation and evaluation) to facilitate youth involvement as a sequential process and to reiterate the importance of coherent and meaningful participation throughout. A schematic overview of all recommendations is presented in Table 1. Table 1 Schematic overview of youth involvements practical recommendations for health promoters, researchers and/or policy-makers During the design of a youth involvement process  During the implementation of a youth involvement process  During the completion of a youth involvement process  Define the purpose of youths’ participation  Introduce all the participants and make them feel part of a team  Incentive  Use an established and reliable methodology  Identify intra-group diversity  Acknowledge youth’s and adult participation  Base the participation on a theoretical framework  Recognise possible stressors and barriers  Assure confidentiality  Choose age-appropriate activities  Set goals  Share experiences  Select a suitable working place and transportation  Remember that youth should collaborate, be involved, but not be solely responsible  Make public resolutions of the process  Provide food if necessary  Think with young people  Make materials available  Consider youth’s participation priorities  Include institutional players  Identify youth’s latest trends  Contemplate diversity  Let young people decide in case of peers’ representation  Minimise pressure  Use everyday language  Collect signed consent by young people and parents/legal guardians  Embrace communication through youth’s usual networks (e.g. social media) as much as young people want  Identify and address any legal concerns  Persuade youth’s creativity  Use of existing research, work and toolkits  During all the youth involvement stages  Guarantee the determination and serious adult commitment Plan and schedule Be open to change Select appropriate participants for partnerships Evaluate the process Motivate Consult young people about their sense of purpose and future Make sure the process’s transparency Participants need to understand limitations and restrictions  During the design of a youth involvement process  During the implementation of a youth involvement process  During the completion of a youth involvement process  Define the purpose of youths’ participation  Introduce all the participants and make them feel part of a team  Incentive  Use an established and reliable methodology  Identify intra-group diversity  Acknowledge youth’s and adult participation  Base the participation on a theoretical framework  Recognise possible stressors and barriers  Assure confidentiality  Choose age-appropriate activities  Set goals  Share experiences  Select a suitable working place and transportation  Remember that youth should collaborate, be involved, but not be solely responsible  Make public resolutions of the process  Provide food if necessary  Think with young people  Make materials available  Consider youth’s participation priorities  Include institutional players  Identify youth’s latest trends  Contemplate diversity  Let young people decide in case of peers’ representation  Minimise pressure  Use everyday language  Collect signed consent by young people and parents/legal guardians  Embrace communication through youth’s usual networks (e.g. social media) as much as young people want  Identify and address any legal concerns  Persuade youth’s creativity  Use of existing research, work and toolkits  During all the youth involvement stages  Guarantee the determination and serious adult commitment Plan and schedule Be open to change Select appropriate participants for partnerships Evaluate the process Motivate Consult young people about their sense of purpose and future Make sure the process’s transparency Participants need to understand limitations and restrictions  Summary of considerations based on reputable international institutional guidelines and programme toolkits for an adequate youth involvement. Table 1 Schematic overview of youth involvements practical recommendations for health promoters, researchers and/or policy-makers During the design of a youth involvement process  During the implementation of a youth involvement process  During the completion of a youth involvement process  Define the purpose of youths’ participation  Introduce all the participants and make them feel part of a team  Incentive  Use an established and reliable methodology  Identify intra-group diversity  Acknowledge youth’s and adult participation  Base the participation on a theoretical framework  Recognise possible stressors and barriers  Assure confidentiality  Choose age-appropriate activities  Set goals  Share experiences  Select a suitable working place and transportation  Remember that youth should collaborate, be involved, but not be solely responsible  Make public resolutions of the process  Provide food if necessary  Think with young people  Make materials available  Consider youth’s participation priorities  Include institutional players  Identify youth’s latest trends  