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IntroductionThe Watersports Inclusion Games is a free annual weekend event, where young people with a range of physical and intellectual disabilities and their families/siblings participate in various inclusive watersports activities.ObjectivesThis study aims to assess the psychological benefits of watersports for young people with various physical and intellectual disabilities and investigate the extent of the impact of the COVID-19 pandemic on their access to watersports.MethodsFollowing a literature review, a survey containing both quantitative and qualitative aspects was constructed using SurveyMonkey and circulated to the parents/guardians of participants three times following the event. The survey was completed anonymously on an opt-in basis and 28 responses that met our criteria for analysis were collected. Qualitative data from free-text responses were grouped under themes and quantitative data was analysed using SPSS.ResultsDespite 64% (n=18) of respondents indicating that their disability increased their vulnerability to COVID-19 in some capacity, the effect of the pandemic on accessibility was not statistically significant. This could be due to the small response number, or the everyday limitations participants faced prior to the pandemic. 92% (n=25) of participants indicated that there was great inclusion in the watersports activities and that they were “very beneficial” regarding the possibility of the whole family’s participation [p=0.005]. The survey also found a statistically significant association between the event’s activities being considered both “accessible” and “very beneficial” in terms of boosting self-confidence, with 57.1% of responses indicating agreement to this. (p=0.016)ConclusionsFull-family participation and accessibility of activities were key facilitators to the enjoyment and benefit of participants. Programmes should be established that allow able-bodied siblings and young people with disabilities to participate in the same activities.Disclosure of InterestNone Declared

Thousands of Rohingya refugee mothers at the world's largest refugee camp located in Bangladesh are at risk of poor mental health. Accordingly, their children are also vulnerable to delayed cognitive and physical development. The aim of this study is to evaluate the effectiveness of an integrated care package in reducing the prevalence of developmental delays among children aged 1 year and improving their mothers' mental health status. This is a parallel, two-arm, single-blind, cluster randomized controlled trial (cRCT). A total of 704 mother-child dyads residing at the Kutupalong refugee camp in Cox's Bazar, Bangladesh, will be recruited from 22 clusters with 32 mother-child dyads per cluster. In the intervention arm, an integrated early childhood development and maternal mental health package will be delivered every quarter to mothers of newborns by trained community health workers until the child is 1 year old. Our primary outcome is a reduction in the prevalence of two or more childhood developmental delays of infants aged 1 year compared to the usual treatment. The secondary outcomes include reduced stunting among children and the prevalence of maternal depression. We will also assess the cost-effectiveness of the integrated intervention, and will further explore the intervention's acceptability and feasibility. At the time of submission, the study was at the stage of endpoint assessment. The data analysis started in December 2020, and the results are expected to be published after the first quarter of 2021. This study will address the burden of childhood developmental delays and poor maternal mental health in a low-resource setting. If proven effective, the delivery of the intervention through community health workers will ensure the proposed intervention's sustainability. ISRCTN Registry ISRCTN10892553; https://www.isrctn.com/ISRCTN10892553. DERR1-10.2196/25047.

In this Journal Club, Azza Warraitch describes a paper detailing challenges of participatory mental health research with youth.

