a. Study setting and scholarly context

This study and all authors were nested within a larger multi-method Participatory Ethnographic Evaluation and Research (PEER) project exploring violence, parent-youth dynamics, COVID-19 and their relationship with youth mental health in Sri Lanka (NIHR award 17/63/47). Evidence on exposure to different forms of violence against children and youth in Sri Lanka remain woefully deficient [21]. Despite Sri Lanka’s often regionally impressive health and education indicators [22], youth mental health, including in the context of violence and now COVID-19, are a growing concern [23]. Sri Lanka continues to observe annual increases in non-fatal self-harm, disproportionately affecting adolescent girls [24], while the legacy of civil conflict (1983–2009) differentially impacts youth along ethnic, geographic and socioeconomic lines.

The authors of this study were not involved in securing the grant through which this and the parent PEER study were made possible. COVID-19, having disrupted original grant plans, introduced an opportunity to explore pandemic-safe alternatives with approval from the funder, grant colleagues, and ethics boards. With a retained but broad goal to explore violence and mental health among youth, the in-country primary investigators–hereafter referred to as the core team–wished to include the views of a diverse cross-section of youth in the role of CBRs. Conscious recruitment through popular local employment platforms; professional, activist, youth (parliament), community-based and educational networks; and social media identified CBRs. Core team members independently and jointly explored candidate participatory methods and presented them in a ‘methods showcase’ to discuss options. PEER was identified as a base approach that could permit COVID-safe participation of all team members and be modified to accommodate CBR input. In keeping with the PEER approach [25], our CBRs were recruited from the same social networks as participants and actively participated in all stages of the parent research cycle from topic selection through dissemination. Through interactive exercises, CBRs chose (i) study foci, (ii) how to work together, (iii) study participants, and (iv) gave feedback on timelines, protocols, and practicalities. The core team collaborated alongside CBRs to shape (v) whether and how to feasibly incorporate additional creative methods, (vi) design of study materials, and (vii) dissemination strategy and outputs, of which this is one. Between March and October 2021, CBRs conducted three iterative rounds of data collection using in-depth interviews, autophotography and creative writing through Story Completion Method. Rounds were punctuated by individualised inter-round debriefs and preliminary team-based data analysis. The current study was conducted concurrently with the PEER project, amid COVID-19. As such, both studies followed Sri Lankan government protocols and personal and participant safety preferences, adjusting activity modes with pandemic conditions.

b. Study sample, team positionalities and reflexivity

CBR eligibility criteria included being 18–29 years old at the start of the study; residing in Eastern, Northern, Southern or Western Provinces to support varied perspectives; being able to commit to active involvement in the full project cycle; and successful completion of the foundational PEER training programme. Twenty-one CBRs were recruited, and all completed their duties. While CBRs contributed anonymised feedback for internal project learning, all 21 also chose to generate these data as external collaborative knowledge (i.e., this study) alongside primary investigators. Table 1 presents CBRs’ background characteristics against an overall national profile where possible (*) [26]. Contemporary national data disaggregated to explore youth (18–29) characteristics including marriage, family and socioeconomic factors are unavailable. Our CBR sample over-represents minority youth proportional to national demographics, particularly Tamils, due to the parent project’s intentional inclusion of often invisibilised communities from previous research. CBRs are also atypical in their near-universal tertiary education as just 3% of the population holds a degree or higher [26], but still represent mixed community backgrounds seldom supported to lead local research efforts. More women (57%) participated than men (43%), above national proportions (52% women, 48% men) [26], but mirroring trends in violence research globally, possibly due to gendered norms, topic perceptions, and greater proximity to survivorhood [7].

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Table 1. Community-based researcher characteristics.

https://doi.org/10.1371/journal.pgph.0000899.t001

The core team has supported multiple community-based research projects through Sri Lanka’s non-profit sector inclusive of youth, violence, and mental health studies (ZR, KV, and SR). AP has led multi-method research on violence and health in Sri Lanka for more than a decade. Together, all research experience and educational levels, languages, ethnicities, religions, genders, socioeconomic backgrounds and geographies relevant to the study are represented in our 25-person team. This diversity supported our team’s ability to internally question assumptions and discuss differences of opinion with a shared goal of better supporting a more collaborative, democratic research practice.

