The study, published in BMC Public Health by Rathi Ramji and Therese Sterner of Malmö University, is remarkable not only for what it found but for how it found it. It forms part of a larger program called Kids in Action for Health Equity, or KAHEQ, which runs in three leisure time centers in the Malmö districts of Lindängen, Rosengård and Helenholm. These are neighborhoods that reports by Save the Children have flagged for concentrated child poverty, characterized by unemployment, overcrowded housing, limited leisure opportunities and safety concerns linked to criminality. Many families there have migrated from the Middle East or Eastern Europe, and language barriers can make accessing services and social participation harder.

What sets the study apart methodologically is that the children were not merely consulted. They were co-researchers. Over twelve months, from June 2023 to June 2024, the researchers met weekly with the children in a participatory action research design, building on community-based participatory research principles pioneered by Kurt Lewin and grounded in Amartya Sen’s capability approach, which treats children as active agents with their own goals rather than passive subjects of adult decisions. The children received identity cards reading Child Co-Researcher, visited the university to see the adult researchers’ workplace, wrote their own code of conduct with consequences gentler than school punishments, and, crucially, took ownership of the analysis itself.

The technique at the heart of the project was photovoice, a method developed by Caroline Wang and Mary Ann Burris in which participants photograph aspects of their lives and interpret the images through group dialogue. But here the children reshaped it into something new, which the authors call Participant Led Collaborative Photovoice, or PLCP. Instead of discussing individual photographs, the children worked in small groups to build collages, wrote presentation scripts together, and presented their collages to their peers. The audience groups then acted as co-researchers, asking probing questions and creating insight cards on post-it notes that summarized keywords from the discussions. The presenting group could correct or refine these cards on a whiteboard, keeping the interpretations child-led every step of the way.

From this material, three themes crystallized, and the children themselves clustered the insight cards and negotiated the labels. The first was feeling safe and supported. The children described security as dynamic and relational: it grew out of calm, emotionally available adults who listen rather than judge, and out of reliable access to material resources. One ten-year-old girl explained, You feel safe knowing that you have an adult to talk to. And that makes us feel good. Another girl, aged eleven, was blunt about the alternative: If adults yell, it doesn’t feel good. It feels better when you get to talk about things instead of just being yelled at. The researchers note that this sensitivity to tone resonates with attachment theory, which holds that responsive adults provide the secure base children need to explore the world with confidence.

The material side of that theme may raise eyebrows in a country that offers free child health services, education and social services until age eighteen. The children emphasized surplus food, clean public spaces, functioning dustbins, clean toilets, and sports equipment as foundations of wellbeing rather than luxuries. Food, they said, was not just about quelling hunger but about the freedom to eat as much as they wanted, which produced a feeling of security. One ten-year-old boy put it plainly: We need to be able to eat as much as we want. Then we feel safe and feel good. Another twelve-year-old explained that without balls and other equipment, recess becomes boring and we do not feel good. The authors interpret this focus as possible awareness of poverty-related constraints at home, where financial strain and crowded housing make such access uncertain, even as prior research links food security and equipment access to measurable improvements in health outcomes.

The second theme, belonging and being included, captured a distinctly social understanding of wellbeing. The children framed fairness and equality as rights, not privileges, insisting that respect should not depend on gender, religion, language, appearance or economic background. Everyone is equally valuable, boys and girls, one ten-year-old girl said. You feel good when you don’t feel judged, even if you’re different. For children navigating multiple cultural contexts, the researchers suggest, this emphasis may reflect lived experience of exclusion or discrimination. The children also described happiness as a collective journey rather than an individual state, expressed through shared games, dancing, drawing and music with friends. And they singled out having a voice: being genuinely involved in decisions, through democratic voting and polling, made them feel important. We get to be part of making decisions, an eleven-year-old boy said. If you say something and it is taken seriously, it means a lot, then you feel important.

The third theme, growing and developing as a person, linked wellbeing to learning and transformation. The children described learning new skills beyond school, from dance and music to horseback riding, and spoke of the confidence that comes from thinking independently and trying things they had never done before. When you get to think for yourself, come up with ideas, and do different things, it makes you feel smart, you can feel yourself growing, one ten-year-old girl reflected. Others framed it in moral terms: It is not just about having fun, but also about becoming a better person. We have learned how to behave and how to be a good friend. The authors connect this to Vygotsky’s sociocultural theory, in which play creates a unique space for children to take on new roles and act beyond their usual level of competence, and they suggest that for families with limited financial resources, community-based leisure centers may be the only arena where such developmental opportunities exist.

The researchers were careful about the power dynamics inherent in adult-child research. Every session opened and ended with open reflections in which children could voice discomfort, note whether adults had taken too much space, or say whether they felt unheard. Adults were never allowed to outnumber children at any session, so that adult voices could not dominate the democratic decision-making. Activity leaders, themselves often born and raised in the same neighborhoods and several of them former attendees of the centers, served as trusted bridges between the researchers and the children, functioning much like the cultural brokers described in earlier literature. Concerns were followed up in weekly planning meetings, and trust was treated as a dynamic process to be renegotiated continuously rather than a box checked once.

The implications stretch well beyond Malmö. As wellbeing becomes increasingly recognized as a social determinant of health, the study shows that children’s own definitions can diverge sharply from the assumptions baked into assessment tools and policy frameworks designed by adults. Several conditions the children named as defining are typically invisible in wellbeing surveys precisely because more privileged settings take them for granted. The findings, the authors argue, underscore the need for interventions and policies that address structural and environmental barriers rather than applying a one-size-fits-all model of the kind Michael Marmot has criticized for ignoring social gradients in health. They also align with the World Health Organization’s recommendation to invest early in children’s wellbeing to reduce health inequalities. The children, having co-analyzed their own data, presented the final themes to their parents and the centers’ leadership, and the results will feed into the ongoing development of a culturally aligned survey tool to measure wellbeing among children in similar contexts. In a field where children are often asked for their opinions but rarely given real influence, that may be the study’s quietest and most radical finding: the kids did not just define wellbeing. They demonstrated it.

Subject of Research: Participatory photovoice research on how migrant-background children in socioeconomically disadvantaged Swedish neighborhoods define wellbeing

Article Title: Understanding wellbeing together with children from migrant backgrounds living in socio-economically disadvantaged neighborhoods- A participatory photovoice study

Article References: Ramji, R., & Sterner, T. (2026). Understanding wellbeing together with children from migrant backgrounds living in socio-economically disadvantaged neighborhoods- A participatory photovoice study. BMC Public Health, 26(1), Article 2944. https://doi.org/10.1186/s12889-026-29910-9

Image Credits: AI Generated

DOI: 10.1186/s12889-026-29910-9

Keywords: child wellbeing, photovoice, participatory research, migrant children, health equity, social determinants of health, Malmö, community-based participatory research, leisure time centers, social inclusion, UNCRC, public health