Application of Youth-Led Participatory Action Research to Examining Adolescent Sexual and Reproductive Health and Rights in Ontario: What Can We Learn?

Abstract

Engaging adolescents and young people as partners in research is increasingly acknowledged as a vital strategy to ensure diverse voices are heard and to catalyze social change. This article, coauthored by adolescent and adult researchers, presents the methodological approach and outcomes of a youth-led participatory action research (YPAR) study in which three teams of youth researchers developed and implemented projects examining equity-related factors affecting adolescent sexual and reproductive health and rights (ASRHR) in Ontario, Canada. Teams of four assigned-female youth researchers aged 16–19 years were recruited from three priority regions through purposive sampling. Selected youth completed a paid 5-day virtual YPAR training. Each youth team, supported by adult research mentors, identified key ASRHR issues in their region and developed a related research question. Each team then determined their study’s design, obtained institutional ethics approval, and conducted data collection, analysis, and interpretation. Based on their findings, teams proposed potential solutions and communicated results to multiple stakeholders. Methodologically, the YPAR process amplified youth voices through a social justice-framed approach to examining ASRHR. Centering the perspectives, values, and experiences of youth positively impacted the youth researchers themselves, while yielding results that were relevant, meaningful, adolescent-responsive, and culturally informed. Results from the youth-led projects identified multiple barriers to accessing sexual and reproductive health services and products. Policy and practice implications encompassed concerns related to geographical accessibility, equity, service provider competence, and content of sexuality education curricula.

Background

Attending to adolescent sexual and reproductive health and rights (ASRHR), including access to comprehensive sexuality education and essential sexual and reproductive health services, is critical to promoting positive adolescent health and developmental trajectories (World Health Organization, 2024). It is well-established that youth who are structurally marginalized, including those living in poverty, lacking access to quality education, experiencing violence, belonging to racialized communities, and identifying as 2-Spirit, Lesbian, Gay, Bisexual, Transgender, Queer/Questioning, Intersex, Asexual+ tend to experience poorer sexual and reproductive health and rights (SRHR) outcomes (Black et al., 2012; Svetaz et al., 2020; Wong et al., 2020). These inequities were compounded by the recent COVID-19 pandemic (Hall et al., 2020; Shadmi et al., 2020; van Dorn et al., 2020).

While young people’s involvement in decisions that affect their health and well-being has been increasingly recognized as critical to addressing their diverse developmental and ASRHR needs (Sawyer & Begun, 2023; World Health Organization, 2017), there are limited examples in the literature of methodologic approaches to or outcomes from projects centering youth voices in research on ASRHR.

Youth-led participatory action research (YPAR) is an equity-oriented research methodology that recognizes young people as experts to generate knowledge and catalyze action to improve their health (Gibbs et al., 2020; Green & Thorogood, 2004). YPAR is a variation of community-based participatory research, a paradigm or approach to inquiry that “equitably involves all partners in the research process and recognizes the unique strengths that each brings” (Wallerstein & Duran, 2006, p. 312). It is informed by key principles such as partnership and colearning between academics and communities, a commitment to capacity building, the production of knowledge that mutually benefits all partners, and sustained commitments to address health inequities (Wallerstein & Duran, 2006). In particular, YPAR is a collaborative and iterative research process where young people are engaged as participants and coresearchers in conducting action-oriented research for social change and equity. This is acknowledged as the difference between doing research “with” versus “on” youth, and ultimately transfers power from adult researchers to adolescent or youth participants (Green & Thorogood, 2004; Ozer & Piatt, 2017).