Background Meaningful involvement of adolescents in health research is their fundamental human right and has many benefits. A lack of awareness among researchers on how to meaningfully involve adolescents in health research has been linked to adolescent under involvement in health research. To address this barrier, studies have reported the need for more guidance. To inform the development of better guidelines on adolescent involvement, there is a need to first consolidate the currently available guidance on adolescent involvement in health research and to identify the gaps in these guidelines. This review aims to systematically identify all the currently available guidelines on adolescent involvement in health research and evaluate their scope, content, context, and quality. Methods This rapid review was pre‐registered with PROSPERO #CRD42021293586. It included documents that incorporated tangible recommendations on the involvement of adolescents in health research. We searched six databases for peer‐reviewed literature: MEDLINE, CINAHL, Embase, Scopus, Web of Science, and ERIC. We conducted a grey literature search in Google Scholar, Google, websites of 472 relevant organisations and sought expert input. The quality of the guidelines was assessed using the Appraisal of Guidelines for REsearch & Evaluation (AGREE‐II) Instrument. Data was analysed using descriptive analyses and narrative synthesis. Results We found that the current guidelines on adolescent involvement in health research are often narrow in scope, targeting specific users and populations while focusing on limited research areas. The guidelines individually fail to provide comprehensive coverage of recommendations across all topics related to adolescent research involvement, that are collectively addressed across all included guidelines. Furthermore, these guidelines tend to be context‐specific and are generally of low quality, often due to inadequate stakeholder involvement and a lack of rigorous development methods. Conclusion This review provides a consolidated list of guidelines on adolescent involvement in health research along with their quality scores as a resource for researchers to select the guidelines suitable for their research topic, context, and scope for adolescent involvement. There is a need to develop a set of guidelines on adolescent involvement in research, which are comprehensive in scope, cover all key aspects of adolescent involvement in health research, can be adapted for different contexts, and which are based on rigorous and systematic methods. Patient and Public Involvement Adolescent co‐researchers D. B. and C. W. were involved at different stages of the review process. D. B. screened 25% of the peer‐reviewed articles at the title and screening stage and 10% at full‐text screening stage. C. W. extracted data from 10% of the included guidelines. Both co‐researchers reviewed and shared their feedback on the article and are co‐authors on this paper. They will also be invited to contribute to further dissemination of the findings from this review.

Background Less than 1% of studies on child and adolescent health report the involvement of adolescents in health research. This is attributed to barriers experienced by researchers and adolescents in the engagement process. To address this under‐involvement of adolescents, we first need a better understanding of the factors that hinder adolescent involvement in health research. Objective We conducted an umbrella review of reviews to consolidate the review‐level evidence on the barriers to meaningful involvement of adolescents in health research. Methods We preregistered this umbrella review of reviews with PROSPERO (CRD42021287467). We searched 11 databases; Google Scholar; and PROSPERO; supplemented by a hand search of the reference lists of eligible reviews, relevant journals, websites of 472 organisations, and input from experts. This resulted in the inclusion of 99 review articles exploring adolescent involvement in studies on adolescent physical or mental health, which were narratively synthesised. Adolescent coresearchers were engaged at all stages of the review. Results We found that adolescent involvement in health research is impeded by several challenges experienced by researchers and adolescents. Some challenges experienced by researchers were organisational issues which included limited resources, gatekeeping and paying adolescents. Some barriers were related to a lack of preparedness among researchers and included a lack of awareness of adolescent involvement, the need for training and guidance, and negative attitudes towards participatory research. There were also barriers around how adolescents can be involved, such as researchers finding it challenging to adapt to new methods, issues with recruitment and retention of adolescents, inclusiveness and accessibility. There were also challenges specific to adolescents, such as adolescents' skills and expertise, training, motivations and study goals. Finally, barriers related to the ethical involvement of adolescents included issues with power dynamics, confidentiality, safety and protection of adolescents. Some of the barriers reported by adolescents included tokenistic involvement, inaccessibility of adolescent involvement, and their competing demands. Conclusion Researchers may find this review useful in understanding and planning for potential challenges of involving adolescents in research. Despite many identified barriers to adolescent engagement, few mitigation strategies were identified to address these barriers. There is a clear need to establish best practices for meaningful adolescent involvement in health research. Public and Patient Involvement in the Review Adolescents were involved at multiple stages of this umbrella review of reviews. They reviewed the protocol, screened 25% of the articles at title and screening stage, screened 10% of full‐text articles, and worked on data analysis. They also helped plan and conduct a participatory workshop with an adolescent advisory group to discuss the challenges experienced by adolescents in health research.

