Published 1st July 2022

By Billie Turner, Ruth Lewis, Carolyn Blake, Kate Astbury, Rebecca Gascoigne and the CONUNDRUM Action Group

Despite growing interest in involving young people in sexual health policymaking and service improvement, very few participatory initiatives exist in Scotland to facilitate this goal. Those that do exist tend to lack sustainability (e.g. sexual health services or policymakers consulting with young people on one-off occasions), or involve young people-led activities to advocate their views to policy audiences, rather than direct collaboration between young people, policymakers and practitioners. In our new project – CONUNDRUM Action – we want to address this by showing how young people, sexual health policymakers and practitioners can work together and learn from each other in a way that is collaborative and sustainable. Our overarching vision is to build and sustain a culture of young people’s meaningful involvement in sexual health policymaking and service improvement in Scotland.

Why was CONUNDRUM Action set up?

CONUNDRUM Action builds on an earlier piece of research – the CONUNDRUM project – which was conducted in 2019-2020 to better understand the factors shaping use and non-use of condoms and contraception among young people in Scotland. Based on the findings from CONUNDRUM, the research team worked with sexual health stakeholders to co-develop nine recommendations for sexual health decision-makers in Scotland. First and foremost, we recommended increasing the meaningful involvement of young people in sexual health policymaking and service improvement. The CONUNDRUM Action project focuses on this goal by creating a virtual Action Group that brings young people into direct conversation with sexual health stakeholders in NHS, Scottish Government and third sector. 

Who is in the CONUNDRUM Action Group?

The Action Group brings together members from a range of different organisations and sectors, including:  

  • 14 young people from CERT (Contraception: Education and Reform Team, Scotland)
  • 6 young people from WCYPP (Waverley Care Young People’s Panel)
  • Sexual health policymakers in Scottish Government
  • NHS health improvement staff from three NHS health boards (Greater Glasgow and Clyde, Lanarkshire and Lothian)
  • Partners from the third sector (Waverley Care)
  • The CONUNDRUM research team from the University of Glasgow and a sexual health researcher from the University of Southampton.

How are the CONUNDRUM Action Group working together?

Members of the CONUNDRUM Action Group have committed to work together over a six-month period (February-July 2022) meeting for two hours every three weeks. The whole project is being conducted virtually, with meetings taking place on Zoom. We are experimenting with different digital tools to share ideas, dialogue, and feedback in meetings, including Google Jamboard and Menti polls. In between meetings, we are using a Teams channel to share information (e.g. meeting summaries), and Padlet to crowdsource group members’ initial thoughts about questions we’ll be discussing in upcoming meetings. In addition, there are always opportunities after meetings for group members to keep adding further thoughts in their own time to the Jamboards that we have created together during meetings.

What has the Action Group been up to so far?

Meeting 1

In our first meeting, we discussed what ‘meaningful involvement’ means to us and decided on the top three priorities to collaborate on as a group.

Our Priorities

  1. Creating a set of young people’s priorities for digital sexual health information and support in Scotland. Policymakers from the Scottish Government and NHS have told us they want to understand what young people in Scotland want from digital sexual health information and support. In the Action Group we’re working on developing a set of priorities for digital sexual health that reflect the views of a diverse range of young people from across Scotland. We will present this information to policymakers to inform the development of online sexual health resources in Scotland. 
  2. Building a map of the sexual health system in Scotland. We are working together using ‘participatory systems mapping’ methods to create two maps of the sexual health system in Scotland: 1) a causal map to understand the underlying reasons for the current level of involvement of young people in sexual health policymaking and service improvement; and 2) a map of sexual health stakeholders in Scotland to understand where decisions are made and to assess the current level of involvement of young people. These maps will be useful tools to understand and visualise the policymaking processes and to identify where and how young people can most influence decisions. The maps are being built in a participatory way during Action Group meetings, as well as through key informant interviews with stakeholders beyond the Action Group. 
  3. Sharing our learning. We will work together to decide how best to share the outputs from the Action Group’s collaboration, including the two systems maps of the sexual health system and a set of priorities for digital sexual health. We will also create blogs and videos to share our learning about building meaningful and sustainable collaboration between young people and other sexual health stakeholders to develop confidence in these ways of working.

Meeting 2

In our second meeting, we discussed our roles within the group, what we wanted to call ourselves and why this terminology matters.  

We like...Definitely not...
Young people/young collaborators/young advisors Kiddos
Sexual health improvement staff Decision makers/leads
Government policymakers Decision makers
Researchers Academics/scientists

The Scottish Government policy lead for Scotland’s Sexual Health and Blood Borne Viruses (SHBBV) Framework talked us through this national framework to understand what it is, and how young people can feed into shaping its update later this year. Group members had the opportunity to submit questions on the Framework and the policymaking process via an anonymous Menti poll. The policy lead then wrote responses to these questions which were shared on the Action Group’s Teams channel.

