Co-creating gender-transformative interventions for adolescent mental, sexual, and reproductive health and rights: Influence of context and actors on process and content in Niger, Ghana, and Burkina Faso.

National adolescent mental, sexual, and reproductive health and rights (AMSRHR) policies in West Africa promote gender-sensitive approaches, but actual programmes remain largely gender-neutral or gender-blind.

• The study covered three West African countries: Niger, Ghana, and Burkina Faso.
• A gap exists between policy rhetoric around gender sensitivity and the gender-neutral or gender-blind nature of implemented programmes.
• This discrepancy was identified through a situational/context analysis phase and co-creation/data validation workshops.
• The study design was a multi-country case study with the case defined as 'processes, context, actors and content of co-creation of gender-transformative adolescent mental, sexual, and reproductive health interventions'.

Context and actors significantly influence both the processes and content of co-creating gender-transformative adolescent health interventions in low and middle income countries.

• Data were drawn from mixed qualitative sources across two research phases: a situational/context analysis and co-creation/data validation workshops.
• The study was conducted in three distinct West African national contexts — Niger, Ghana, and Burkina Faso — allowing comparison across settings.
• The multi-country case study design enabled exploration of how differing national contexts shaped co-creation processes and intervention content.
• Both macro-level factors (national policy environments) and actor-level factors (stakeholder positions and power dynamics) were identified as influential.

Effectively engaging powerful stakeholders with diverse positions is an important consideration in co-creating AMSRHR interventions.

• Stakeholders held diverse and sometimes conflicting positions on AMSRHR issues.
• The presence of powerful stakeholders required deliberate strategies for engagement during co-creation processes.
• This was identified as one of three key considerations for co-creation of effective interventions.
• The finding emerged from co-creation and data validation workshops conducted across the three countries.

Gendered power imbalances within co-creation processes themselves must be explicitly attended to when developing AMSRHR interventions.

• Power imbalances related to gender were found to operate not only in the broader health system but also within the co-creation process itself.
• Failing to address these imbalances could undermine the gender-transformative goals of the interventions being developed.
• This was identified as a distinct and important consideration separate from stakeholder engagement.
• The finding draws on participatory data collection methods that allowed observation of group dynamics during workshops.

Raising critical consciousness of complex AMSRHR issues through non-threatening, participatory approaches is essential to the co-creation process.

• Non-threatening and participatory approaches were found necessary to facilitate open discussion of sensitive AMSRHR topics.
• Raising critical consciousness was identified as a key mechanism for enabling meaningful engagement with gender-transformative concepts.
• This approach was particularly important given the complex and potentially contentious nature of gender, mental health, and sexual and reproductive health topics in these contexts.
• The finding is relevant to co-creation processes in low and middle income country settings more broadly.

The study drew on mixed qualitative data sources across two phases to examine co-creation of gender-transformative adolescent health interventions in West Africa.

• Phase one involved a situational/context analysis.
• Phase two involved co-creation and data validation workshops.
• Data sources were qualitative and mixed in nature, spanning three countries.
• The case was defined as 'processes, context, actors and content of co-creation of gender-transformative adolescent mental, sexual, and reproductive health interventions'.