The Determinants of Health through the Eyes of Youth: A Multi-Site Youth-Led Health Assessment

Objective:  Health inequities have been well documented. We explore strategies for closing the gap between health-promoting assets that appear to be available in communities, and youth engagement of those assets.  Previous efforts to understand this question have been examined through data distal to the lived experience of youth, for example with surveys designed and implemented by adults with minimal youth input. There is a need for youth informed data, which can only come through partnerships with youth. Research partnerships can produce the nuanced data needed to develop appropriate, community relevant strategies to tackle health inequities, while simultaneously empowering residents (Wallerstein & Duran, 2006). Engaging those traditionally left out of the research process, community engaged approaches present a needed paradigm shift in health research.

This presentation describes the processes and outcome data associated with the implementation of a multi-site youth-led health assessment designed to engage Black and Latino youth, in community health research.  The Center for Promise, the research arm of America’s Promise Alliance, partnered to the Boston University School of Social Work in order to broaden their youth wellness and development research agenda to include youth-led initiatives designed to identify health priority areas, as well as health risk and protective factors for health embedded in living and social environments.

Methods: Partner organizations in six U.S, cities were identified. Organizations included those serving youth in low-income communities who were both connected and disconnected from school. Ten young people were hired by the Center for Promise at each site (n=60) as youth researchers.  Teams at each site received introductory training in the areas of health inequities and the determinants of health as well as ecological systems theory and community health assessment.  In addition, ongoing in person and online training was provided over the course of the project period in weekly meetings and prior to each critical phase of the project (data collection; data management and analysis; and dissemination).  Teams identified health priority areas, generated questions and developed assessment protocols.  Prior to implementation teams from across the country shared their protocols with one another, to identify common themes.  Assessments were implemented over a period that ranged from 3-4 weeks across sites; protocols ranged from photovoice projects and key informant interviews to observational assessment and audits. Once data was analyzed youth met with their counterparts from across the country to generate key themes.  Local as well as national dissemination plans were developed, which were presented by the youth at a forum in Washington, DC.

Findings and implications: The benefits of youth-led health assessment are many. Youth conceptualizations of their health and wellness, as well as the determinants of health and wellness are different from those of adults. In addition, youth-led assessment facilitates further youth participation; their approaches to data collection are more culturally appropriate. Moreover, in the context of analysis, they pick up on nuances in the data that may otherwise be missed by adults. Listening to young people (the “end-user” of our work) provides critical insights into how best to support them.