COVID-19 shines a light on health inequities in communities of color: A youth-driven photovoice inquiry

Key Challenges and Potential Strategies for Engaging Youth with Lived Experience in Clinical Science

Centering the perspectives of youth with lived experience (YWLE) in psychopathology is critical to engaging in impactful clinical research to improve youth mental health outcomes. Over the past decade there has been a greater push in clinical science to include community members, and especially community members with lived experience, in all aspects of the research process. The goal of this editorial is to highlight the need for and importance of integrating YWLE into every stage of clinical science research, from idea generation to interpretation and dissemination of research findings. We identify five key problems associated with pursuing research on adolescent mental health without involvement of YWLE and propose strategies to overcome barriers to youth engagement in clinical science research. We conclude with a call to action, providing guidance to clinical scientists, institutions, and funding agencies in conducting research on youth psychopathology with YWLE.

Facing Power: Navigating Power Dynamics in a Youth Participatory Action Research Project Situated within a Healthcare Setting

Youth Participatory Action Research (YPAR) is oftentimes cited as a method guided by social justice principles to uplift youth voice and pursue youth priorities in research. However, to uphold these principles, YPAR researchers must address how youth and adults alike negotiate power differentials to be equal partners in research and scholarship. We explore YPAR power sharing through a reflexive thematic analysis of in-depth, semi-structured interviews (n= 42) and focus groups (n=2) conducted at three timepoints (baseline, mid-point, and exit) with youth (n=8) and adult (n=6) researchers engaged in a YPAR exploring health equity at a large, safety-net hospital. Our analyses suggest that both youth and adult researchers negotiate power dynamics in a YPAR at every stage of the project. YPAR researchers made four recommendations to negotiate power: 1) preserve time for relationship building, 2) structure group expectations, 3) require training for adults working with youth of color, and 4) designate youth-only spaces. This study provides an in-depth analysis of youth and adult reflections on power across a YPAR project. Our findings indicate that YPAR requires significant investment in resources, including time to reflect on and process power, transparent and structured expectations, and ongoing training to uphold principles of YPAR.

Using Online Photovoice to Explore Food Decisions of Families on Low Income: Lessons Learnt During the COVID-19 Pandemic

The method of photovoice has been previously used to effectively engage with socioeconomically disadvantaged groups and explore their eating behaviours. In this methodological article, we draw on our experiences from using photovoice through online interviews with families on low income about their food decisions. A purposive recruitment approach targeted parents of children 2-17 years old who lived on a tight budget across the island of Ireland. Participants provided demographic information and were invited to take photographs of food-related decisions and activities for 1 week during the COVID-19 lockdown. The photographs were then discussed through an online communication platform to generate qualitative data. A total of 28 parents participated in the photo-elicited interviews and shared a total of 642 photographs of factors that influenced their food decisions. Following the interviews, the researchers documented their reflections which focused on (1) participants' engagement with the online photo-elicitation and (2) practical aspects around participant consent and data safety. The participants in our study engaged well with the online photovoice method and shared a variety of photos which provided ample material to facilitate the conversations around their food environment and its impact on their food decisions. Our experiences can provide novel insights into using photovoice in a virtual environment and useful considerations around ethics and data collection for researchers who work with socioeconomically disadvantaged groups. Photo-elicited interviews offer an engaging and flexible data collection technique that can highlight issues informing future priorities of healthcare policy.

Youth engagement to achieve health equity: Are healthcare organizations and leaders prepared?

Youth engagement in institutional decision-making is necessary to ensure policy and practice is responsive and relevant to youth and community needs. In particular, it is critical to engage the voices and experiences of youth of Color who have historically been marginalized by healthcare organizations. The present study used multiple methods to examine youth and adult perspectives on the facilitators and barriers to implementing a citywide youth advisory board of youths of Color for a safety net hospital. Data were analyzed using thematic analysis. The findings illustrate the need to employ an antiracist framework to ensure organizational and adult readiness to engage youth of Color in an advisory board. Organizational readiness included assessing organizational culture, clear expectation setting, and creating safe spaces for youth. Adult readiness included adult facilitators who are trained in antiracist and equity-focused practice and the youth-adult partnership model, and a recognition of the bidirectional benefits of youth engagement in decision-making. The implications and recommendations of this study are timely given the historical mistrust between healthcare organizations and communities of Color, as well as the racial health inequities that have been further exposed during the COVID-19 pandemic.