Contemplate diversity  Let young people decide in case of peers’ representation  Minimise pressure  Use everyday language  Collect signed consent by young people and parents/legal guardians  Embrace communication through youth’s usual networks (e.g. social media) as much as young people want  Identify and address any legal concerns  Persuade youth’s creativity  Use of existing research, work and toolkits  During all the youth involvement stages  Guarantee the determination and serious adult commitment Plan and schedule Be open to change Select appropriate participants for partnerships Evaluate the process Motivate Consult young people about their sense of purpose and future Make sure the process’s transparency Participants need to understand limitations and restrictions  During the design of a youth involvement process  During the implementation of a youth involvement process  During the completion of a youth involvement process  Define the purpose of youths’ participation  Introduce all the participants and make them feel part of a team  Incentive  Use an established and reliable methodology  Identify intra-group diversity  Acknowledge youth’s and adult participation  Base the participation on a theoretical framework  Recognise possible stressors and barriers  Assure confidentiality  Choose age-appropriate activities  Set goals  Share experiences  Select a suitable working place and transportation  Remember that youth should collaborate, be involved, but not be solely responsible  Make public resolutions of the process  Provide food if necessary  Think with young people  Make materials available  Consider youth’s participation priorities  Include institutional players  Identify youth’s latest trends  Contemplate diversity  Let young people decide in case of peers’ representation  Minimise pressure  Use everyday language  Collect signed consent by young people and parents/legal guardians  Embrace communication through youth’s usual networks (e.g. social media) as much as young people want  Identify and address any legal concerns  Persuade youth’s creativity  Use of existing research, work and toolkits  During all the youth involvement stages  Guarantee the determination and serious adult commitment Plan and schedule Be open to change Select appropriate participants for partnerships Evaluate the process Motivate Consult young people about their sense of purpose and future Make sure the process’s transparency Participants need to understand limitations and restrictions  Summary of considerations based on reputable international institutional guidelines and programme toolkits for an adequate youth involvement. During ‘all the involvement stages’, health promoters, researchers and/or policy-makers must consider: Commitment: Adults should be willing to adapt to youth’s necessities [41] and be devoted to the whole process. Planning and schedule: Consider sufficient time for each activity. Schedules should be adapted to the youth’s needs and their other commitments (i.e. school and extra-curricular activities) [35]. Be open to change: Organisers must accept youth’s perspectives and ideas and be willing to adjust rules, which meet their needs [37]. Selectiveness: Choose the appropriate participants for partnerships. Youth vary widely in their level of development and readiness to assume responsibility, and adults vary widely in their degree of commitment and willingness to work with youth [13]. Evaluation: Participants should evaluate the process before, during and after its execution. For this purpose, apply short questions with simple language, avoiding abstract concepts. There are no right or wrong answers, and this message must be reiterated during data collection. Also, ensure to register all kind of answers, even if these are non-verbal methods of communication (e.g. drawings) [6]. Motivation: Ensure participant’s engagement for the whole process [42]. Sense of purpose: Consult youth’s expectations and goals in their healthy lifestyles [10]. Transparency: All the process needs to be clear, providing straightforward data on their right to express views freely [35]. Limitations: Participants need to understand the restrictions that affect the processes [10]. During ‘the design’ of a youth involvement process, health promoters, researchers and/or policy-makers must consider: Purpose: Clearly state the reasons for youth involvement and the expectations of this participation [43]. Established methodology: All the process should be evidence-based, ethical, realistic and properly resourced [6]. There are models described for youth involvement, which could help design a plan [6, 11, 29, 31]. Theoretical framework: Social science theories and conceptual models provide the basis for understanding human behaviours [44]. Theoretical frameworks help monitor both youth and adult involvement in the activities (e.g. empowerment theoretical framework) [31]. Age-appropriate activities: Participation activities need to be meaningful to youth according to their capabilities [20, 