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Article

‘Nothing Gets Realised Anyway’: Adolescents’ Experience of Co-Creating Health Promotion Measures in Municipalities in Norway

by
Mari Sylte
1,*,
Monica Lillefjell
1,2,
Bodil Elisabeth Valstad Aasan
3,4 and
Kirsti Sarheim Anthun
1,5
1
Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, 7491 Trondheim, Norway
2
Department of Public Health, University of Stavanger, 4036 Stavanger, Norway
3
HUNT Research Centre, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, 7491 Trondheim, Norway
4
Levanger Hospital, Nord-Trøndelag Hospital Trust, 7600 Levanger, Norway
5
Department of Health Research, SINTEF Digital, 7030 Trondheim, Norway
*
Author to whom correspondence should be addressed.
Societies 2023, 13(4), 89; https://doi.org/10.3390/soc13040089
Submission received: 1 February 2023 / Revised: 28 March 2023 / Accepted: 30 March 2023 / Published: 1 April 2023

Abstract

:
In this study, we aimed to explore how adolescents experience co-creating health promotion measures in four municipalities in Norway. We applied a qualitative design with group interviews (n = 9) among forty-nine adolescents participating in projects related to ‘Program for Public Health Work in Municipalities’ (2017–2027). Additionally, participatory observation of project activities was performed in two municipalities. We conducted a data-driven thematic analysis to analyse the data. The most prominent finding was that the adolescents often expressed feelings of resignation and dissatisfaction. Furthermore, we identified four underlying reasons behind the resignation and dissatisfaction. These were related to long project duration, the experience of not having an influence on the outcome, promises not being kept and lack of information and continuity in their participation. Essential features for meaningful participation were not present, and the findings suggest that the municipalities had limited success in facilitating participation that adolescents perceived as meaningful. The findings indicate that despite good intentions and policies supporting children’s participation, effort placed on implementing such policies in practice is still needed. This study adds knowledge regarding important factors to consider when involving young people in co-creating measures to avoid unintended effects such as disempowering adolescents.

1. Introduction

Children and young people’s participation in democratic processes has gained increasing traction over the last decade and has become prominent within youth-related policy and practice [1]. The United Nations Convention on the Rights of the Child states that children have the right to express their views and be listened to [2], although how this is implemented in practice can vary. In Norway, children’s right to participate has become a central part of public policy through legislation such as the Norwegian Planning and Building Act [3] and the Norwegian Public Health Act [4]. Additionally, municipalities are obliged to establish young people’s parliaments or youth councils, and municipal councils must, in certain circumstances, gather and assess suggestions from this population in decision-making processes [5].
Participation is defined as ‘the process of sharing decisions which affect one’s life and the life of the community in which one lives’ [6] (p. 5). Participation is highly related to empowerment, and a process of empowerment needs to occur to enable meaningful participation. Achieving this empowerment requires shared control, ownership and the ability to participate in a way that influences decisions and the allocation of resources [7]. However, children’s participation in decision-making processes is often criticised as being symbolic or tokenistic [6,8], or for being neglected altogether [9].
Children and young people’s participation in planning and developing health promotion measures has shown several beneficial outcomes. It can help secure tailored measures and improve their sustainability [2,10,11], and children and young people can offer valuable insight into the built environment and provide ideas that adult stakeholders have not considered [11]. By being included in decision-making processes, children can develop an appreciation for democracy and a feeling of being a part of a larger community, and thus become empowered and develop a personal identity, valuable skills and competencies [11,12,13,14].
However, it has also been argued that such participation may result in negative outcomes [15]. Participation may, in fact, increase social inequalities as people with higher socioeconomic backgrounds tend to participate, influence, and benefit more from participatory processes [16,17]. Moreover, participation can result in distrust among the participants if expectations are not met [16]. Thus, enabling meaningful youth participation may require a shift in the attitudes of decision-makers who can be hesitant to give up power [7].
The term co-creation is being increasingly used in the literature to describe the participatory process, and there exist various definitions [18]. According to Torfing et al. [19], co-creation in the public sector is a process where two or more public and private actors attempt to solve a shared problem by exchanging knowledge, resources, and ideas and where the outcome is the enhancement of public value. While there are multiple frameworks, principles and recommendations for carrying out successful and meaningful co-creation processes with both adult citizens [20] and with children and young people [21,22,23], most guides on youth participation focus on making participation effective in creating community change and direct less attention to increasing the satisfaction of the youth participants [24].
Additionally, when evaluating the participation of young people, reports are often carried out from the perspective of adults [25,26], focus on specific outcomes such as competency and skills [12,24] or explore young people’s participation in research [27]. Fewer studies explore how young people experience the participation process when co-creating health promotion measures. From the few existing studies, it has been reported that children want to participate, to be heard and to influence their community and surroundings [28,29,30], but that barriers and challenges such as translation of ideas, maintaining ongoing communication and long timeframes negatively impact children’s experience of the participation process [25,30,31].
Thus, in the present study, we aimed to explore how adolescents experience co-creating health promotion measures in four municipalities in Norway. Co-creation is conceptualised in line with Torfing’s definition [19] cited above, and the actors featured in our study are the public sector (adult stakeholders from the municipalities) and the civic sector (the adolescents). We use the terms adolescents/children/young people interchangeably for the sake of variation.

