Ambulatory Assessment may be an answer to engaging ‘hard to reach’ youth in research

Phone in pocket, youth mentoring research.By Dr. Bep Uink, Society for Research on Adolescence

Editor’s Note: In mentoring research, acquiring representative, diverse, samples is very important. Dr. Bep Uink (Kulbardi Aboriginal Centre, Murdoch University, Perth WA, Australia) discusses success to date using Ambulatory Assessment through smartphones to increase the participation of Indigenous youth, who are often underrepresented in research. She also touches on the specifics of how AA may be able to bridge these divides. Passive data collection opens doors into a new world of objective data-collection that will likely be increasingly common in the future. 

Diversity in adolescent research is a cornerstone value of The Society for Research on Adolescence. Although great strides toward inclusion are being made, Indigenous youth in particular remain underrepresented in developmental studies, in both the northern and southern hemispheres. In the global south, Australian Indigenous youth (i.e. Aboriginal and Torres Strait Islander youth) are some of the most at risk for psychological distress, yet the least studied.

With its growing applicability, Ambulatory Assessment (AA) represents a promising method for researchers to engage with Aboriginal and Torres Strait Islander youth. AA allows youth to report on psychologically-meaningful phenomenon (e.g. stressors, emotions) as they unfold in their day-to-day life.  Globally, scholars are recognizing a need for innovative techniques for collecting and evaluating health outcomes data in traditionally ‘hard to reach’ groups. AA also has a substantial history in cross-cultural research.

However, the potential of using AA with Australian Indigenous youth is yet to materialize. Promisingly, digital technology via smartphone applications is being used to target Indigenous youth suicide prevention, self-management of alcohol and drug use, and parenting. In our own AA work, just under 8% of adolescents in identified as Aboriginal or Torres Strait Islander, which is well above the national Indigenous population rate of 3.3%. These figures indicate the feasibility of AA with Indigenous youth.

Contemporary tensions between researchers and Australian Indigenous community members, rooted in historical harms, underlie the current under presentation of Indigenous youth in adolescent health research. AA, delivered via smartphone technology, has the potential to reduce these barriers in several ways;

  1. Researcher perceived as untrustworthy. Researchers can be perceived as untrustworthy, given harmful ways in which Aboriginal and Torres Strait Islander Australians have been treated in scientific and anthropologic research. Particular concerns arise around how data will be handled. This concern is far from unique to Indigenous Australians; minority groups globally report a jaggered history with Western research. Enhancing privacy of youths’ data can assist in building trust between youth and researchers. In AA studies, adolescents can be encouraged to enter passwords on smartphones to ensure privacy of their data (although see Odgers, 2019 for a discussion). Data entered via smartphones is also typically sent to an online server and not stored on the actual device, thus enhancing youths’ privacy. Given tensions around trust, it is vital for researchers to begin Indigenous youth research with prior Written Research Agreements which outline to youth how their data will be used. This will be particularly important for AA methods which collect ‘passive data’.
  2. Perceived lack of privacy from family/community members. In my work in the Indigenous mental health sector, I often hear that youth do not want to attend Indigenous-specific services over fear of family or community members finding out their confidential information. Again, the discretion provided by smartphones can be leveraged here, with youth being encouraged to enter health information that is sent directly to the researcher This eliminates the need for a youth to relay sensitive information verbally, which could be over heard by family or community members. Researchers can also include links to health resources as part of AA protocols. For example, researchers can provide hotline numbers at the end of AA surveys that ask about daily mood and mental health symptoms. Youth can also be encouraged to put a personalized cover on their phone, apply different background settings, and set unique passwords as a way to personalize their phone and create a sense of device ownership.


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