Developing a participatory approach for exploring young people's perspectives on health inequalities

The enduring existence of health inequalities, unfair differences in the health and wellbeing of different groups in society, is a key concern for many citizens, researchers and policymakers. Research that has focused on public views of the causes of these differences suggests that, in general, people have well-developed understandings of the factors that contribute to health inequalities. People from communities across the UK have identified the range of upstream factors which influence their health and the health of those around them, including housing conditions, unemployment and lack of funding for communities and services. Despite both policymakers and public groups understanding these causes, limited progress has been made towards reducing health inequalities in Scotland or UK-wide. Citizens' views on this lack of progress, and their perceptions of potential policy measures which could reduce health inequalities, have not been explored in detail. Young people's perspectives on these issues are also not currently well understood.

Media representations of health inequalities can negatively impact those communities and individuals most impacted by inequalities by furthering feelings of stigma or shame, related to the areas they live in being labelled deprived or disadvantaged. Calls for new qualitative research suggests that researchers should engage sensitively with the topic and avoid stigmatising language, but also aim to include diverse population groups to explore the consequences of inequality across society. Various models of research have been proposed to overcome some of these barriers, including participatory research which invites participants to actively shape projects and contribute to outputs alongside researchers.

In order to develop our understanding of young people's views on health inequalities, this project involves working together with young people in Glasgow and Leeds, cities where reducing health inequalities is a priority. Creative organisations (Impact Arts in Glasgow and Opera North in Leeds), who have contributed to the development of this project, will facilitate the engagement of groups of young people in several workshop sessions. These sessions will be led by researchers and creative partners, who are experienced in delivering creative engagement events with groups of the public, to explore the causes and consequences of health inequalities. Participants will also be supported to discuss their perspectives on potential policy solutions, pursuing those issues which they prioritise as most important or most relevant to their lives, communities or peers. Over the course of the sessions participants will also engage in creative processes to produce artistic outputs that reflect their perspectives on the enduring public health problem of health inequalities. These creative outputs will provide the focus for a series of engagement events and workshops with representatives from local government, health boards, third sector organisations and local communities. By generating new insights and creative representations of these, young people will be facilitated to actively contribute to ongoing policy discussions about the reduction of social inequalities in health across both local and national contexts.

Policy decision-makers: Creation of the advisory group in the early stages of the project will allow for key input from policy decision-makers (including local and national government representatives and public health bodies) in the design of the project. Meetings of this group will aim to identify opportunities for young people to engage directly with policy priorities related to health inequalities - e.g. those proposed in The Life Chances of Young People in Scotland, A Report to the First Minister (Eisenstadt, 2017). Project progress will be communicated in monthly updates sent by email, and through online communications (blogs and project-specific social media content). The advisory group members will be joined by additional local and national decision-makers, identified by young people, at showcase events planned by participants. Decision-makers will also be invited to workshops in Glasgow and Leeds to discuss research findings. These events will facilitate prolonged engagement with the outputs of the research. More formal presentations will be made to wider audiences of policymakers at meetings of groups like the Scottish Parliament cross-party group on health inequalities, and similar groups in Westminster and Northern England. Insights are particularly relevant to decision-makers who identified health inequalities as a priority issue in Glasgow and Leeds, particularly given that lack of public support is often cited as a barrier to developing evidence-informed policy among decision-makers (Smith 2013).

Advocacy groups: Representatives from advocacy groups (e.g. Poverty alliance, The Equality Trust) and third sector organisations with an interest in health inequalities will also be invited to inform project development by joining the advisory group and attend dissemination meetings and workshops. Developing relationships with advocacy organisations will also provide a platform for dissemination of young people's creative outputs beyond the length of the project. Depending on participants' preferences artworks (or visual/audio/online content) could be shared with organisations for use in ongoing advocacy work.

Participants: A diverse mix of young people, some of whom are not in education, training or employment, will be engaged in the project. Engaging these young people will be led by Impact Arts whose programme includes working with young people in Scotland's most deprived areas. The aim of this work is to engage with young people through arts-based activities to increase confidence, contribute to wellbeing, and improve employability. These outcomes will be considered throughout development of the data collection phase, session plans and process for generating creative outputs. Evaluation of the outcomes for young people will be measured by Impact Arts. Importantly, at the close of the project, young people will be invited (in both sites) to continue to engage with Impact Arts or Opera North in longer term programmes.

Wider community groups: A key aim of dissemination events will be to engage with the wider community in each group's area. Depending on participants' preferences on delivery, this could involve inviting local school groups to engage in workshops on the social determinants of health, or creating launch events which run over afternoons and evenings so members of the community can engage with creative outputs of the research.

Impact Arts and Opera North: The two creative partner organisations will acts as co-facilitators of Development Phase workshops, and will develop new connections to both social and public health researchers and policymakers (local and national) with an interest in health inequalities. Both organisations will be invited to engage in broader knowledge exchange activities, including ongoing communication with the Advisory Group, co-authored publications, and through face-to-face meetings and events with wider stakeholders, including communities and policy decision-makers.