35]. Given the formative stage in which they live, activities should consider the integration of learning skills in mathematics, social studies, communications, critical thinking and problem solving [40]. Working place and transportation: Adults are responsible for creating safe environments where youth feel welcome and therefore, willing to share their views [11]. Identify conditions, personal risks and protective factors to create a formal or informal place where involved youth feel safe [40]. If possible, schedule meetings in easily accessible places, considering that youth usually do not have a personal vehicle. Organisers should provide travel vouchers or promptly reimburse youth for transportation costs [37]. Food: Youth rarely have the means to buy meals or dinners outside of their home. When meetings overlap with meal times, consider providing youth with either food or sufficient funds to pay for meals [37]. Materials: The cost of materials and dispensations (cameras, developing, printing, art materials) must be included in project budget and covered by the responsible party. For this reason, it is indispensable to have a list of materials needed for each activity and participant [6]. Institutional players: Adults should seek to integrate institutions within the social environment that influence the life of the youth that will participate (e.g. schools, community centres, city councils) [11]. Diversity: Youth participation must aim to include all youth rather than only a few easy to reach potential participants, regardless of their background and without discrimination on any grounds -age, race, sex, language, religion, political, national, ethnic or social origin, disability or other status [34]. Efforts should be made to include adolescents from vulnerable backgrounds [6] (e.g. youth in public care, with learning difficulties, living in low-income communities). Pressure minimisation: Give participants some time to reflect and confirm their commitment to the process [35]. Clarify that youth’s involvement is a voluntary participation, in which no right or wrong answers exist. Signed consent: Information for youth and parents/legal guardians about the process must be provided and it must be clearly explained, including: objectives, description of the process and the roles of each participant, person or institution responsible (include timescale if possible), number of expected participants and their ages, facilitators, logistics and support available [35]. Identify legal concerns: Seek consent to use any material collected during activities (e.g. ideas, pictures, drawings, photographs or other materials created) for reports or dissemination [6]. Also, consider processing the adequate work permits or insurance if youth involved is employed. Existing research and toolkits: Identify similar youth participation models or toolkits in your field. Drawing inspiration from previous successful interventions programme design or research may work as a tool for questioning, understanding, and addressing the issue at hand [39]. During ‘the implementation’ of a youth involvement process, health promoters, researchers and/or policy-makers must consider: Presentation and team formation: Be sure that all participants meet each other, creating a casual atmosphere. Clearly, state the roles and responsibilities of everyone in the process. Each participant will need to agree to the assigned roles and responsibilities [37]. Intra-group diversity: Recognise within the group any age, socioeconomic background, race, colour, sex, language, and religion, political or ethnic origin. Some of these factors may act as constraints in youth’s social interaction [34]. Barriers: Individual and/or group health risks and stressors can be identified in various domains (e.g. family, peers, school, etc.) that can have effects on the individual perspectives [40]. Identify, manage and remove any stressors and/or barriers wherever possible [6]. Goals: Set clear targets with the youth as a common agreement [35]. Collaboration and involvement with no sole responsibility: Aim to create a balance of power between adults and youth during the research and participation process [28]. Remember that it is a partnership; neither the young people nor adults are necessarily subordinate of the other [37]. Lack of adult involvement in youth participation may obstruct rather than encourage optimal adolescent development and empowerment [11]. Brainstorming: Create a co-learning relationship where youth and adults raise the level of collective critical consciousness. Adults can be actively involved in fostering conditions for youth [11], and help them to be more open to learn, engage in critical dialogue and exercise creativity [10]. Priorities: Establish priorities for the process, generating theories of causality, solutions and change [39]. Latest trends: Youth culture evolves so rapidly that by the time older age groups begin to understand it, youth have already adopted a new trend. To create an empathic