Strengthening evidence syntheses with adolescent involvement: an umbrella review

Strengthening evidence syntheses with adolescent involvement: an umbrella review | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Strengthening evidence syntheses with adolescent involvement: an umbrella review Azza Warraitch, Matylda Sulowska, Ciara Wacker, Maria Lee, Delali Bruce, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5319859/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 04 Apr, 2025 Read the published version in Systematic Reviews → Version 1 posted 5 You are reading this latest preprint version Abstract Background Stakeholder involvement in evidence syntheses has been shown to enhance the quality and relevance of reviews. Despite the critical role adolescents can play in shaping their health outcomes, they remain underrepresented in contributing to reviews on topics that directly affect them. To fully unlock the potential of evidence syntheses for adolescent health, it is crucial to understand how adolescents can contribute at various stages of the review process and how their involvement can influence outcomes. Methods To achieve this, we conducted an umbrella review examining adolescent involvement in reviews related to adolescent health research, complemented by a case study that highlights how adolescents were engaged at various stages of this review. We ran a search across 11 databases, screened reference lists and twelve journals, and consulted experts in youth involvement. Results We found only 10 reviews which meaningfully involved adolescents. In those reviews, adolescents were engaged at almost every stage of the review process, with most involvement centred around interpreting findings or co-authoring the final reports. While adolescent participation was often consultative, there were examples of more collaborative involvement using a wide range of methods, even at technical stages like study selection and data analysis. Conclusion The findings highlighted the potential for adolescents’ input to improve the quality and outcomes of evidence syntheses by grounding the process and findings in their experiences and insights. To maximise the impact of adolescent involvement, we call for engagement of adolescents throughout the review process and the adoption of frameworks to ensure transparency and consistency in reporting. Systematic review registration: PROSPERO (CRD42021287467) Adolescent involvement Participatory research Youth engagement Evidence syntheses methods Figures Figure 1 Figure 2 Figure 3 Introduction Over the past two decades, there has been an increased demand for adolescent involvement in research.( 1 ) Adolescent involvement is defined as ‘research that is done ‘with’ or ‘by’’ young people, ‘not ‘to’, ‘about’ or ‘for’ them’.( 2 , 3 ) This approach aligns with Article 12 of the UN Convention on the Rights of the Child (UNCRC), which states that young people have the right to participate in decisions affecting them, including in research and the design of services.( 4 ) A wealth of evidence highlights the benefits of adolescent involvement in research.( 5 ) For adolescents, active involvement in research builds their skills and knowledge,( 6 , 7 ) supports academic and career development by building their resumes,( 8 ) strengthens their relationships,( 9 ) and contributes to their personal growth.( 10 ) For the research itself, adolescent involvement ensures the study is more relevant to the needs of adolescents,( 3 ) improves recruitment and data collection processes,( 11 , 12 ) increases the rigor of data analysis,( 13 ) and broadens the dissemination of findings.( 14 ) Additionally, adolescent involvement results in researchers gaining valuable insights and skills related to effectively engaging with adolescents throughout the research process.( 7 , 10 ) Beyond empirical research, adolescents can also contribute to secondary research, particularly in evidence syntheses.( 15 ) The significance of overall stakeholder involvement in evidence syntheses is well established, with multiple case studies demonstrating how stakeholders can be successfully involved in systematic reviews.( 16 – 20 ) Stakeholder involvement increases the relevance of synthesised evidence to the needs of the target population, can promote its uptake into practice, promotes transparency in the process, and makes the process and findings more credible.( 20 , 21 ) This recognition of the benefits of stakeholder involvement in evidence synthesis has led to the development of frameworks( 22 ) and guidance on involving the public at various stages of the review process.( 23 – 25 ) However, adolescents are less frequently involved in conducting evidence syntheses compared to other stakeholders.( 26 ) This was highlighted in a study exploring consumer involvement practices, where interviews were conducted with key informants from seven internationally renowned organisations that focus on commissioning and conducting reviews and involving consumers in their reviews. These interviews revealed that various types of stakeholders and consumers were being involved in evidence syntheses at their organisations, but children and adolescents were notably absent from the review processes at all of these organisations.( 24 ) Similarly, in reviews exploring overall public and patient involvement (PPI) in evidence syntheses, only a few examples of adolescent involvement have been identified. The most comprehensive analysis of overall stakeholder involvement in different types of reviews, conducted by Pollock, identified a total of 291 reviews.( 20 ) Of these, only eight reviews—less than 3% of those involving overall stakeholders—engaged young people. This stands in contrast to the more frequent involvement of adult stakeholders in conducting evidence syntheses. Furthermore, the current guidance on consumer or stakeholder involvement in systematic reviews is primarily focused on adults, underscoring the lack of emphasis on adolescent involvement.( 23 – 25 ) The prioritisation of adult involvement in evidence syntheses reflects a deeper issue of adultism—the belief that adults are inherently more knowledgeable, capable, or valuable than young people.( 27 ) This belief often limits adolescents' involvement in decisions that impact them, placing them at a disadvantage compared to adult stakeholders. To address adultism in evidence synthesis practices and to promote adolescent involvement, it is crucial to understand how adolescents can actively contribute to evidence syntheses and how their involvement impacts them and the review process. We conducted an umbrella review to consolidate evidence on: i) the methods used to involve adolescents at different stages of the evidence synthesis process, ii) the challenges and facilitators affecting adolescent involvement in evidence syntheses, iii) the impacts of adolescent involvement on both the review and the adolescents themselves, and iv) the best practices for involving adolescents in evidence syntheses. Additionally, this paper describes the methods used to engage adolescent co-researchers and advisors at different stages of this umbrella review, demonstrating how adolescents can be successfully involved throughout the evidence synthesis process. The objective is to provide recommendations for how to engage adolescents in evidence syntheses in light of the outcomes and challenges associated with different approaches. Methodology This umbrella review was conducted following the Cochrane guidelines for overviews of reviews, with some adaptations—such as the types of reviews included—to better align with the review's objectives. The review was registered with the International Prospective Register of Systematic Reviews (CRD42021287467) , and any methodological changes were preregistered in the updated PROSPERO record. This paper is part of a larger evidence synthesis aimed to consolidate all the review-level literature on adolescent involvement in health research. A detailed description of the methods used can be found in the published protocol paper (28) . Search strategy The search strategy for this umbrella review focused on adolescents aged 10–24 years, adolescent involvement in health research, and the review type (including various review formats such as scoping, systematic reviews, and meta-analyses), using Boolean operators to combine terms. Authors AW and KH collaborated with a research librarian (GF) from Trinity College Dublin to develop the search strategy. The detailed search strategy is provided on the OSF page of the review ( https://osf.io/cx7y9/?view_only=4f40ba5530f64c608c405ce66a4a7243 ). Information sources for peer-reviewed and grey literature search We searched the Cochrane Database of Systematic Reviews, MEDLINE, Scopus, Embase, PsycINFO, PsycArticles, CINAHL, Epistemonikos, and Health Systems Evidence, to identify relevant reviews. The grey literature search involved multiple components. A simplified search strategy with fewer key terms was applied to Google Scholar, limited to the first 10 pages of results. The top 10 paediatric, perinatology, and child health journals from the Scimago Journal and Country Rank list were reviewed using a similar simplified strategy. Conference abstracts, theses, reports, and unpublished reviews were identified through Web of Science and ProQuest searches, with strategy adapted to each database's interface. Reviews registered on PROSPERO were also searched, and review authors were contacted to share data from reviews close to or recently completed. A targeted search of websites from relevant organisations focused on adolescent health (including government, non-profits, and health organisations) was conducted within Google and the Mental Health Innovation Network database. Additionally, a search for youth health organisations in low- and middle-income countries was conducted, focusing on the top results for each of the 137 countries using World Bank classifications. A simplified search strategy was used for organisational websites, and experts in youth involvement in health research were contacted for potentially relevant materials. Reference lists from eligible reviews were screened, and the Connected Papers software was used to identify similar papers. Since these sources were searched in December 2021, we updated our search by screening the list of reviews included in another umbrella review on youth involvement in health research, published in 2024, to identify further relevant reviews.(29) Additionally, we conducted a hand search of the volumes published from 2021 to 2024 of two journals focused on public and patient involvement in health research: Health Expectations and Research Involvement and Engagement . We systematically reviewed each issue of these journals, screening titles, abstracts, and keywords to identify articles relevant to our inclusion criteria. Full texts of potentially relevant articles were examined to determine their inclusion in our updated review. Eligibility criteria The umbrella review included various types of reviews to include a range of qualitative outcomes related to adolescent involvement. Only reviews focusing on adolescents aged 10–24 were included, with flexibility for reviews that did not specify exact age ranges but focused on children and adolescents. We included reviews that explored adolescent involvement in health research related to physical and mental health, and reported on strategies, best practices, barriers, mitigation strategies, or evidence gaps in adolescent involvement. Only reviews published in English were included. Selection of studies Search results were imported into Covidence to remove duplicates. AW handled the title and abstract screening for all articles, while the co-researchers screened 25% to reduce bias. For full-text screening and data extraction, AW screened all articles, while co-researchers reviewed 10% to ensure accuracy. Any disagreements were settled through discussions among the team, and if needed, a fourth researcher was consulted (Figures 1 and 2). Data extraction and synthesis Data for this paper was extracted in Excel by a young co-researcher (MS) and checked by AW. Data was extracted on the area of health research, countries where adolescents were involved, type of review, characteristics of adolescents, aim of involvement, stage of the review process, level of involvement, methods used, challenges faced, facilitators, compensation provided, benefits of involvement for adolescents, how feedback was incorporated, the impacts of involvement on the review, and best practices identified. A narrative synthesis was conducted by AW by thoroughly reviewing the extracted data for familiarisation, followed by deductive coding. The resulting codes were organised into broader themes, which were then summarised in descriptive and tabular formats to align with the research aims. Results The results presented for the adolescent involvement process and the outcomes of their involvement are based on the reviews included in this umbrella review and examples of adolescent involvement at different stages of this review. Adolescent involvement in included reviews We identified only 10 reviews for inclusion in this manuscript that examined adolescents’ involvement in health research, where adolescents were engaged at one or more stages of the review process (Figures 1 and 2). The characteristics of the included reviews are summarised below. Characteristics of included reviews Most reviews ( n =6) focused on adolescent involvement in overall health research.(1, 3, 30-33) Two reviews explored health and social sciences,(7, 34) one focused on mental health research,(35) and one looked specifically at the involvement of adolescents who had adverse childhood experiences.(36) Four were rapid reviews,(3, 7, 33, 34) while two were systematic,(32, 35) scoping,(1, 30) and narrative reviews.