Date of Degree
Doctor of Philosophy (Ph.D.)
Community Health and Social Sciences
Emma K. Tsui
Other Social and Behavioral Sciences | Public Health | Public Health Education and Promotion | Social Justice
youth participatory action research, community-based research, adolescent health, sexual consent, health departments
Background: Health departments are vital to community-partnered public health efforts and research and are positioned to influence community or policy level systems that impact population health. However, while some health departments partner with community members in their programming, not much is known about health departments partnering with community youth. From 2018-2019 the New York City Department of Health & Mental Hygiene (NYC DOHMH) implemented a youth participatory action research (YPAR) project to develop a public awareness campaign in partnership with youth and adult community stakeholders for a federally funded program. It was the first participatory research conducted by the agency that involved youth and adult community partners in such an extensive way. The goal of that YPAR project was to understand sexual consent communication among NYC adolescents, 12 focus groups were conducted with 113 young adults ages 13-20 years old to develop a public awareness campaign in partnership with youth and adult community advisory groups on the topic of sexual consent communication. Presented in this research are three separate but interrelated studies that highlight YPAR conducted with health departments. Specifically, the three studies aimed to: (1) use single case study methodology to analyze the YPAR project implemented by the NYC Health Department, (2) implement grounded theory methodology to analyze focus group data from the NYC DOHMH YPAR project to explore the similarities and differences in perspectives on sexual consent among youth participants, and (3) conduct a rapid scoping review of existing literature on YPAR projects conducted with health departments in the United States to determine what is known about youth partnered research done in partnership with health department.
Methods: Single-case case study methodology was utilized to analyze the NYC DOHMH YPAR project and explore how participatory research conducted in partnership with community youth can be supported by the health department through 13 key stakeholder interviews with individuals who had participated in either the research or action phase of the original YPAR project and document analysis of 97 documents including emails, summary reports, minutes, presentations, and agendas was used to triangulate interview findings. In-depth grounded theory analysis was then conducted on the 12 transcripts to expand on the findings uncovered by youth-partnered analysis previously done in the NYC DOHMH YPAR project. Deeper analysis explored differences and similarities in youth perceptions of the practice of sexual consent between groups of youth identified as younger (13-to-16-year-olds) versus older (17-to-20-year-olds) as well as between self-identified female and self-identified male youth. Lastly, a rapid scoping review was conducted to explore YPAR led by or partnered with health departments and assess the extent of youth participation and health department involvement in these. Literature was pulled from two databases on articles published in English since 1985 representing work conducted in the United States. A total of 309 articles were identified (with three duplicates), 306 underwent first level screening and 16 underwent full text review. Seven articles met the inclusion criteria.
Results: The single-case study uncovered (1) Practices that Positively Impacted the YPAR Project, (2) Practices that Negatively Impacted the YPAR Project and (3) Reasons for Supporting YPAR projects. Positive practices included the allocation of program staff well-versed in community engagement best practices and the strategic leveraging of limited resources allocated to the project. Negative practices uncovered multi-level approval systems, unreliable and inflexible funding streams, and challenges surrounding the protection of the health department brand. Reasons for supporting YPAR projects highlighted opportunities for creating unique and successful content and how reinvestments in communities help improve relationships with community members, including youth.
Grounded theory analysis of the NYC DOHMH YPAR data uncovered eight main categories of perspectives on the practice of sexual consent communication across the 12 focus groups. Among these categories were how youth navigate interpersonal experiences with their partners such as: verbal consent, body language, rejection, and relationship dynamics. There were also categories that reflected youth’s navigation of systemic, cultural, and societal factors such as: media, gendered sexual scripts, rape concerns, and drug and alcohol use.
The analysis of the rapid scoping review articles revealed that YPAR projects were done in partnership with health departments but mostly led by community-based organizations. Health department involvement in the projects was most categorized as moderate except whereas youth involvement in the projects was most categorized as substantial. All articles except for one reflected YPAR being conducted in California counties and highlighted outcomes of youth involvement for both the research and action phases of these projects. Research findings were leveraged by many of the projects to influence change at the local, community or policy levels.
Conclusion: The single-case study of the NYC DOHMH YPAR project uncovered positive practices that if supported by the agency would benefit potential future community-partnered or YPAR projects. Project management strategies that incorporated best practices in community engagement were integral to successful project completion as well as the navigation of challenges of working with bureaucratic systems. Lessons and recommendations that may be valuable to other local health departments interested in engaging youth and community members in participatory research were also shared. Grounded theory analysis of focus group data from the NYC DOHMH YPAR project revealed similarities in youth perspectives across youth groups, such as the preference for verbal communication to clear up confusion or the leveraging of trust in long-term relationships to bypass the need for verbal consent. Differences were also identified, such as the greater concern among younger participants over the awkwardness of navigating verbal communication or rejection, or the greater concern for danger among female participants. The rich context provided by these diverse NYC youth inform recommended areas for better education on the topic of sexual consent communication. Findings from the rapid scoping review on YPAR projects led by or partnered with health departments suggest that there is a paucity of publications describing youth participatory action research led by or partnered with health departments. Future research should be conducted to explore other possible sources, including gray literature, that may expound on the motivators, benefits and challenges of health departments conducting youth participatory action research.
Cortes, Vivian, "Nothing About Youth Without Youth: Involving Youth in Participatory Action Research Conducted With Health Departments" (2023). CUNY Academic Works.
Available for download on Monday, November 11, 2024