interaction with youth, be sure that participating adults are updated on the latest tendencies and youth’s preferences [45]. Decision in peers’ representation: Let participants select among themselves those that will represent them [35]. Everyday language: The participatory process should include a language with which youth are familiar. Avoid labels or nicknaming among youth without their approval [43]. Communication: Nowadays, youth communicate to a larger extent via social media applications and services. As such, it should be considered as a practical tool in youth involvement. Social media allows interaction outside the confines of physical proximity, which could benefit the involvement procedure beyond face-to-face interactions [46]. Creativity: Allow youth to express themselves in a way that others may appreciate what they hear. Be sure to encourage creativity during the process [47]. During ‘the evaluation’ of a youth involvement process, health promoters, researchers and/or policy-makers must consider: Incentive or rewarding participation: This does not necessarily mean an economic or tangible reward. Ensure participation ends in a meaningful way, e.g. evaluate satisfaction, pride or incentives [11]. Acknowledging: Recognise all the participants’ contributions in the process, both youth and adults [10, 34]. Confidentiality: Youth participants should afford the same degree of protection regarding confidentiality, anonymity and data protection as adult participants [6]. Communication: Support youth’s share their experiences, which can have a powerful impact on audiences of all ages [35]. Resolutions: Identify power differentials between participants. Move toward change strategies on these levels that mediate power by improving conditions for youth, ensuring that the results from this collaboration are translated into actions. In addition, findings should be accessible to the general audience to raise awareness [6, 29]. Discussion Youth involvement in health-related programmes can make a difference in programme success [10, 37, 48]. There is evidence to suggest that participatory approaches to health add value to programmes [10, 33]. In many ways, however, it is as much about changing cultures [24] as it is about changing processes. For this reason, youth involvement as a health promotion strategy has the potential to promote health by satisfying youth’s developmental needs in a positive manner [11]. Youth involvement is not a traditional risk-factor based public health approach; it provides a new focus on the assets that youth inherently possess, adopts them while also eliciting changes in youth themselves. However, the best frameworks may include elements of both approaches (public health and youth development) working together [48–50]. Some successful health-related programmes have reported the use of youth involvement as a fundamental strategy (Table 2) [24, 48, 51–53]. For instance, the Spanish participation at the European Youth Tackling Obesity (EYTO) project, (implemented as a randomised controlled trial) significantly increased daily fruit consumption and daily physical activity practice in adolescent’ participants. This positive result is attributable to the youth being involved in the design and implementation stages of the activities [48, 51–53]. In the referenced examples, youth involvement supported the creation of a collective critical consciousness [11], not only by creating a work synergy with adults, but also raising awareness among peers and their communities. However, youth participation can pose a challenge to health promoters, researchers and policy-makers as they balance the importance of involving end-users to increase uptake of effective interventions, programmes and policies [47] and the feasibility of those approaches in light of resource limitations or knowledge constraints that may dissuade them from engaging. Essentially, the main challenge is how to effectively involve youth to create a working synergy that improves policies and programmes worldwide. For this reason, and for a proper evaluation of this strategy, health programmes that include youth should put this strategy into practice. Table 2 Examples of youth involvement as a health promotion strategy Project Name  Country  Description  Website  The Students Commission  Canada  Founded in 1991 to help young people put their ideas for improving themselves, their communities and their world into action. In 2000, it became the lead of The Centre of Excellence for Youth Engagement, which networks academics, youth organisations and young people together to provide research and training to improve youth programmes and youth engagement in Canada. The Commission works with the Health Behaviour in School-aged Children (HBSC), a WHO Collaborative Study, in Canada team to develop and carry out their youth participation efforts. For an example of their work [10].  