2.1 Stage 1: Identifying the Research Questions

2.2 Stage 2: Identifying Relevant Studies

To identify published academic articles, electronic database searches were initially conducted by a health sciences librarian on June 29, 2021. List of databases searched include Medline (Ovid), Embase (Ovid), CINAHL (EBSCO), Education Source (EBSCO) PsycInfo (Ovid), IBSS (ProQuest), ERIC (ProQuest) and Sociological Abstracts (ProQuest). The search strategy developed included use of terms focused on the following concepts: (1) postsecondary settings (e.g. college, university), (2) mental health and (3) engagement frameworks or models used to involve students in research (see Supplementary Information 1 for the search strategy used for each database). The definition of postsecondary (or tertiary) education can differ by countries and regions, as such we have utilized the World Bank's definition [38]: “all formal postsecondary education, including (i) public and private universities, (ii) colleges, (iii) technical training institutes, and (iv) vocational schools”. No limits or filters were used. Using the PRESS guidelines [39], a second health sciences librarian peer-reviewed a draft of the OVID Medline search strategy before search translation. Following the initial deduplication of search results using EndNote [40], all searches were added to Covidence [41] where remaining duplicate searches were identified and removed. The search was updated on January 23rd, 2024, using the method outlined by Bramer and Bain [42].

A grey literature search was conducted following the guidelines outlined in the Grey Matters tool in 2021 and updated in January 2024. No relevant records were identified since most grey literature documents (e.g., reports, working papers) outlined practices and policies based on research findings without reference to the research methods and design (e.g., the type of engagement framework used); therefore, they did not meet this review's inclusion criteria outlined next.

2.3 Stage 3: Study Selection

Study selection was completed in two phases: initial title and abstract screening followed by full-text screening of short-listed abstracts, completed independently by two reviewers. Any conflicts for selecting studies during the two screening phases were reviewed and discussed by the research team, including the principal investigator (K.C.), before a final decision was made. Inclusion criteria for selecting studies were (1) written in English language, (2) based at a postsecondary setting (e.g. college, university), (3) describes PSS mental health research and (4) lists and/or describes the engagement framework used to involve students in the research process. Select document types, including conference abstracts, protocol papers, dissertations and editorials, were excluded.

2.4 Stage 4: Charting the Data

Two reviewers independently piloted data extraction of five articles to perform reliability comparison and review extraction results with the principal investigator (K.C.). Once reliability was established, data from the remaining documents was extracted by a single reviewer and entered into Microsoft Excel. The type of data extracted include year and country of publication, research questions, aims/objectives, study design used, population of interest, sample size, researcher composition (to identify number of students involved in research), methods, name and description of engagement framework used and facilitators and barriers to engaging students and/or using frameworks to engage students.

2.5 Stage 5: Collating, Summarizing and Reporting the Results

To address research Question 1, a list of engagement frameworks used across documents was generated. Two reviewers grouped the identified frameworks using Greenhalgh's taxonomy of 5 frameworks on supporting and evaluating patient and public involvement in research [27]: power-focused, priority-setting, study-focused, report-focused and partnership-focused. We reviewed principles and characteristics associated with the framework as well as practices implemented as part of the framework. Where the study frameworks included characteristics or features which could be placed in more than one category, we categorized them according to best fit. Specifically, they were categorized based on how the study team described their understooding and implementation of the principles of the framework within their research. To address research Question 2, we extracted and compiled a list of barriers and facilitators reported while engaging PSS in mental health research. Barriers and facilitators have been classified into two categories previously used for youth engagement in mental health research: relational and process [22]. Best practices of patient engagement have been referred to as being presented within ‘frameworks’ and ‘models’ [26]. We adopted the term ‘framework’ for this review, as used in Greenhalgh et al.'s taxonomy [27].

