Editorial: Moving Beyond Tokenism: Toward Sustainable Youth Engagement to Improve the Implementation of Public Health Programs and Interventions

Ucheoma Catherine Nwaozuru ^1* Emily Haines ¹ Thembekile Shato ² Chisom Obiezu-umeh ³ Juliet Iwelunmor ²

• ¹ School of Medicine, Wake Forest University, Winston-Salem, United States
• ² School of Medicine, Washington University in St. Louis, St. Louis, Missouri, United States
• ³ Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States

Youth engagement involves the leadership of adolescents and young adults in developing, implementing, and evaluating programs and research that impact their health and well-being. 1 Youth engagement in its true form centers youth in research by the power dynamics between the researcher and youth participants. Growing evidence highlights the benefits of youth engagement in closing the research-to-practice gaps for youth-based interventions. [2][3][4] Hence, it is increasingly considered essential to engage individuals with lived experience at all stages of research projects, examining issues relevant to them to improve research quality and relevance.This special issue, 'Toward Sustainable Youth Engagement to Improve the Implementation of Public Health Programs and Interventions,' was developed to document collective efforts to promote youth engagement in implementing public health programs and interventions. It is a compilation of articles that share insights, strategies, and lessons learned from various research projects and initiatives that have successfully engaged youth in public health. Although not exhaustive of the work in this area, these articles reflect the growing importance of youth engagement in research, some approaches for youth engagement, and lessons learned. We summarize the articles in this special issue in two main and overlapping themes:Youth engagement for identifying salient needs and solutions to health issues that impact youth:Ratliff and colleagues open this collection by documenting lessons learned in their work focused on using Youth Participatory Action Research (YPAR) to engage young people who have experienced homelessness in Boston in research that impacts their lives. YPAR accredits the disenfranchisement of youth partly to adult dismissal of their agency and challenges this by positioning youth as researchers who can shape study design and methods. Through YPAR, youth in this project generated research questions and were fully incorporated into the research team. They were trained to actively participate in research activities and compensated for their time. Ratliff et al. comment on the challenges faced in engaging a uniquely vulnerable population of young people in YPAR and offer practical solutions for nurturing inclusive, trauma-responsive, and flexible environments to mitigate these challenges. Similarly, Chow and colleagues highlight youth community advisory boards (CABs) as sustainable mechanisms for youth engagement in developing policies and advancing the implementation of interventions for young people. In the manuscript, they describe a network of youth CABs comprising young people between the ages of 13 to 26 years living with or affected by HIV operating in four regions in Tanzania. The CABs were engaged to understand the priority health needs of Tanzanian youth and to further generate youthdriven solutions to address these needs. Chow et al. highlight the importance of youth engagement in setting policy agendas to ensure that the needs of youth are met. The study underscores the relevance and importance of actively engaging youth in addressing issues that affect them. Altogether, the two studies emphasize the need for youth engagement to not only identify the problems that affect youth and their proposed solutions but also offer strategies to engage them in subsequent phases of research design and execution.Benning and colleagues leveraged a youth research group (YRG) model to guide, co-create, monitor, and evaluate the implementation of PrEP delivery to young people (15-29 years old) in Cape Town, South Africa. The YRG was a youth group convened to guide the intervention development, implementation, and process. The YRG comprised 80 young people aged 16-29, purposively selected to represent the population of interest. An evaluation of the model garnered positive feedback from the YRG members, including feelings of empowerment, a perception of genuine youth engagement, and consultation that was not tokenistic. Nwaozuru and colleagues used an innovation bootcamp model to engage youth in developing and implementing HIV self-testing delivery strategies for youth in Nigeria. Innovation bootcamp, informed by humancentered design principles, is an accelerated training program to provide research implementation, entrepreneurial skills, and project management skills among participants. The manuscript describes the innovation bootcamp process and the five youth-driven HIV service delivery strategies that emerged. The study highlights the feasibility of the innovation bootcamp model in building capacity among youth to lead solutions and the potential to enhance the sustainability of community interventions. In addition, Coakley and colleagues describe using Youth Participatory Action Research (YPAR) to engage adolescents and young women in the design and delivery of a sport-based, after-school sexual and reproductive health program in South Africa. This methodology included multiple steps, including youth investigator recruitment, youth investigator training, co-design of YPAR methods, youth investigator-led data collection, collaborative analysis and interpretation, and dissemination. The evaluation of the process highlights high program acceptability, partly attributed to the inclusion of end users-adolescent girls and young women-in the intervention's design, delivery, and evaluation. Collectively, these studies provide descriptions of innovative models for including youth in the design, delivery, and evaluation of interventions. In addition, the studies also highlight the need to explore sustainable and creative strategies further for the continued inclusion of youth beyond the lifespan of the intervention implementation and evaluation process.In conclusion, this special issue was an attempt to collect lessons and recommended practices from researchers on fostering meaningful youth engagement and avoiding tokenism. The articles included in this collection highlight the benefits and utility of youth engagement and some strategies for youth engagement. They also showcase different levels of involvement, with some studies integrating youth across multiple phases of the research process, including research question generation, study design, data collection, analysis, implementation, evaluation, and dissemination. This underscores both the feasibility and value of youth participation in all aspects of research. While the level of engagement may vary based on feasibility, the studies in this issueprimarily conducted in African countries-offer valuable insights that contribute to the broader discourse on youth involvement. Although the applicability of these findings may have regional limitations, they provide important perspectives on sustaining meaningful youth engagement. We hope this collection sparks further discussions and actions toward ensuring youth voices are front and center in issues that affect them.