Cultivating this more collaborative dynamic was a conscious and continuous effort by the core team, in which some members benefit from more formal education, proficiency in English, and research experience to CBRs. Two core team members are, however, minority youth themselves and not all possess more years of professional experience to CBRs. While we may choose differently in future projects, terms like power were not often explicitly invoked in local language discussions with team members. As per explicit preferences of the group, we instead spoke in terms of “collaboration”, sharing decision-making and leadership, and about practical concrete choices and behaviours that could democratise participation further. Local power structures of ethnicity, age, gender, socioeconomic status, education level, language, and regional location also required continuous attention. To that end, the core team took steps to maintain flatter power relations between themselves and CBRs and among CBRs through language and action including: (1) assigning language-matched debrief “buddies”, avoiding terms like “line management” and “supervisory meetings”; (2) stressing open door policies; (3) privileging local languages and colleagues with less experience in different scenarios, and (3) organising team work in ways that would encourage all CBRs’ voices to be heard. Debriefs were framed as “curiosity sessions” for both buddies, and intentionally designed to elicit feedback from CBRs on the process of doing the research, not just on the content being generated through it. The team leader (AP) aimed to position herself alongside and not above core colleagues by performing similar duties (e.g., debrief buddy) as much as possible. The core team did not seek to steer decision-making unless it was necessary given formal responsibilities.

c. Data collection

SR reviewed study information with each CBR in language-matched written and oral forms; all provided written informed consent. As CBRs were employed by and reporting to the core team, we took steps to minimise concerns over confidentiality, power, and performance, and reduce reporting or disclosure bias. First, CBRs pseudonymised submissions using a unique ID. Second, CBRs completed a brief, pseudonymised demographic form and received a structured journaling template in their preferred language. CBRs maintained personal cloud folders only accessible by SR until study completion. In line with guidance [18], no data were reviewed by core team members until the parent study and all CBR duties concluded.

Structured journaling was chosen over freewriting to support reflection across the team and project cycle on shared and underexplored issues of importance including CBRs’ needs and experiences of conducting sensitive research [15]. As an autoethnographic method [27], journaling has been used by primary investigators as an aid for emotional release, process documentation, self-reflection, evaluation, and learning, but applied rarely with CBRs or in LMIC sensitive projects like ours [12, 18]. Following three PEER data collection rounds, CBRs answered four objective-orientated questions based on that specific round’s experience. Questions were a guide and not intended to limit self-reflection. CBRs could type or handwrite entries in English, Sinhala, or Tamil. Professional translators supporting the larger project translated non-English entries; core team members cross-checked against original submissions for accuracy and reliability of English material pre-analysis. Translators were subject to confidentiality and data protection agreements. In total, 63 unique journal entries were submitted from the 21 CBRs.

Importantly, CBRs were also given research diaries for private and instruction-free use. In addition, debriefs, guided by a uniform protocol, were conducted as reflexivity sessions [2] between each CBR and an assigned core team member after every round. This may have encouraged self-reflection in multiple ways, potentially impacting journal entries, though CBRs understood these sources would not be subject to analyses for this study.

d. Data analysis and co-production of this paper

Two core team members led application of Attride-Stirling’s [28] six-step process for thematic analysis. AP first randomly selected 10% of journal entries for manual and largely inductive semantic coding, developing an initial coding framework (step 1). Journal entries were then uploaded in NVivo (QSR International) to support data management and ongoing analysis. SR tested the initial coding framework against a second 10% sample, proposing codebook adjustments as she identified themes (step 2). AP and SR double coded a third random 10% sample with minor revisions. ZR and KV independently reviewed the framework with minimal modification. Remaining data were coded under Basic Themes in the framework, adjusting labels as appropriate. Where common relationships were evident, Basic Themes were grouped to create Organising Themes. AP and SR constructed a thematic network (step 3), visually organising all existing themes in the software, (re)interrogating patterns and connections. Finally, four Global Themes capturing all mid- and lower-level categories supported more abstracted claims about CBRs’ experiences in this study [28]. Results (steps 4–5) and their implications (step 6) are presented jointly in Results and Discussion and Recommendations. S1 Table provides selected quotes from one Global Theme illustrating early analysis to final themes.

