Promoting Mental Health, Physical Activity and Healthy and Sustainable Dietary Behavior, among Practical Education Students in the Netherlands: Protocol for a Multiphase Study with a Focus on Participatory Research (Preprint)

BACKGROUND While a healthy lifestyle at a young age benefits youth now and later in life, not all youth have equal access to resources and support for adopting a healthy lifestyle. Most youth health promotion programs target the general adolescent population without addressing underlying equity issues. Similarly, participatory research, a promising methodology for the development of health promotion programs and addressing health equity, leaves youth in more vulnerable positions often underrepresented. This research addresses these gaps by focusing on participatory research for health promotion program design with youth in practical education (praktijkonderwijs or PrO in Dutch). OBJECTIVE This research has two objectives: (1) to get insight in how to meaningfully involve youth in vulnerable positions in participatory research for health promotion by focusing on PrO students as a case study and (2) to get insight in possible outputs and outcomes of the developed health promotion programs. METHODS The research in this protocol is part of the LIFTS (Healthy Lifestyle for Low-Literate teenagers) project, which aims to promote a healthy lifestyle for PrO students using a participatory approach. The current research uses a multiphase mixed methods research design consisting of three studies. Regarding objective one, we conduct a systematic literature review (study 1) and an empirical qualitative study at PrO schools (study 2). The systematic literature review examines current knowledge on empowering approaches to engage PrO students, and similar youth groups, as co-researchers in health promotion program design and implementation. The qualitative study explores if and how PrO students can meaningfully be engaged as co-researchers in participatory research for health promotion program design. In line with participatory research, we developed research methods in collaboration with PrO schools and relevant LIFTS stakeholders. Regarding objective two, we will conduct a realist evaluation of the newly designed health promotion programs within LIFTS (study 3). RESULTS At the start of 2025, the protocol for the systematic literature review (study 1) was ready and submitted to PROSPERO (International Prospective Register of Systematic Reviews). In September 2025, we finished the data collection and analysis of the empirical qualitative study (study 2) and writing the results. The realist evaluation (study 3) is foreseen for 2026. CONCLUSIONS This research contributes to the advancement of academic knowledge in the field of health promotion and participatory research with youth in vulnerable positions. We expect to deliver practical recommendations and lessons learned on how to actualize youth empowerment in participatory research for health promotion, which may inspire future researchers. Additionally, we seek to promote health equity in the Netherlands by contributing to the development and implementation of tailored health promotion programs for PrO students.