(31, 36) Characteristics of adolescents involved Most reviews were conducted in the UK ( n =6).(1, 3, 30, 31, 34, 36) Two reviews included adolescents from Canada,(32, 35) and one review each included adolescents from Ireland(33) and the USA.(35) The number of adolescents involved in reviews depended on their roles. For example, the number of adolescent co-researchers involved ranged from one(30, 34, 36) to three,(35) while the number of adolescent advisors varied from six(31) to 27.(1) Only three reviews reported the age of the adolescents involved,(1, 33, 35) which ranged from 12 to 24 years old. Two of these reviews, however, only included adolescents over the age of 18.(33, 35) Adolescents’ genders were reported in five reviews; these reviews all involved only male or female adolescents and young people. (30, 33-36) Six reviews provided details on the background of adolescents involved. Four reviews engaged adolescents with previous relevant experience. In one review, this experience was related to previous involvement in mental health research(35) while two others focused on individuals with experience receiving services.(30, 34) One review involved adolescents with lived experiences of mental health challenges,(1) and two included young students as co-researchers.(33, 36) Level of adolescent involvement at different stages of the review process We categorised adolescent involvement using the 11 stages of a review outlined by the Cochrane Ecosystem(37) with an additional 12th stage proposed by Pollock et al.(22) The level of adolescent involvement at different stages of evidence synthesis process is reported in figure 3. Two reviews involved adolescents as co-researchers throughout the entire review process, though specific stages and methods used were not described.(32, 36) Methods and impacts of adolescent involvement at different stages of the review process: findings from the included reviews and this umbrella review This section reports on how adolescents were involved at different stages of the evidence syntheses process and highlights the impacts of their involvement at these stages. Overall suggestions for adolescent involvement in the evidence synthesis process are provided in the supplementary table 1. Developing the questions and planning methods In two reviews, adolescents helped refine the review's scope and questions. For example, Rouncefield-Swales consulted a young service user, leading to a shift in focus towards the impacts of adolescent involvement, and specifically to examining the characteristics of those included or excluded from the research process.(30) Larkins and colleagues(7) conducted a week-long online hackathon with peer researchers from marginalised groups. Through daily creative problem-solving sessions, adolescents contributed to refining core aspects of the review, including the development of research questions, defining key terms, and determining the eligibility criteria. In one review, adolescents’ involvement at later stages resulted in the refinement of methods used. Thomas and colleagues(31) reported how adolescents’ input as members of a youth advisory group during the interpretation and dissemination stages led to an unexpected but useful revision of the data extraction process. After discussions with adolescents, the team revised their data extraction form to include additional aspects identified by adolescents as important. In our umbrella review, adolescents were not involved in these steps due to time constraints and the urgency of registering the protocol with PROSPERO. This limited our ability to identify, recruit, and train adolescents in time to incorporate their input at these stages. Writing and publishing the protocol Adolescent involvement was not reported at this stage in any of the included reviews. In our umbrella review, we involved three adolescent co-researchers (DB, ML, PC) in reviewing the initial draft of the protocol paper.(28) The co-researchers received training on the basics of research protocols, to familiarise them with what a research protocol includes, its purpose, and the key sections. Co-researchers were given the protocol draft to review individually and were encouraged to annotate sections they found unclear and to provide suggestions for improvement. After the individual review, the co-researchers participated in one-on-one discussions with the lead author (AW), who explored the rationale behind their suggestions. Co-researchers flagged areas where the protocol’s language was too technical or inaccessible. They recommended using simpler, more youth-friendly alternatives to technical terms, and suggested changes to improve grammatical accuracy. In instances where feedback could not be fully incorporated, AW explained the reasoning behind this to the co-researchers. Developing the search strategy and running the search in databases At the search strategy development stage, Larkins and colleagues’(7) hackathon engaged adolescents to contribute directly to the development of the search strategy by brainstorming relevant terms and methods for identifying studies that focused on adolescent involvement in research. None of the reviews reported involvement of adolescents in running the search. In our umbrella review, adolescents were not involved in these steps due to time constraints that limited the opportunity for recruitment and training, coupled with the urgency of running the search to start the review process. Study selection In the study selection phase, Warraitch and colleagues(33) involved a young co-researcher in the title and abstract and full-text screening stages. This co-researcher screened 25% of the articles at the title and abstract stage and 10% of the articles at the full-text stage. At this same stage, Wilson and colleagues(3) involved adolescents as consultants by seeking their help to identify relevant studies on adolescent involvement in health research that had been missed during both the database and grey literature searches. In conducting this umbrella review, we involved a young co-researcher (DB) in two levels of article screening: the title and abstract screening and the full-text screening. She was provided with brief training, focusing on an overview of the umbrella review methodology using the Cochrane guidelines for overviews of reviews,(38) how to assess studies based on titles and abstracts, applying eligibility criteria at the full text stage, and how to document the reasons for exclusion. She also received guidance on using Covidence, the review management software, and how to use its different features. She was provided with a detailed document outlining the eligibility criteria, which were discussed in training sessions to ensure clarity and consistency in applying these. Furthermore, AW conducted mock screening sessions with DB, allowing her to practice decision-making and receive feedback. This helped familiarise her with the types of articles she would screen during the review process. The co-researcher (DB) then independently screened 25% of the articles at the title and abstract stage and 10% at the full-text screening stage. In cases where there were discrepancies between two reviewers’ decisions on article inclusion or exclusion, consensus meetings were held to resolve any differences. DB’s insights often led to further discussion and, in some cases, the inclusion of articles that might have otherwise been excluded. Data extraction At the data extraction stage, Warraitch and colleagues(33) involved a young co-researcher as a second reviewer for some of the included articles, to ensure data accuracy and consistency. In our umbrella review, three adolescent co-researchers (DB, ML, PC) were involved in extracting relevant data from 10% of the included reviews. During the training sessions, co-researchers were familiarised with data extraction forms and were guided on how to identify and extract the required data. This training ensured they could identify the relevant information in different sections of the papers. Before starting the full extraction process, the co-researchers participated in pilot exercises where they extracted data from a few sample studies and were provided with feedback by AW. Once trained, co-researchers participated in the data extraction process independently using a standardised template. After completing their extractions, they met with AW to discuss the process and address any discrepancies. Throughout the data extraction process, adolescent co-researchers received ongoing support from AW. Data analysis and interpretation of findings McCabe and colleagues engaged adolescents as co-researchers in reviewing the categories and themes that emerged from the coded data. Adolescents helped refine these categories by merging similar codes under relevant themes, ensuring that their perspectives were accurately reflected in the analysis.(35) In five reviews, adolescents were actively consulted when interpreting the findings, providing a critical layer of reflection on how the results aligned with their lived experiences. For instance, McCabe and colleagues held a consultation meeting with three adolescents, using their input to revise key sections of the study. Their feedback led to the addition of new impacts and challenges, a restructuring of the recommendations section, the inclusion of more specific examples, and revisions in the phrasing of some recommendations. This process ensured that the findings were both relevant and practical from a youth perspective.(35) Similarly, Erwin and team(34) engaged a young person to interpret the review's findings based on her own experiences. Sellars and colleagues(1) took a similar approach, holding two consultation meetings with youth advisory groups to get input on specific elements of their review. The first was a 40-minute face-to-face session with six adolescents aged 17-18, and the second was a virtual session with 21 adolescents aged 14-17. These consultations focused on visual representations related to youth advisory groups (YAGs), discussing the pros and cons of YAG involvement, providing recommendations for reporting YAG activities, and suggesting preferred methods of acknowledgment and dissemination. These sessions allowed adolescents to influence both the content and presentation of the review’s findings. Larkins and colleagues(7) referred to the overlap between the findings of the initial hackathon conducted with adolescents and the findings from the review to highlight the convergences and disagreements in adolescents’ perspectives and the findings reported in the studies. While Thomas and team also consulted adolescents during the interpretation stage, the specifics of their involvement were not detailed, pointing to a need for greater transparency in reporting such contributions.(31) In this umbrella review, an adolescent co-researcher (ML) contributed to synthesising the findings using the extracted data along with the lead author AW. She was trained using the narrative synthesis guidance manual,(39) on the process of coding, sorting similar codes into categories, and describing these categories. ML then helped code data from five reviews using both inductive and deductive coding. After coding individual studies, ML met with AW to compare their coding and discuss any discrepancies. Additionally, we conducted a participatory workshop with 12 adolescent advisors to interpret the findings from the included reviews on the challenges adolescents face during their participation in health research. Two adolescent co-researchers (CW, JH) took an active role in planning this participatory workshop. They were provided with two training sessions to orient them to the current umbrella review and its findings, different participatory methods that can be used to engage adolescents in health research, the aims and goals of the workshop, and the importance of creating a space where adolescent advisors felt comfortable sharing their experiences and opinions. Following the training, the co-researchers worked together to outline the workshop’s design, proposed the use of different interactive elements (e.g., icebreakers, group activities) and strategies to keep discussions focused on the research questions. Twelve adolescent advisors - nine male and three female advisors, from both Kenya and Ireland- participated in the workshop. Co-researchers (CW, JH) and the lead researcher (AW) facilitated discussions on the reported challenges to adolescent involvement in the review and prompted the group to share any additional barriers and to suggest the mitigation strategies to address the reported barriers. The adolescent advisory group agreed with most of the challenges reported in the review but also shared several additional barriers, which had not been adequately covered in the literature. CW and JH recorded the discussions using sticky notes and charts, capturing key insights and suggestions in real-time. After the workshop, co-researchers (CW, JH) helped synthesise the data collected during the workshop. Each suggestion made by adolescent advisors during the workshop was given a unique code. Co-researchers were responsible for assigning these codes and organising them into broader themes. Once the coding was completed, co-researchers and AW aggregated the codes into overarching themes. The findings of this workshop are reported elsewhere (40). Write-up and dissemination Adolescents played a significant role in the write-up and dissemination stages across several reviews, often contributing as co-authors and co-creators of outputs. For example, McCabe and team involved a young person in developing illustrations, graphs, and writing parts of the paper, ensuring their contributions were recognised in both content development and authorship.(35) Similarly, Erwin and colleagues engaged a young person in interpreting findings through her lived experience, incorporating her reflections and acknowledging her as a co-author.