www.studentscommission.ca/  The Dream Teens Project  Portugal  In 2013 was launched in Portugal to give voice to young people in matters that affect them. Participants (under-18) were actively involved in the elaboration of research instruments and group debates on issues such as mental health, sexuality, substance consumption, self-harm, interpersonal violence, academic success and expectations, family support, social support networks, leisure, among others. Young people have identified emerging problems, gaps and solution trajectories [51].  www.dreamteens-en.aventurasocial.com/  The European Youth Tackling Obesity (EYTO) Project  UK, Portugal, Czech Republic, Spain  In 2014 was launched to create a multicentre project. Five selected adolescents (in each country) were tasked with designing and implementing youth-led social marketing approach to promote healthy eating and physical activity and to stem the rise in obesity amongst young people aged between 13 and 18 years old living in low socioeconomic areas [47, 50].  http://www.eyto.org.uk/  Project Name  Country  Description  Website  The Students Commission  Canada  Founded in 1991 to help young people put their ideas for improving themselves, their communities and their world into action. In 2000, it became the lead of The Centre of Excellence for Youth Engagement, which networks academics, youth organisations and young people together to provide research and training to improve youth programmes and youth engagement in Canada. The Commission works with the Health Behaviour in School-aged Children (HBSC), a WHO Collaborative Study, in Canada team to develop and carry out their youth participation efforts. For an example of their work [10].  www.studentscommission.ca/  The Dream Teens Project  Portugal  In 2013 was launched in Portugal to give voice to young people in matters that affect them. Participants (under-18) were actively involved in the elaboration of research instruments and group debates on issues such as mental health, sexuality, substance consumption, self-harm, interpersonal violence, academic success and expectations, family support, social support networks, leisure, among others. Young people have identified emerging problems, gaps and solution trajectories [51].  www.dreamteens-en.aventurasocial.com/  The European Youth Tackling Obesity (EYTO) Project  UK, Portugal, Czech Republic, Spain  In 2014 was launched to create a multicentre project. Five selected adolescents (in each country) were tasked with designing and implementing youth-led social marketing approach to promote healthy eating and physical activity and to stem the rise in obesity amongst young people aged between 13 and 18 years old living in low socioeconomic areas [47, 50].  http://www.eyto.org.uk/  Table 2 Examples of youth involvement as a health promotion strategy Project Name  Country  Description  Website  The Students Commission  Canada  Founded in 1991 to help young people put their ideas for improving themselves, their communities and their world into action. In 2000, it became the lead of The Centre of Excellence for Youth Engagement, which networks academics, youth organisations and young people together to provide research and training to improve youth programmes and youth engagement in Canada. The Commission works with the Health Behaviour in School-aged Children (HBSC), a WHO Collaborative Study, in Canada team to develop and carry out their youth participation efforts. For an example of their work [10].  www.studentscommission.ca/  The Dream Teens Project  Portugal  In 2013 was launched in Portugal to give voice to young people in matters that affect them. Participants (under-18) were actively involved in the elaboration of research instruments and group debates on issues such as mental health, sexuality, substance consumption, self-harm, interpersonal violence, academic success and expectations, family support, social support networks, leisure, among others. Young people have identified emerging problems, gaps and solution trajectories [51].  www.dreamteens-en.aventurasocial.com/  The European Youth Tackling Obesity (EYTO) Project  UK, Portugal, Czech Republic, Spain  In 2014 was launched to create a multicentre project. Five selected adolescents (in each country) were tasked with designing and implementing youth-led social marketing approach to promote healthy eating and physical activity and to stem the rise in obesity amongst young people aged between 13 and 18 years old living in low socioeconomic areas [47, 50].  http://www.eyto.org.uk/  Project Name  Country  Description  Website  The Students Commission  Canada  Founded in 1991 to help young people put their ideas for improving themselves, their communities and their world into action. In 2000, it became the lead of The Centre of Excellence for Youth Engagement, which networks academics, youth organisations and young people together to provide research and training to improve youth programmes and youth engagement in Canada. The Commission works with the Health Behaviour in School-aged Children (HBSC), a WHO Collaborative Study, in Canada team to develop and carry out their youth participation efforts. For an example of their work [10].  