Meeting 3

In our third meeting, we learnt about ‘participatory systems mapping’ and worked together to start creating ‘systems maps’ of the sexual health policy and practice landscape in Scotland as well as young people’s current level of involvement in decision-making. These maps will help us to identify the best leverage points to strengthen young people’s involvement.

Meeting 4

In our fourth meeting, in small breakout rooms we reviewed different examples of existing online sexual health content from key national websites to understand what young people do and do not find engaging. We also continued working on our causal map by using Jamboard to vote on the most important systems factors preventing young people’s involvement in sexual health policy and practice.

Meeting 5

In our fifth meeting, we completed the final preparatory stage of our causal map by using Jamboard to vote on the most important effects of young people’s low involvement in sexual health policy and practice. The next stage will be to start building the map by drawing links between causes and effects.

What are the next steps for the CONUNDRUM Action Group?

Over the next few weeks, young people in the Action Group will have the opportunity to co-lead activities relating to our priorities. This will include working with the research team to:

  • Co-lead online workshops with groups of young people beyond the Action Group to gain a more in depth understanding of what young people across Scotland want from digital sexual health resources. Once we have collected this information, we will work together to present young people’s priorities to policymakers to inform the future development of digital sexual health information and support in Scotland.
  • Co-lead online interviews with sexual health practitioners and policymakers who are key decision-makers across Scotland to inform our stakeholder map of the sexual health system. We will ask interviewees about what, when and how decisions are made, who is involved in making these decisions, and to what extent young people are currently involved. After we have conducted all the interviews, we will work together to analyse the data collected and build the stakeholder map. We will also write a scientific article about the participatory systems mapping process.
  • Co-produce ways to share our learning about young people’s meaningful involvement in sexual health policymaking with as many people as possible (e.g. by writing blog posts and/ or creating a podcast). We hope these outputs will help to demonstrate the value of working with young people to co-produce policy and services.

What is it like being part of the Action Group?

“Over the course of the Action Group’s trajectory thus far, we (as young people) have been able to make meaningful contributions alongside professionals in the sexual health sector. This is very much needed. As service users ourselves, we can directly advocate for our needs, allowing decisions to be made that reflect our actual experiences and will (hopefully) improve service efficiency. The Action Group meetings are dynamic and engaging, and the structure of the sessions ensures that everyone has a chance to share their expertise without hierarchy. I have personally found it rewarding to engage with academics and stakeholders in the NHS, Scottish Government and third sector to share our lived experience and offer possible solutions to the current lack of digital resources for young people accessing sexual health services. In turn, I have gained an extensive awareness of how policymakers make and analyse decisions, including through using systems mapping methods to identify new areas for youth involvement. The collaboration and sharing of expertise between young people and sector professionals has been the most impactful aspect of the project and I believe it will bring about meaningful change, encouraging other working groups to follow suit. I am excited to see the final deliverables of the project and am confident that these will embed young people’s voices into sexual health policymaking and service improvement in Scotland.” – Rebecca Gascoigne (Strategic Advisor, CERT)

“Being a part of the action group has already been a rewarding and enjoyable experience. Meetings are organised in an interactive format allowing the young people and stakeholders to engage in meaningful dialogue, allowing us to share ideas and opinions in a friendly environment. Meetings are often structured to allow the most time for smaller breakout rooms to discuss specific questions and then a shorter amount of time to feed back our thoughts to the larger group. I think this structure has created productive meetings producing valuable output without them feeling overwhelming or difficult to contribute to. Furthermore, there have been many opportunities to give feedback on our experience of the group. This has allowed participants to help shape the direction of the meetings, but also the project as a whole, which I feel has created a deeper engagement and sense of participation. I am excited to continue to be a part of this project and to see the final output from the group.” – Kate Astbury (Co-President, CERT)

Evaluating as we go

We have been collecting live feedback at the end of each Action Group meeting using Menti Polls to evaluate what has worked well and what could be improved for future sessions. In addition, halfway through the project, Action Group members were invited to complete an ‘Action Group Journey’ using Google Jamboard. This activity gave group members a space to reflect on their personal experiences of being part of the Action Group and allowed us to review what we have learnt together about young people’s meaningful involvement so far. We will return to these Action Group Journeys at the end of the project to add further reflections and feedback.  

Thanks to everyone who has participated in CONUNDRUM Action so far! If you would like to get involved, or if you have any comments or questions about the project, please get in touch at sphsu-conundrum@glasgow.ac.uk. You can also find project updates on Twitter at #ProjectCONUNDRUM.

First published: 1 July 2022

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