2. Materials and Methods

2.1. Project Context: ‘Program for Public Health Work in Municipalities’ (2017–2027)

The study is carried out in the context of ‘Program for Public Health Work in Municipalities’ (2017–2027). This is a national program whose main goal is for municipalities to establish systematic and long-term public health work that promotes mental health and wellbeing and prevents substance abuse in children and adolescents. The Ministry of Health and Care Services owns and funds the program. Municipalities apply for admission and receive funding and support from the county council. Participating municipalities develop health promotion measures based on local needs assessments and the involvement of the local population. A sub-goal is to establish routines for the participation and involvement of children and adolescents in health promotion measures. Children and young people’s participation is a requirement; however, who participates and how to engage them is up to each municipality [32].
Each municipality has an interdisciplinary and cross-sectoral project group that develops and implements the measures in collaboration with adolescents. The municipalities implement various measures. In this study, three municipalities were renovating their schoolyards, and one was establishing a youth club. Henceforth, we refer to the schoolyards and youth club as the ‘projects’ or ‘measures’. Children aged between ten and sixteen were involved in the projects and participated in various ways, including through pupil councils, school subjects and activities during and after school hours. The municipalities used several methods, such as oral consultations, surveys, interviews, drawing, making cardboard models and tools such as Padlet (a digital corkboard) and Mentimeter (a web-based poll).
The level of involvement varied during the processes in each of the municipalities. By high level of involvement, we refer to the application of more than one involvement strategy (i.e., digital tools, physical workshops with creative processes, decision-making meetings) or the use of one strategy that managed to engage all, or close to all, children in the target group. In Table 1 below, it is evident that all municipalities used several strategies to involve the adolescents, though it varied over the course of the project whether these strategies were used once or several times, if they managed to engage broadly, and if the involvement strategies were spread out thinly, or concentrated during only one stage. In general, though, the involvement of the target groups was most intense, or at a higher level, during the first stage of the project processes.
According to the Norwegian centrality index [33], Municipality 1 is defined as urban (population density of twenty-seven inhabitants per km2 [34]) compared to Municipalities 2, 3 and 4, which are defined as rural communities (population density ranging from three to six inhabitants per km2 [34]). See Table 1 for more information about the municipalities, their chosen measure and the methods and arenas for young people’s participation.
Table 1. Population, measure and methods and arenas for participation.
Table 1. Population, measure and methods and arenas for participation.
MunicipalityPopulation (as of 1 January 2022 *)MeasureMethods and Arenas for Young People’s Participation
Municipality 125,000Schoolyard renovationPupils were involved in a brainstorming day at school.
Municipality 2 6000Schoolyard renovationThe pupil council was consulted by the project leader.
Pupils in lower secondary school were involved in creative activities during classes (carpentry, painting, etc.).
Pupils in primary and lower secondary school took part in a drawing competition (‘My Dream Schoolyard’).
Pupils were consulted by an architect and researchers (interviews and GPS registration of schoolyard activities).
Adolescents and adult stakeholders took part in an ‘activity night’ with image scraping.
Municipality 32000Establishment of a youth clubPupil council members were represented in the project group.
8th graders were involved in creative activities during classes (cardboard modelling, image scraping, room sketching, etc.).
Prioritizing challenges with pupils in lower secondary school (using the digital tool Mentimeter).
Brainstorming with pupils in lower secondary school (using the digital tool Padlet).
Municipality 46000Schoolyard renovation5th–10th graders were involved in an activity night/brainstorming with adult stakeholders (group work aimed at prioritizing wishes and needs for a schoolyard).
5th–10th graders were consulted by the project leader during school hours.
The pupil council was occasionally consulted by the project leader.
* Numbers retrieved from Statistics Norway [34], rounded off to the nearest 1000.