(34) Warraitch and team also involved two young co-researchers in reviewing the manuscript and providing input, with both credited as co-authors.(33) Other reviews involved adolescents in either co-producing a lay summary of the findings and key recommendations for researchers (30) or in reviewing the summary of the review, with their feedback leading to revisions in the discussion section.(31) Sellars and team involved adolescents in developing a dissemination strategy that moved beyond traditional academic articles. This approach ensured that the review's findings reached a wider audience through methods tailored to adolescent engagement.(1) In terms of knowledge mobilisation, Sanchez and colleagues formed a youth advisory board to lead the process of sharing the review’s findings, though specific details on their contributions were not provided.(32) In this umbrella review, all adolescent co-researchers (DB, ML, PC, CW, JH, SB) actively contributed to the dissemination of the findings from the review in different forms. CW helped organise an online webinar with AW aimed at both academic and public audiences. She helped prepare the presentation materials, including slides and talking points, and co-presented the findings from the review on the benefits of adolescent involvement in health research for the adolescents themselves. Some co-researchers also co-presented the findings of the review at the Trinity Centre for Global Health weekly departmental seminars. For example, DB co-presented the protocol of the review along with AW at one of the departmental seminars held in 2022, while CW, ML, JH co-presented the findings on the challenges to adolescent involvement in health research and the findings from the participatory workshop with AW at a departmental seminar in 2023. All co-researchers contributed as co-authors on three papers that resulted from this review. DB, ML, and PC co-authored the protocol paper by reviewing and refining the paper and ensuring the use of inclusive and accessible language. They also helped draft sections of other papers. For example, ML led the writing of the methods section of the paper reporting the challenges to adolescent involvement in health research and is acknowledged as the second author(40). CW and SB took the lead on writing the introduction, methods, and results sections of a paper that highlights the positive impacts of adolescent involvement in health research. They also developed illustrations for the paper and were acknowledged as joint first authors alongside AW (14). Challenges and facilitators to adolescent involvement in reviews None of the included reviews reported any specific facilitators that supported adolescent involvement in the evidence synthesis process. Only one review, conducted by Sellars et al., reported financial constraints and limited time as barriers to adolescent involvement. These constraints impacted how and when adolescents could participate in the review, suggesting that resources can play a significant role in determining the extent of adolescent engagement.(1) In our umbrella review, most of the adolescent co-researchers lacked previous experience in systematic reviews or academic research. This meant that additional time was needed for training and for their full participation in technical stages, such as screening and data extraction. Another key challenge faced during the review process was the need for flexibility in accommodating the diverse schedules and commitments of adolescent co-researchers. Many of the co-researchers were balancing other responsibilities, such as school and work, which created difficulties in coordinating group discussions and timely completion of tasks such as screening and data extraction. Impacts of the involvement process on adolescents and reviews None of the reviews reported any formal assessment of the impacts of the involvement process on adolescents or the review itself. In terms of the positive impacts of involvement on adolescents, they were credited as co-authors in five papers.(32-36) For our umbrella review, adolescent co-researchers received training in systematic review methodologies, including study selection, data extraction, narrative synthesis, and academic writing. They also gained technical skills by using research tools like Covidence. In recognition of their work, co-researchers were compensated through co-authorship on papers and strengthening their CVs and professional profiles. Adolescent advisors were compensated with gift vouchers for their time and contributions. Adolescent involvement in this umbrella review helped ensure that the review was more relevant and inclusive for adolescents. For example, by co-authoring the outputs from the reviews, they identified areas where the language was too technical and suggested adolescent -friendly alternatives. Further, their feedback during the study selection process helped include reviews that might otherwise be overlooked by adult researchers. The active role of co-researchers in planning and facilitating the participatory workshop with adolescent advisors ensured the workshop was adolescent-centred and engaging. Their input on structuring interactive sessions and icebreakers helped create a comfortable environment for the participants, which led to richer, more open discussions. Adolescent advisors brought their unique insights in the interpretation process by identifying challenges faced by adolescents in participatory health research that are not always reported in the literature. Discussion This umbrella review is the first to consolidate evidence on adolescent involvement in evidence syntheses on their engagement in health research. We identified 10 papers describing adolescent involvement in different types of reviews and provided examples of how adolescents were involved at different stages of the current review. Our findings indicate that adolescents were involved in nearly all stages of the review process, demonstrating that adolescents can be successfully engaged throughout evidence synthesis. A diverse range of creative and participatory methods—such as informal consultations, youth advisory groups, hackathons, and collaborative meetings—were used to involve adolescents at different stages. This involvement strengthened the review process and outcomes by enhancing the relevance of the review for adolescents, improving methodological rigor, bringing unique insights to the interpretation of findings, and ensuring greater accessibility during dissemination. These findings align with previous reviews on stakeholder involvement in evidence syntheses,( 17 , 41 ) supporting the feasibility and value of incorporating diverse perspectives of adolescents in the evidence synthesis process. Current landscape and recommendations for adolescent involvement in evidence syntheses While adolescents were engaged at almost all stages of the review process, they were most frequently involved in the interpretation and write-up stages. This is congruent with existing research, which shows that adolescents are more commonly involved in later stages of health research projects.( 3 , 42 ) However, this contrasts with findings from other reviews on overall stakeholder involvement in realist reviews,( 17 , 41 ) who reported that stakeholders were frequently engaged across clarifying the scope, developing program theories in realist reviews, and participating in data analysis and synthesis. The higher engagement of adolescents in the interpretation and write-up stages of reviews may be because these stages require less specialised technical expertise, making them more accessible for adolescent involvement. The nature of adolescent involvement in most reviews was consultative, where their input and advice were sought, with only two reviews actively engaging adolescents as co-researchers. This trend mirrors findings from Power and colleagues, who noted that most realist reviews involved stakeholders as consultants and advisors at specific stages.( 41 ) This may be attributed to practical constraints, such as the technical complexity of some stages of the review process (e.g., conducting searches) or resource limitations, which may make it unfeasible to involve adolescents at a higher level.( 1 ) A wide variety of methods used to engage adolescents contrasts with the more conventional methods used for overall stakeholder involvement in evidence syntheses. For stakeholders, commonly used methods included focus group discussions, interviews, ranking techniques, and meetings or workshops with advisory groups. The difference suggests that more innovative and diverse approaches are necessary to effectively engage adolescents in the review process compared to general stakeholders. This corroborates with broader research on adolescent involvement in health research, which emphasises the importance of using more engaging and flexible methods to sustain meaningful adolescent involvement.( 43 ) Given the wide variation in the number of adolescents engaged at different stages of the review process, there is no set number of adolescents required for involvement in evidence syntheses; rather, the number depends on their role and level of involvement in the project. In our umbrella review, we engaged five co-researchers at different stages of the review process, tailoring their involvement to their interests and the tasks available. The same outcomes could potentially have been achieved with just one or two adolescents, but five were involved to accommodate their limited availability due to other commitments. Involving multiple adolescents is also considered good practice because it makes the process more adolescent-friendly and accessible. At the interpretation stage, in particular, it is important to ensure diversity in the group of adolescents. This need for diverse input likely explains why a higher number of adolescents were engaged as advisors during this phase in both the included reviews and our umbrella review. The findings indicate that both adolescents with and without previous professional or lived experience can be successfully involved in conducting evidence syntheses, depending on their role in the project. For example, reviews that engaged adolescents with prior experience — either through contributing to research or through lived experience related to the topic — tended to involve them in tasks such as planning the review or interpreting the findings based on their experiences.( 1 , 30 , 34 , 35 ) In contrast, reviews that involved adolescents without prior experience often engaged them as co-researchers in conducting various stages of the evidence synthesis itself.( 33 , 36 ) This pattern aligns with adolescent involvement in our review, where students without previous experience were engaged as co-researchers across multiple stages of the umbrella review. Meanwhile, advisors with previous experience contributing to health research were involved specifically at the interpretation stage. Process outcomes of adolescent involvement in evidence syntheses Most of the reviews did not report any challenges, facilitators, or overall recommendations or best practices for involving adolescents in evidence syntheses. The few challenges that were mentioned aligned with the challenges reported in other case studies of adolescent involvement in reviews( 44 ) or general barriers found in broader adolescent involvement literature, such as resource limitations, time constraints, and logistical issues.( 40 , 44 ) One of the few recommendations highlighted in the reviews concerned not requiring ethics approval for adolescent involvement, which has been a point of ambiguity in previous reviews on stakeholder involvement in evidence syntheses.( 17 , 20 ) Similarly, reviews did not report on any positive or negative impacts of involvement in the review for the adolescents. However, adolescents were acknowledged as co-authors in five reviews,( 32 – 36 ) which can further strengthen adolescents’ CVs and may have implications for their academic and career outcomes.( 14 ) Evaluation and reporting of adolescent involvement Other key details missing from the papers included a description of the training provided to adolescents, and any ethical implications considered during their involvement. This lack of reporting on crucial elements of the adolescent involvement process can be attributed to the absence of formal, planned evaluations of adolescent participation in evidence syntheses,( 45 ) and a lack of reporting tools or guidelines to report the findings. The issue of inadequate evaluation and poor reporting of adolescent involvement aligns with similar findings in reviews of overall stakeholder involvement in evidence syntheses.( 20 , 41 ) Pollock and colleagues found that the majority of the reviews in their study did not conduct formal evaluations and did not use any reporting tools to present how stakeholders were engaged. Power and colleagues highlighted similar issues with poor reporting and a lack of detail in reviews on how stakeholders were involved.( 41 ) To address this, researchers need to use evaluation frameworks to formally evaluate the adolescent involvement process in evidence syntheses.( 32 ) Furthermore, there is a need to adhere to reporting guidelines like the Guidance for Reporting Involvement of Patients and the Public (GRIPP) checklist to ensure transparency and consistency in reporting of adolescent involvement in evidence syntheses.( 46 ) Impacts of adolescent involvement on the review process and outcomes Despite the inadequate evaluation and reporting, adolescent involvement consistently demonstrated positive impacts on the quality and relevance of evidence syntheses in several key areas. Involving adolescents in shaping research questions helped ensure that the reviews addressed topics relevant to their lived experiences.