YPAR processes and outcomes can promote agency, self-efficacy and well-being both within the youth researchers themselves, and across the communities they investigate (Ozer, 2017; Ozer & Piatt, 2017; Rodríguez & Brown, 2009). In addition, this approach generates results that are relevant, meaningful, adolescent-responsive and culturally informed (Ozer et al., 2020). As it promotes critical consciousness, YPAR has particular applicability to studies of social determinants of health (Ozer & Piatt, 2017), such as those postulated to underpin inequitable SRHR outcomes among structurally marginalized adolescents. YPAR has gained increased prominence as a community-based methodology for research and for the development and implementation of youth-oriented health programs, services or interventions, particularly when addressing sensitive health issues such as sexual and reproductive health (Lassi et al., 2022).

Despite the promising benefits of YPAR to adolescents, organizations and community development, youth are infrequently engaged as truly equal partners in the design and implementation of research that impacts their lives (Powers & Tiffany, 2006). This article, coauthored by youth and adult researchers, describes our approach to applying a YPAR methodology to explore ASRHR, presents the findings derived from the three youth-led research projects generated by the study, and critically reflects on key methodological considerations for this approach.

This article describes part of a larger study which aimed to address key gaps in our understanding of inequities in ASRHR outcomes and experiences, employing a two-phase mixed-methods approach. In Phase 1, a quantitative analysis of province-wide health administrative data on ASRHR trends before and during the COVID-19 pandemic was conducted (Vandermorris et al., 2024). In Phase 2, represented by this article, we sought to amplify the voices of youth and respond to the calls for a social justice-framed approach to enhance ASRHR, particularly during the COVID-19 pandemic (Hall et al., 2020), through the application of a YPAR methodology. Specific objectives of this Phase 2 considered experiences during and beyond the COVID-19 pandemic and aimed to: (a) examine adolescents’ priorities and experiences in relation to ASRH services across multiple regions and (b) identify youth-driven policy and program solutions to address ASRHR.

Method

Implementing YPAR

The YPAR phase of this study was conducted from November 2021 to July 2022. Our approach followed the four key steps of the YPAR process described by Ozer and Piatt (2017), as depicted in Figure 1.

Figure 1.

Steps of YPAR (Ozer & Piatt, 2017)

The multidisciplinary research and mentor team was composed of seven female adults (SB, HB, MH, BM, AT, AV, and JW), across a range of professions (e.g., adolescent medicine, public health, social work, and epidemiology), with expertise in conducting quantitative and qualitative research, and diverse levels of experience (early career to senior career researchers). A public health PhD candidate (MT) also provided research, logistical, communication and mentorship support with youth researchers. All adult members of the study team were involved in the study design and provided capacity building and mentorship to youth researchers.

Selection of Priority Regions for YPAR

Phase 1 of this study entailed a population-based, repeated cross-sectional analysis of ASRHR outcomes (primary outcome: pregnancy; secondary outcomes: contraceptive management visits, contraception prescription uptake, and sexually transmitted infection management visits) for over 630,000 female adolescents (12–19 years) residing in Ontario, Canada, during pre- and COVID-19 pandemic periods. Details of Phase 1 methods and findings have been previously reported (Vandermorris et al., 2024). The three regions (Southwestern Ontario, Central South Ontario, and Northern Ontario) with the highest rates of the primary outcome (adolescent pregnancy) were selected as the priority regions for Phase 2 of the study.

Recruitment of Youth Researchers

Purposive sampling strategies were employed to recruit four assigned-female youth researchers (ages 16–19 years) in each of the three priority regions identified in Phase 1. Local youth organizations, educational facilities, and child welfare agencies were engaged as partners to recruit the youth researchers. Interested youth were interviewed by a study team member (AV) to explore their motivation to learn new skills, intersectional lived experiences, interest in collaborating with other youth, and sense of service to their communities. Youth selected as youth researchers were onboarded as study collaborators and subsequently received hourly compensation for their work. Each youth research team was paired with two research mentors from the adult study team and supported by the study coordinator.

YPAR Training

Youth researchers participated in a 5-day, 16-hour virtual training program to prepare them for the YPAR process. Topics covered during the training curriculum included ASRHR, intersectionality theory, research skills for quantitative and qualitative data collection and analysis, research ethics, and research project logistics (e.g., timeline, resources, funding). At the end of each training day, we collected training feedback and recommendations for the subsequent training days. Details of the training curriculum are depicted in Table 1.

