Participant-generated timelines as a novel strategy for assessing youth resilience factors: A mixed-methods, community-based study

Published:August 11, 2022DOI:


      • Participant-generated timelines are an interactive strategy to assess youth perceptions of their life quality trajectory.
      • For youth who have experienced adversity, the timeline activity may prompt reflection on resources for coping.
      • Participant-generated timelines may guide nursing interventions with youth who have experienced normative challenges.



      The purpose of this study was to explore youth perceptions of resilience through participant-generated timelines as a potential new strategy for nursing research and practice.

      Design and methods

      We used a concurrent triangulation design to collect and analyze qualitative and quantitative data from a statewide, community-based sample of 448 youth ages 8 to 17 years. We collected three sources of data during two waves of data collection in 2019 and 2021: a participant-generated timeline, a brief structured interview, and a PROMIS pediatric global health measure.


      The timeline activity was easy to administer and well accepted by youth in a community setting. Youth reporting an adverse experience or mental health challenge in the previous year had unique patterns of variability in the timelines, and more frequently reported certain resilience factors, including family support and regulatory, interpersonal, and meaning-making assets. Pandemic-related differences were noted between the two cohorts.


      The timeline drawing activity reflects and extends findings from a standard measure of global health. This activity benefits both the participant and the clinician or researcher by helping youth to communicate how they make sense of the world, honoring different ways of knowing and prompting recollection of coping appraisals and resilience factors.

      Practice implications

      Participant-generated timelines are a developmentally appropriate and interactive strategy for assessing youth perceptions of their internal strengths. In conjunction with traditional assessments, this strategy may support the identification of malleable targets for intervention in practice with youth who have experienced adversity or mental health challenges.