( 30 ) Input from adolescents helped refine review methodologies, such as improving data extraction to capture adolescent-relevant aspects,( 31 ) enhancing search strategies by incorporating terms and concepts that adult researchers may have overlooked,( 7 ) and adding a layer of accuracy during study selection and data extraction.( 33 ) Adolescent involvement in data analysis, interpretation, and dissemination ensured that results reflected their lived experiences, and made the outputs more accessible and engaging.( 1 , 35 ) These benefits further build the case for involving adolescents at multiple stages of the evidence syntheses process to enhance both the quality and relevance of the evidence syntheses. Limitations This umbrella review has some limitations. First, it was restricted to English-language reviews. Second, relevant reviews using different terminology for adolescent involvement may have been missed despite a broad search strategy. Third, it focused solely on adolescents aged 10–24, limiting generalisability to younger children. Fourth, the original search for this review was conducted in December 2021. While we made an effort to update it by screening articles included in a more recently published umbrella review and by hand-searching two relevant journals for papers published in the last two years, it is still possible that some relevant papers were not included. Conclusion In this umbrella review, we found that adolescents can contribute to various stages of evidence synthesis, particularly in interpretation and dissemination of findings, using a wide range of methods. Their participation enhances the relevance and quality of evidence by ensuring that findings reflect adolescents’ lived experiences and unique insights, offering perspectives that may be overlooked by adult researchers. The predominantly consultative nature of adolescent involvement—often limited to later stages in most of the included reviews—reflects practical constraints and a reliance on tasks that require less specialised expertise. The identification of mechanisms through which adolescent involvement impacts review outcomes is significantly limited by inadequate reporting and evaluation. Addressing these gaps through the adoption of established reporting guidelines and systematic evaluations will be crucial for improving both the quality of adolescent involvement and the evidence synthesis process itself. Abbreviations UNCRC: UN Convention on the Rights of the Child PPI: Public and Patient Involvement YAGs: Youth Advisory Groups Declarations Ethics approval and consent to participate: Only secondary data was included in this umbrella review; therefore, ethical approval or informed consent of participants was not required. Availability of data and materials All data files and supplementary materials for this review can be accessed at https://osf.io/cx7y9/?view_only=4f40ba5530f64c608c405ce66a4a7243. Conflict of interests The authors declare that they have no competing interests. Funding statement AW received the Ussher Fellowship from Trinity College Dublin to support her PhD research. However, this project was not funded. Authors’ contributions AW and KH conceptualised and wrote the paper with valuable inputs from MS, CW, ML, DB, JH, QK. MS, DB, ML, QK, contributed to the screening, data extraction, and analysis of this review, while CW and JH led the participatory workshops with the youth advisory group, as young co-researchers. All authors have reviewed and approved the final manuscript. Acknowledgments We would like to acknowledge all members of the Trinity Centre for Global Health and School of Psychology – especially Drs Frédérique Vallieres, and Elizabeth Nixon – for their valuable inputs. We would also like to thank Ms. Geraldine Fitzgerald, the research librarian at the School of Psychology, Trinity College Dublin, for her feedback and input on the search strategy for this umbrella review. We are also thankful to all the members of the youth advisory group for sharing their valuable insights in the participatory workshop. References Sellars E, Pavarini G, Michelson D, Creswell C, Fazel M. Young people's advisory groups in health research: Scoping review and mapping of practices. Archives of Disease in Childhood. 2021;106(7):698-704. Authority NHR. What is Public Involvement in Research? 2015 [Available from: https://www.hra.nhs.uk/planning-and-improving-research/best-practice/public-involvement/. Wilson O, Daxenberger L, Dieudonne L, Eustace J, Hanard A, Krishnamurthi A, et al. A rapid evidence review of young people’s involvement in health research. London: Wellcome. 2020;3. United N. United Nations Convention on the Rights of the Child. United Nations Conventions on the Rights of the Child. 1989. Patton GC, Sawyer SM, Santelli JS, Ross DA, Afifi R, Allen NB, et al. Our future: a Lancet commission on adolescent health and wellbeing. The Lancet. 2016;387(10036):2423-78. Valdez ES, Skobic I, Valdez L, O Garcia D, Korchmaros J, Stevens S, et al. Youth Participatory Action Research for Youth Substance Use Prevention: A Systematic Review. Subst Use Misuse. 2020;55(2):314-28. Larkins C, Nowland R, Robertson L, Farrelly N, Sharpe D, Roy AN, et al. 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Matagalpa and Belfast: CESESMA and Queen’s University. 2012. Warraitch A, Bruce D, Lee M, Curran P, Khraisha Q, Hadfield K. Involving adolescents in the design, implementation, evaluation and dissemination of health research: an umbrella review protocol. BMJ open. 2023;13(6):e069695. Wyatt KA, Bell J, Cooper J, Constable L, Siero W, Pozo Jeria C, et al. Involvement of children and young people in the conduct of health research: A rapid umbrella review. Health Expectations. 2024;27(3):e14081. Rouncefield-Swales A, Harris J, Carter B, Bray L, Bewley T, Martin R. Children and young people’s contributions to public involvement and engagement activities in health-related research: A scoping review. PLoS ONE. 2021;16(6):e0252774. Thomas C, Cockcroft E, Jenkins G, Liabo K. Working with children and young people in research: supportive practices and pathways to impact. Journal of child health care. 2023:13674935231171451. Sanchez S, Thorburn R, Rea M, Kaufman P, Schwartz R, Selby P, et al. A systematic review of theories, models and frameworks used for youth engagement in health research. Health Expectations. 2024;27(1):e13975. Warraitch A, Wacker C, Bruce D, Bourke A, Hadfield K. A rapid review of guidelines on the involvement of adolescents in health research. Health Expectations. 2024;27(3):e14058. Erwin J, Burns L, Devalia U, Witton R, Shawe J, Wheat H, et al. Co‐production of health and social science research with vulnerable children and young people: A rapid review. Health Expectations. 2024;27(2):e13991. McCabe E, Amarbayan M, Rabi S, Mendoza J, Naqvi SF, Thapa Bajgain K, et al. Youth engagement in mental health research: a systematic review. Health Expectations. 2023;26(1):30-50. Pavarini G, Smith LM, Shaughnessy N, Mankee-Williams A, Thirumalai JK, Russell N, et al. Ethical issues in participatory arts methods for young people with adverse childhood experiences. Health Expectations. 2021;24(5):1557-69. Collaboration C. Cochrane review ecosystem [Available from: http:// community.cochrane.org/review-production/cochranereview-ecosystem. Pollock M, Fernandes RM, Becker LA, Pieper D, Hartling L. Chapter V: overviews of reviews. Cochrane Handbook for systematic reviews of interventions version. 2020;6. Popay J, Roberts H, Sowden A, Petticrew M, Arai L, Rodgers M, et al. Guidance on the conduct of narrative synthesis in systematic reviews. A product from the ESRC methods programme Version. 2006;1(1):b92. Warraitch A, Lee M, Bruce D, Curran P, Khraisha Q, Wacker C, et al. An umbrella review of reviews on challenges to meaningful adolescent involvement in health research. Health Expectations. 2024;27(1):e13980. Power J, Dada S, Booth A, De Brún A, Gilmore B. Advisory groups in realist reviews: Systematically mapping current research and recommendations for practice. Cochrane Evidence Synthesis and Methods. 2024;2(6):e12073. Shamrova DP, Cummings CE. Participatory action research (PAR) with children and youth: An integrative review of methodology and PAR outcomes for participants, organizations, and communities. Children and Youth Services Review. 2017;81:400-12. Freire K, Pope R, Jeffrey K, Andrews K, Nott M, Bowman T. Engaging with children and adolescents: a systematic review of participatory methods and approaches in research informing the development of health resources and interventions. Adolescent Research Review. 2022;7(3):335-54. Oliver K, Rees R, Brady LM, Kavanagh J, Oliver S, Thomas J. Broadening public participation in systematic reviews: A case example involving young people in two configurative reviews. Research Synthesis Methods. 2015;6(2):206-17. Jamal F, Langford R, Daniels P, Thomas J, Harden A, Bonell C. Consulting with young people to inform systematic reviews: an example from a review on the effects of schools on health. Health expectations. 2015;18(6):3225-35. Staniszewska S, Brett J, Simera I, Seers K, Mockford C, Goodlad S, et al. GRIPP2 reporting checklists: Tools to improve reporting of patient and public involvement in research. BMJ (Online). 2017;358. Kirby P. A Guide to Actively Involving Young People in Research: For Researchers, Research Commissioners, and Managers. A Guide to Actively Involving Young People in Research: For Researchers, Research Commissioners and Managers. 2004. 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chart\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-5319859/v1/6ea3c56062cef4039095139a.png"},{"id":70379957,"identity":"f2864fa4-23fa-4e2f-bc7b-7d1affcdf323","added_by":"auto","created_at":"2024-12-02 15:51:47","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":115871,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003e\u003cstrong\u003eFlow chart of study selection and inclusion from all sources\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-5319859/v1/61caac4365b167d861568538.png"},{"id":70379960,"identity":"0b53bc6b-275e-49fa-a061-75545205642b","added_by":"auto","created_at":"2024-12-02 15:51:47","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":92348,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003e\u003cstrong\u003eLevel of adolescent involvement at different stages of the evidence synthesis process\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-5319859/v1/873dd36ffcf6e983b9078a29.png"},{"id":80082131,"identity":"3aa8ff35-db66-4960-98c2-854ec5da0d0a","added_by":"auto","created_at":"2025-04-07 16:07:38","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1473632,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5319859/v1/9219adc0-2e6c-415e-8d9b-49baa191c3e0.pdf"},{"id":70379954,"identity":"beaa2cb2-3014-49d1-b316-8cfb1f5577db","added_by":"auto","created_at":"2024-12-02 15:51:47","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":18656,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementarymaterials.docx","url":"https://assets-eu.researchsquare.com/files/rs-5319859/v1/c9d26ae797ec822136431209.docx"},{"id":70379959,"identity":"2ba7c05d-7c6b-4776-93dc-a64662877dfa","added_by":"auto","created_at":"2024-12-02 15:51:47","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":31919,"visible":true,"origin":"","legend":"","description":"","filename":"PRISMA2020checklistAW.docx","url":"https://assets-eu.researchsquare.com/files/rs-5319859/v1/615d4c4c7d0cb654bc85ce0c.docx"}],"financialInterests":"","formattedTitle":"Strengthening evidence syntheses with adolescent involvement: an umbrella review","fulltext":[{"header":"Introduction","content":"\u003cp\u003eOver the past two decades, there has been an increased demand for adolescent involvement in research.(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) Adolescent involvement is defined as \u0026lsquo;research that is done \u0026lsquo;with\u0026rsquo; or \u0026lsquo;by\u0026rsquo;\u0026rsquo; young people, \u0026lsquo;not \u0026lsquo;to\u0026rsquo;, \u0026lsquo;about\u0026rsquo; or \u0026lsquo;for\u0026rsquo; them\u0026rsquo;.(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) This approach aligns with Article 12 of the UN Convention on the Rights of the Child (UNCRC), which states that young people have the right to participate in decisions affecting them, including in research and the design of services.(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) A wealth of evidence highlights the benefits of adolescent involvement in research.(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) For adolescents, active involvement in research builds their skills and knowledge,(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e) supports academic and career development by building their resumes,(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e) strengthens their relationships,(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e) and contributes to their personal growth.(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e) For the research itself, adolescent involvement ensures the study is more relevant to the needs of adolescents,(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) improves recruitment and data collection processes,(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e) increases the rigor of data analysis,(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e) and broadens the dissemination of findings.(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e) Additionally, adolescent involvement results in researchers gaining valuable insights and skills related to effectively engaging with adolescents throughout the research process.(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eBeyond empirical research, adolescents can also contribute to secondary research, particularly in evidence syntheses.