Coming of age: Understanding the potential of adolescent participation in the evaluation of adolescent reproductive and sexual health services: Rapid evidence review protocol

There are over a billion adolescents in the world (UNICEF, 2020), who have unique and rapidly evolving experiences. Health systems can benefit from this unique expertise in identifying and addressing the health, development and well-being challenges that face this population. The involvement of young people as equal partners in decisions that affect them can have multiple benefits, such as youth themselves identifying the problems most relevant to them, mapping environmental and ecological influences on their identified problems and engendering critical consciousness and reflection to ‘disrupt’ or challenge social and contextual factors that continue to maintain health inequities (Ozer et al., 2020). Adolescents and youth (aged 15-24 years) practice a wide range of sexual practices, and sexual and reproductive health education can reduce sexual risk behaviours by delaying first contact/sexual initiation, reducing unplanned pregnancies, HIV and other sexually transmitted diseases, increasing contraceptive use, and thus protecting their health (Szydlowski, 2015). A rigorous global review of adolescent reproductive and sexual health (ARSH) interventions also suggests that sexual and reproductive health education and counselling can play a crucial role increasing adolescent’s knowledge of sexual health and use of contraceptives (Salam et al., 2016). Since the International Conference on Population and Development in 1994, many aspects of ARSH have substantially improved, vis expansion in the public knowledge and discourse on adolescents’ needs, barriers and concerns (Liang et al., 2019). However, decision- and policy- making on adolescent SRH can be subject to public morality and restrictive cultural norms and practices influencing families and communities. Moreover, weak health systems, stigma and discrimination and a lack of effective interventions can result in the needs of young people and adolescents not being met adequately. Globally, there is a call to accelerate the adoption of a holistic view of adolescent sexuality, in keeping with the 2030 Agenda for Sustainable Development (Starrs et al., 2018; WHO, 2017). Though there is considerable research and scholarship on adolescent experiences and perceptions of using/accessing adolescent health services, the generation of such evidence has seldom involved young people and adolescents themselves (Beattie et al., 2021). While some of this research may have culminated from self-reported or collected through innovative ways (music therapy, photography/photovoice), the involvement of adolescents and young people in the design and interpretation of research remains limited, and has usually been generated by adults by collecting data from adolescents and young people. There is growing evidence that investing in adolescents (aged 10–19 years) and promoting their meaningful participation in decision-making can provide crucial impetus for their long-term health and well-being, and reduce inter- generational vulnerabilities and health disadvantages (Clark et al., 2020; Cheng et al., 2016; Patton et al., 2016). As participation approaches relevant to health equity efforts that engage young people in agentic roles gain ground (Ozer et al., 2018), there is increasingly a space for practice-relevant research driven by adolescents themselves. There is a need for focused research on the potential for adolescent participation in health services evaluation, and I am proposing to undertake a rapid review of evidence on adolescent participation in the design and conduct of ARSH service evaluations. This review will map the current research evidence on adolescent participation in sexual and reproductive health service evaluation, from across the world. It is intended that this rapid review will help achieving the following objectives: 1. Identify the current evidence available on adolescent participation in sexual and reproductive health service evaluation; 2. Document the participation of adolescents across stages of the evaluation process; 3. Critique and synthesise evidence on the impact of adolescent participation on ARSH service evaluation; 4. Identify and document the best and emerging practices in adolescent participation in the evaluation of ARSH services from across the world.