2.2. Data Collection

A qualitative design with group interviews and participatory observation was chosen to capture the experiences of adolescents who had been involved in co-creating health promotion measures in four municipalities participating in the program. Municipalities were included based on a set of criteria. They all had to be part of the Program for Public Health Work in Municipalities in a county in Central Norway; they had to be developing a public health measure targeting adolescents; and at least one participation activity had to be carried out. Participating municipalities were required to apply The Trøndelag Model for Public Health Work as a working method [35]. We ensured that the included municipalities varied in population size and rural and urban areas. This was carried out to explore municipalities with different available resources and number of adolescents.
The municipalities varied in terms of where they were in the process. Municipality 1 had recently started their schoolyard project and had involved adolescents for the first time a couple of weeks before the interviews were conducted. Municipalities 2 and 4 had been working on the projects for a few years. They had renovated parts of their schoolyards but were not fully finished. In Municipality 3, they had been working on the youth club for three years prior to the interviews; however, they had not started the construction work yet.
The interview participants were recruited by contacting the project leader in each municipality, who put us in contact with teachers and principals at the respective schools. The teachers and principals recruited young people based on who had participated in the municipality’s measure. We emphasised that we wanted a balance in sex ratio and variation in the participants’ backgrounds, interests and experiences of the process to capture a broad spectrum of experiences. We outlined that we wanted to interview two groups of six to eight participants in each municipality, but it was up to the principals and teachers to choose whether they invited all adolescents involved in the project or just some of them—as long as the interviewees volunteered and fitted the abovementioned criteria. In Municipality 3, we conducted one additional interview with adolescents who were represented in the municipality’s project group. The principals and teachers decided on the composition of the group interviews, with the aim of composing groups where adolescents would feel comfortable sharing their thoughts. Participants were aged between ten and sixteen. Nine group interviews were conducted with a total of forty-nine participants. See Table 2 for information about interview participants.
The interviews were conducted at the children’s schools during school hours, and they ranged from twenty to fifty minutes. The first author conducted interviews in collaboration with a fellow researcher. We took turns asking questions while the other researcher served as an observer. The observer also ensured all interviewees had a chance to participate in the discussions and wrote notes. The two researchers and the interviewees were the only ones present during the interviews. A semi-structured interview guide with ten questions was used.
All interviews started with a presentation from the researchers, the aim of the interview and how and for what purpose the interview data would be used. After everyone in the group had introduced themselves, and the interviewees confirmed they wanted to participate in the interviews, we started asking questions from the interview guide. Examples of questions are: ‘What do you think about children’s participation in matters concerning them?’, ‘Can you tell us about the public health measure?’, ‘Can you tell us about how you participated in the measure?’, ‘What has been good about participating in the measure?’ and ‘What could have been done to improve your participation?’. All interviews were audio-recorded and transcribed verbatim.
The first author conducted participatory observation of project activities involving adolescents in Municipalities 1 and 3. In Municipality 1, the researcher participated in a one-day session in ‘brainstorming’ (idea-generating process), where she followed one group of five pupils throughout the day, working together with the children on the tasks they had been assigned. In Municipality 3, the researcher participated on two occasions: one time, when the 7th–10th grade students were brainstorming in groups how and why they wanted to participate in the youth club project; and one day with 8th graders, where they, in groups, were using creative methods such as cardboard modelling and room sketching to plan the new youth club. On both occasions, the researcher walked between the groups, asking questions about what they were carrying out and thinking about while doing it.
In both municipalities, the pupils attending were informed about the presence, role and background of the researcher and the aim of the observations. Observations were only conducted based on informed consent from all pupils and teachers present in the room. The observations were performed to gain contextual insights, inform the interview guide, get to know the children a little, and deepen our understanding of the activities that would later be referred to during interviews. The data were obtained by taking field notes immediately after attending the project activities. Due to COVID-19 restrictions, observations were not conducted in all municipalities. The data were collected during 2021 and 2022.

