Unravelling complexity: a realist approach to youth participation in sexual and reproductive health research.

Researchers in the field of sexual and reproductive health and rights (SRHR) increasingly recognise the value of engaging young people (YP) as active partners in research. However, there are also challenges associated with youth participation in research and more evidence is needed on how participatory methods work across settings, for different groups of YP. Starting from realist principles, this paper develops an initial program theory that explains the mechanisms through which youth participatory research can create meaningful outcomes. A realist review was conducted and complemented with realist expert interviews. The review included 87 original and 30 reflective articles published between January 2019 and June 2024. It examines how participatory methods with YP (aged 10-24 years) contributed to SRHR research. Analysis focused on identifying relevant factors and causal relationships that were synthesised in a Causal Loop Diagram (CLD). Realist interviews with eight researchers experienced in implementing youth participatory methods were conducted to refine the CLD. Participatory methods have the potential to enhance YP's ability to talk about SRHR, have sustainable positive impact on YP, and enhance data quality, through the mechanisms of improved control, comfort, rapport, playfulness, and adapted communication tools. Several contextual variables influence these mechanisms; i.e. YP's interests and capacities to participate, rigidity of research institutions requirements, taboo, power dynamics, and opportunities to learn about and evaluate participatory methods. This study proposes a theory that explains how participatory methods can achieve outcomes and offers a foundation for further application of youth participatory methods in SRHR research.