Sexual Health

Unravelling complexity: a realist approach to youth participation in sexual and reproductive health research.

TL;DR

This realist review develops an initial program theory explaining the mechanisms through which youth participatory research can create meaningful outcomes in sexual and reproductive health and rights research, synthesised in a Causal Loop Diagram.

Key Findings

Participatory methods have the potential to enhance young people's ability to talk about SRHR, have sustainable positive impact on young people, and enhance data quality.

  • These outcomes are achieved through specific mechanisms: improved control, comfort, rapport, playfulness, and adapted communication tools.
  • The review included 87 original and 30 reflective articles published between January 2019 and June 2024.
  • The study focused on young people aged 10-24 years.
  • Findings were synthesised into a Causal Loop Diagram (CLD) to represent causal relationships between factors.

Several contextual variables were identified that influence the mechanisms through which participatory methods operate in SRHR research.

  • Contextual variables include: young people's interests and capacities to participate, rigidity of research institutions' requirements, taboo, power dynamics, and opportunities to learn about and evaluate participatory methods.
  • These contextual factors moderate whether the mechanisms of control, comfort, rapport, playfulness, and adapted communication tools are activated.
  • Realist expert interviews with eight researchers experienced in implementing youth participatory methods were conducted to refine the CLD.

A realist review methodology complemented by expert interviews was used to develop an initial program theory for youth participatory research in SRHR.

  • The review combined 87 original articles and 30 reflective articles.
  • Articles were published between January 2019 and June 2024.
  • Eight realist expert interviews were conducted with researchers experienced in youth participatory methods.
  • Analysis focused on identifying relevant factors and causal relationships, synthesised in a Causal Loop Diagram.

The study identifies a gap in evidence regarding how participatory methods work across different settings and for different groups of young people in SRHR research.

  • Researchers in the SRHR field increasingly recognise the value of engaging young people as active partners in research.
  • Challenges associated with youth participation in research are acknowledged.
  • More evidence was identified as needed on how participatory methods work across settings and for different groups of young people aged 10-24 years.
  • The paper develops an 'initial program theory' intended as a foundation for further application and testing.

The study proposes a theory that explains how participatory methods can achieve outcomes and offers a foundation for further application of youth participatory methods in SRHR research.

  • The program theory is represented as a Causal Loop Diagram synthesising factors and their causal relationships.
  • The theory was refined through realist expert interviews with eight experienced researchers.
  • The authors describe this as an 'initial program theory,' indicating it is intended for further testing and refinement.
  • The theory is positioned as starting from 'realist principles' to explain mechanisms of participatory research.

What This Means

This research suggests that when young people are actively involved as partners in sexual and reproductive health research — rather than just as study subjects — the research process and its outcomes can be improved. By reviewing 117 published articles and interviewing eight expert researchers, the study identified specific ways this works: participatory methods can give young people more control over the research process, make them more comfortable discussing sensitive topics, build trust between researchers and participants, introduce playfulness into research activities, and use communication tools adapted to young people's needs. Together, these factors can help young people talk more openly about sexual and reproductive health, produce better quality research data, and even have lasting positive effects on the young people involved. However, the research also found that whether these benefits actually occur depends heavily on context. Factors such as whether young people have the interest and capacity to participate, how flexible or rigid research institutions are, cultural taboos around sexual health topics, power imbalances between adults and young people, and whether researchers have opportunities to learn and reflect on participatory approaches all shape how well these methods work. The findings were organized into a visual diagram showing how these factors connect and influence each other. This research matters because it moves beyond simply saying youth participation is valuable, and instead tries to explain the specific conditions under which it works and why. The framework developed — called an initial program theory — is intended as a practical foundation that researchers can use, test, and refine when designing studies that involve young people in sexual and reproductive health research across different cultural and institutional settings.

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Citation

Remmerie L, Schoenmakers I, van Reeuwijk M, Dewaele A, Tucker J, Michielsen K. (2026). Unravelling complexity: a realist approach to youth participation in sexual and reproductive health research.. Sexual health. https://doi.org/10.1071/SH25154