2.3. Analysis

We conducted a data-driven thematic analysis inspired by Braun and Clarke [36,37]. In the first phase of the analysis, all transcripts were read to obtain an overview. In the second phase, initial coding of each interview was conducted. Phase three included searching for patterns across the transcripts, and it became evident that one topic in particular kept coming up in the interviews, either as a main topic that the interview centered around or it popped up repeatedly while addressing various other topics. These were experiences and accounts of resignation and dissatisfaction. Upon reading and rereading the interview transcripts in light of our research questions, the main theme of resignation and dissatisfaction was developed. Therefore, in phase four, we searched the transcripts for accounts of what had created feelings of resignation and dissatisfaction among the adolescents. In phase five, we searched the observational field notes by using the candidate themes and collated the observational data with the interview data. In phase six, we reviewed the themes by going back and forth between codes and themes. In phase seven, we defined and refined the themes, clarifying their focus and naming them. The theme names are based on quotes from the interviews; however, in revised formats, these quotes were shortened, and the wording was changed to clarify and accommodate the theme’s content.
In the last phase, we wrote the manuscript by trying to tell the story of the data and by supporting it with illustrative extracts. The interviewees were given pseudonyms, by naming them Pupil 1, 2, 3, etc., and which municipality they belonged to in the reporting of results was also anonymized. During the analysis, we went back and forth between the phases, coding and re-coding several times. In addition, we reread the dataset to ensure that all pertinent information was coded and to avoid missing the meaning of the dataset as a whole.
The first two phases of the process were conducted by the first author, while the second and last authors took part in the next phases. The analysis drew heavily on the interview transcripts and used data from observations to further understand what the interviewees were talking about. All the interviews contributed to the results. Microsoft Word was used to manage the data.

2.4. Reflexivity

All authors work in the field of public health and have previous experience in conducting research with young people. While MS and BEVA are young researchers with limited research experience, ML and KSA are experienced researchers currently carrying out research within the context of ‘Program for Public Health Work in Municipalities’ (2017–2027). We believe that the composition of authors’ previous experience and proximity/distance regarding the topic have facilitated interesting discussions and perspectives.
We acknowledge our role in the research and that our previous experiences, assumptions and beliefs influence the research process. As such, we have tried to make our methodological choices and assumptions as transparent as possible. In the reporting of this study, we followed the consolidated criteria for reporting qualitative research (COREQ) checklist [38].

2.5. Ethics

Written informed consent was collected from all participants and their guardians prior to interviews and observations in collaboration with the participants’ teachers. The teachers handed out information and consent letters to the interviewees, who took them to their guardians and returned them prior to the interviews and observations. The children were also informed orally about the aim of the research, how and what the data were going to be used for, that their statements were going to be anonymized and that they could withdraw at any time.
The study was assessed by the Norwegian Agency for Shared Serviced in Education and Research, and it was found that the study fulfilled national ethical standards for research (protocol code 451348). The study was also submitted for consideration to the Regional Committee for Medical and Health Research Ethics Central Norway (REC), but it was not deemed necessary for approval due to the study not being classified as health research (application number 334116).

3. Results

To most interviewees, participation within the context of the public health program meant being allowed to influence the project and having power to make decisions regarding the measure. However, while the interviews touched upon several themes, one striking finding was the often-expressed feeling of resignation and dissatisfaction among the adolescents. Though the adolescents had been positive about the projects and their involvement in them initially, their eagerness declined as time passed. Several said they did not care much about the projects anymore.
There were some differences in the expression of these negative feelings between groups. Older adolescents expressed more resignation than younger adolescents, and those who had first been involved in the public health measures a long time ago seemed more resigned than those who had recently participated for the first time. For instance, in Municipality 1, where adolescents had recently been involved in the schoolyard project for the first time and had limited experience of being involved, the adolescents seemed more eager and optimistic towards participating compared to adolescents from the other municipalities.
When investigating the reasons behind the dissatisfaction and resignation in the interview material, four reasons seemed to be especially strongly emphasised: (1) Everything takes such a long time; (2) The outcome of the schoolyard/youth club shows whether we have had any influence or not; (3) Nothing they have promised has actually happened; and (4) We have not heard anything since the first time we were involved. In the following, these themes will be presented more closely. We have also included the interviewees’ suggestions on how the involvement process should have been improved when this was specifically mentioned. See Figure 1 for main theme and subthemes.