As a measure of analytical quality control and member checking, all authors reviewed our results in all-team virtual workshops, jointly assessing the fairness of interpretations. Analysis was presented by theme and in local languages and used interactive mediums like Zoom and Miro to invite feedback from co-authors. CBRs had introductory thematic analysis training. While this was originally for inter-round PEER data analysis to support iterative tool development, CBRs were able to transfer analytical skills to assess this study’s results and conclusions. CBRs identified gaps which were rectified by the core team in subsequent drafts. A subset of CBRs reviewed the English draft in depth to support translation (RC, RD, TD, SK, LM, LS, PV) and all authors voted on a study title. The paper was approved by authors through a trilingual digital co-writing workshop. Trilingual ‘how to’ guides were developed for CBRs to fully participate in registering with and approving the final submission to the journal.

e. Ethical considerations

Ethics approval was granted by University College London (REF 2744/007), the Institute for Health Policy (IRB/2020-026), and University of Colombo (EC-19-122). Limited demographic data were collected to preserve CBR privacy. Less than 2% of co-production literature comes from LMICs [2] and previous similar studies have not recognised CBRs’ contributions as co-authors in research about them [15, 18], despite co-authorships’ potential to strengthen CBR leadership, research translation and impact [14]. Co-authorship with our CBRs in this study is thus appropriate by editorial standards [29], and just, acknowledging proportional labour of Global South researchers–primary and novice [2, 30, 31]. We offer Sinhala and Tamil abstracts to aid local access to this study (S1 File). As CBRs are co-authors of this paper, quotes are pseudonymised [7]. Finally, while desirable in many instances, our dataset is not open access to ensure anonymity of PEER study participants who are (closely) socially connected to this study’s authors and may be re-identified through its underpinning data. This is in keeping with standards for consent set forth by the ethics approval granted for this study. Additional information regarding the ethical, cultural, and scientific considerations specific to inclusivity in global research is included in the Supporting Information (S1 Text).

a. Learning about research, violence, and mental health

Learning experiences and (outstanding) needs across the project cycle received considerable attention from CBRs who highlighted professional and personal development and learning implications for their future contributions to community development.

b. Personal-professional boundaries

The benefits and drawbacks of interviewing one’s peers in research have been widely debated [3, 12, 37, 40–42]. CBRs’ chosen parent-study participants ranged from very close friends to colleagues with whom socialising beyond the workplace had never occurred. CBRs then reflected upon their mixed experience conducting data collection within these social networks citing pros, cons, and the need for strategies to navigate their dual personal-professional roles.

Overall, and in line with other peer studies [12, 37], CBRs largely perceived quality of conversations and information were improved by greater familiarity–increasing transparency, feedback, and more open, detailed discussions: “I very well knew about two participants…not…much about the third person. The known participants shared information like speaking to a friend. The information I received from the third person was less” (ID12). Familiarity was particularly beneficial given the sensitive nature of the parent study: “Our pre-existing relationship was [a] help…they were open…because they trust me” (ID20). CBRs also felt prior relationships supported participants’ “willingness to [commit and] engage” (ID02) in three rounds of data collection over an extended period without prior “monetary gains” (ID02) or other incentives.

In contrast, some researchers identified disadvantages to personal relationships including a sense that participants sometimes held information back due to known common peers and/or presuming CBRs already knew certain facts or stories: ‘They were not inclined to talk about things deeply, they were not taking the interview seriously and sometimes they just assumed that I knew some of the facts and their opinions” (ID21). Mutual familiarity with community members “already known” (ID20) to CBRs also meant participants sometimes ‘overshared’ and had to be encouraged to maintain anonymity of others: "I had to say, ‘don’t mention names’” (ID20). Beyond over- or under-sharing information, some participants became easily distracted and “went off the track” (ID03), diverting conversations away from the study’s focus–a difficulty observed in other peer studies perhaps reflecting the atypical nature of interview-style discourse for both parties [37]. This sense of informality made it difficult to establish boundaries with (some) participants; a challenge requiring a balancing act across personal-professional roles that can be difficult to maintain [41, 43, 44].

