Exploring young people's perspectives of health inequalities

Case Study

Dr Hannah Fairbrother, Senior Lecturer in Public Health at the University of Sheffield, led a research team that explored young people’s understandings of inequalities in health and the wider social determinants of health. The project was conceived before the Covid-19 pandemic began, and the changes this led to gave the team an opportunity to reflect on how this impacted on their ethical and methodological processes.

This case study presents some of the findings related to this project, including the project overview, a blog post and links to helpful resources such as their Strategy for engaging and working with young people and guidance for how to talk to young people about health inequalities.

In addition to the main overarching findings of the research (more here) there was an opportunity for reflection on the ways that the Covid-19 pandemic necessitated adaptations to the methodological approach, such as moving the majority of the research online.

However, there were unanticipated positive outcomes- particularly related to the ways the community partners enabled the research. Following the research, the research team reflected on the ways that Covid-19 had forced change to their approach and the ways they had navigated this.

Project Overview

Project Lead

Dr Hannah Fairbrother, Health Sciences School, The University of Sheffield

Project Members

Prof Liddy Goyder, Prof Carolyn Summerbell, Dr Caroline Dodds-Reynolds, Prof Karen Lock, Dr Matt Egan, Eleanor Holding, Mary Crowder, Naomi Griffin, Nicholas Woodrow, Vanessa Er, Nicky Knights & Steph Scott, Emma Rigby, Jeremy Sachs and Rachael McKeown.

Funder

National Institute for Health Research, School for Public Health Research

Overview

Our project explored young people’s perspectives on factors influencing health in their local area, their understandings and experiences of health inequalities and their priorities for reducing health inequalities

Process

We carried out focus groups (n=18 with 42 YP aged 13-21) in three geographical areas with high levels of deprivation in England, UK.

Recruited through local youth organisations, each group of YP took part in interlinked focus groups, which included a participatory concept mapping exercise to explore factors influencing health and discussion of newspaper articles relevant to health inequalities.

Conceived before the Covid-19 pandemic, we had to adapt our approach and ways of working, while still trying to ensure that our methods would be engaging, accessible and sensitive.

Exploring health inequalities through online focus groups - navigating the ethical and methodological challenges

In this short blog post for Covid Realities, "Discussing ‘tricky topics’ with young people at a distance: the challenges of exploring sensitive subjects in virtual focus groups", we discuss our experiences of conducting online focus groups with young people exploring health inequalities. We outline the methodological and ethical challenges we encountered, and share some of the ways we sought to navigate these.

For a more detailed discussion, please see our paper: Woodrow et al. (2021) Exploring inequalities in health with young people through online focus groups: navigating the methodological and ethical challenges

Webinar: Engaging and working with young people

The NIHR Schools for Public Health Research, Primary Care Research and Social Care Research hosted a webinar to explore engaging and working with young people, featuring the research team as well as the community project partners, Chilypep and the Association for Young People’s Health.

In this webinar, members of our research team reflected on our experiences and challenges when working with young people and the real value of working closely with youth organisations. Chilypep and AYPH also shared their insights from the voluntary sector on working with young people and participating in research.

Project resources

Principles for engaging and working with children and young people

We brought together insights from our partner youth organisation, Chilypep, the Association for Young People’s Health (AYPH) and INVOLVE guidelines to develop a set of principles of engaging and working with children and young people.

Association for Young People's Health (AYPH) (2022) 'Language matters: how to talk about health inequalities in the context of young people'.

AYPH researched the language and terminology used to describe young people’s health inequalities. In this blog post, Rachael McKeown, one of the co-authors on the project, shares what AYPH found out.

Project Findings

We’ve published our overarching findings paper here (it’s available open access).

Some of the young people who took part in the research worked with Nifty Fox, visual storytellers, to create an animation based on their priorities for reducing health inequalities.

Young people also worked with AYPH to create a Health Inequalities toolkit for young people - all about how young people can have a fair and equal opportunity to be healthy. The toolkit can be used in schools and youth groups and is designed to give young people information as well as ideas and inspiration about how to take action to help reduce health inequalities.

Participatory Mapping

One of the activities for the focus groups was a participatory mapping exercise (more details on this method in the Jessiman et al. 2021 paper). When this practice is carried out in person, it involves using post-it notes or similar resources and working as a group to sort out ideas. However, as this research was carried out online, the platform Jamboard was used instead.

Due to time constraints (not wanting young people to have to be doing online sessions for too long) the researchers initially grouped the factors using mapping software outside of the focus group session and then took these 'maps' back to the participants as a springboard for further discussion with the young people in the second of the three focus groups.

Participatory Map: Supplementary Material available from Fairbrother, et al. (2022).

References

Association for Young People's Health (2022). 'Language matters: how to talk about health inequalities in the context of young people'. Accessed https://ayph.org.uk/language-matters-young-peoples-health-inequalities/.

Fairbrother H, Woodrow N, Crowder M, Holding E, Griffin N, Er V, Dodd-Reynolds C, Egan M, Lock K, Scott S, Summerbell C et al (2022). ‘It all kind of links really’ : young people’s perspectives on the relationship between socioeconomic circumstances and health. International Journal of Environmental Research and Public Health, 19(6), 3679-3679.

Fairbrother, H., Goyder, L., Summerbell, C., Dodds-Reynolds, C., Lock,K., Egan, M., Holding, E., Crowder, M., Griffin, N., Woodrow, N., Er, V., & Scott, S. (nd) Enabling children and young people’s involvement in whole system action to reduce inequalities in the social determinants of health. NIHR School for Public Health Research. Accessed https://sphr.nihr.ac.uk/research/enabling-children-and-young-peoples-involvement-in-whole-system-action-to-reduce-inequalities-in-the-social-determinants-of-health/.

Holding, E., Crowder, M., Fairbrother, H., Griffin, N., & Woodrow, N. (2021). Strategy for engaging and working with children and young people. Accessed https://sphr.nihr.ac.uk/wp-content/uploads/2021/06/Principles-for-engaging-with-CYP-June-2021.pdf.

Jessiman PE, Powell K, Williams P, Fairbrother H, Crowder M, Williams JG, et al. (2021) A systems map of the determinants of child health inequalities in England at the local level. PLoS ONE 16(2): e0245577. https://doi.org/10.1371/journal.pone.0245577

NIHR (2021) Engaging and working with young people: webinar recording now available. Accessed https://sphr.nihr.ac.uk/news-and-events/news/engaging-and-working-with-young-people-webinar-recording-now-available/.

Woodrow, N., Crowder, M., Fairbrother, H., Griffin, N., Holding., E. (2021). Discussing ‘tricky topics’ with young people at a distance: the challenges of exploring sensitive subjects in virtual focus groups. Covid Realities. Accessed https://covidrealities.org/researching-poverty/tricky-topics-young-people.

Woodrow, N., Fairbrother, H., Crowder, M., Goyder, E., Griffin, N., Holding, E. and Quirk, H. (2022), "Exploring inequalities in health with young people through online focus groups: navigating the methodological and ethical challenges", Qualitative Research Journal, Vol. 22 No. 2, pp. 197-208. https://doi.org/10.1108/QRJ-06-2021-0064

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