3.1. Everything Takes Such a Long Time

Long project duration was the factor adolescents most often expressed dissatisfaction with. According to participants, this was the main reason they lost their eagerness and motivation to participate in the municipalities’ projects. When discussing how they had experienced the involvement process so far, one youth said, ‘I think it works pretty well, but it takes so much time before it is done. Then people start to get tired’ (Pupil 3, Municipality 2).
In some cases, the participants had been involved in the project years prior to the municipalities entering the public health program. Participation in the program enabled municipalities to carry out measures that had been viewed as necessary for years. Thus, the project periods seemed even longer to the adolescents. Although the adolescents were excited about the measures and being involved initially, they observed unexpectedly little progress in the projects. One adolescent who was engaged in the establishment of a youth club said:
‘One teacher promised a pupil who was in the 7th grade that it would be finalised before he leaves [primary school]. He left a long time ago, and nothing has happened yet. That drags down our moods a bit. We do not really think it will be realised. We do a lot, but nothing happens’ (Pupil 2, Municipality 3).
Meanwhile, the adolescents wanted to participate in more meetings and spend more time on the activities they were involved in. They often felt they had to rush through the activities. The adolescents emphasised the importance of giving them time when they were consulted.
In the municipality establishing a youth club, the young people expressed that they did not understand why the project took so much time and required so much deliberation. They just wanted a place to stay, meet their friends, access Wi-Fi and charge their phones. Furthermore, young people said they partly understood that it took a lot of time to plan and implement the initiatives; however, they suggested that smaller alterations could be carried out while waiting for the measure to be completed. This way, they could at least enjoy parts of the measure.
‘It is good that they are putting so many things inside it and that it will be that good. But they should at least have made some small changes quickly so that we could stay there in the meantime until it is finalised’ (Pupil 1, Municipality 3).
‘Things should have happened faster. Things that can be installed quickly can be done right away. For example, putting out benches, that does not take that long. And trees should be planted quickly so that they can grow’ (Pupil 4, Municipality 4).
The resignation expressed due to the long project durations was often related to the fact that the adolescents did not get to benefit from the completed projects. The adolescents were worried that by the time the measure was completed, it would no longer meet their needs, or they had transferred to high school and would not get to use it. In addition, adolescents said they could not account for what future adolescents would like in their schoolyard or youth club. Thus, they did not see the point of being involved if they were not the ones who would get to use the new schoolyard or youth club. The interviewees suggested that younger children should participate instead as they were the ones who would get to enjoy the result.

3.2. The Outcome of the Schoolyard/Youth Club Shows Whether We Have Had Any Influence or Not

Several participants emphasised the importance of their efforts leading to actual results and shared that in their experience to date, this was often not the case. Either the measures had not yet been finalised, or their suggestions had been discarded. For example, in the municipality establishing a youth club, the adolescents were waiting impatiently to see their suggestions being implemented but had not seen any signs of the youth club being built.
When asked whether they experienced having any influence on the project, two adolescents said:
‘It depends on how the youth club turns out. I think we have had some influence so far. However, it depends on how it will turn out. Because that will show whether we have been allowed to influence it or not’ (Pupil 2, Municipality 3).
‘We 8th graders made models of the youth club where we could put the things we wanted inside. That was nice. However, whether there was any point in doing it… we certainly hope so, because there was no point in doing so if the youth club does not get realised’ (Pupil 1, Municipality 3).
The participants expressed that it was important not only to be listened to but also that their ideas were taken seriously, considered and actually carried out. Several said there should be a reason for their participation. Feeling that their ideas were not taken into proper consideration made them sad and disappointed.

3.3. Nothing They Have Promised Has Actually Happened

Another reason participants expressed resignation and disappointment was a feeling of not obtaining what had been promised. This experience was linked to the involvement in the process itself, the timeframe and the outcome of the measures. For example, in one municipality, the adolescents said they had been promised a visit to other schools to look at their outdoor area for inspiration. This had not happened, and they did not know why. One youth said, ‘It makes us discouraged from participating. It’s not that fun being involved in this if they keep saying, “We will go to different schools and see how it is there”, and then it does not happen’ (Pupil 2, Municipality 2).