To aid this balancing, CBRs developed and practiced four strategies. First, they made conscious decisions about participant selection, drawing on core team guidance around eligibility, inclusivity and suitability for research participation [17]. Many researchers intentionally chose not to interview peers overly similar or “very close to [them]” (ID17), believing some distance may strengthen their professional identity and legitimacy and enable them to “conduct a professional and successful interview” (ID17) while simultaneously offering new, and diverse views [19]. Next, and when possible given COVID-19 and technology conditions, CBRs encouraged in-person or at least video-call modes to support connectedness during data collection–a beneficial practice for cultivating intimacy and supported engagement for sensitive research and during the pandemic [45, 46]. Third, CBRs used clear communication of expectations and appropriate disclosure practices prior to interviews to establish boundaries and a sense of professionalism from the outset:

I decided to approach and communicate with my peers/friends with professionalism to help establish a clear boundary between data collector and friend/peer. For example, scheduling a date and time for an interview would entail a call to my participants followed by an email with relevant information… advising them to take a look at these documents prior to the meeting, so that I can address any questions before the interview. (ID05)

Finally, CBRs had to actively reinforce boundaries during the interview process, for example encouraging that all casual conversation occur after the interviews and steering conversations “back to the main topic” (ID03) when required. Boundaries were perceived to be clearer and easier to maintain by later rounds of data collection due to both parties’ practice and CBRs’ reinforcement [19]. In the next section, we extend our discussion of boundaries amongst other challenges, and explore CBRs’ resourceful efforts to overcome them.

c. Navigating challenges

We identified four primary challenges in conducting sensitive participatory research in our context including interpersonal, time management, health and safety, and technological difficulties, with COVID-19 producing cross-cutting impacts. We explore their impact upon and mitigation by CBRs in turn below.

Identified challenges

Interpersonal challenges, including expanded reflection upon boundaries, took centre stage in CBR journals. Like other peer studies [18], participants’ busy schedules presented hurdles for completing data collection, creating atypical working hours: “I had to conduct late night interviews because my participants weren’t available during the daytime…it was a bit difficult for me” (ID13). At the extreme, managing interview bystanders required multiple rounds of rescheduling, for example when participants joined during work hours and discontinued to attend to colleagues or clients. Some CBRs reported participant reticence speaking about sensitive issues, such as “sexuality and [pre-marital love] affairs” (ID17), when family were home. Distractions and interruptions also arose in the form of phone calls, text messages and food deliveries to participants–the latter a lifestyle impact of COVID-19 in our setting.

Participants’ and sometimes CBRs’ emotions were, however, the most discussed interpersonal challenge, as observed in other research groups [16, 33]. Discomfort with video calls in certain circumstances, participants’ confusion and fear of questions due to perceived inadequate knowledge, both parties’ stress around scheduling and managing technological difficulties were all reported, in addition to initial nervousness, perceived lack of control, and frustration for CBRs. Given their youth demographic, some participants balancing employment and higher education seemed over-stretched during interviews: “[She was] extremely exhausted…due to university assignments therefore I did not receive the maximum amount of information from her” (ID06). Although PEER seeks third-person perspectives [25], two participants became “emotional” (ID19) self-disclosing personal stories, one pausing the interview temporarily, only continuing “after discussing things” (ID14) with their friend and CBR. Notably, managing emotions was not regarded as concerning for CBRs as other challenges raised below. Despite varied options for onward support, in line with best practice [7, 12], neither participants nor CBRs disclosed utilising them nor requested assistance from the core team, and no serious adverse events were reported. This may ease funder and ethics board anxieties around ‘risk’ in sensitive research [34], but likely points to our proactive supportive working conditions mitigating concerns as presented later.