2.6 PSS Engagement in This Review

A key recommendation while conducting a scoping review is to consult with research partners [36, 43], as it enhances the quality of this review and facilitates knowledge dissemination [43]. Thus, the study team engaged with an established campus-based student mental health research advisory group, inclusive of the three listed student co-authors [CL, OL, SP] to lead this review. The advisory group brings a diverse range of expertise relevant to student mental health and well-being, including research, advocacy and lived experience expertise. During Stages 4 and 5 described above, the study team met with the student research advisory group to conduct two consultations on early findings from the review. Ahead of both meetings, student advisors extensively reviewed the shared findings and developed feedback to share with the study team. At the first meeting, students reviewed findings summarized from all documents, which included descriptions of engagement frameworks used, barriers and facilitators listed, and the initial categorization of frameworks using Greenhalgh's taxonomy [27], to assist with effectively synthesizing and reporting the results of this review. Student advisors provided feedback regarding revising the description of select frameworks, specifically when the distinction between certain frameworks was not clear (e.g., participatory action research and codesign). Students also advised reclassifying select frameworks within Greenhalgh's taxonomy [27]; they specifically recommended classifying frameworks based on how the authors described them, which resulted in the same framework reported across multiple documents being classified under different categories (e.g., participatory action research is classified under both study-focused and partnership-focused frameworks, as described below). All tables reporting study results were updated based on students' feedback. During the second meeting, the study team presented updated tables reflecting student recommendations for approval; the three student co-authors also self-selected to continue supporting this review, including preparing the manuscript during this meeting. Students then developed recommendations for implementing an engagement framework specifically for PSS mental health research. After finalizing the results, the student co-authors identified key findings to be explored in the discussion section and outlined discussion points to be further developed in the reporting stage. Additionally, the three listed student co-authors reviewed and revised this manuscript.

3.1 Characteristics of Included Documents

Figure 1 shows the PRISMA flow diagram, which outlines the process of article selection. The total number of records identified was 12,491. Following the deduplication of records, the title and abstract of 8743 records were screened. 167 full-text articles were screened to assess eligibility; of those, 26 articles were included in this review.

The characteristics of the included articles (n = 26) are presented in Table 1. The research methodology used across studies included qualitative (n = 12; 46%), quantitative (n = 7; 27%) and mixed-methods (n = 7; 27%). Most studies (n = 18) used an observational design, while the remaining eight studies used an experimental design for evaluating interventions developed to support PSS mental health. The majority of the studies (73%) included samples of university students (n = 19); five studies included college students, and two studies included both college and university students.

3.2 Power-Focused Frameworks

Central to this category of frameworks is identifying and challenging power differences, with the goal of promoting power sharing between researchers and individuals with lived experience who are engaged in research [27]. Three studies [44, 46, 52] reported using frameworks which fell into this category. Ehlinger et al. [52] reported using community-based participatory research (CBPR), which they described as aiming to minimize researcher bias through establishing a meaningful partnership between researchers and community members (e.g., transgender and gender nonconforming college students in their study) to cocreate knowledge and change within the community. The other two frameworks classified in this category are photo-elicitation [46] and coproduction design with principles of critical pedagogy integrated [44]. Benjamin et al. [46] described using photo-elicitation, asking participants to self-direct data collection through photo capture with the aim of equalizing the role between researcher and participant. Meanwhile, Alsopp et al. [44] described using the coproduction framework while applying principles of critical pedagogy to colead the research study with students, arguing that using a coproduction framework itself is not sufficient to address power imbalances among researchers and students.

3.3 Priority-Setting Frameworks

This framework category was defined as those describing a process for collaboration amongst researchers and individuals to identify and establish priorities for research (i.e. establishing topics that should be pursued in research) [27]. None of the included documents reported using frameworks or models which aligned with this category.