(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e) The significance of overall stakeholder involvement in evidence syntheses is well established, with multiple case studies demonstrating how stakeholders can be successfully involved in systematic reviews.(\u003cspan additionalcitationids=\"CR17 CR18 CR19\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e) Stakeholder involvement increases the relevance of synthesised evidence to the needs of the target population, can promote its uptake into practice, promotes transparency in the process, and makes the process and findings more credible.(\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e) This recognition of the benefits of stakeholder involvement in evidence synthesis has led to the development of frameworks(\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e) and guidance on involving the public at various stages of the review process.(\u003cspan additionalcitationids=\"CR24\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eHowever, adolescents are less frequently involved in conducting evidence syntheses compared to other stakeholders.(\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e) This was highlighted in a study exploring consumer involvement practices, where interviews were conducted with key informants from seven internationally renowned organisations that focus on commissioning and conducting reviews and involving consumers in their reviews. These interviews revealed that various types of stakeholders and consumers were being involved in evidence syntheses at their organisations, but children and adolescents were notably absent from the review processes at all of these organisations.(\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e) Similarly, in reviews exploring overall public and patient involvement (PPI) in evidence syntheses, only a few examples of adolescent involvement have been identified. The most comprehensive analysis of overall stakeholder involvement in different types of reviews, conducted by Pollock, identified a total of 291 reviews.(\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e) Of these, only eight reviews\u0026mdash;less than 3% of those involving overall stakeholders\u0026mdash;engaged young people. This stands in contrast to the more frequent involvement of adult stakeholders in conducting evidence syntheses. Furthermore, the current guidance on consumer or stakeholder involvement in systematic reviews is primarily focused on adults, underscoring the lack of emphasis on adolescent involvement.(\u003cspan additionalcitationids=\"CR24\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e) The prioritisation of adult involvement in evidence syntheses reflects a deeper issue of adultism\u0026mdash;the belief that adults are inherently more knowledgeable, capable, or valuable than young people.(\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e) This belief often limits adolescents' involvement in decisions that impact them, placing them at a disadvantage compared to adult stakeholders.\u003c/p\u003e \u003cp\u003eTo address adultism in evidence synthesis practices and to promote adolescent involvement, it is crucial to understand how adolescents can actively contribute to evidence syntheses and how their involvement impacts them and the review process. We conducted an umbrella review to consolidate evidence on: i) the methods used to involve adolescents at different stages of the evidence synthesis process, ii) the challenges and facilitators affecting adolescent involvement in evidence syntheses, iii) the impacts of adolescent involvement on both the review and the adolescents themselves, and iv) the best practices for involving adolescents in evidence syntheses. Additionally, this paper describes the methods used to engage adolescent co-researchers and advisors at different stages of this umbrella review, demonstrating how adolescents can be successfully involved throughout the evidence synthesis process. The objective is to provide recommendations for how to engage adolescents in evidence syntheses in light of the outcomes and challenges associated with different approaches.\u003c/p\u003e"},{"header":"Methodology","content":"\u003cp\u003eThis umbrella review was conducted following the Cochrane guidelines for overviews of reviews, with some adaptations\u0026mdash;such as the types of reviews included\u0026mdash;to better align with the review\u0026apos;s objectives. The review was registered with the International Prospective Register of Systematic Reviews (CRD42021287467)\u003cem\u003e,\u003c/em\u003e and any methodological changes were preregistered in the updated PROSPERO record. This paper is part of a larger evidence synthesis aimed to consolidate all the review-level literature on adolescent involvement in health research. A detailed description of the methods used can be found in the published protocol paper\u0026nbsp;(28)\u003cem\u003e.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSearch strategy\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe search strategy for this umbrella review focused on adolescents aged 10\u0026ndash;24 years, adolescent involvement in health research, and the review type (including various review formats such as scoping, systematic reviews, and meta-analyses), using Boolean operators to combine terms. Authors AW and KH collaborated with a research librarian (GF) from Trinity College Dublin to develop the search strategy. \u0026nbsp;The detailed search strategy is provided on the OSF page of the review (\u003cem\u003ehttps://osf.io/cx7y9/?view_only=4f40ba5530f64c608c405ce66a4a7243\u003c/em\u003e\u003cem\u003e).\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformation sources for peer-reviewed and grey literature search\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe searched the Cochrane Database of Systematic Reviews, MEDLINE, Scopus, Embase, PsycINFO, PsycArticles, CINAHL, Epistemonikos, and Health Systems Evidence, to identify relevant reviews. The grey literature search involved multiple components. A simplified search strategy with fewer key terms was applied to Google Scholar, limited to the first 10 pages of results. The top 10 paediatric, perinatology, and child health journals from the Scimago Journal and Country Rank list were reviewed using a similar simplified strategy. Conference abstracts, theses, reports, and unpublished reviews were identified through Web of Science and ProQuest searches, with strategy adapted to each database\u0026apos;s interface. Reviews registered on PROSPERO were also searched, and review authors were contacted to share data from reviews close to or recently completed. A targeted search of websites from relevant organisations focused on adolescent health (including government, non-profits, and health organisations) was conducted within Google and the Mental Health Innovation Network database. Additionally, a search for youth health organisations in low- and middle-income countries was conducted, focusing on the top results for each of the 137 countries using World Bank classifications. A simplified search strategy was used for organisational websites, and experts in youth involvement in health research were contacted for potentially relevant materials. Reference lists from eligible reviews were screened, and the Connected Papers software was used to identify similar papers.\u003c/p\u003e\n\u003cp\u003eSince these sources were searched in December 2021, we updated our search by screening the list of reviews included in another umbrella review on youth involvement in health research, published in 2024, to identify further relevant reviews.(29)\u0026nbsp;Additionally, we conducted a hand search of the volumes published from 2021 to 2024 of two journals focused on public and patient involvement in health research: \u003cem\u003eHealth Expectations\u003c/em\u003e and \u003cem\u003eResearch Involvement and Engagement\u003c/em\u003e. We systematically reviewed each issue of these journals, screening titles, abstracts, and keywords to identify articles relevant to our inclusion criteria. Full texts of potentially relevant articles were examined to determine their inclusion in our updated review.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEligibility criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe umbrella review included various types of reviews to include a range of qualitative outcomes related to adolescent involvement. Only reviews focusing on adolescents aged 10\u0026ndash;24 were included, with flexibility for reviews that did not specify exact age ranges but focused on children and adolescents. We included reviews that explored adolescent involvement in health research related to physical and mental health, and reported on strategies, best practices, barriers, mitigation strategies, or evidence gaps in adolescent involvement. Only reviews published in English were included.\u003c/p\u003e\n\u003ch3\u003eSelection of studies\u003c/h3\u003e\n\u003cp\u003eSearch results were imported into Covidence to remove duplicates. AW handled the title and abstract screening for all articles, while the co-researchers screened 25% to reduce bias. For full-text screening and data extraction, AW screened all articles, while co-researchers reviewed 10% to ensure accuracy. Any disagreements were settled through discussions among the team, and if needed, a fourth researcher was consulted (Figures 1 and 2).\u003c/p\u003e\n\u003ch3\u003eData extraction and synthesis\u003c/h3\u003e\n\u003cp\u003eData for this paper was extracted in Excel by a young co-researcher (MS) and checked by AW. Data was extracted on the area of health research, countries where adolescents were involved, type of review, characteristics of adolescents, aim of involvement, stage of the review process, level of involvement, methods used, challenges faced, facilitators, compensation provided, benefits of involvement for adolescents, how feedback was incorporated, the impacts of involvement on the review, and best practices identified.\u003c/p\u003e\n\u003cp\u003eA narrative synthesis was conducted by AW by thoroughly reviewing the extracted data for familiarisation, followed by deductive coding. The resulting codes were organised into broader themes, which were then summarised in descriptive and tabular formats to align with the research aims.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe results presented for the adolescent involvement process and the outcomes of their involvement are based on the reviews included in this umbrella review and examples of adolescent involvement at different stages of this review.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAdolescent involvement in included reviews\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe identified only 10 reviews for inclusion in this manuscript that examined adolescents\u0026rsquo; involvement in health research, where adolescents were engaged at one or more stages of the review process (Figures 1 and 2). The characteristics of the included reviews are summarised below.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eCharacteristics of included reviews\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMost reviews (\u003cem\u003en\u003c/em\u003e=6) focused on adolescent involvement in overall health research.(1, 3, 30-33)\u0026nbsp;Two reviews explored health and social sciences,(7, 34)\u0026nbsp;one focused on mental health research,(35)\u0026nbsp;and one looked specifically at the involvement of adolescents who had adverse childhood experiences.(36)\u0026nbsp;Four were rapid reviews,(3, 7, 33, 34)\u0026nbsp;while two were systematic,(32, 35)\u0026nbsp;scoping,(1, 30)\u0026nbsp;and narrative reviews.(31, 36)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eCharacteristics of adolescents involved\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMost reviews were conducted in the UK (\u003cem\u003en\u003c/em\u003e=6).(1, 3, 30, 31, 34, 36) Two reviews included adolescents \u0026nbsp;from Canada,(32, 35) and one review each included adolescents from Ireland(33) and the USA.(35) The number of adolescents involved in reviews depended on their roles. For example, the number of adolescent co-researchers involved ranged from one(30, 34, 36) to three,(35) while the number of adolescent advisors varied from six(31) to 27.(1) Only three reviews reported the age of the adolescents involved,(1, 33, 35) which ranged from 12 to 24 years old. Two of these reviews, however, only included adolescents over the age of 18.(33, 35) Adolescents\u0026rsquo; genders were reported in five reviews; these reviews all involved only male or female adolescents and young people. (30, 33-36) Six reviews provided details on the background of adolescents involved. Four reviews engaged adolescents with previous relevant experience. In one review, this experience was related to previous involvement in mental health research(35) while two others focused on individuals with experience receiving services.(30, 34) One review involved adolescents with lived experiences of mental health challenges,(1) and two included young students as co-researchers.(33, 36)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eLevel of adolescent involvement at different stages of the review process\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe categorised adolescent involvement using the 11 stages of a review outlined by the Cochrane Ecosystem(37)\u0026nbsp;with an additional 12th stage proposed by Pollock et al.(22)\u0026nbsp;The level of adolescent involvement at different stages of evidence synthesis process is reported in figure 3. Two reviews involved adolescents as co-researchers throughout the entire review process, though specific stages and methods used were not described.