Table 1.

Summary of Topics Covered During the 5-Day Youth Participatory Action Research Training Curriculum

Training day	Topic
Day 1	Introductions and Community Guidelines
	Meet the Adult and Youth Research Team
	Team Building Activity
	The State of Adolescent Sexual and Reproductive Health and Rights (ASRHR) in Ontario
	Sexual and Reproductive Health Rights (SRHR) in Ontario
	Impact of COVID-19 on ASRHR
	Impact of COVID-19 on SRHR in Ontario
	Phase 1 Sexual and Reproductive Health Outcomes
	Phase 2 Youth Participatory Action Research
Day 2	Introduction to Youth Participatory Action Research
	Research as a tool for change
	Youth Leadership and Community Organizing
	Team Decision-Making Process
	Introduction to Intersectionality and Power Flower
Day 3	Comparing your Community’s SRHR to an Ideal
	Identifying Community Issues and Assets
	Brainstorming Potential Research Questions
	Hypothesis Development
	Personal Reflections on the Topic
Day 4	Research Methods: Interviews
	Research Methods: Focus Groups
	Research Methods: Mapping
	Research Methods: Photovoice
	Research Methods: Surveys
	Mind Mapping Research Questions and Methods
Day 5	Research Bias
	Research Ethics
	Refining Research Design with the SPIDER Tool
	YPAR Overview
	Project Management and Next Step

Youth researchers were engaged using virtual platforms (e.g., Zoom, Jamboard, and Menti) throughout the training curriculum and study implementation process. Teams collaboratively brainstormed and discussed pressing SRHR challenges or concerns among youth in their communities, along with existing community assets to address these issues. A sample of one team’s results from this step is shown in Figure 2.

Figure 2.

Sample Jamboard Used to Facilitate Community Mapping of ASRHR Issues and Assets

YPAR Phases

Following completion of the YPAR training program, each youth-led research team embarked on the four-step YPAR process.

Step one: Issue identification

Youth-led research teams began by identifying ASRHR priority issues in their communities. Results from Phase 1 (Vandermorris et al., 2024), published peer-reviewed studies, gray literature, and health and social service agency resources were used to facilitate an understanding of ASRHR issues that affect adolescent populations in the teams’ respective regions, and the current programs or policies in place to address challenges. Supported by mentors and using several conceptualization tools, including mind mapping and the SPIDER Tool (Cooke et al., 2012), youth researchers then progressed from broad identification of issues to collectively produce a guiding research question and objectives (Figure 3).

Figure 3.

Samples of the Application of Mind-Mapping and SPIDER Conceptualization Tools to Move Youth Research Teams From Issue Identification to Research Question Development

Step 2: Research design and data collection

Youth teams were introduced to a range of qualitative and quantitative research designs, methodologies, and methods for generating data. Potential data collection methods reviewed included surveys, interviews, focus group discussions, photovoice, storytelling, and participatory mapping. Given the prevailing COVID-19 public health restrictions, technologically-driven models of conducting YPAR were presented, and youth researchers were encouraged to utilize diverse digital platforms/technologies (e.g., mobile phones, social media, etc.) for data production and sharing (Flicker et al., 2008; Gibbs et al., 2020). Throughout the data generation process, youth researchers met weekly on a virtual platform, with at least one adult mentor present to offer logistical and methodological support. The progress of youth-led projects was facilitated by the completion of bi-weekly reports in which they documented their achievements, outlined challenges encountered, and reflected on the next steps to be taken. These were then discussed during their weekly meetings.

Step 3: Data analysis and interpretation

Each youth-led research team completed data analysis congruent with their chosen research methodology [simple descriptive statistics for survey studies (Teams 1 and 3); qualitative thematic analysis (Braun & Clarke, 2006) for the semi-structured interviews (Team 2)]. Analyses were supported by and reviewed in collaboration with the adult study mentors. Each team engaged in a series of discussions regarding the interpretation of findings.