In addition to scheduling challenges, time management proved challenging for some CBRs and participants, particularly in lengthier rounds with multiple methods. Breaking interviews into multiple sessions was sometimes necessary. Rare, but important, CBRs’ personal health impacted timelines, creating additional stress: “It was really hard for me. I have [a chronic health condition] as well. That was a real stress time period for me [sic]. These days, I haven’t enough sleep” (ID20). One CBR and participant were hospitalised, while one core team member and one CBR suffered family bereavement for non-COVID reasons mid-project, all requiring support. Technology, chiefly internet connectivity, presented regular difficulty for all CBRs during virtual data collection [47]. Extreme weather in monsoon season, power cuts, and poor local infrastructure in less connected areas sometimes rendered video-calls too difficult. CBRs felt this reduced their ability to engage with “participants’ emotions and body reactions…via phone” (ID07), impacting interview quality.

A cross-cutting challenge, COVID-19 impacted our research practice in every way [48], extending the entire project timeline, altering fieldwork, increasing technological challenges, and affecting the health and safety and socioeconomic circumstances of all parties. Unlike older generations’ careers affected by the country’s civil war, COVID was the first significant disruptor impacting our CBRs’ early working lives, testing their resilience. Akin to other peer studies in COVID [46], our CBRs navigated shifting data collection to phone, WhatsApp, or Zoom as government COVID-19 responses introduced risk-reduction efforts: “During the second interview the Covid-19 pandemic situation worsened. Travel restrictions were imposed. Therefore, the interviews were not done face-to-face” (ID21). Pandemic-induced shop closures and travel constraints meant photocopying materials and reaching open establishments became difficult, while postal disruptions made sending supplies difficult. In more mobile windows, face-to-face interviews were preferred, but introduced interpersonal challenges of conducting interviews in participants’ homes with more bystanders and less privacy than usual. Most significantly, COVID-19 directly affected the families, health, and wellbeing of all parties. Family and multiple personal infections required one core team member, one CBR, and one participant to quarantine at home, while another participant was quarantined at a mandated government-run centre: “My participants were victims of the COVID-19 virus. Even I had to go through quarantine and had to face difficulties continuing with the interviews” (ID08). Tragically, one CBR and two participants lost family members to COVID-19 mid-project. Remarkably all our affected participants and CBRs chose to continue, even despite one team’s focus on COVID’s impact on youth mental health and their participants’ direct experiences of loss. While discontinuation without penalty was offered, in the spirit of true co-production, we respected CBRs’ and participants’ agency to choose involvement for themselves [33].

Strategies for navigating challenges

CBRs developed communication, planning, and technology strategies to (partially) overcome challenges encountered during fieldwork [14, 47], applying learning from training and previous rounds [19].

Efforts to reduce social desirability bias [49] saw CBRs deploy communication strategies including asking participants to move location in the home to avoid distractions and interruptions from bystanders. Engaging with bystanders directly also helped to agree a manageable way forward, as practiced in foundational training: “At the training session, the core team created a role play scenario to help us deal with interruptions from family members. The activity was helpful in managing the challenge” (ID05). Insightfully, some CBRs asked participants about vocabulary preferences to discuss culturally sensitive topics like “sex and violence” (ID06) and sought private settings away from family bystanders to discuss them: “I asked…if he needs to move to a free safe place. He agreed and we went outside to his garden…after that, he spoke more openly and comfortably” (ID17). During interviews, CBRs “gave a short break” (ID07) to ease emotionality, simplified questions and granted extra time for participants expressing confusion or fear over their perceived ‘lack of subject knowledge’. Some CBRs ended interviews by “check[ing] in with the participants to make sure they [had] a chance to express their opinions and feeling about the interview” (ID05)–something CBRs deemed a worthwhile practice. Finally, honest and timely communication with the core team was used to navigate delays and setbacks.

Pre-paid allowances for internet expenses for CBRs and participants removed cost hurdles to accessing devices and data and demonstrated trust in CBRs: “Even though there were technical difficulties, the participants were encouraged by giving them expenses for internet facilities” (ID02). However, challenges with internet connectivity and power required compromises like sharing visual tools via WhatsApp as opposed to screen sharing in real time and choosing when during interviews to use video- over voice-based calls: “Since the conversation about violence and harm can be triggering to some, I asked the participant to turn on their camera, to monitor their verbal and non-verbal behaviour” (ID05).