(32, 36)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods and impacts of adolescent involvement at different stages of the review process: findings from the included reviews and this umbrella review\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThis section reports on how adolescents were involved at different stages of the evidence syntheses process and highlights the impacts of their involvement at these stages.\u0026nbsp;\u003c/strong\u003eOverall suggestions for adolescent involvement in the evidence synthesis process are provided in the supplementary table 1.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eDeveloping the questions and planning methods\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn two reviews, adolescents helped refine the review\u0026apos;s scope and questions. For example, Rouncefield-Swales consulted a young service user, leading to a shift in focus towards the impacts of adolescent involvement, and specifically to examining the characteristics of those included or excluded from the research process.(30)\u0026nbsp;Larkins and colleagues(7)\u0026nbsp;conducted a week-long online hackathon with peer researchers from marginalised groups. Through daily creative problem-solving sessions, adolescents contributed to refining core aspects of the review, including the development of research questions, defining key terms, and determining the eligibility criteria. In one review, adolescents\u0026rsquo; involvement at later stages resulted in the refinement of methods used. Thomas and colleagues(31)\u0026nbsp;reported how adolescents\u0026rsquo; input as members of a youth advisory group during the interpretation and dissemination stages led to an unexpected but useful revision of the data extraction process. After discussions with adolescents, the team revised their data extraction form to include additional aspects identified by adolescents as important. In our umbrella review, adolescents were not involved in these steps due to time constraints and the urgency of registering the protocol with PROSPERO. This limited our ability to identify, recruit, and train adolescents in time to incorporate their input at these stages.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eWriting and publishing the protocol\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAdolescent involvement was not reported at this stage in any of the included reviews. In our umbrella review, we involved three adolescent co-researchers (DB, ML, PC) in reviewing the initial draft of the protocol paper.(28)\u0026nbsp;The co-researchers received training on the basics of research protocols, to familiarise them with what a research protocol includes, its purpose, and the key sections. Co-researchers were given the protocol draft to review individually and were encouraged to annotate sections they found unclear and to provide suggestions for improvement. After the individual review, the co-researchers participated in one-on-one discussions with the lead author (AW), who explored the rationale behind their suggestions. Co-researchers flagged areas where the protocol\u0026rsquo;s language was too technical or inaccessible. They recommended using simpler, more youth-friendly alternatives to technical terms, and suggested changes to improve grammatical accuracy. In instances where feedback could not be fully incorporated, AW explained the reasoning behind this to the co-researchers.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eDeveloping the search strategy and running the search in databases\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAt the search strategy development stage, Larkins and colleagues\u0026rsquo;(7)\u0026nbsp;hackathon engaged adolescents to contribute directly to the development of the search strategy by brainstorming relevant terms and methods for identifying studies that focused on adolescent involvement in research. None of the reviews reported involvement of adolescents in running the search. In our umbrella review, adolescents were not involved in these steps due to time constraints that limited the opportunity for recruitment and training, coupled with the urgency of running the search to start the review process.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eStudy selection\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn the study selection phase, Warraitch and colleagues(33)\u0026nbsp;involved a young co-researcher in the title and abstract and full-text screening stages. This co-researcher screened 25% of the articles at the title and abstract stage and 10% of the articles at the full-text stage. At this same stage, Wilson and colleagues(3)\u0026nbsp;involved adolescents as consultants by seeking their help to identify relevant studies on adolescent involvement in health research that had been missed during both the database and grey literature searches.\u003c/p\u003e\n\u003cp\u003eIn conducting this umbrella review, we involved a young co-researcher (DB) in two levels of article screening: the title and abstract screening and the full-text screening.\u0026nbsp;She was provided with brief training, focusing on an overview of the umbrella review methodology using the Cochrane guidelines for overviews of reviews,(38)\u0026nbsp;how to assess studies based on titles and abstracts, applying eligibility criteria at the full text stage, and how to document the reasons for exclusion.\u0026nbsp;She also received guidance on using Covidence, the review management software, and how to use its different features.\u0026nbsp;She was provided with a detailed document outlining the eligibility criteria, which were discussed in training sessions to ensure clarity and consistency in applying these.\u0026nbsp;Furthermore, AW conducted mock screening sessions with DB, allowing her to practice decision-making and receive feedback.\u0026nbsp;This helped familiarise her with the types of articles she would screen during the review process.\u0026nbsp;The co-researcher (DB) then independently screened 25% of the articles at the title and abstract stage and 10% at the full-text screening stage.\u0026nbsp;In cases where there were discrepancies between two reviewers\u0026rsquo; decisions on article inclusion or exclusion, consensus meetings were held to resolve any differences.\u0026nbsp;DB\u0026rsquo;s insights often led to further discussion and, in some cases, the inclusion of articles that might have otherwise been excluded.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eData extraction\u003c/em\u003e\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAt the data extraction stage, Warraitch and colleagues(33)\u0026nbsp;involved a young co-researcher as a second reviewer for some of the included articles, to ensure data accuracy and consistency.\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003eIn our umbrella review, three adolescent co-researchers (DB, ML, PC) were involved in extracting relevant data from 10% of the included reviews. During the training sessions, co-researchers were familiarised with data extraction forms and were guided on how to identify and extract the required data. This training ensured they could identify the relevant information in different sections of the papers. Before starting the full extraction process, the co-researchers participated in pilot exercises where they extracted data from a few sample studies and were provided with feedback by AW. Once trained, co-researchers participated in the data extraction process independently using a standardised template. \u0026nbsp;After completing their extractions, they met with AW to discuss the process and address any discrepancies. Throughout the data extraction process, adolescent co-researchers received ongoing support from AW.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eData analysis and interpretation of findings\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMcCabe and colleagues engaged adolescents as co-researchers in reviewing the categories and themes that emerged from the coded data. Adolescents helped refine these categories by merging similar codes under relevant themes, ensuring that their perspectives were accurately reflected in the analysis.(35)\u0026nbsp;In five reviews, adolescents were actively consulted when interpreting the findings, providing a critical layer of reflection on how the results aligned with their lived experiences. For instance, McCabe and colleagues held a consultation meeting with three adolescents, using their input to revise key sections of the study. Their feedback led to the addition of new impacts and challenges, a restructuring of the recommendations section, the inclusion of more specific examples, and revisions in the phrasing of some recommendations. This process ensured that the findings were both relevant and practical from a youth perspective.(35)\u0026nbsp;Similarly, Erwin and team(34)\u0026nbsp;engaged a young person to interpret the review\u0026apos;s findings based on her own experiences.\u003c/p\u003e\n\u003cp\u003eSellars and colleagues(1)\u0026nbsp;took a similar approach, holding two consultation meetings with youth advisory groups to get input on specific elements of their review. The first was a 40-minute face-to-face session with six adolescents aged 17-18, and the second was a virtual session with 21 adolescents aged 14-17. These consultations focused on visual representations related to youth advisory groups (YAGs), discussing the pros and cons of YAG involvement, providing recommendations for reporting YAG activities, and suggesting preferred methods of acknowledgment and dissemination. These sessions allowed adolescents to influence both the content and presentation of the review\u0026rsquo;s findings. Larkins and colleagues(7)\u0026nbsp;referred to the overlap between the findings of the initial hackathon conducted with adolescents and the findings from the review to highlight the convergences and disagreements in adolescents\u0026rsquo; perspectives and the findings reported in the studies. While Thomas and team also consulted adolescents during the interpretation stage, the specifics of their involvement were not detailed, pointing to a need for greater transparency in reporting such contributions.(31)\u003c/p\u003e\n\u003cp\u003eIn this umbrella review, an adolescent co-researcher (ML) contributed to synthesising the findings using the extracted data along with the lead author AW. She was trained using the narrative synthesis guidance manual,(39)\u0026nbsp;on the process of coding, sorting similar codes into categories, and describing these categories. ML then helped code data from five reviews using both inductive and deductive coding. After coding individual studies, ML met with AW to compare their coding and discuss any discrepancies.\u003c/p\u003e\n\u003cp\u003eAdditionally, we conducted a participatory workshop with 12 adolescent advisors to interpret the findings from the included reviews on the challenges adolescents face during their participation in health research. Two adolescent co-researchers (CW, JH) took an active role in planning this participatory workshop. They were provided with two training sessions to orient them to the current umbrella review and its findings, different participatory methods that can be used to engage adolescents in health research, the aims and goals of the workshop, and the importance of creating a space where adolescent advisors felt comfortable sharing their experiences and opinions. Following the training, the co-researchers worked together to outline the workshop\u0026rsquo;s design, proposed the use of different interactive elements (e.g., icebreakers, group activities) and strategies to keep discussions focused on the research questions.\u003c/p\u003e\n\u003cp\u003eTwelve adolescent advisors - nine male and three female advisors, from both Kenya and Ireland- participated in the workshop. Co-researchers (CW, JH) and the lead researcher (AW) facilitated discussions on the reported challenges to adolescent involvement in the review and prompted the group to share any additional barriers and to suggest the mitigation strategies to address the reported barriers. The adolescent advisory group agreed with most of the challenges reported in the review but also shared several additional barriers, which had not been adequately covered in the literature. CW and JH recorded the discussions using sticky notes and charts, capturing key insights and suggestions in real-time.\u003c/p\u003e\n\u003cp\u003eAfter the workshop, co-researchers (CW, JH) helped synthesise the data collected during the workshop. Each suggestion made by adolescent advisors during the workshop was given a unique code. Co-researchers were responsible for assigning these codes and organising them into broader themes. Once the coding was completed, co-researchers and AW aggregated the codes into overarching themes. The findings of this workshop are reported elsewhere (40).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eWrite-up and dissemination\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAdolescents played a significant role in the write-up and dissemination stages across several reviews, often contributing as co-authors and co-creators of outputs. For example, McCabe and team involved a young person in developing illustrations, graphs, and writing parts of the paper, ensuring their contributions were recognised in both content development and authorship.(35)\u0026nbsp;Similarly, Erwin and colleagues engaged a young person in interpreting findings through her lived experience, incorporating her reflections and acknowledging her as a co-author.(34)\u0026nbsp;Warraitch and team also involved two young co-researchers in reviewing the manuscript and providing input, with both credited as co-authors.(33)\u0026nbsp;Other reviews involved adolescents in either co-producing a lay summary of the findings and key recommendations for researchers\u0026nbsp;(30)\u0026nbsp;or in reviewing the summary of the review, with their feedback leading to revisions in the discussion section.