Children's voices in community-based promotion of childhood health and wellbeing and the responses of community stakeholders

Rising childhood obesity highlights the need for preventive strategies. Community-based approaches and the inclusion of children's perspectives have been recommended; however, children's involvement often remains symbolic, with little translation of their views into action. Aiming to guide involvement, this study explores the process of conveying 7-10-year-old children's perspectives on leisure time and local health initiatives to adult community stakeholders and to examine stakeholders' engagement with children's perspectives. The study is part of the Danish project Generation Healthy Kids. We conducted 15 workshops with 57 children to explore their perspectives on leisure and health initiatives within their community. Using a modified Write, Draw, Show and Tell approach, we collected and thematically analyzed audio recordings, post-it notes, and drawings from workshops. Findings were presented to adult stakeholders in six communities and their responses documented. Children identified organized sports, activities with family and friends, and varied creative after-school activities as important for good leisure time, while negative influences included chores, conflicts, loneliness, injuries, and failures. They valued community initiatives including family, storytelling, exploration, and a festive atmosphere. Stakeholders responded to the perspectives with interest and requests for actionable, local insights. Further, there was a tendency among some stakeholders to maintain an adult perspective and focus on feasibility concerns when discussing the use of children's perspectives in developing or refining local health initiatives. Our findings suggest that to support the process of translating children's perspectives into action, consideration of participation levels, timing, and ethics is essential. Multimodal methods can be used to accommodate children's diverse ways of expression and involving children earlier and more actively is recommended.