3.4. We Have Not Heard Anything since the First Time We Were Involved

In the interviews, the young people also described a lack of information and continuity in their participation. These two factors seem to be intertwined, and we therefore present them in one theme. The participants said they did not receive sufficient information in order to become properly involved in the projects. One said, ‘When we do not get information about what is going to happen, it is a bit difficult to pay attention, help, contribute and so on’ (Pupil 6, Municipality 4). Furthermore, the participants said they were not always informed about how long the projects were going to last or why the projects were delayed.
The adolescents emphasised the importance of getting to know what was going on in the projects and why their ideas were not chosen. In spite of this, they rarely received any feedback on the suggestions they made or an explanation as to why their ideas were not realised. Often, they did not hear anything about what was going on and only observed measures being implemented. As a result, the participants did not feel as though they were taking part in the decisions and experienced little influence on the outcome. ‘The only thing we have… we have seen things happening but not heard anything about it’ (Pupil 7, Municipality 2).
The researcher who attended participation activities with young people in two municipalities observed that adolescents did not recall what and how they had been involved when interviewing them a couple of weeks later. The adolescents had to be reminded of the participation activities and the information they had been given before they remembered it.
Adolescents were typically most involved in the first stages of the process, and all municipalities had arranged activities to mark the project’s start. The first involvement was often quite comprehensive, with many people involved, both young people and adults. Adolescents had a chance to express their thoughts and desires about the schoolyard or youth club in various ways. However, as the projects were carried out, the involvement of young people and the flow of information seemed to decline or stop completely. The participants said they often did not know what the plan was after being engaged in involvement activities or as the projects progressed. As one interviewee put it, ‘It was that day at the activity day that the ideas were formed, and afterwards we have not heard much about it’ (Pupil 7, Municipality 4). The adolescents said they felt left in the dark.
All the adolescents said they wanted to be more involved in the projects, and not only in the first stages. Most said they would like to be involved in the making and realisation of their schoolyard and youth club, not only in the planning phase. When we asked the adolescents what could be carried out to involve them more, one said, ‘Perhaps getting a bit more information. We know very little about what is going to happen. We know that we are getting a new schoolyard and that we will get some new things. It would have been nice to know a bit more’ (Pupil 6, Municipality 4).
The pupil council representatives were often those who were most involved in the measures and received the most information. However, the representatives said they found it hard to pass on information to their peers and preferred that adults did it. This could explain why the young people knew little about what was going on, as little information was passed on from the pupil council to their classmates.
The adolescents also talked about several initiatives they believed had failed. Often, it seemed that the young people related failed initiative to them not being included in the decisions, not having received any information about it, and not understanding the choices the adult stakeholders had made.