(31)\u003c/p\u003e\n\u003cp\u003eSellars and team involved adolescents in developing a dissemination strategy that moved beyond traditional academic articles. This approach ensured that the review\u0026apos;s findings reached a wider audience through methods tailored to adolescent engagement.(1)\u0026nbsp;In terms of knowledge mobilisation, Sanchez and colleagues formed a youth advisory board to lead the process of sharing the review\u0026rsquo;s findings, though specific details on their contributions were not provided.(32)\u003c/p\u003e\n\u003cp\u003eIn this umbrella review, all adolescent co-researchers (DB, ML, PC, CW, JH, SB) actively contributed to the dissemination of the findings from the review in different forms. CW helped organise an online webinar with AW aimed at both academic and public audiences. She helped prepare the presentation materials, including slides and talking points, and co-presented the findings from the review on the benefits of adolescent involvement in health research for the adolescents themselves. Some co-researchers also co-presented the findings of the review at the Trinity Centre for Global Health weekly departmental seminars. For example, DB co-presented the protocol of the review along with AW at one of the departmental seminars held in 2022, while CW, ML, JH co-presented the findings on the challenges to adolescent involvement in health research and the findings from the participatory workshop with AW at a departmental seminar in 2023.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll co-researchers contributed as co-authors on three papers that resulted from this review. DB, ML, and PC co-authored the protocol paper by reviewing and refining the paper and ensuring the use of inclusive and accessible language. They also helped draft sections of other papers. For example, ML led the writing of the methods section of the paper reporting the challenges to adolescent involvement in health research and is acknowledged as the second author(40). CW and SB took the lead on writing the introduction, methods, and results sections of a paper that highlights the positive impacts of adolescent involvement in health research. They also developed illustrations for the paper and were acknowledged as joint first authors alongside AW (14).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eChallenges and facilitators to adolescent involvement in reviews\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone of the included reviews reported any specific facilitators that supported adolescent involvement in the evidence synthesis process. Only one review, conducted by Sellars et al., reported financial constraints and limited time as barriers to adolescent involvement. These constraints impacted how and when adolescents could participate in the review, suggesting that resources can play a significant role in determining the extent of adolescent engagement.(1)\u003c/p\u003e\n\u003cp\u003eIn our umbrella review, most of the adolescent co-researchers lacked previous experience in systematic reviews or academic research. This meant that additional time was needed for training and for their full participation in technical stages, such as screening and data extraction. Another key challenge faced during the review process was the need for flexibility in accommodating the diverse schedules and commitments of adolescent co-researchers. Many of the co-researchers were balancing other responsibilities, such as school and work, which created difficulties in coordinating group discussions and timely completion of tasks such as screening and data extraction.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eImpacts of the involvement process on adolescents and reviews\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone of the reviews reported any formal assessment of the impacts of the involvement process on adolescents or the review itself. In terms of the positive impacts of involvement on adolescents, they were credited as co-authors in five papers.(32-36)\u0026nbsp;For our umbrella review, adolescent co-researchers received training in systematic review methodologies, including study selection, data extraction, narrative synthesis, and academic writing. They also gained technical skills by using research tools like Covidence. In recognition of their work, co-researchers were compensated through co-authorship on papers and strengthening their CVs and professional profiles. Adolescent advisors were compensated with gift vouchers for their time and contributions.\u003c/p\u003e\n\u003cp\u003eAdolescent involvement in this umbrella review helped ensure that the review was more relevant and inclusive for adolescents. For example, by co-authoring the outputs from the reviews, they identified areas where the language was too technical and suggested adolescent -friendly alternatives. Further, their feedback during the study selection process helped include reviews that might otherwise be overlooked by adult researchers. The active role of co-researchers in planning and facilitating the participatory workshop with adolescent advisors ensured the workshop was adolescent-centred and engaging. Their input on structuring interactive sessions and icebreakers helped create a comfortable environment for the participants, which led to richer, more open discussions. Adolescent advisors brought their unique insights in the interpretation process by identifying challenges faced by adolescents in participatory health research that are not always reported in the literature.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis umbrella review is the first to consolidate evidence on adolescent involvement in evidence syntheses on their engagement in health research. We identified 10 papers describing adolescent involvement in different types of reviews and provided examples of how adolescents were involved at different stages of the current review. Our findings indicate that adolescents were involved in nearly all stages of the review process, demonstrating that adolescents can be successfully engaged throughout evidence synthesis. A diverse range of creative and participatory methods\u0026mdash;such as informal consultations, youth advisory groups, hackathons, and collaborative meetings\u0026mdash;were used to involve adolescents at different stages. This involvement strengthened the review process and outcomes by enhancing the relevance of the review for adolescents, improving methodological rigor, bringing unique insights to the interpretation of findings, and ensuring greater accessibility during dissemination. These findings align with previous reviews on stakeholder involvement in evidence syntheses,(\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e) supporting the feasibility and value of incorporating diverse perspectives of adolescents in the evidence synthesis process.\u003c/p\u003e \u003cdiv id=\"Sec23\" class=\"Section2\"\u003e \u003ch2\u003eCurrent landscape and recommendations for adolescent involvement in evidence syntheses\u003c/h2\u003e \u003cp\u003eWhile adolescents were engaged at almost all stages of the review process, they were most frequently involved in the interpretation and write-up stages. This is congruent with existing research, which shows that adolescents are more commonly involved in later stages of health research projects.(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e) However, this contrasts with findings from other reviews on overall stakeholder involvement in realist reviews,(\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e) who reported that stakeholders were frequently engaged across clarifying the scope, developing program theories in realist reviews, and participating in data analysis and synthesis. The higher engagement of adolescents in the interpretation and write-up stages of reviews may be because these stages require less specialised technical expertise, making them more accessible for adolescent involvement. The nature of adolescent involvement in most reviews was consultative, where their input and advice were sought, with only two reviews actively engaging adolescents as co-researchers. This trend mirrors findings from Power and colleagues, who noted that most realist reviews involved stakeholders as consultants and advisors at specific stages.(\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e) This may be attributed to practical constraints, such as the technical complexity of some stages of the review process (e.g., conducting searches) or resource limitations, which may make it unfeasible to involve adolescents at a higher level.(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) A wide variety of methods used to engage adolescents contrasts with the more conventional methods used for overall stakeholder involvement in evidence syntheses. For stakeholders, commonly used methods included focus group discussions, interviews, ranking techniques, and meetings or workshops with advisory groups. The difference suggests that more innovative and diverse approaches are necessary to effectively engage adolescents in the review process compared to general stakeholders. This corroborates with broader research on adolescent involvement in health research, which emphasises the importance of using more engaging and flexible methods to sustain meaningful adolescent involvement.(\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eGiven the wide variation in the number of adolescents engaged at different stages of the review process, there is no set number of adolescents required for involvement in evidence syntheses; rather, the number depends on their role and level of involvement in the project. In our umbrella review, we engaged five co-researchers at different stages of the review process, tailoring their involvement to their interests and the tasks available. The same outcomes could potentially have been achieved with just one or two adolescents, but five were involved to accommodate their limited availability due to other commitments. Involving multiple adolescents is also considered good practice because it makes the process more adolescent-friendly and accessible. At the interpretation stage, in particular, it is important to ensure diversity in the group of adolescents. This need for diverse input likely explains why a higher number of adolescents were engaged as advisors during this phase in both the included reviews and our umbrella review.\u003c/p\u003e \u003cp\u003eThe findings indicate that both adolescents with and without previous professional or lived experience can be successfully involved in conducting evidence syntheses, depending on their role in the project. For example, reviews that engaged adolescents with prior experience \u0026mdash; either through contributing to research or through lived experience related to the topic \u0026mdash; tended to involve them in tasks such as planning the review or interpreting the findings based on their experiences.(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e) In contrast, reviews that involved adolescents without prior experience often engaged them as co-researchers in conducting various stages of the evidence synthesis itself.(\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e) This pattern aligns with adolescent involvement in our review, where students without previous experience were engaged as co-researchers across multiple stages of the umbrella review. Meanwhile, advisors with previous experience contributing to health research were involved specifically at the interpretation stage.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003eProcess outcomes of adolescent involvement in evidence syntheses\u003c/h2\u003e \u003cp\u003eMost of the reviews did not report any challenges, facilitators, or overall recommendations or best practices for involving adolescents in evidence syntheses. The few challenges that were mentioned aligned with the challenges reported in other case studies of adolescent involvement in reviews(\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e) or general barriers found in broader adolescent involvement literature, such as resource limitations, time constraints, and logistical issues.(\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e) One of the few recommendations highlighted in the reviews concerned not requiring ethics approval for adolescent involvement, which has been a point of ambiguity in previous reviews on stakeholder involvement in evidence syntheses.(\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e) Similarly, reviews did not report on any positive or negative impacts of involvement in the review for the adolescents. However, adolescents were acknowledged as co-authors in five reviews,(\u003cspan additionalcitationids=\"CR33 CR34 CR35\" citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e) which can further strengthen adolescents\u0026rsquo; CVs and may have implications for their academic and career outcomes.(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e)\u003c/p\u003e \u003cdiv id=\"Sec25\" class=\"Section3\"\u003e \u003ch2\u003eEvaluation and reporting of adolescent involvement\u003c/h2\u003e \u003cp\u003eOther key details missing from the papers included a description of the training provided to adolescents, and any ethical implications considered during their involvement. This lack of reporting on crucial elements of the adolescent involvement process can be attributed to the absence of formal, planned evaluations of adolescent participation in evidence syntheses,(\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e) and a lack of reporting tools or guidelines to report the findings. The issue of inadequate evaluation and poor reporting of adolescent involvement aligns with similar findings in reviews of overall stakeholder involvement in evidence syntheses.