Grace Spencer

Young People's Perspectives on Health: Empowerment, or Risk?.

Purpose – Research to date has identified young peoples perspectives on a number of health‐related topics such as smoking, alcohol, sexual health, physical activity and healthy eating. Whilst this body of research draws important attention towards young peoples views on topical health concerns, it arguably remains located within a pre‐defined agenda; thereby marginalising young peoples own, and potentially different, frames of reference when discussing health. In light of this omission, the aim of this paper is to examine young peoples own understandings of health in line with their own frames of reference.Design/methodology/approach – Data were collected from 55 young people aged 15‐16 years through group discussions, individual interviews and observational data in a school and surrounding community settings. Key themes were analysed for their implications for “emic” conceptualisations of health. Young peoples perspectives were further compared with accounts given by professionals.Findings – Two key...

Ethical and Epistemological Insights: A Case Study of Participatory Action Research with Young People

Debates over how to determine age of consent for youth to participate in research feature prominently in the practice of researchers, research ethics boards (REBs), and community decision makers working with youth. In particular, tensions can arise over how the ethical principles of beneficence, autonomy, and justice are interpreted and applied in research involving young people. We discuss our experiences obtaining ethical approval to conduct a participatory action research project involving youth and the differences of opinion we encountered regarding underage youths capability to make informed consent. We suggest that researchers, REBs, and community decision makers all share a responsibility to conduct proactive outreach to youth participants, so that they are adequately informed of their rights related to research.

Young people and health: Towards a new conceptual framework for understanding empowerment:

In recent times, empowerment has become the focus of much work with young people amidst increasing concerns about their health. Empowerment is often offered as a ‘solution’ to such concerns, with the uncritical assumption being made that empowerment unproblematically results in positive health outcomes. While much of the health promotion literature advocates ‘empowerment’, it often does so without offering a clear conceptualisation of the word itself or indeed addressing the thorny theoretical tensions surrounding the concept’s root word of power. In light of this omission, this article offers a more theoretically informed conceptualisation of empowerment and considers the relationship to young people’s health. This article outlines a more dynamic and generative conceptualisation of empowerment than hitherto articulated in the literature, informed by Lukes’ multidimensional perspective of power. Drawing on findings from an ethnographic study on empowerment and young people’s health, this article develops six conceptually distinct forms of empowerment (impositional, dispositional, concessional, oppositional, normative and transformative). Data were collected from 55 young men and women aged 15–16 years through group discussions, individual interviews and observational work in a school and surrounding community settings in England. Crucially, these six new forms of empowerment capture and synthesise individual, structural and ideological elements of power that differentially, and sometimes inconsistently, shape the possibilities for young people’s empowerment. Of significance is the way in which these different forms of empowerment intersect to (re)produce relations of power and may offer different possibilities for health promotion.

The ‘healthy self’ and ‘risky’ young Other: young people's interpretations of health and health-related risks

Concern about health-related risks dominates modern day public health discourses on young peoples health. Based on ‘official’ notions of health, the public health risk-based approach not only downplays the potentially different meanings young people attach to concepts of health, but it also has a tendency to problematise and pathologise young people and their health. Drawing on findings from an ethnographic study with young people aged 15–16 years in England (n = 55); in this article, I examine young peoples understandings of health and health-related risks. I used group discussions, individual interviews and observational work in a school and surrounding community settings to collect the data on which this article is based. In this article, I show the importance young people in my study attached to ‘being happy’ and ‘having fun’, but also how dominant constructions of youth as a time of risk were taken up and reproduced by young people themselves to create and sustain differences amongst young people. I examine the implications of these differences for young peoples health and the possibilities for empowerment – highlighting some of the emergent contradictions between young peoples constructions of the ‘healthy self’ and ‘risky’ young Other. Specifically, in this article, I highlight young peoples preference for a more positive conceptualisation of their health, one which recognises the importance of their shared social positioning for the promotion of health.

Examining concepts of power and agency in research with young people

Concepts of power and agency have become increasingly prominent in the youth studies literatures and related research. A focus of the research to date has been an examination of how a better understanding of young peoples lived experiences can reveal possibilities for young peoples agency to emerge. Despite increased interest in the term agency, much less has been said about how the concept is defined and recognized in research with young people, including what the concept may entail but crucially, how the term is linked to and underpinned by the related concept of power. This paper seeks to contribute to our understanding of power and agency as utilized in research with young people. The discussion that follows identifies the possible ways in which different theoretical positions shape our understanding of how power and agency are investigated and how these understandings inform the ways we interpret young peoples perspectives and actions as holding potential for ‘agency’. Drawing on recent empirical examples, we consider how varying interpretations of power and/or agency shape not only the ways in which young peoples agentic experiences are theorized (and the related ontological and epistemological assumptions these positions imply) but also the presumed effects of that agency.