Step 4: Developing solutions

The final step of the YPAR process involved the youth researchers developing potential solutions to address the specific domain of ASRHR they had chosen, drawing on the insights gained through their respective studies. To facilitate this stage, youth researchers participated in a 2-day in-person knowledge mobilization symposium. Topics addressed during this symposium included identifying key stakeholders, knowledge mobilization strategies, and preparing academic talks. Each youth-led team developed a series of policy recommendations based on their research findings, converted these recommendations into social media posts, and developed a research poster and 10-minute academic talk summarizing their project and findings, which was then presented at an invited institutional research rounds.

Ethics approval was received from the Hospital for Sick Children for the broader study on COVID-19 and ASRHR, as well as each youth-led study.

Youth-Led Projects

Team 1: Southwestern Ontario

Youth Research Team 1 developed an 18-item online survey to investigate adolescents’ care-seeking behaviors, experiences of health providers’ attitudes or judgment, accessibility of services, and the impacts of COVID-19 on the sexual and reproductive health and well-being of individuals ages 13–21 years, who were assigned female at birth and resided in Southwestern Ontario. Snowball sampling was employed for online study recruitment through social media platforms of the youth and adult study team members. The survey tool took 7–10 minutes to complete and was anonymous and confidential. It included two verification questions to ensure participants were from the relevant region. Study participants were emailed a $5 gift card upon survey completion as compensation for their time.

Team 2: Central South Ontario

Youth Research Team 2 sought to explore how the intersectional identities of youth in Central South Ontario influenced experiences of school-delivered sexual health education. The team developed a semi-structured interview guide that examined young people’s notions of identity, sources of information about sexual health, and experiences of school-delivered comprehensive sexuality education. Purposive sampling was conducted through community organizations and online, followed by snowball sampling, to reach youth of diverse ethnicities, races, and religions. Inclusion criteria involved being a young person aged 13–18 years, speaking English, and having completed or being in the process of completing at least one sexual education course at a school in the target region. Interviews were conducted over zoom by one youth researcher and ranged from 40 to 60 minutes. Participants received a $10 gift card as a token of appreciation for their time and contributions. Interviews were audio recorded and transcribed verbatim by study team members. Thematic analysis was guided by six stages, as described by Braun and Clarke (2006), including familiarization with interview transcripts, generating a list of initial codes, generating initial themes, reviewing themes, defining and naming themes, and writing study findings. Transcripts were coded inductively and codes were produced through iterative (adult/youth) team discussions. A codebook was developed through iterative revisions and discussions among the research team for reliability and maintaining consistency in the interpretation of data. Codes were then grouped into higher order themes which offer generalized statements on young people’s lived experiences of comprehensive sexuality education (Becker, 1998).

Team 3: Northern Ontario

Youth Research Team 3 designed an online survey to identify factors that influenced access to sexual and reproductive health products for teens in Northern Ontario. Inclusion criteria for study participation was being between 13 and 19 years of age, living in Northern Ontario, and having access to internet/an electronic device. Recruitment was conducted by sharing study posters on social media, in schools, and in youth centers in the region. The survey included demographic questions, as well as questions examining the experience of accessing SRH-related products, defined as menstrual hygiene products, condoms/contraception, pregnancy tests, and sexually transmitted infection (STI) medications. The survey took approximately 15 minutes to complete, and participants received a $5 gift card as compensation for their time.

Results

YPAR Process

Sixty-seven youth across the three priority regions expressed interest in participating in the project as youth researchers. Of these, 40 responded to invitations and were interviewed by an adult study team member. Four youth from each of the three regions were selected as youth researchers, with 12 youth total participating. Youth researchers ranged in ages from 16 to 19 years, with more than half under the age of 18 years (n = 7; 57.7%). Most youth researchers identified as female (83.3%), and two individuals identified as nonbinary (16.7%). At the time of this project, half of the youth researchers were completing their secondary school education (50.0%), five attending postsecondary education college or university (41.7%), and one was not currently attending school. Table 2 displays the demographic characteristics of the youth researchers.