ABSTRACT Background Adolescent involvement in health research has numerous benefits for the research, researchers, and the adolescents involved. However, evidence on the impacts of adolescent involvement in health research is anecdotal and subjective, relying on informal reflections rather than prospectively planned and rigorous evaluations. These limitations of the current evidence base highlight the need for more structured and prospectively planned evaluations of adolescent involvement in health research. To achieve this, we explored how adolescent co‐researchers involved in a guideline development project experienced their involvement, what facilitated their sustained participation, what outcomes resulted, and how specific engagement practices may have contributed to these outcomes. Methods This evaluation was co‐designed and led by trained adolescent co‐researchers. Semi‐structured interviews were conducted with five adolescent co‐researchers involved in a guideline development project. Reflexive thematic analysis was conducted to analyse the data. Emerging themes were mapped onto the Youth Engagement Framework. To build a theory of change, we used the Public Involvement Impact Assessment Framework to trace how initial motivations, engagement practices, and contextual barriers contributed to observed outcomes. Results Findings are organised around four key themes: initiators, qualities of engagement process, sustainers, and outcomes of the involvement process. Adolescent co‐researchers reported being motivated by opportunities for skill development, career growth, and roles aligned with their interests, and highlighted the role of supportive involvement practices in sustaining their involvement. They shared some predominantly positive outcomes from their involvement, including enhanced research knowledge and skills, co‐authorship opportunities, financial compensation, and strengthened relationships with the research team. Conclusion Adolescent engagement is shaped not just by individual motivation, but also by social and institutional factors, indicating the need for system‐level changes to enable meaningful and equitable involvement. To maximise benefits, researchers should tailor involvement processes to adolescents' needs, supported by a clear theory of change. Public and Patient Involvement This evaluation was co‐designed with adolescents and led by a trained adolescent co‐researcher. Three young people (aged 17–24) were involved at different stages of the study. One acted as a consultant during the study design phase, helping to define the evaluation framework and refine interview guides. The others were hired as co‐researchers to support data collection and analysis. The lead adolescent co‐researcher conducted interviews, proofread transcripts, supported coding and theme development, and contributed to manuscript drafting.

IntroductionA lack of awareness on how to engage adolescents in research has been reported as one of the barriers to meaningful youth involvement in health research. Currently, available guidelines on youth involvement are limited in terms of the scope (e.g., focused on limited health research areas), content (e.g., include broad principles) and context (e.g., most guidelines are from high-income countries) for which the guidelines are applicable. To address this, we will develop a set of comprehensive guidelines based on consolidated evidence on youth involvement in health research. To inform these guidelines, we are first conducting an umbrella review to (1) summarise and synthesise findings from reviews on involving adolescents in health research, (2) consolidate the challenges experienced in youth involvement and the recommendations to mitigate these challenges, (3) identify best practices and (4) identify gaps and methodological weaknesses in the extant literature on involving adolescents in health research.Methods and analysisWe will include review articles exploring adolescents’ involvement in studies aiming to improve their physical or mental health. Databases to be searched include Cochrane Database of Systematic Reviews, Medical Literature Analysis and Retrieval System Online (MEDLINE), Scopus, Embase, PsycINFO, PsycArticles, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Epistemonikos and Health Systems Evidence. A grey literature search will be conducted in Web of Science, ProQuest, Google Scholar and PROSPERO, supplemented by a handsearch of the reference lists of eligible reviews, relevant journals, websites of related organisations and input from experts. Data will be analysed using narrative synthesis.Ethics and disseminationEthical approval is not required as we are not collecting participant data as part of this review. The findings of this umbrella review will be disseminated through peer-reviewed publications, participatory workshops and academic conferences.PROSPERO registration numberCRD42021287467.

Refugees' parenting behaviour is profoundly influenced by their mental health, which is, in turn, influenced by their situation of displacement. Our research presents the first systematic review on parenting and mental health in protracted refugee situations, where 78% of all refugees reside. We pre-registered our protocol and screened documents in 22 languages from 10 electronic databases, reports by 16 international humanitarian organisations and region-specific content from the top 100 websites for each of the 72 countries that ‘host’ protracted refugees. Our criteria were empirical papers reporting parenting and parental mental health data on refugees who are in a protracted refugee situation. Studies including only internally displaced or stateless persons were excluded. A total of 18,125 documents were screened and 30 studies were included. We identified a universal pathway linking macro-level stressors in protracted refugee situations, such as movement restrictions and documentation issues, to symptoms of depression and anxiety, which, in turn, led to negative parenting practices. Additionally, culture-specific pathways were observed in the way parental mental health and parenting were expressed. Situational (e.g., overcrowding) and relational factors (e.g., spousal dynamics) modulated both of these pathways. Biases in the research included the over-representation of specific protracted refugee situations, overreliance on self-reported data, and a heavy focus on mothers while neglecting fathers and other caregivers. Longitudinal research is needed to clarify the directionality and causality between specific macro-level stressors in a given protracted refugee situation and parental mental health and practices. Refugees were rarely consulted or involved in the design of research concerning their parenting and parental mental health. In recognising the existing links between protracted refugee situations, parental mental health, and parenting, our systematic review calls for a shift in thinking: from focusing solely on the micro aspects that affect ‘refugee parenting’ to understanding and tackling the broader macro-level stressors that drive them. We urge larger and long-term research efforts that consider diverse protracted refugee situations, greater investment in science communication and diplomacy with governments, and stronger implementation of durable solutions by states to alleviate the roots of refugee parents' distress and negative parenting practices. •Refugee mental health and parenting relationship is important to understand in context.•Our review targets protracted refugee situations, where 78% of refugees reside.•Protracted refugee situations could impact refugee parenting through parental mental health.•Universal and culture-specific pathways may exist, shaped by relational and situational factors.•Contributions of past stressors like war trauma were weak and indirect on parenting.•Extant research emphasises psychopathology and harsh parenting over resilience.

