Developing a comprehensive and inclusive measure for young people’s sexual wellbeing: International participatory research with young people

The field of sexual and reproductive health (SRH) has undergone substantial transformations in the last decades. Initially focused on population control, the field witnessed a paradigm shift to a more comprehensive view on SRH after the International Conference on Population and Development (ICPD) in 1994 (Barot, 2014). The most recent World Health Organization (WHO) working definition of sexual health, dating from 2006, illustrates this paradigm shift. It moves away from the traditional focus on absence of disease, to a more comprehensive understanding, acknowledging the importance of a positive approach that considers wellbeing, pleasure, and sexual rights for all (WHO, 2006; WHO, 2017). Building on this shift, numerous academics have advocated to integrate a "positive approach" into SRH research, programs, and service delivery (Gruskin & Kismödi, 2020; Landers & Kapadia, 2020; Michielsen et al., 2016; Pitts & Greene, 2020). A positive approach involves acknowledging the importance of pleasurable sexual relationships, trust, and communication for self-esteem and overall wellbeing (Starrs et al., 2018). However, translating this rhetoric into practice has proven to be challenging, as demonstrated by the persistent lack of positive elements in research and programs (Philpott et al., 2021; Starrs et al., 2018). This substantiates the immediate need for tools to operationalize the “positive approach” and support researchers in reshaping their research practices. This is especially critical for young people. A noteworthy body of literature demonstrates the importance of equipping young people with agency, skills, and competencies to yield positive outcomes, including the ability to engage in safe and pleasurable sexual experiences (Goldfarb, 2021). However, additional evidence is required to substantiate this. Applying a positive approach in research practices will generate a more comprehensive and nuanced understanding of their sexuality, adding to an "evidence base" that is until now unmistakably politicized and biased towards the risks and negative consequences of sexuality, and not in line with young people’s needs and rights (Harden, 2014; Kågesten & van Reeuwijk, 2021). Having an indicator that embodies the positive approach is crucial for facilitating the generation of robust evidence about young people’s sexuality. The concept of Sexual Wellbeing (SW) emerged as a promising indicator embracing a positive approach and expanding the scope of SRH research. The concept was discussed in 2007 by a WHO working group, with the aim to offer a broader interpretation of sexual health, but was not defined, or translated into measures (WHO, 2010). This lack of clarification does not align with the needs in the academic field where the interest in the concept of SW is clearly growing. A review on the concept of SW identified major gaps in its conceptualization, demonstrating the limitations of not having an appropriate framework (Lorimer, 2019). Several researchers have recognized the importance of conceptualizing SW, and have attempted to do so (Mitchell et al., 2021; Lorimer et al., 2022). While these initial frameworks are valuable starting points, a number of important gaps remain. Current attempts to conceptualize SW mainly have a theoretical and opinion-based foundation, and fall short in considering inclusivity towards youth perspectives, diverse cultural settings, and the relevance of online contexts. To address the gaps in the existing frameworks, this research will collaborate with young people to develop a comprehensive framework to measure, and monitor SW, including its online components, among young people globally. It is crucial to recognize that engaging diverse young people in discussions to establish a framework for SW will be challenging, considering the sensitivity of the topics (Lassi et al., 2023; Page et al., 2023). To ensure meaningful youth participation in SRH research, it is therefore critical to adapt current methods and establish comfortable research environments. Consequently, the primary objective of this research extends beyond bridging gaps in understanding and measuring SW. First, it aims to develop suitable strategies to create comfortable, youth-friendly research methods to ensure engagement of diverse groups of young people to conceptualize SW.

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