Table 2.

Key Demographic Features of Youth Researchers at Time of Recruitment (n = 12)

Characteristic	n (%)
Age (years)
16	2 (16.7)
17	5 (41.7)
18	2 (16.7)
19	3 (25.0)
Gender identity
Female	10 (83.3)
Nonbinary	2 (16.7)
Educational level
Grade 11	1 (8.3)
Grade 12	5 (41.7)
University	5 (41.7)
Not currently enrolled in school	1 (8.3)

YPAR Projects

Results of YPAR projects for each of the three youth-led study teams are depicted in Figure 4A–C. Additional knowledge dissemination materials developed during Step 4 of the YPAR process (“developing solutions”) can be found in Supplemental Appendix 1.

Figure 4.

(A) Team 1 (Southwestern Ontario) study: “How COVID-19 is affecting the sexualities of assigned female at birth (AFAB) youth 13–21.” (B) Team 2 (Central South Ontario) study: “Intersectional identities and sexual health education: A study on young people’s experiences of school-delivered sex education.” (C) Team 3 (Northern Ontario) study: “Identifying barriers and facilitators to access to sexual and reproductive health products for adolescents in Northern Ontario”

Team 1: Impact of COVID-19 on Sexualities of Assigned Female at Birth Youth in Southwestern Ontario

A total of 58 participants completed the online survey. Of those respondents, the majority (65.5%) had never sought care for sexual health-related needs from a medical provider. Furthermore, 51.7% endorsed having avoided health care for sexual health needs due to fear of judgment from the provider and over 30% of participating youth indicated hesitation in seeking help or information despite need. Half of the youth surveyed reported that COVID-19 had made sexual health care difficult to access, while the majority (67.2%) did not find that access to sexual health products was impacted by COVID-19. A key policy recommendation emerging from this study, generated by youth researchers, was that all health care providers engage in additional “sensitivity training” to ensure adolescents receive nonjudgmental care (Figure 4A).

Team 2: Influence of Intersectional Identities on Young People’s Perceptions and Experiences of Sexual Health Education in the Central South Ontario Region

A total of eight semi-structured interviews were conducted with youth (aged 14–17 years). Key themes produced included (a) adolescents are a diverse group and sexuality education needs to be tailored to address their unique social identities and SRHR needs; (b) sexuality education should be adapted to align with young people’s evolving capacities and SRH needs; and (c) sexual education curriculum should promote positive sexuality and healthy relationships (see Figure 4B for supporting quotes). Youth researchers produced multiple policy recommendations, including (a) comprehensive sexuality education should be integrated into the secondary school curriculum across all 4 years; (b) sexuality education curriculum must be redesigned to consider and respond to the intersectional experiences of youth; (c) a variety of instructional modalities should be employed to optimize student engagement in material; and (d) sexual education should promote positive sexuality, rather than focusing solely on risks and negative outcomes.

Team 3: Barriers and Facilitators to SRH Products for Adolescents in Northern Ontario

A total of 114 adolescents completed the online survey, the majority of whom (61.5%) identified as cis-female. The mean age of respondents was 17.4 years. Although 92% of respondents reported having ever required access to sexual health-related products, 32% of youth surveyed experienced substantial barriers to buying sexual health products locally, including stigma, cost, distance, disability, and identifying as 2SLGBTQIA+. The most commonly endorsed factor that made youth uncomfortable buying sexual health-related products was stigma/embarrassment associated with having to buy products in their own community. In addition, over one quarter of participants indicated cost was a barrier to accessing sexual health products, and almost one-fifth (19%) reported access to products was prevented by experiencing a disability (Figure 4C). Policy recommendations generated by Team 3 in response to study findings included making menstrual products available for free in all (male and female) public bathrooms, requiring high schools to have a nurse on site monthly to address contraceptive needs, and increasing research on alternative contraceptive methods for individuals with disabilities.

