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"Sometimes it feels like it's just for show": Discourses, experiences, and practices of equity in relation to everyday challenges, youth mental health, and public youth mental health promotion
Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).ORCID iD: 0000-0001-8592-9692
2026 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Youth mental health as well as health equity are well-discussed topics within the public debate and within public health. Swedish young people who are being marginalized, for instance in relation to race, gender, class, ability, gender identity or sexual identity, are experiencing more mental ill health than other young people. Despite this knowledge, youth mental health programs do not seem to consider aspects of health inequities in the planning, conducting, or evaluation of interventions. The overall aim of this thesis was to explore understandings, meanings, and practices of equity in relation to everyday challenges, youth mental health, and public youth mental health promotion in Sweden. The thesis is a compilation of four qualitative studies. The first two are focus group studies with young people, the third is a critical discourse analysis of regional action plans for mental health, and the fourth a participatory action research study with practitioners working with young people. For the purpose of this thesis, the findings from each study were analyzed based on the overall aim of the thesis and synthesized. From the synthetization of the findings of the four studies, the different perspectives of young people, practitioners, and policy provided varied understandings, meanings, and practices of equity. The understandings of equity are represented by Equity as an ideal. The meanings of equity are represented by Equity as tangible inequities. The practices of equity are represented by Equity as (in) action. For inequities to become equity and for equity to become more than an ideal, actions on systemic injustices are needed. Action must come from participation by those marginalized by the unjust system and those hit hardest by youth mental health inequities, in order to lead to meaningful and sustainable change. Youth participation should not only entail practitioners inviting young people to participate, but also practitioners and policy supporting youth selforganization for mental health justice. 

Place, publisher, year, edition, pages
Malmö: Malmö University Press, 2026. , p. 91
Series
Malmö University Health and Society Dissertations, ISSN 1653-5383, E-ISSN 2004-9277 ; 2026:2
National Category
Public Health, Global Health and Social Medicine
Research subject
Health and society studies
Identifiers
URN: urn:nbn:se:mau:diva-82536DOI: 10.24834/isbn.9789178777044ISBN: 978-91-7877-703-7 (print)ISBN: 978-91-7877-704-4 (electronic)OAI: oai:DiVA.org:mau-82536DiVA, id: diva2:2036322
Public defence
2026-03-06, Allmänna sjukhuset, HS aula, Jan Waldenströms gata 25, Malmö, 09:00
Opponent
Supervisors
Available from: 2026-02-06 Created: 2026-02-06 Last updated: 2026-02-13Bibliographically approved
List of papers
1. Exploring young people's experiences of race, gender and socioeconomic status in relation to everyday challenges: A focus group study
Open this publication in new window or tab >>Exploring young people's experiences of race, gender and socioeconomic status in relation to everyday challenges: A focus group study
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2024 (English)In: Children & society, ISSN 0951-0605, E-ISSN 1099-0860, Vol. 38, no 1, p. 228-244Article in journal (Refereed) Published
Abstract [en]

Reports indicate a decrease in youth mental health in Sweden but at the same time research suggests that what is interpreted as mental ill-health could be considered everyday challenges by young people themselves. The distribution of mental health and illness among young people is uneven based on inequities related to factors such as race, gender and socioeconomic status. Sweden in particular is a country with large socioeconomic inequities in youth mental health and in school results, compared to other European countries. The aim of this study was to explore young people's experiences of the role of race, gender and socioeconomic status in relation to everyday challenges. Sixty-five young people aged 13–15 years old were recruited by student health services and participated in focus group discussions at schools in the southernmost part of Sweden. Data were analysed by secondary analysis with deductive qualitative content analysis using Ecosocial theory of disease distribution as theoretical framework. The analysis resulted in one main theme; Navigating inequities to gain and keep social status, with three underlying themes; Guided by social norms, Negative impact in everyday life and Importance of family influence. Participants were aware and critical of norms and expectations related to race, gender and socioeconomic status. Experiences of prejudice and unfairness was both own lived experiences by the participants as well as observed through friends and classmates. Young people spontaneously identify everyday challenges related to race, gender and socioeconomic status, even when not asked directly about these issues. Conforming to sexist, racist and classist, expectations is a way to lose and gain status in a school setting. Many of the inequities discussed related to socioeconomic status and the direct consequences of having or not having money. Young people's everyday experience of inequities is important to consider in youth mental health promotion aiming to tackle health inequities. Further research is needed on those experiences and how this affects mental health.

Place, publisher, year, edition, pages
John Wiley & Sons, 2024
National Category
Public Health, Global Health and Social Medicine
Identifiers
urn:nbn:se:mau:diva-59106 (URN)10.1111/chso.12718 (DOI)000951574600001 ()2-s2.0-85150983307 (Scopus ID)
Available from: 2023-04-04 Created: 2023-04-04 Last updated: 2026-03-04Bibliographically approved
2. Young people's proposals for tackling everyday challenges in order to improve mental health: a qualitative comparison study based on different socioeconomic neighborhoods
Open this publication in new window or tab >>Young people's proposals for tackling everyday challenges in order to improve mental health: a qualitative comparison study based on different socioeconomic neighborhoods
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2025 (English)In: BMC Public Health, E-ISSN 1471-2458, Vol. 25, no 1, article id 91Article in journal (Refereed) Published
Abstract [en]

Background: Everyday challenges and stress negatively affect young people's mental health. Socioeconomic status (SES) is associated with different stressors and different stress-coping mechanisms. Many interventions target youth mental health, but few consider socioeconomic differences in the planning, implementation, or evaluation. In a Swedish context socioeconomic status is related with migration experience. The aim of the study was to explore proposals for tackling everyday challenges among young people from different socioeconomic neighborhoods.