www.studentscommission.ca/  The Dream Teens Project  Portugal  In 2013 was launched in Portugal to give voice to young people in matters that affect them. Participants (under-18) were actively involved in the elaboration of research instruments and group debates on issues such as mental health, sexuality, substance consumption, self-harm, interpersonal violence, academic success and expectations, family support, social support networks, leisure, among others. Young people have identified emerging problems, gaps and solution trajectories [51].  www.dreamteens-en.aventurasocial.com/  The European Youth Tackling Obesity (EYTO) Project  UK, Portugal, Czech Republic, Spain  In 2014 was launched to create a multicentre project. Five selected adolescents (in each country) were tasked with designing and implementing youth-led social marketing approach to promote healthy eating and physical activity and to stem the rise in obesity amongst young people aged between 13 and 18 years old living in low socioeconomic areas [47, 50].  http://www.eyto.org.uk/  The youth involvement recommendations in this manuscript are not checklists to follow, but aim to facilitate a process that reflects a true partnership between youth and adults in a professional setting, integrating the perspectives and skills of youth with the experience of adults [10]. These recommendations stem from evidence of what works and may be useful along health promotion efforts and future youth research. The practical suggestions seek to contribute towards the development of evidence-base on health promotion, research and policy-making and practice around youth participation while also reducing the gap between stakeholder intent and understanding of youth participation in health-related activities. Conclusion Youth involvement in health-related activities needs to be a carefully planned process that, at every stage, encourages synergy between youth and relevant adult stakeholders such as health promoters, researchers or policy-makers. Thoughtfully implementing youth participation as a health promotion strategy will help all involved stakeholders achieve health and wellbeing goals. This synergy should catalyse joint efforts aimed at the improvement of young people’s health. Acknowledgements The authors would like to thank Professor Candace Currie for her insight in writing this paper, and for giving MA-M the opportunity to work at the WHO Collaborative Centre for International Child and Adolescent Health Policy, and Child and Adolescent Health Research Unit from the University of St Andrews and Dr Jo Inchley for her valuable comments in developing this manuscript. Funding This review had no specific support or funding. References 1 Adolescence: a period needing special attention - recognizing-adolescence. World Health Organization (WHO). http://apps.who.int/adolescent/second-decade/section2/page1/recognizing-adolescence.html (24 June 2017, date last accessed). 2 Maharaj RG, Nunes P, Renwick S. Health risk behaviours among adolescents in the English-speaking Caribbean: a review. Child Adolesc Psychiatry Ment Health  2009; 3: 10. Google Scholar CrossRef Search ADS PubMed  3 Catalano RF, Fagan AA, Gavin LE et al.  . Worldwide application of prevention science in adolescent health. Lancet  2012; 379: 1653– 64. Google Scholar CrossRef Search ADS PubMed  4 Adrian M, Charlesworth-Attie S, Vander Stoep A et al.  . Health promotion behaviors in adolescents: prevalence and association with mental health status in a statewide sample. J Behav Health Serv Res  2014; 41: 140– 52. Google Scholar CrossRef Search ADS PubMed  5 Naudeau S, Cunningham W, Lundberg MK et al.  . Programs and policies that promote positive youth development and prevent risky behaviors: An international perspective. New Dir Child Adolesc Dev  2008; 122: 75– 87. Google Scholar CrossRef Search ADS   6 National Children’s Bureau. Guidelines for research with children and young people . London: National Children’s Bureau, 2011. London: National Children’s Bureau Research Centre. 7 Marx M, Finger W, Mahler H Youth participation guide: assessment planning and implementation. Arlington, Virginia. 2005 8 Participation Models Citizens, Youth, Online. Creative Commons. Demokratie & Dialog website. http://www.demokratie-dialog.de/work/Participation-Models20110703.pdf (7 March 2017, date last accessed). 9 Rajani R. The participation rights of adolescents: A strategic approach . New York: UNICEF, 2001: 1– 67. 10 Cook P. Understanding the effects of adolescent participation in health programmes. Int J Children’s Rights  2008; 16: 121– 39. Google Scholar CrossRef Search ADS   11 Wong NT, Zimmerman MA, Parker EA. A typology of youth participation and empowerment for child and adolescent health promotion. Am J Community Psychol  2010; 46: 100– 14. Google Scholar CrossRef Search ADS PubMed  12 Youth Participation Fact Sheet. United Nations and the Focal Point on Youth Web site http://www.un.org/esa/socdev/documents/youth/fact-sheets/youth-participation.pdf (23 August 2016, date last accessed). 