From theory to practice: A narrative literature review of co-creation and participatory methods in adolescent movement behaviors

Background Adolescence is a critical developmental period during which movement behaviors – including physical activity, sedentary behavior, and sleep – and associated health outcomes are established. Conventional health promotion interventions have shown limited long-term effectiveness, particularly in socioeconomically disadvantaged settings, partly because they rely on adult-centered approaches that overlook adolescents lived experiences and social complexity. Co-creation has emerged as an alternative, positioning young people as active partners in intervention development. Objective To synthesize how co-creation and participative approaches have been theorized, operationalized, and evaluated in adolescents’ health promotion, in socioeconomically disadvantaged contexts, focusing on systems thinking, implementation processes, and sustainability. Methods A narrative literature review was conducted using Scopus, Web of Science, PubMed, ScienceDirect, and PsycINFO. Studies were selected for their relevance to youth participation, adolescents’ health promotion, systems thinking, and implementation science. Data were analyzed through interpretive comparison and thematic synthesis. Results Eight studies met the inclusion criteria. Evidence revealed a shift from initial studies’ consultation-based participation to shared decision-making and youth leadership across intervention design, implementation, and evaluation. Co-creation emerged not as a single methodology but as a continuum of participatory practices requiring sustained facilitation, organizational readiness, and multi-stakeholder collaboration. Across studies, adolescents contributed contextual knowledge that improved intervention relevance, acceptability, and stakeholder ownership. Systems thinking was embedded within socioecological and participatory processes rather than formal systems methods. Sustainability relied less on maintaining specific intervention components than on institutionalizing participatory structures and feedback mechanisms that supported continued youth engagement. Evaluation approaches increasingly prioritized implementation processes, contextual adaptation, and organizational change over behavioral outcomes alone, although robust long-term evidence remains scarce. Conclusions The review suggests that co-creation should be understood as a system-oriented governance process rather than merely a participatory methodology. Future research should evaluate how participatory interventions strengthen the long-term adaptative capacity of schools, communities, and health systems, alongside their effects on adolescent movement behaviors and well-being.