Planning strategies demonstrated initiative and anticipated interpersonal and technology challenges. CBRs used planning to minimise challenges in subsequent rounds by drawing on successful strategies of previous rounds and other CBRs, as exemplified below:

I made sure to communicate… what is expected of [participants] during the interview. As this round was occurring through Zoom, I made sure that participants understood the importance of 1) situating themselves in a space with privacy and little interruption from others…, 2) having the video on…, and 3) having sufficient data to ensure smooth communication… participants were informed that this round will be lengthy compared to the last round… Communicating the above at least a week before the interview was helpful in preparing the participant for Round 2. (ID05)

d. Experiences of (support from) the core team

Our fourth and final global theme, CBRs reflected on the role of the core team and the nature of support received by them across the project cycle. Their reflections focused on working and interpersonal conditions they valued, and the particular gestures or provisions offered by the core team believed to support these conditions; we review them in turn below.

CBRs vocalised an overall appreciation for the core team and felt able and enabled to reach out for assistance throughout the project [14], often multiple times: “The support received from the core team was highly beneficial in how I was able to manage this challenge” (ID05). Unlike some sensitive studies, including those with primary investigators and in highly resourced settings [44], our CBRs did not raise concerns around feeling isolated or unsupported. Many instead noted sufficient support due to core team accessibility and responsive communication: “As the main team maintained a good communication with the interviewers, I could ask about anything, at any time” (ID21). The core team was perceived as “understanding of the situation” (ID05), flexible and willing to negotiate reasonable changes in light of CBRs’ own schedules, considering their role in the parent project was not always their sole commitment, and accommodating of participant challenges. CBRs also noticed the core team’s anticipation of their needs, particularly with pre-fieldwork training, illustrated later in this section [7, 50].

Five key core team provisions, or gestures, were identified as contributory to positive interpersonal dynamics and ultimately CBR performance. First, accessibility and consistent, comprehensive communication was buoyed by provision of multiple communication modes and the core team’s ability to communicate in all languages, supporting a more inclusive team: “Any method (WhatsApp, call, text) convenient to us could be used to contact them” (ID21). Second, training programmes were perceived to prepare CBRs pre-fieldwork and render new challenges more manageable [7]: “Although it was a new experience, it was not that difficult because of the training” (ID19). Some researchers expressed confidence to manage challenges (e.g., disrupted interviews) on their own, due to the trainings and component activities like role play, later reducing their need to request additional help. As in other peer studies [12, 13], initial training provided a place to comfortably raise pre-fieldwork concerns, while debriefs–a third provision between rounds–continued this protected sharing space. CBRs also valued debriefs for facilitating self-reflection of their own limitations during fieldwork [39]. Coupled with a fourth provision of extra team or one-to-one practice sessions with core team members, CBRs felt better able to navigate the research process and work towards improving over subsequent rounds. This multi-modal support is well-illustrated below:

…after the two [initial] days of training, I personally did not feel ready to conduct the interviews. I felt that I needed more practice. Maybe the core team felt this lack of readiness…which led them to hold [additional] training… it helped build my confidence as a data collector. We were given an opportunity and a space to practice, and…feedback as to what we could have done differently, and what best practices we could continue to do. This feedback and [later] practice sessions helped me develop direction and intuition as a data collector. Furthermore, it certainly shaped my ability to deal with the stuckness [sic] that I experienced during interviews. (ID05)

Finally, resources both in terms of time and consumable inputs such as internet and travel allowance, further support brochures, IT equipment, and end-of-project vouchers as tokens of appreciation for participants, were appreciated by CBRs and participants alike, noting that “with them, the participants became confident and trusting about the interviews” (ID21). In particular, technology like phones, cameras and laptops, and associated running costs were critical resources for remote participation. All CBRs had access to basic smart phones and internet connection and were furnished with data in advance so as not to disadvantage any individual’s access to internet throughout the study. Other inequalities in technology access were addressed through offers to provide devices to CBRs according to their needs to enable fair participation. Some CBRs chose not to accept additional devices (e.g., laptops), preferring to work in other mediums, and the core team respected these decisions as it did not impact CBRs’ ability to join discussions nor to deliver quality work. Other projects may require more uniform use of technologies. These resources, emphasising wellbeing, were particularly critical during COVID-19 in recognition of the “mental and emotional toll of the pandemic in their personal lives” [46, p7].