Discussion

Our implementation of a YPAR methodology sought to harness and expand youth expertise with regards to community-engaged inquiry and action on issues of ASRHR. Embedding youth as partners in the research process helped to ensure that research topics and objectives were contextually appropriate, meaningful, and relevant to adolescents and peers in their region. Common areas of concern relating to ASRHR identified and endorsed by participants in the youth-led projects pertained predominantly to structural issues that undermine the accessibility, availability, appropriateness, and quality of SRH services and comprehensive sexuality education for young people in Ontario. These findings echo previous youth-led work on ASRHR undertaken in the region (Flicker et al., 2008); however it is notable that a discourse around these issues in Ontario has not been prominent in the adult-led academic literature to date. Policy recommendations based on empirical data generated through the youth-led research underscored the need to: (a) improve geographical equity in access to sexual and reproductive health care and products; (b) enhance the competence and responsiveness of service providers regarding ASRHR; and (c) strengthen the provision of comprehensive sexual education curriculum in schools, guided by an intersectional lens.

For the youth researchers involved in this initiative, YPAR facilitated self-development, an increase in confidence, and an opportunity to address community needs, consistent with previous research employing this methodological approach (Anyon et al., 2018; Fortin et al., 2022; Lassi et al., 2022; Ritterbusch et al., 2020). Youth researchers in this study gained skills pertaining to qualitative and quantitative research design, research ethics, and diverse strategies to generate and analyze data. They were also offered opportunities to present study findings and policy recommendations to diverse stakeholders in several academic spaces, including invitations to present at their educational institutions, multidisciplinary research seminars, and international research conferences. This study highlights the potential for knowledge creation and activism when youth are placed at the center of research endeavors and supported both financially and practically to critically examine the needs of communities to which they are intimately connected. By sharing power between adult and youth researchers, youth learned tangible research skills, while adult mentors gained fresh insights into the priorities and perspectives of youth through authentic engagement and mutually beneficial interactions.

Youth-adult partnerships play a central role in YPAR, facilitating the collaborative construction of knowledge and the collective tackling of societal challenges (Anyon et al., 2018; Ozer et al., 2020). An important strength of this adult-youth research collaboration was the deep commitment to adopting a YPAR approach by both youth and adults; adult mentors volunteered time to train and support youth teams on evenings and weekends and youth were committed to weekly meetings with their study team and regular mentorship meetings amid other academic and personal demands. In addition, the breadth of expertise and skills among the adult mentorship team represented an asset, as adult researchers were able to lead capacity building, provide sustained mentorship, and support youth research teams to gain methodological and substantive skills and knowledge aligned with their research objectives. Finally, this project generated diverse opportunities for youth to network and establish connections with a vibrant group of peers interested in SRHR, as well as with various health professionals. These relationships have endured beyond the completion of the study. A systematic review on the impact of youth involvement in YPAR by Anyon et al. (2018), suggests that “agency and leadership” and “academic and career outcomes” were among the most common skills influenced through their engagement.

This study was conducted online through multiple media technologies due to constraints posed by the COVID-19 pandemic and our commitment to actively involve youth from multiple regions across Ontario. Our implementation bolsters previous research on e-PAR (Flicker et al., 2008) (a model for using technology and PAR) to encourage critical youth engagement toward their community needs and social activism using media and technology, in a manner that may reduce geographic barriers to participation. In acknowledging and valuing youth knowledge and contribution, this form of PAR integrates creative technologies in which youth are already involved (Maley et al., 2004). With youth as coresearchers, youth designed research projects using media technologies that further promoted youth engagement, including Zoom, Jamboard (a digital whiteboard) and other virtual spaces to catalyze discussion and the cocreation and production of knowledge. Online surveys and interviews with study participants conducted by Zoom were identified as accessible and acceptable research methods for data collection, particularly in the COVID-19 context. Although visual participatory methods, such as photovoice and mapping, were considered, ultimately the youth researchers decided that surveys and interviews were more congruent with their research objectives and limitations imposed by COVID-19 restrictions. This study illustrates that engaging youth researchers through virtual platforms to facilitate training, mentorship, collaboration, and data generation and analysis is a cost-effective, feasible, and accessible approach that may be considered by future YPAR study teams or projects.