3.4 Study-Focused Frameworks

Most of the studies (n = 14) reported using frameworks which aligned with the study-focused category, which are frameworks focused on how patients or persons with lived experience can be involved throughout the different stages and procedures of conducting a study [27]. Characteristics of these frameworks broadly include examining and understanding the research context; ensuring proper advanced planning and support for different study stages; avoiding tokenism in engagement efforts; supporting inclusivity; building and maintaining trusting relationships with patient partners, etc [27]. This category included studies where PSS were engaged in research targeting product or service design, particularly in advanced planning and establishing ongoing relationships with PSS in research. Specifically, this included studies that employed codesign [49, 54], co-development [66] and participatory design research [53, 57, 61] where PSS were engaged in research and development of online applications and tools to support student mental health. Two studies that engaged with students to enhance student mental health services have also been classified in this category (engagement framework designed for the chemistry department mental health initiative [59] and World Café [50]).

Studies included in this category used photovoice [56, 64, 68] and photo-elicitation [62], where these frameworks have been described as strengths of the study design, aligning them with the intent of study-focused frameworks to enhance the quality of research. Two studies [48, 55] that described employing PAR have been categorized here since they described the involvement of students throughout the research process. For example, Hotez et al. [55] described engaging with students in the design, dissemination and analysis of the research survey investigating the impact of the COVID-19 pandemic on college students' mental health.

3.5 Report-Focused Frameworks

These frameworks include guidelines on reporting patient and/or public engagement in research [27], for example, the GRIPP-2 checklist for appraising studies on their reporting of different items related to patient engagement in the research process [72]. We found no studies in our search which reported using a report-focused framework.

3.6 Partnership-Focused Frameworks

A total of 9 studies reported using partnership-focused frameworks, defined by Greenhalgh [27] as those optimizing individual engagement in research. Greenhalgh [27] identified common themes of this framework category as: developing power-sharing arrangements, establishing meaningful and consistent communication, providing training (to both researchers and partners), and evaluating engagement processes and impact. Four studies reporting use of PAR [47, 58, 60, 67] or a type of PAR approach (e.g. participatory course-based undergraduate research) [63], which, as described, aligned most closely with this category due to their reported processes, such as implementing training. For example, Murphy-Shigematsu et al. [60] reported providing extensive training to students spanning across eight sessions where students learned about study design, data collection and analysis. These PAR studies also emphasized the active role of students as “active research members” [67] or “researchers” [47]. Murphy-Shigematsu et al. [60] defined student research partners as “consultants”. This vocabulary reflects an attempt towards establishing balance and power between researchers and students in leading research, which is central to both the principles of power and partnership-focused framework [27]. However, we classified them under partnership-focused, as researchers described using elements beyond power-sharing, such as training and/or evaluation, to facilitate student engagement in research.

Three studies that reported using co-development [45], codesign [69] and participatory design research [65] were categorized within this group. Two studies [65, 69] are from the same research group, describing engagement activities and outcomes through engaging PSS in co-designing a mobile application to support PSS in navigating and accessing mental health services. PSS in these studies were trained in research [65], as well as provided opportunities to lead workshops and activities for supporting the crowdsourcing of resources [69]. VanHeerwaarden et al. [65] also described conducting an evaluation of the workshops held where students provided positive feedback that they felt safe sharing their thoughts, as well as recommendation for allocating adequate time for these workshops. These components of providing training and leadership opportunities to students and evaluating the engagement processes aligns with the principles of partnership-focused research. A single custom-designed framework (e.g., the Nurture-U student advisory group) [51] has been categorized as partnership-focused due to its practices of power-sharing with PSS throughout their research project and adoption of the ‘patient engagement guidance tool’ [73] specifically for evaluating the quality of student engagement.

Facilitators included principles such as a focus on a safe environment, respect and communication [50], as well as practical steps such as using small groups and paper-based approaches to encourage engagement [51, 54, 65]. Clearly establishing roles and providing training were also highlighted as facilitators [69].

Barriers described included issues around resource and time constraints [52, 54], including challenges in scheduling students given their busy academic calendars and competing priorities. Further, within certain frameworks it can be challenging to establish or to know how to manage conflicting perspectives from different student partners [51, 65].