13 Inchley J, Currie D. Growing up unequal: gender and socioeconomic differences in young people’s health and well-being. Health Behaviour in School-aged Children (HBSC) study: international report from the, 2014. Health Policy for Children and Adolescents, No. 7 . Copenhaghen: World Health Organization, 2013. 14 Patton GC, Sawyer SM, Santelli JS et al.  . Our future: a Lancet commission on adolescent health and wellbeing. Lancet  2016; 387: 2423– 78. Google Scholar CrossRef Search ADS PubMed  15 Gavine A, Morgan A, Aleman-Diaz AY et al.   The benefits of involving young people in the health development process: protocol for a systematic review. (Under review for publication). 16 Gavine A, Aleman-Diaz AY, Currie C et al.   The engagement of young people in the development and implementation of programmes to secure health: a systematic review. St Andrews: St Andrews Medical School (Under review for publication). 17 Adolescent Health, World Health Organization, 2018. Adolescent health. http://www.who.int/maternal_child_adolescent/adolescence/en/ (19 January 2017, date last accessed). 18 United Nations Convention on the Rights of the Child ( 1989) (UNCRC) ‘Your rights under the UNCRC’ United Nations Children’s Fund (UNICEF) Youth Voice website: https://downloads.unicef.org.uk/wpcontent/uploads/2010/05/UNCRC_united_nations_convention_on_the_rights_of_the_child.pdf (16 January 2017, date last accessed). 19 UNCRC General Comment No.19 on Public Budgeting for the Realization of Children’s Rights: 29 launches contributing to awareness, partnerships, children’s voices and pledges on investment in children. UNCRC. The Child Rights Connect Working Group on Investment in Children Website: http://eurochild.org/fileadmin/public/05_Library/Thematic_priorities/01_Childrens_Rights/Other/GC_No._19_launch_results.pdf (7 January 2017, date last accessed). 20 Alderson P, Morrow V. Ethics, Social Research and Consulting with Children and Young People . Ilford: Barnardo’s, 2004. 21 Investing in children: The European child and adolescent health strategy 2015–2020. WHO Regional Office for Europe Website. http://www.euro.who.int/en/healthtopics/Life-stages/child-and-adolescent-health/policy/investing-in-children-theeuropean-child-and-adolescent-health-strategy-20152020 7 March 2017, date last accessed). 22 World Health Organization. Programming for Adolescent Health and Development . Geneva: World Health Organization, 2001. PubMed PubMed  23 Jensen BB, Simovska V, Larsen N et al.  . Young people want to be part of the answer . Copenhagen: WHO Regional Office for Europe. Copenhagen, 2005. 24 Pan Canadian Joint Consortium for School Health’s (JCSH) Youth Engagement (YE) Toolkit. Pan Canadian Joint Consortium for School Health’s (JCSH) Website. http://www.jcsh-cces.ca/ye-book/ (15 March 2017, date last accessed). 25 Scheve JA, Perkins DF, Mincemoyer CC, Welsh JA. Say YES to youth: Youth engagement strategies . University Park, PA: The Pennsylvania State University, 2005. 26 Christens BD, Kirshner B. Taking stock of youth organizing: an interdisciplinary perspective. In Flanagan CA, Christens BD (Eds.), Youth civic development: work at the cutting edge. New Dir Child Adolesc Dev  2011; 134: 27– 41. Google Scholar CrossRef Search ADS   27 Foster-Fishman PG, Law KM, Lichty LF, Aoun C. Youth ReACT for Social Change: a method for youth participatory action research. Am J Community Psychol  2010; 46: 67– 83. Google Scholar CrossRef Search ADS PubMed  28 Larson R, Walker K, Pearce N. A comparison of youthQdriven and adultQdriven youth programs: balancing inputs from youth and adults. J Community Psychol  2005; 33: 57– 74. Google Scholar CrossRef Search ADS   29 Hart R. Children’s participation: From tokenism to citizenship (no. 4) . Florence: UNICEF International Child Development Centre, 1992. 30 Shier H. Pathways to participation: openings, opportunities, and obligations. Children and Society. Child Soc  2001; 15: 107– 17. Google Scholar CrossRef Search ADS   31 Jennings LB, Parra-Medina DM, Hilfinger-Messias DK, McLoughlin K. Toward a critical social theory of youth empowerment. J Comm Pract  2006; 14: 31– 55. Google Scholar CrossRef Search ADS   32 Klaus H. Youth empowerment to achieve patient engagement. N C Med J  2015; 76: 187– 8. Google Scholar PubMed  33 Morgan A, Aleman-Diaz AY Measuring what matters for young people’s health and well-being: an asset approach. Learning for Well-being Magazine. Bloemendaal, The Netherlands. 2016. 34 Farthing R. Why youth participation? Some justifications and critiques of youth participation using New Labour’s youth policies as a case study. Youth Policy  2012; 109: 71– 97. 35 Children’s participation in public decision-making. Why should I involve children?  Brussels: Jeunesse de la Fédération Wallonie-Bruxelles, 2014. 