Background Stakeholder involvement in evidence syntheses has the potential to enhance the quality and relevance of reviews. However, adolescents rarely participate in evidence synthesis, mainly because their role and influence in shaping the synthesis process relating to health outcomes are poorly understood. To fully unlock the potential of evidence syntheses for adolescent health, it is crucial to understand how adolescents can contribute at various stages of the review process and how their involvement can influence outcomes. Methods To achieve this, we conducted an umbrella review examining adolescent involvement in reviews related to adolescent health research, complemented by a case study that highlights how adolescents were engaged at various stages of this review. We ran a search across 11 databases, screened reference lists and 12 journals, and consulted experts in youth involvement. Results We found only 10 reviews which involved adolescents. In those reviews, adolescents were engaged at almost every stage of the review process, with most involvement centred around interpreting findings or co-authoring the final reports. While adolescent participation was often consultative, there were examples of more collaborative involvement using a wide range of methods, even at technical stages like study selection and data analysis. However, reviews did not report on the impacts or benefits of adolescent involvement in evidence syntheses. Conclusion To maximise the impact of adolescent involvement, we call for engagement of adolescents throughout the review process and the adoption of frameworks to ensure transparency and consistency in reporting. Systematic review registration PROSPERO CRD42021287467.

Background Ninety percent of children with mental health problems live in low or middle-income countries (LMICs). School-based programs offer opportunities for early identification and intervention, however implementation requires cross-sector collaboration to assure sustainable delivery of quality training, ongoing supervision, and outcomes monitoring at scale. In Pakistan, 35% of school-aged children are reported to have emotional and behavioral problems. As in many other LMICs, the government agencies who must work together to mount school-based programs have limited resources and a limited history of collaboration. The “Theory of Change” (ToC) process offers a way for new partners to efficiently develop mutual goals and long-term prospects for sustainable collaboration. Objective Develop a model for scale-up of school based mental health services in public schools of Pakistan. Methods We used ToC workshops to develop an empirically supported, ‘hypothesized pathway’ for the implementation of WHO’s School Mental Health Program in the public schools of rural Pakistan. Three workshops included 90 stakeholders such as policy makers from education and health departments, mental health specialists, researchers, head teachers, teachers and other community stakeholders including non-governmental organizations. Results The ToC process linked implementers, organizations, providers and consumers of school mental health services to develop common goals and relate them (improved child socioemotional wellbeing, grades and participation in activities) to interventions (training, monitoring and supervision of teachers; collaboration with parents, teachers and primary health care facilities and schools). Key testable assumptions developed in the process included buy-in from health care providers, education officials and professionals, community-based organizations and families. For example, teachers needed skills for managing children’s problems, but their motivation might come from seeking improved school performance and working conditions. Poverty, stigma and lack of child mental health literacy among teachers, administration, and parents were identified as key hypothesized barriers. Children and their families were identified as key stakeholders to make such a program successful. Discussion ToC workshops assisted in team building and served as a stakeholders’ engagement tool. They helped to develop and support testable hypotheses about the structures, collaborations, and knowledge most important to scaling-up school based mental health services in Pakistan.