Limitations

Despite the demonstrable benefits for youth, adult research teams, and the academy more broadly, several challenges related to time, resources, study recruitment, and evaluation were encountered. First, this study involved a significant time investment from both youth and adult mentors throughout the YPAR component of the study. Youth teams were expected to attend an initial multiday training, followed by weekly group meetings with mentors. The youth research team from Southwestern Ontario faced difficulties in recruiting participants for their study and had to adapt their research questions and approaches to overcome this challenge. Finally, a robust evaluation of the youth researcher’s perspectives was not conducted. Concerns arose that youth researchers might feel pressure to participate or rate the opportunity favorably were identified as potential ethical considerations. Adult research team members were also concerned that evaluating the experiences of youth researchers might inadvertently imply that studying their experiences was the primary motivation for the project, potentially diminishing youth researchers’ sense of being equal partners in the research process. During structured but informal feedback discussions with youth researchers during the YPAR training sessions, they indicated increased understanding both of research methodologies and of issues influencing ASRHR and expressed excitement to be engaged in this work. However, future efforts should consider formal opportunities to evaluate young people’s experiences participating as coresearchers in academic spaces. For example, other YPAR adult-youth collaborations have successfully integrated mixed-methods evaluations and may offer lessons to consider process and outcome measures across multiple levels of impact, including youth development, behavior change, as well as employing qualitative methods to explore youth and adult experiences of engagement (Fortin et al., 2022; Lindquist-Grantz & Abraczinskas, 2020).

Implications for Practice

Health promotion practitioners should engage youth as coresearchers in multidisciplinary settings. Throughout the research process, technology can be leveraged as a cost-effective and acceptable strategy to engage youth as experts and partners. Practitioners conducting qualitative YPAR must critically reflect on and rigorously document and disseminate the prospects/challenges of this approach to inquiry, as this will offer novel insights that can support other practitioners to meaningfully involve youth in all stages of developing, implementing, and evaluating health programs or interventions.

Youth-generated ASRHR priorities may also guide health and education practitioners and institutions, emphasizing the need for increased implementation of responsive health services and comprehensive sexuality education for youth. Youth-led recommendations and priorities for ASRHR health promotion and service provision practices included increased training for health care providers to deliver confidential, nonjudgmental reproductive health services; recognition of young people’s intersecting identities and ensuring that sexuality education is comprehensive and tailored to their diverse needs; and improved access to menstrual hygiene products and contraception for all young people.

Conclusion

YPAR is an innovative and inclusive research methodology that supports the engagement of youth to advocate for their participatory and sexual and reproductive health and rights. It holds immense promise as an approach to identify previously unrecognized priorities for inquiry and to generate nuanced results with direct relevance to adolescent populations. Application of YPAR to the investigation of adolescent sexual and reproductive health and rights in this study revealed pervasive structural issues which undermine accessibility, availability, appropriateness, and quality of SRH services and education. Methodologically, this initiative demonstrates that conducting rigorous research in true partnership with young people is possible and that YPAR can facilitate equity-oriented, robust, and meaningful inquiry into issues of relevance to youth. Sharing lessons learned and strategies employed to adapt and implement YPAR in a multidisciplinary team and mixed-methods study is critical to guide other academic and community-based institutions to more meaningfully integrate youth as equal and active partners in all stages of the research process.