(\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e) Pollock and colleagues found that the majority of the reviews in their study did not conduct formal evaluations and did not use any reporting tools to present how stakeholders were engaged. Power and colleagues highlighted similar issues with poor reporting and a lack of detail in reviews on how stakeholders were involved.(\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e) To address this, researchers need to use evaluation frameworks to formally evaluate the adolescent involvement process in evidence syntheses.(\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e) Furthermore, there is a need to adhere to reporting guidelines like the Guidance for Reporting Involvement of Patients and the Public (GRIPP) checklist to ensure transparency and consistency in reporting of adolescent involvement in evidence syntheses.(\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec26\" class=\"Section3\"\u003e \u003ch2\u003eImpacts of adolescent involvement on the review process and outcomes\u003c/h2\u003e \u003cp\u003eDespite the inadequate evaluation and reporting, adolescent involvement consistently demonstrated positive impacts on the quality and relevance of evidence syntheses in several key areas. Involving adolescents in shaping research questions helped ensure that the reviews addressed topics relevant to their lived experiences.(\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e) Input from adolescents helped refine review methodologies, such as improving data extraction to capture adolescent-relevant aspects,(\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e) enhancing search strategies by incorporating terms and concepts that adult researchers may have overlooked,(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e) and adding a layer of accuracy during study selection and data extraction.(\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e) Adolescent involvement in data analysis, interpretation, and dissemination ensured that results reflected their lived experiences, and made the outputs more accessible and engaging.(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e) These benefits further build the case for involving adolescents at multiple stages of the evidence syntheses process to enhance both the quality and relevance of the evidence syntheses.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec27\" class=\"Section3\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eThis umbrella review has some limitations. First, it was restricted to English-language reviews. Second, relevant reviews using different terminology for adolescent involvement may have been missed despite a broad search strategy. Third, it focused solely on adolescents aged 10\u0026ndash;24, limiting generalisability to younger children. Fourth, the original search for this review was conducted in December 2021. While we made an effort to update it by screening articles included in a more recently published umbrella review and by hand-searching two relevant journals for papers published in the last two years, it is still possible that some relevant papers were not included.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn this umbrella review, we found that adolescents can contribute to various stages of evidence synthesis, particularly in interpretation and dissemination of findings, using a wide range of methods. Their participation enhances the relevance and quality of evidence by ensuring that findings reflect adolescents\u0026rsquo; lived experiences and unique insights, offering perspectives that may be overlooked by adult researchers. The predominantly consultative nature of adolescent involvement\u0026mdash;often limited to later stages in most of the included reviews\u0026mdash;reflects practical constraints and a reliance on tasks that require less specialised expertise. The identification of mechanisms through which adolescent involvement impacts review outcomes is significantly limited by inadequate reporting and evaluation. Addressing these gaps through the adoption of established reporting guidelines and systematic evaluations will be crucial for improving both the quality of adolescent involvement and the evidence synthesis process itself.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eUNCRC:\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eUN Convention on the Rights of the Child\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePPI: Public and Patient Involvement\u003c/p\u003e\n\u003cp\u003eYAGs: Youth Advisory Groups\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e Only secondary data was included in this umbrella review; therefore, ethical approval or informed consent of participants was not required. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data files and supplementary materials for this review can be accessed at https://osf.io/cx7y9/?view_only=4f40ba5530f64c608c405ce66a4a7243. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAW received the Ussher Fellowship from Trinity College Dublin to support her PhD research. However, this project was not funded. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAW and KH conceptualised and wrote the paper with valuable inputs from MS, CW, ML, DB, JH, QK. \u0026nbsp;MS, DB, ML, QK, contributed to the screening, data extraction, and analysis of this review, while CW and JH led the participatory workshops with the youth advisory group, as young co-researchers. All authors have reviewed and approved the final manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to acknowledge all members of the Trinity Centre for Global Health and School of Psychology \u0026ndash; especially Drs Fr\u0026eacute;d\u0026eacute;rique Vallieres, and Elizabeth Nixon \u0026ndash; for their valuable inputs. We would also like to thank Ms. Geraldine Fitzgerald, the research librarian at the School of Psychology, Trinity College Dublin, for her feedback and input on the search strategy for this umbrella review. We are also thankful to all the members of the youth advisory group for sharing their valuable insights in the participatory workshop.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eSellars E, Pavarini G, Michelson D, Creswell C, Fazel M. Young people\u0026apos;s advisory groups in health research: Scoping review and mapping of practices. Archives of Disease in Childhood. 2021;106(7):698-704.\u003c/li\u003e\n\u003cli\u003eAuthority NHR. What is Public Involvement in Research? 2015 [Available from: https://www.hra.nhs.uk/planning-and-improving-research/best-practice/public-involvement/.\u003c/li\u003e\n\u003cli\u003eWilson O, Daxenberger L, Dieudonne L, Eustace J, Hanard A, Krishnamurthi A, et al. 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Cochrane review ecosystem [Available from: http:// community.cochrane.org/review-production/cochranereview-ecosystem.\u003c/li\u003e\n\u003cli\u003ePollock M, Fernandes RM, Becker LA, Pieper D, Hartling L. Chapter V: overviews of reviews. Cochrane Handbook for systematic reviews of interventions version. 2020;6.\u003c/li\u003e\n\u003cli\u003ePopay J, Roberts H, Sowden A, Petticrew M, Arai L, Rodgers M, et al. Guidance on the conduct of narrative synthesis in systematic reviews. A product from the ESRC methods programme Version. 2006;1(1):b92.\u003c/li\u003e\n\u003cli\u003eWarraitch A, Lee M, Bruce D, Curran P, Khraisha Q, Wacker C, et al. An umbrella review of reviews on challenges to meaningful adolescent involvement in health research. Health Expectations. 2024;27(1):e13980.\u003c/li\u003e\n\u003cli\u003ePower J, Dada S, Booth A, De Br\u0026uacute;n A, Gilmore B. Advisory groups in realist reviews: Systematically mapping current research and recommendations for practice. Cochrane Evidence Synthesis and Methods. 2024;2(6):e12073.\u003c/li\u003e\n\u003cli\u003eShamrova DP, Cummings CE. Participatory action research (PAR) with children and youth: An integrative review of methodology and PAR outcomes for participants, organizations, and communities. Children and Youth Services Review. 2017;81:400-12.\u003c/li\u003e\n\u003cli\u003eFreire K, Pope R, Jeffrey K, Andrews K, Nott M, Bowman T. Engaging with children and adolescents: a systematic review of participatory methods and approaches in research informing the development of health resources and interventions. Adolescent Research Review. 2022;7(3):335-54.\u003c/li\u003e\n\u003cli\u003eOliver K, Rees R, Brady LM, Kavanagh J, Oliver S, Thomas J. Broadening public participation in systematic reviews: A case example involving young people in two configurative reviews. Research Synthesis Methods. 2015;6(2):206-17.\u003c/li\u003e\n\u003cli\u003eJamal F, Langford R, Daniels P, Thomas J, Harden A, Bonell C. Consulting with young people to inform systematic reviews: an example from a review on the effects of schools on health. Health expectations. 2015;18(6):3225-35.\u003c/li\u003e\n\u003cli\u003eStaniszewska S, Brett J, Simera I, Seers K, Mockford C, Goodlad S, et al. GRIPP2 reporting checklists: Tools to improve reporting of patient and public involvement in research. BMJ (Online). 2017;358.\u003c/li\u003e\n\u003cli\u003eKirby P. A Guide to Actively Involving Young People in Research: For Researchers, Research Commissioners, and Managers. A Guide to Actively Involving Young People in Research: For Researchers, Research Commissioners and Managers. 2004.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":true,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"systematic-reviews","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"sysr","sideBox":"Learn more about [Systematic Reviews](http://systematicreviewsjournal.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/sysr/default.aspx","title":"Systematic Reviews","twitterHandle":"@MedicalEvidence","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Adolescent involvement, Participatory research, Youth engagement, Evidence syntheses methods","lastPublishedDoi":"10.21203/rs.3.rs-5319859/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5319859/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003e Stakeholder involvement in evidence syntheses has been shown to enhance the quality and relevance of reviews. Despite the critical role adolescents can play in shaping their health outcomes, they remain underrepresented in contributing to reviews on topics that directly affect them. To fully unlock the potential of evidence syntheses for adolescent health, it is crucial to understand how adolescents can contribute at various stages of the review process and how their involvement can influence outcomes.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003e To achieve this, we conducted an umbrella review examining adolescent involvement in reviews related to adolescent health research, complemented by a case study that highlights how adolescents were engaged at various stages of this review. We ran a search across 11 databases, screened reference lists and twelve journals, and consulted experts in youth involvement.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003e We found only 10 reviews which meaningfully involved adolescents. In those reviews, adolescents were engaged at almost every stage of the review process, with most involvement centred around interpreting findings or co-authoring the final reports. While adolescent participation was often consultative, there were examples of more collaborative involvement using a wide range of methods, even at technical stages like study selection and data analysis.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe findings highlighted the potential for adolescents\u0026rsquo; input to improve the quality and outcomes of evidence syntheses by grounding the process and findings in their experiences and insights. To maximise the impact of adolescent involvement, we call for engagement of adolescents throughout the review process and the adoption of frameworks to ensure transparency and consistency in reporting.\u003c/p\u003e\u003ch2\u003eSystematic review registration:\u003c/h2\u003e \u003cp\u003ePROSPERO (CRD42021287467)\u003c/p\u003e","manuscriptTitle":"Strengthening evidence syntheses with adolescent involvement: an umbrella review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-12-02 15:51:42","doi":"10.21203/rs.3.rs-5319859/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major revision","date":"2024-11-21T11:13:22+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"","date":"2024-11-06T07:09:55+00:00","index":0,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-11-04T02:32:10+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-10-24T03:36:54+00:00","index":"","fulltext":""},{"type":"submitted","content":"Systematic Reviews","date":"2024-10-23T10:38:17+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"systematic-reviews","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"sysr","sideBox":"Learn more about [Systematic Reviews](http://systematicreviewsjournal.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/sysr/default.aspx","title":"Systematic Reviews","twitterHandle":"@MedicalEvidence","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"de21bffe-9055-42b3-8a30-0a46f4e471ab","owner":[],"postedDate":"December 2nd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-04-07T16:04:10+00:00","versionOfRecord":{"articleIdentity":"rs-5319859","link":"https://doi.org/10.1186/s13643-025-02815-1","journal":{"identity":"systematic-reviews","isVorOnly":false,"title":"Systematic Reviews"},"publishedOn":"2025-04-04 15:57:30","publishedOnDateReadable":"April 4th, 2025"},"versionCreatedAt":"2024-12-02 15:51:42","video":"","vorDoi":"10.1186/s13643-025-02815-1","vorDoiUrl":"https://doi.org/10.1186/s13643-025-02815-1","workflowStages":[]},"version":"v1","identity":"rs-5319859","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5319859","identity":"rs-5319859","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}