Methods: Eight focus groups, with participants between 13 and 15 years old from eight schools, were conducted in the south of Sweden. The participants discussed proposals for tackling everyday challenges. Using comparative thematic analysis, the focus group transcripts were divided into two groups, based on the socioeconomic status of the school's neighborhood, and analyzed comparatively. Most of the participants in low SES neighborhoods had foreign background and most of the participants in high SES neighborhoods were Swedish born.

Results: The analysis resulted in four shared themes between the two SES groups: society is responsible, school is responsible, parents are responsible, and I am responsible. The differences and similarities between the two groups are presented in sub-themes. Many of the proposals were similar between the two SES groups, but with different underlying issues and examples.

Conclusion: Both groups proposed that adults must listen more to young people in order to improve the everyday challenges young people face. However, the low SES group in general expressed both more frustration and more agency, compared to the high SES group. This could be important to consider when planning school-based mental health promotion in different socioeconomic neighborhoods.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2025
Keywords
Everyday challenges, Mental health promotion, Qualitative comparison study, Socioeconomic inequities, Youth mental health
National Category
Public Health, Global Health and Social Medicine
Identifiers
urn:nbn:se:mau:diva-73337 (URN)10.1186/s12889-024-21147-8 (DOI)001394299200018 ()39780092 (PubMedID)2-s2.0-85215098126 (Scopus ID)
Available from: 2025-01-27 Created: 2025-01-27 Last updated: 2026-02-06Bibliographically approved
3. "Good and equitable health" – a critical analysis of equity discourses in Swedish regional action plans for mental health
Open this publication in new window or tab >>"Good and equitable health" – a critical analysis of equity discourses in Swedish regional action plans for mental health
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2026 (English)In: Critical Public Health, ISSN 0958-1596, E-ISSN 1469-3682, Vol. 36, no 1, article id 2611573Article in journal (Refereed) Published
Abstract [en]

The goal of Swedish public health policy is to create conditions that enable good and equitable health and eliminate avoidable health inequities. Although previous research emphasizes the importance of considering inequities in mental health promotion and policy, and although researchers and policy makers emphasize the importance of a system-approach to mental health, there seems to be an ambiguity in how the concept of equity is understood. Therefore, the aim of this study was to critically examine equity and inequity discourses in Swedish regional action plans for mental health. A critical discourse analysis based on Foucault’s discourse theory was used to reveal discursive practices of inequity. Twenty-two regional action plans for mental health were analyzed. The analysis identified three discourse strands: the vague language of equity, the inequitable people, and education as a pathway to equity, all of which are entangled through the individualization of equity. Overall, the equity discourse was interpreted as representing a naturalistic and liberal view on equity. This could be understood as contributing to upholding the system of inequities rather than dismantling it. There is a need for clarification about the considered causes of mental health inequities as well as possible solutions.

Place, publisher, year, edition, pages
Taylor & Francis Group, 2026
National Category
Public Health, Global Health and Social Medicine
Research subject
Health and society studies
Identifiers
urn:nbn:se:mau:diva-81462 (URN)10.1080/09581596.2025.2611573 (DOI)001654646700001 ()2-s2.0-105026675471 (Scopus ID)
Available from: 2026-01-07 Created: 2026-01-07 Last updated: 2026-02-06Bibliographically approved
4. Steps Toward Justice: a model for equitable involvement of young people in mental health promotion
Open this publication in new window or tab >>Steps Toward Justice: a model for equitable involvement of young people in mental health promotion
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2025 (English)In: Frontiers in Public Health, E-ISSN 2296-2565, Vol. 13, article id 1636799Article in journal (Refereed) Published
Abstract [en]

Introduction: Mental ill-health affects young people being marginalized to a greater extent than other young people. Nevertheless, are groups being marginalized underrepresented in health research and practice. Several models regarding youth participation have been developed, but knowledge is still lacking on how health promotion practitioners can equitably involve young people when developing health promotion efforts.

Aim: This study aims to (1) describe how participatory action research was used to develop a model for practitioners to equitably involve young people in mental health promotion initiatives and (2) present the finalized model, Steps Towards Justice.

Methods: Through a participatory action research approach, a group of practitioners constructed a model for an equitable involvement of young people in mental health promotion. The model was developed further together with focus groups of practitioners and young people.

Results: The finalized model consists of three phases: preparing, conducting, and applying, with different steps of action to be taken in each phase. To identify inclusion and exclusion, practitioners need to be critical and aware of their own prejudice and values throughout the process. The practice of involving young people equitably also includes creating safe spaces and valuing young people of different backgrounds equally in their contribution to mental health promotion.

Conclusion: The model can be useful for practitioners wanting to involve young people when planning and conducting mental health promotion, for instance at schools or youth centers. It can foster the process of critical reflection around equitable practices and taking steps toward justice through concrete actions of involvement, moving beyond a vague discourse of “everyone is welcome.”

Place, publisher, year, edition, pages
Frontiers Media SA, 2025
National Category
Public Health, Global Health and Social Medicine
Research subject
Health and society studies
Identifiers
urn:nbn:se:mau:diva-80625 (URN)10.3389/fpubh.2025.1636799 (DOI)001624930100001 ()41323630 (PubMedID)2-s2.0-105023453851 (Scopus ID)
Available from: 2025-11-13 Created: 2025-11-13 Last updated: 2026-02-06Bibliographically approved

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