4. Discussion

In this study, we have explored the experiences of young people involved in co-creating three schoolyards and one youth club in four municipalities in Norway. The study reports perspectives from an underrepresented group in both research and community development. Although adolescents in the current study also expressed positive experiences from the process, the main finding was expressions of dissatisfaction and resignation. Their resignation and dissatisfaction seemed to stem from various conditions linked to the involvement processes and projects, four of which stood out as being most often reported across the interviews. These were: (1) Everything takes such a long time; (2) The outcome of the schoolyard/youth club shows whether we have had any influence or not; (3) Nothing they have promised has actually happened; and (4) We have not heard anything since the first time we were involved.
The first condition—everything takes such a long time—was related to long timeframes and children not having the chance to use the completed schoolyards or youth club. When it came to the second condition—the outcome shows whether we have had any influence or not—they experienced not having an influence on the outcome when they saw no visible results of their efforts. The third condition—nothing they have promised has actually happened—was related to children experiencing that promises were not kept by adult stakeholders. Lastly, the fourth condition—we have not heard anything since the first time we were involved—was tied to the organisation of the involvement process, in which adolescents were typically involved only at the beginning of the projects and did not receive sufficient information further down the line.
The findings coincide with features that have been reported to be essential for young people to experience their participation as meaningful [22,39]. Meaningful participation depends on providing adolescents with time and a safe space to express themselves, but also transparent processes where they are given appropriate information to inform their views, as well as providing them with feedback and certainty that their views are seriously considered by those with the power to take action; these factors have all been found to be important [21,22,39,40]. Findings from our study indicate that simply being consulted or having a say was not sufficient for young people to view their participation as valuable or meaningful, mirroring the findings of other studies [14,25,41]. The literature highlights the need for children to perceive their actions as contributing to making a difference and having an impact on the outcome in order for them to feel empowered [9,14,42]. Several of the abovementioned requirements were lacking in the participation processes that the adolescents in the current study took part in.
The interviewees described their participation as a single event or short-term involvement and said they wanted to be engaged more often. This is consistent with findings from reviews investigating the engagement of children in participatory activities, which show that children are most often engaged during the first stages of the process and mainly by being consulted [12,27]. Involvement early in the projects, ongoing commitment and continuity in the engagement have also been highlighted as key factors for successful participation [2,7,21]. By involving the adolescents engaged in the municipalities’ projects in every step of the process, the young people could probably have gained more ownership of both the process and the outcome.
Young people in the current study said that if they had received more information, participating in the projects would be easier and more appealing, a finding also reported by Protacio-de Castro et al. [43]. By feeling more included in the process and receiving feedback and information on the decisions made, the young people participating in the schoolyard and youth club projects could have gained more ownership of the process, and it could have prevented misunderstandings and unmet expectations. This could have been carried out by, for example, regularly informing adolescents about the project’s progress, either through physical meetings, via teachers, or through more informal channels such as Facebook or Instagram. In addition, adolescents should be included in the decision regarding how and what they want to be informed about.
Young people participating in the schoolyard and youth club projects had several suggestions for improvement. This included downscaling or carrying out smaller alterations along the way to experience progress in the projects and that their efforts influenced the outcome, including younger adolescents (as they were the ones who were going to use the finished projects), receiving more information and feedback on their ideas, and getting involved in every step of the process.
However, this might require time, resources, and competencies the municipalities do not have to facilitate participation. Limited budgets, resources and competencies have been found to constrain professionals in facilitating involvement processes with young people. [9,25]. Additionally, the outbreak of the COVID-19 pandemic placed constraints on the involvement processes of the municipalities included in this study. The pandemic led to several delays and changes in plans due to hygienic restrictions. In certain periods, the municipalities could not gather young people in groups, thus limiting involvement and information flow.
It is important to note that although our study provides evidence for potential negative outcomes of involving adolescents in co-creation processes, it must not be used as an excuse for not involving young people in matters that concern them. Children’s participation is legislated; thus, not involving them would not be legally sound nor an acceptable approach [8]. Our findings underscore the importance of taking a critical stance when planning and carrying out involvement processes with adolescents.

Methodological Reflections

We noticed that some of the young people had a hard time answering questions regarding the participation process in the interviews. We strived to ask open questions but found that, in some situations, we had to come up with examples for the young people to comprehend. This reflects one of the challenges in involving children and young people: striving not to lead them towards a specific outcome whilst offering examples to make it easier for them to understand the questions and possibilities. Similar reflections on the balance between ensuring children’s understanding and, at the same time, not influencing their responses have been noted in another study [44].
A strength of the study is the triangulation of data sources [45]. We experienced that the observations provided us with the opportunity to ask more specific questions regarding the activities the adolescents had been involved in and provided insight into what the young people were talking about in the interviews. This also contributed to data the interviews did not offer, such as the information the young people were given when participating in project activities and the methods used. In the interviews, we could further explore and validate what the researcher had observed in the two municipalities where observations were conducted. A limitation of the study is that observations were not conducted in all municipalities because of COVID-19 restrictions.
There was variety in the amount of time that had passed since the interviewees had been engaged in participation activities and in how far the municipalities had come in their projects. This affected how much experience adolescents had from the co-creation process. Additionally, the study was carried out during the COVID-19 pandemic, which might have affected the findings. Most municipalities were relatively rural and sparsely populated, which must be considered when evaluating the transferability of findings.