36 Ott MA, Rosenberger JG, McBride KR, Woodcox SG. How do adolescents view health? Implications for state health policy. J Adolesc Health  2011; 48: 398– 403. Google Scholar CrossRef Search ADS PubMed  37 Klindera K, Menderweld J. Youth involvement in prevention programming . Washington, D.C.: Advocates for Youth, 2001. 38 Janina B, Lobo R, Hallett J, Brown G, Maycock B. My-Peer Toolkit [1.0] Developing an online resource for planning and evaluating peer-based youth programs. Youth Stud Aust  2012; 31: 53. 39 Zimmerman MA. Psychological empowerment: issues and illustrations. Am J Community Psychol  1995; 23: 581– 99. Google Scholar CrossRef Search ADS PubMed  40 Berg M, Coman E, Schensul JJ. Youth action research for prevention: a multi-level intervention designed to increase efficacy and empowerment among urban youth. Am J Community Psychol  2009; 43: 345– 59. Google Scholar CrossRef Search ADS PubMed  41 Dotterweich J Practice Matters—Strengthening Youth Involvement. New York City: ACT for Youth Center of Excellence, Cornell University, University of Rochester, the New York State Center for School Safety, and Cornell Cooperative Extension of New York City. 2014 42 Luciana M, Collins PF. Incentive motivation, cognitive control, and the adolescent brain: is it time for a paradigm shift? Child Dev Perspect  2012; 6: 392– 9. Google Scholar PubMed  43 Millstein SG, Petersen AC, Nightingale EO. Adolescent health promotion: Rationale, goals, and objectives. Promoting the health of adolescents: New directions for the twenty-first century . Oxford: Oxford University Press, 1993. 44 Baranowski T, Cullen KW, Nicklas T, Thompson D, Baranowski J. Are current health behavioral change models helpful in guiding prevention of weight gain efforts? Obes Res  2003; 11: 23S– 43S. Google Scholar CrossRef Search ADS PubMed  45 Willis PE, Jones S, Canaan J, Hurd G. Common culture: Symbolic work at play in the everyday cultures of the young . Milton Keynes: Open University Press, 1990. 46 McBride DL. Risks and benefits of social media for children and adolescents. J Pediatr Nurs  2011; 26: 498– 9. Google Scholar CrossRef Search ADS PubMed  47 Resnick MD, Catalano RF, Sawyer SM, Viner R, Patton GC. Seizing the opportunities of adolescent health. Lancet  2012; 379: 1564– 7. Google Scholar CrossRef Search ADS PubMed  48 Aceves-Martins M, Llauradó E, Tarro L et al.  . School-based, peer-led, social marketing intervention to engage Spanish adolescents in a healthy lifestyle (‘We Are Cool’-Som la Pera Study): a parallel-cluster randomized controlled study. Child Obes  2017; 13: 300– 13. Google Scholar CrossRef Search ADS PubMed  49 Birkhead GS, Riser MH, Mesler K, Tallon TC, Klein SJ. Youth development is a public health approach. Introduction. J Public Health Manag Pract  2006; 12: S1– 3. Google Scholar CrossRef Search ADS   50 Mokwena S. Putting youth engagement into practice: A toolkit for action. Commonwealth Youth and Development . London: Commonwealth for action, 2007. 51 Llauradó E, Aceves-Martins M, Tarro L et al.  . A youth-led social marketing intervention to encourage healthy lifestyles, the EYTO (European Youth Tackling Obesity) project: a cluster randomised controlled trial in Catalonia, Spain. BMC Public Health  2015; 15: 607. Google Scholar CrossRef Search ADS PubMed  52 Frasquilho D, Ozer EJ, Ozer EM et al.  . Dream teens: adolescents-led participatory project in Portugal in the context of the economic recession. Health Promot Pract  2016; 19: 51– 9. Google Scholar CrossRef Search ADS PubMed  53 Matos MG, Simões C. From positive youth development to youth’s engagement: the dream teens. Int J Emot Educ  2016; 8: 4– 18. © The Author(s) 2018. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/about_us/legal/notices)

Journal

International Journal for Quality in Health CareOxford University Press

Published: May 18, 2018

There are no references for this article.

You’re reading a free preview. Subscribe to read the entire article.


DeepDyve is your
personal research library

It’s your single place to instantly
discover and read the research
that matters to you.

Enjoy affordable access to
over 18 million articles from more than
15,000 peer-reviewed journals.

All for just $49/month

Explore the DeepDyve Library

Search

Query the DeepDyve database, plus search all of PubMed and Google Scholar seamlessly

Organize

Save any article or search result from DeepDyve, PubMed, and Google Scholar... all in one place.

Access

Get unlimited, online access to over 18 million full-text articles from more than 15,000 scientific journals.

Your journals are on DeepDyve

Read from thousands of the leading scholarly journals from SpringerNature, Elsevier, Wiley-Blackwell, Oxford University Press and more.

All the latest content is available, no embargo periods.

See the journals in your area

DeepDyve

Freelancer

DeepDyve

Pro

Price

FREE

$49/month
$360/year

Save searches from
Google Scholar,
PubMed

Create lists to
organize your research

Export lists, citations

Read DeepDyve articles

Abstract access only

Unlimited access to over
18 million full-text articles

Print

20 pages / month

PDF Discount

20% off