Shifting power dynamics in global health through youth engagement: a participatory mini-designathon

Although engaging adolescents and young adults (10–24 years old) has been a focus of civic engagement studies and political participation research for at least 40 years, it has only come to the forefront of global health research in the past two decades.¹ During this period, norms for youth engagement evolved from simply including youth as participants to fostering more meaningful and inclusive participation through youth workshops, youth advisory boards (YABs), crowdsourcing open calls, and other engagement approaches.^2,3 Through YABs, researchers gain and ideally integrate insights from young people with lived experience in the local community or target population of the research.³ Similarly, crowdsourcing for health leverages the creativity of a group to solve a problem and shares these solutions with the public.⁴ Crowdsourcing open calls aimed at eliciting youth-generated ideas have been organised to improve health outcomes among young people, including in the areas of sexual and mental health, in low- and middle-income countries (LMICs).^5,6

The World Health Organization (WHO) defines meaningful adolescent and youth engagement as an inclusive, intentional, and mutually respectful partnership between adolescents, youth, and adults. It further emphasises that such engagement involves recognising and addressing power imbalances that hinder young people from being acknowledged as experts on their own needs and priorities, while also fostering their leadership capacities.⁷ Despite this recognition, the formal prioritisation of YABs in research, and increased utilisation of crowdsourcing, unbalanced power dynamics persist.¹ Traditional youth workshops for youth engagement typically involve only young people, excluding those with decision-making power and relevant insights.⁸ This exclusion limits the impact and relevance of the solutions and resolutions generated in these forums. Unstable and unequal power dynamics between researchers and YAB members have been identified as a major challenge in the implementation of YABs, particularly in LMICs. Furthermore, although open calls are designed to prioritise youth-led ideas, decision-making authority often remains with adults serving as judges or steering committee members, despite occasional inclusion of youth in the evaluation process.³

These power imbalances, when not acknowledged and actively addressed, often result in tokenistic cameos with minimal impact on research priorities.⁹ Deliberate attention and adequate resources must be allocated to youth–adult power-sharing, promoting equity, and increasing the power of marginalised adolescents and young adults (AYAs) in global health research. In many cases, tokenistic youth engagement is a compromise borne out of good intentions that, unfortunately, misses a growing evidence base on optimal youth engagement strategies. How can we meaningfully engage young people in a way that seamlessly integrates into existing activities in resource-limited settings?

We introduce an innovative approach to this challenge – a mini-designathon. A designathon is a three-stage process informed by design thinking that includes preparation with end-users, an intensive period of collaboration, and follow-up activities for implementation and research.¹⁰ It allows participants to work as active partners to address issues affecting them, increasing participation and accountability.¹¹ Designathons are most similar to hackathons; however, although hackathons generally focus on creating technological solutions, designathons are typically centred on designing health interventions. The intensive period of a designathon often requires significant funding and administrative support.¹⁰ Alternatively, a mini-designathon is primarily in person, is briefer (e.g. a few hours) and can be seamlessly embedded in a conference, meeting, or classroom activity. This limits the need for extensive additional resources.

Mini-designathons foster equity and promote meaningful power-sharing between researchers and youth by establishing a flat group hierarchy and facilitating collaborative engagement around a shared objective. Rather than positioning the researcher as the central authority, the process shifts the group’s focus toward co-developing a tangible deliverable. This collective orientation not only mitigates hierarchical dynamics but also affirms the role of youth as equal partners with lived experience and contextual expertise. Furthermore, by incorporating youth-centred or informal deliverables, such as artistic forms of expression, or, alternatively, offering youth-friendly orientation sessions for more technical content, mini-designathons can help reduce knowledge asymmetries that often sustain power imbalances in traditional research settings.

They are an effective avenue for applying principles espoused in youth participatory action research (YPAR) in resource-limited settings and contexts (see Table 1).¹² YPAR is a methodology rooted in equity wherein youth engage in research and action on issues significant to them, potentially influencing adolescent health outcomes.¹² YPAR generally commences with youth identifying a problem or question they wish to address, and afterwards engaging in iterative research and action processes under the mentorship of adult facilitators with considerations of power dynamics. Our mini-designathon model builds on and expands the YPAR framework by integrating design thinking into the participatory action research cycle, enabling young people not only to identify and analyse problems but also to co-create interventions in real time. In addition, YPAR often occurs over prolonged periods involving cycles of inquiry and reflection,¹³ but mini-designathons expedite this process within shorter timeframes, facilitating rapid ideation, collaboration, and prototyping of solutions informed by youths. This model is well suited for resource-constrained settings, providing a practical and scalable approach to implementing the principles of YPAR in settings with limited time, resources, and infrastructure. Mini-designathons depart from conventional, slower participatory approaches and present a novel approach to youth engagement, preserving the essential principles of YPAR while enhancing the innovative, solution-focused abilities of adolescents in global health research.

A typical structure for a mini-designathon is illustrated in Fig. 1. Key considerations for a mini-designathon include making it a team-based event with diverse participants. This approach fosters valuable idea-sharing among groups that typically have limited interaction, offering a distinct advantage over traditional youth workshops.⁸ It is essential to create an atmosphere that fosters open and honest communication among team members. There should be at least one clear deliverable to give participants a focused objective. Also, to maximise cost-effectiveness, it should be integrated into an existing activity, with careful attention given to logistical coordination.

Fig. 1.

A typical structure for a mini-designathon.

Our team organised a mini-designathon in partnership with the Adolescent HIV Prevention and Treatment Implementation Science Alliance (AHISA), led by the U.S. National Institute of Health’s Fogarty International Centrer. The mini-designathon was co-created with members of the AHISA Youth Advisory Group (AHISA YAG), who virtually met to plan and develop the structure of the participatory activity. Teams consisting of young people and experienced researchers collaborated informally to produce engaging poems, dances, and artworks around the theme of ‘celebrating youth engagement’. In a routine de-identified post-conference survey, one adult participant noted, ‘I enjoyed the … participatory groups; we saw some hidden talents in the groups and experienced the value of having diverse perspectives’. A description of the mini-designathon, benefits, and implementation considerations is in Supplementary material file S1.

The global health community is finally realising that meaningfully engaging youth is not only in our best interest but also optimal for sustainable health interventions.^14,15 However, the methods to carry out this engagement at all levels have not kept pace. Cost-effective and responsive participatory activities such as mini-designathons are promising strategies to meet this need, particularly in resource-constrained settings.

Supplementary material

Supplementary material is available online.