5. Conclusions

The aim of this study was to explore how adolescents experience co-creating schoolyards and a youth club in four municipalities in Norway. The main finding developed based on a thematic analysis across interviews was expressions of resignation and dissatisfaction. Positive experiences also occurred but were less prominent. We found that adolescents’ feelings of resignation and dissatisfaction were linked to experiencing long timeframes, providing efforts that did not seem to lead to actual results, a sense of promises not being kept by adult stakeholders, and a lack of information and continuity in the involvement process.
Our findings suggest that while the intentions from the municipalities were good, they had limited success in facilitating participation processes that adolescents perceived as meaningful. It became apparent that features that are described as essential for the successful involvement of young people were absent. The study provides knowledge regarding important factors to consider when involving adolescents in co-creating projects to avoid the unintended effect of disempowering adolescents. We also report suggestions for improvement which can have important implications for the practice of co-creation processes with adolescents. This includes downscaling projects, implementing smaller alterations along the way, striving for continuity in adolescents’ involvement, repeated information, and transparent processes.
Our findings indicate that despite policies supporting children’s participation, effort placed on implementing such policies into practice is still needed.

Author Contributions

Conceptualization, M.S., M.L., B.E.V.A. and K.S.A.; methodology, M.S., M.L. and K.S.A.; formal analysis, M.S., M.L. and K.S.A.; investigation, M.S., M.L. and K.S.A.; resources, M.L.; data curation, MS, M.L. and K.S.A.; writing—original draft preparation, M.S., M.L., B.E.V.A. and K.S.A.; writing—review and editing, M.S., M.L., B.E.V.A. and K.S.A.; visualization, M.S., M.L. and K.S.A.; supervision, M.L. and K.S.A.; project administration, M.L. and K.S.A. All authors have read and agreed to the published version of the manuscript.

Funding

This research was funded by Norges Forskningsråd (Research Council of Norway), grant number 302705.

Institutional Review Board Statement

The study was conducted in accordance with the Declaration of Helsinki and assessed by the Norwegian Agency for Shared Services in Education and Research (protocol code 451348).

Informed Consent Statement

Written informed consent was obtained from all participating adolescents and their guardians. The adolescents were also informed orally. Confidentiality was emphasised, and the participants were informed that they could withdraw at any time.

Data Availability Statement

Not applicable.

Acknowledgments

The authors would like to thank the participating adolescents for sharing their time and experience in the interviews. We also thank the project leaders and stakeholders in the municipalities who recruited adolescents and facilitated the interviews and observations.

Conflicts of Interest

The authors declare no conflict of interest.

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Figure 1. Main theme and subthemes.
Figure 1. Main theme and subthemes.
Societies 13 00089 g001
Table 2. Information about interview participants.
Table 2. Information about interview participants.
MunicipalityNumber of Interviews and Participants (Age)
Municipality 1Interview 1: 3 girls, 3 boys (10–14)
Interview 2: 2 girls, 3 boys (10–14)
Municipality 2Interview 1: 3 girls, 3 boys (10–12)
Interview 2: 3 girls, 3 boys (14–16)
Municipality 3Interview 1: 2 girls, 1 boy (12–15)
Interview 2: 2 girls, 4 boys (12–13)
Interview 3: 3 girls, 3 boys (12–13)
Municipality 4Interview 1: 4 girls, 1 boy (10–12)
Interview 2: 3 girls, 3 boys (14–16)
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Sylte, M.; Lillefjell, M.; Aasan, B.E.V.; Anthun, K.S. ‘Nothing Gets Realised Anyway’: Adolescents’ Experience of Co-Creating Health Promotion Measures in Municipalities in Norway. Societies 2023, 13, 89. https://doi.org/10.3390/soc13040089

AMA Style

Sylte M, Lillefjell M, Aasan BEV, Anthun KS. ‘Nothing Gets Realised Anyway’: Adolescents’ Experience of Co-Creating Health Promotion Measures in Municipalities in Norway. Societies. 2023; 13(4):89. https://doi.org/10.3390/soc13040089

Chicago/Turabian Style

Sylte, Mari, Monica Lillefjell, Bodil Elisabeth Valstad Aasan, and Kirsti Sarheim Anthun. 2023. "‘Nothing Gets Realised Anyway’: Adolescents’ Experience of Co-Creating Health Promotion Measures in Municipalities in Norway" Societies 13, no. 4: 89. https://doi.org/10.3390/soc13040089

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