The Sydney playground project- levelling the playing field: a cluster trial of a primary school-based intervention aiming to promote manageable risk-taking in children with disability

BackgroundProviding children and adults with opportunities to engage in manageable risk taking may be a stepping stone toward closing the gap in life conditions currently experienced by young people with disabilities. We aim to demonstrate the effectiveness of a simple, innovative program for 1) changing the way parents and teachers view manageable risk-taking for children with disabilities and 2) increasing the level of responsibility that children take for their own actions, as seen on the school playground.Methods/DesignWe will employ a cluster repeated measures trial with six Sydney-area primary-school-based programs for children with disabilities. The intervention comprises two arms. 1) Risk-reframing- teachers and parents will participate together in small group intervention sessions focusing on the benefits of manageable risk-taking; 2) Introduction of play materials- materials without a defined purpose and facilitative of social cooperation will be introduced to the school playground for children to use at all break times. A control period will be undertaken first for two school terms, followed by two terms of the intervention period. Outcome measures will include playground observations, The Coping Inventory, qualitative field notes, and The Tolerance of Risk in Play Scale.DiscussionNew national programs, such as Australia’s National Disability Insurance Scheme, will place increasing demands on young people with disabilities to assume responsibility for difficult decisions regarding procuring services. Innovative approaches, commencing early in life, are required to prepare young people and their carers for this level of responsibility. This research offers innovative intervention strategies for promoting autonomy in children with disabilities and their carers.Trial RegistrationAustralian and New Zealand Clinical Trials Registration Number ACTRN12614000549628 (registered 22/5/2014).

Examining the Concept of Choice in Sexual Health Interventions for Young People

Concepts of choice are often drawn upon within sexual health promotion discourses to encourage young people to take “responsibility” for and promote their own sexual health and reproductive control. A systematic literature search using predefined inclusion criteria identified peer-reviewed articles focusing on sexual health interventions for young people. Discourse analysis was used to interrogate how concepts of choice were articulated or inferred within the interventions. Of the eligible studies (n = 30), 16 were based on theories of behavioral change, suggesting a linear pathway between choice and improvements in sexual health. Studies that accounted for contextual factors were a minority (n = 6). Overall, study reports offered a limited account of the “situatedness” of young people’s opportunities to exercise choice. This reliance had a tendency to position young people as passive recipients of interventions which seemed to undermine the more active notion of “making choices” presented within these frameworks.

What Kind of Trouble? Meeting the Health Needs of ‘Troubled Families’ through Intensive Family Support

The policy rhetoric of the UK Coalition governments ‘Troubled Families’ initiative, and that of New Labours earlier Respect Agenda, share an emphasis on families’ responsibilities, or rather their irresponsibility, and their financial costs to society. Giving children a chance of a better life coincides, in this framing, with reducing costs for the taxpayer. The research reported here was based on a national study of Family Intervention Projects (FIPs), funded by the UK government between 2009 and 2012, beginning under New Labour, continuing over a period when the FIP programme was discontinued, and ending after the Troubled Families programme had begun. The research involved over 100 in-depth interviews with stakeholders, including service managers, family key workers, and caregivers and children in twenty families, to consider critical questions about the kinds of trouble that families experience in their lives, and how they are recognised in the policy and practice of intensive family intervention.

Sustainable development goals for health promotion: a critical frame analysis

The Sustainable Development Goals (SDGs) lay the foundations for supporting global health and international development work for the next 15 years. Thirty years ago, the Ottawa Charter defined health promotion and outlined key principles for global action on health, including the importance of advocating, enabling and mediating for health equity. Advocacy underscores a human right to health and suggests political action to support its attainment. Enabling speaks to health promotions focus on the empowerment of people and communities to take control over their health and aspirations. Mediation draws attention to the critical intersectoral partnerships required to address health and social inequities. Underpinned by this approach, the aim of this paper is to consider how key health promotion principles, namely, rights, empowerment and partnership feature (and are framed) within the SDGs and to consider how these framings may shape future directions for health promotion. To that end, a critical frame analysis of the Transforming Our World document was conducted. The analysis interrogated varying uses and meanings of partnerships, empowerment and rights (and their connections) within the SDGs. The analysis here presents three framings from the SDGs: (1) a moral code for global action on (in)equity; (2) a future orientation to address global issues yet devoid of history; and (3) a reductionist framing of health as the absence of disease. These framings raise important questions about the underpinning values of the SDGs and pathways to health equity - offering both challenges and opportunities for defining the nature and scope of health promotion.

Health experiences of children and young people who migrate – Opportunities for health education:

Research on migration and health is gaining significant ground, with a focus on the adverse physical and mental health outcomes experienced by migrants. The health-related experiences of children and young people who migrate, however, are relatively absent, with children’s migration and health status often conflated with that of their parents. The omission of children’s own perspectives limits knowledge about how health is understood and experienced by child migrants, including the identification of best ways to support their health. Drawing on the empirical literature on child migrants and health from the World Health Organization’s (WHO) Western Pacific Region, we adopt a critical perspective to examine how the research to date supports a particular way of understanding and investigating the health of children and young people who migrate. Specifically, we highlight how a dominant focus on parents’ migration status, (negative) health outcomes and patterns of risk behaviours limits, rather than aids, the understanding of migrant children’s health. In doing so, we illustrate how much of the evidence base upholds Westernised biomedical notions of health and privileges the use of particular methodologies to assess health outcomes and reduce health risks. These preferences, in turn, shape the subsequent range of ‘appropriate’ forms of health education for, rather than with, children. We conclude by drawing on some exceptions and consider the opportunities these provide for developing health education in line with children’s own understandings of health – crucially underscoring the importance migrant children and young people attach to the more social aspects of their health and migration experiences.