4.1 Barriers and Facilitators of Student Engagement in PSS Mental Health Research

Given the lack of consistency in reporting the five framework types, it was challenging to comprehensively identify barriers and facilitators specific to each. We therefore summarized barriers and facilitators that were reported across the five engagement frameworks included in this review. Most of the identified barriers, such as lack of funding to conduct patient engagement, challenges with time commitments and lack of resources to actually implement feedback from patient partners, have been identified in the broader literature on patient engagement in general [20, 22, 77]. Further, facilitation strategies such as providing training to patient experts or clearly establishing roles and responsibilities have also been shown to support patient engagement in other areas [19, 21].

There are, however, certain unique characteristics of the PSS population that require a tailored engagement framework as well as supports to enhance student engagement in research. For example, students' personal commitments and timelines were noted as a potential barrier for engagement [53]. PSS's level of commitment fluctuates with the academic calendar and the nature of moving through an academic degree or diploma programme is such that students may complete their semesters or programmes before the conclusion of a study, thus creating challenges with continuous engagement throughout the typical lifespan and phases of a study. Processes described within engagement frameworks may need to incorporate alignment with the academic calendar to minimize burdens on PSS co-researchers as well as ensure that student expertise is being integrated consistently across a study.

Attending to power differentials was also among the identified facilitators. Unattended differences in power between researchers and patient partners have previously been explored in the literature on patient engagement as a challenge to safe and authentic engagement [22, 25]. Specifically, prior research has spoken to the risk of a “co-opted relationship”, wherein there is a focus on inducting and assimilating the patient partner into the research environment, rather than on how the patient partner may lead aspects of research and influence the status quo [77]. This type of relationship, which has been described as being similar to a supervisor-student relationship [77] may be a greater risk for PSS, who are receiving training and education in the same setting where they are engaging as experts with lived experience. As mentioned in the previous section, challenges exist with vocabulary used to describe PSS partners and the boundaries between these roles may be further complicated as PSS inhabit roles as trainees and research assistants in studies. Strategies such as implicit bias training or exercising critical reflectivity to enhance researcher awareness of their role and power [78] may help to mitigate some of the harmful power imbalances that exist in community- or patient-engaged research. Particular attention should be paid to the potentially dual role as expert partner and trainee that students may be experiencing in the campus setting. Many of the studies included in this review did not explicitly refer to power imbalances when discussing barriers and facilitators to PSS engagement, making this a priority consideration for the development or tailoring of an engagement framework.

4.2 Student Driven Recommendations for an Engagement Framework for PSS Mental Health Research

As described in Table 5, students identified a range of recommendations that built upon components of all identified frameworks and emphasize the critical importance of adapting existing tools to meet current needs.

A core principle encompassing all recommendations provided by students is the need for a comprehensive reporting system of all engagement strategies utilized. Notably, we found no implementation of report-focused frameworks in our review. Focusing on strong reporting will aid in successful implementation of validated student engagement strategies and will help to promote utilization and refinement of best practices. Students engaged in our consultations consistently emphasized the importance of clear reporting to ensure that engagement practices are continually strengthened. Integration of, and adherence to, reporting guidelines are recommended to address the lack of detail and consistency that is currently found in the reporting of patient engagement across disciplines [79]. The GRIPP2 reporting checklist for patient and public involvement in research [72] elicits clear commentary on researchers' definition of engagement, frameworks and engagement methods used, barriers and facilitators and other aspects of the engagement process. The GRIPP2 [72] could potentially be adapted for use in PSS engagement, with tailoring based on student-driven recommendations. For example, the definition of engagement item (Item 2A) might include a requirement for clear reporting on the role of students to delineate trainee research assistants from PSS engaged for their lived expertise. Another example might be adapting the item that requires commentary on contextual factors that influenced patient engagement (8E), to include sub-items specific to the unique student-researcher power differential present in PSS engagement.