Abstract
BACKGROUND: Socioeconomic determinants of health are well-documented, yet adolescents' perspectives are often under-represented. The study aimed to engage adolescents in a low-income sub-Saharan setting to explore their daily experiences and analyse their perceptions of inequality within their local environment. METHODS: A photovoice project was conducted from January to March 2024 with six adolescents aged 16-19 years in Bissau, the capital of Guinea-Bissau. Participants used disposable cameras to capture up to 15 photos each, representing daily inequalities and documented reflections through narratives using the PHOTO method, that is, writing notes about the photo, its context and potential implications for change. After 2 weeks, participants selected key images and engaged in a focus group discussion to analyse their photos. Thematic analysis was conducted using Atlas.ti. RESULTS: Four themes of inequality emerged: education, health and sanitation, environment and economy. Adolescents highlighted inadequate access to healthcare and sanitation facilities, environmental degradation, disparities between public and private schools and economic hardship limiting access to education and work. Their narratives revealed frustration over systemic barriers, yet demonstrated awareness and creativity in navigating challenges. CONCLUSIONS: Adolescents' visual narratives provide insights into their experiences of inequality, highlighting the value of participatory methods in amplifying youth voices. The findings suggest the need for equity-focused interventions addressing structural determinants for inequality across the four identified themes. Including adolescents in policy development is important to promote social justice and their well-being.