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        • Bagnoli A.
        Beyond the standard interview: The use of graphic elicitation and arts-based methods.
        Qualitative Research. 2009; 9: 547-570
        • Barfield P.A.
        • Driessnack M.
        Children with ADHD draw-and-tell about what makes their life really good.
        Journal for Specialists in Pediatric Nursing. 2018; 23 (Article 12210)
        • Berends L.
        Embracing the visual: Using timelines with in-depth interviews on substance use and treatment.
        Qualitative Report. 2011; 16: 1-9
        • Biglan A.
        • Flay B.R.
        • Embry D.D.
        • Sandler I.N.
        The critical role of nurturing environments for promoting human well-being.
        American Psychologist. 2012; 67: 257
        • Bronfenbrenner U.
        Ecology of the family as a context for human development.
        Developmental Psychology. 1986; 22: 723-742
        • Caputo A.
        Social desirability bias in self-reported well-being measures: Evidence from an online survey.
        Universitas Psychologica. 2017; 16: 1-13
        • Castro F.G.
        • Kellison J.G.
        • Boyd S.J.
        • Kopak A.
        A methodology for conducting integrative mixed methods research and data analyses.
        Journal of Mixed Methods Research. 2010; 4: 342-360
        • Christmas C.M.
        • Khanlou N.
        Defining youth resilience: A scoping review.
        International Journal of Mental Health and Addiction. 2019; 17: 731-742
        • Clatworthy S.
        • Simon K.
        • Tiedeman M.E.
        Child drawing: Hospital—An instrument designed to measure the emotional status of hospitalized school-aged children.
        Journal of Pediatric Nursing. 1999; 14: 2-9
        • Creswell J.W.
        • Plano Clark V.L.
        • Gutmann M.L.
        • Hanson W.E.
        Advances in mixed methods research designs.
        in: Tashakkori A. Teddlie C. Handbook of mixed methods in social and behavioral research. SAGE Publications, 2003: 209-240
        • D2D
        • D’Amico M.
        • Denov M.
        • Khan F.
        • Linds W.
        • Akesson B.
        Research as intervention? Exploring the health and well-being of children and youth facing global adversity through participatory visual methods.
        Global Public Health. 2016; 11: 528-545
        • Deguara J.
        Young children’s drawings: A methodological tool for data analysis.
        Journal of Early Childhood Research. 2019; 17: 157-174
        • Demerath E.
        • Spector L.
        D2D Participant Demographics.
        University of Minnesota, 2021
        • Driessnack M.
        Draw-and-tell conversations with children about fear.
        Qualitative Health Research. 2006; 16: 1414-1435
        • Duckworth A.L.
        • Steen T.A.
        • Seligman M.E.P.
        Positive psychology in clinical practice.
        Annual Review of Clinical Psychology. 2005; 1: 629-651
        • Forkey H.
        • Szilagyi M.
        • Kelly E.T.
        • Duffee J.
        • Springer S.H.
        • Fortin K.
        • Weber Zetley L.
        Trauma-informed care.
        Pediatrics. 2021; 148 (Article e2021052580)
        • Forrest C.B.
        • Bevans K.B.
        • Pratiwadi R.
        • Moon J.
        • Teneralli R.E.
        • Minton J.M.
        • Tucker C.A.
        Development of the PROMIS® pediatric global health (PGH-7) measure.
        Quality of Life Research. 2014; 23: 1221-1231
        • Gauntlett D.
        • Holzwarth P.
        Creative and visual methods for exploring identities.
        Visual Studies. 2006; 21: 82-91
        • Gonzalez-Mendez R.
        • Ramírez-Santana G.
        • Hamby S.
        Analyzing Spanish adolescents through the lens of the resilience portfolio model.
        Journal of Interpersonal Violence. 2021; 36: 4472-4489
        • Grych J.
        • Hamby S.
        • Banyard V.
        The resilience portfolio model: Understanding healthy adaptation in victims of violence.
        Psychology of Violence. 2015; 5: 343-354
        • Guillemin M.
        • Drew S.
        Questions of process in participant-generated visual methodologies.
        Visual Studies. 2010; 25: 175-188
        • Hamama L.
        • Ronen T.
        Children’s drawings as a self-report measurement.
        Child & Family Social Work. 2009; 14: 90-102
        • Hamby S.
        • Grych J.
        • Banyard V.
        Resilience portfolios and poly-strengths: Identifying protective factors associated with thriving after adversity.
        Psychology of Violence. 2018; 8: 172
        • Hamby S.
        • Taylor E.
        • Smith A.
        • Blount Z.
        Resilience portfolio questionnaire manual: Scales for youth.
        Life Paths Research Center, 2018
        • Hamby S.
        • Taylor E.
        • Smith A.
        • Mitchell K.
        • Jones L.
        • Newlin C.
        New measures to assess the social ecology of youth: A mixed-methods study.
        Journal of Community Psychology. 2019; 47: 1666-1681
        • Harris P.A.
        • Taylor R.
        • Thielke R.
        • Payne J.
        • Gonzalez N.
        • Conde J.G.
        Research electronic data capture (REDCap)-A metadata-driven methodology and workflow process for providing translational research informatics support.
        Journal of Biomedical Informatics. 2009; 42: 377-381
        • Hays R.D.
        • Bjorner J.B.
        • Revicki D.A.
        • Spritzer K.L.
        • Cella D.
        Development of physical and mental health summary scores from the patient-reported outcomes measurement information system (PROMIS) global items.
        Quality of Life Research. 2009; 18: 873-880
        • Kalisch R.
        • Kampa M.
        Stressor appraisal as an explanation for the influence of extra- individual factors on psychological resilience.
        in: Ungar M. Multisystemic resilience: Adaptation and transformation in contexts of change. Oxford Scholarship Online, 2021: 135-152
        • Kesby M.
        Participatory diagramming: Deploying qualitative methods through an action research epistemology.
        Area. 2000; 32: 423-435
        • Kolar K.
        • Ahmad F.
        • Chan L.
        • Erickson P.G.
        Timeline mapping in qualitative interviews: A study of resilience with marginalized groups.
        International Journal of Qualitative Methods. 2015; 14: 13-32
        • Kortegast C.
        • McCann K.
        • Branch K.
        • Latz A.O.
        • Kelly B.T.
        • Linder C.
        Enhancing ways of knowing: The case for utilizing participant-generated visual methods in higher education research.
        The Review of Higher Education. 2019; 42: 485-510
        • Lampropoulou A.
        Personality, school, and family: What is their role in adolescents' subjective well-being.
        Journal of Adolescence. 2018; 67: 12-21
        • Layous K.
        • Chancellor J.
        • Lyubomirsky S.
        Positive activities as protective factors against mental health conditions.
        Journal of Abnormal Psychology. 2014; 123: 3-12
        • Layous K.
        • Sweeny K.
        • Armenta C.
        • Na S.
        • Choi I.
        • Lyubomirsky S.
        The proximal experience of gratitude.
        PLoS One. 2017; 12 (Article e0179123)
        • Literat I.
        “A pencil for your thoughts”: Participatory drawing as a visual research method with children and youth.
        International Journal of Qualitative Methods. 2013; 12: 84-98
        • Ma L.
        • Mazidi M.
        • Li K.
        • Li Y.
        • Chen S.
        • Kirwan R.
        • Wang Y.
        Prevalence of mental health problems among children and adolescents during the COVID-19 pandemic: A systematic review and meta-analysis.
        Journal of Affective Disorders. 2021; 293: 78-89
        • Malchiodi C.A.
        Understanding children’s drawings.
        Guilford Press, 1998
        • Medina-Muñoz M.
        • Chase R.
        • Roger K.
        • Loeppky C.
        • Mignone J.
        A novel visual tool to assist therapy clients' narrative and to disclose difficult life events: The life story board.
        Journal of Systemic Therapies. 2016; 35: 21-38
        • Minnesota Department of Education
        2020-21 enrollment [Data set].
        • Mitchell M.
        • Muftakhidinov B.
        • Winchen T.
        • Trande A.
        Engauge digitizer (Version 12.1) [Computer software].
        GitHub, 2021
        • Noonan R.J.
        • Boddy L.M.
        • Fairclough S.J.
        • Knowles Z.R.
        Write, draw, show, and tell: A child-centred dual methodology to explore perceptions of out-of-school physical activity.
        BMC Public Health. 2016; 16
        • Park N.
        • Peterson C.
        • Seligman M.
        Strengths of character and well-being: A closer look at hope and modesty.
        Journal of Social and Clinical Psychology. 2004; 23: 628-634
        • Patterson M.L.
        • Markey M.A.
        • Somers J.M.
        Multiple paths to just ends: Using narrative interviews and timelines to explore health equity and homelessness.
        International Journal of Qualitative Methods. 2012; 11: 132-151
        • PROMIS - Global Health
        Global health.
        • Puura A.
        • Puura K.
        • Rorarius M.
        • Annila P.
        • Viitanen H.
        • Baer G.
        Children’s drawings as a measure of anxiety level: A clinical pilot study.
        Pediatric Anesthesia. 2005; 15: 190-193
        • Rapkin B.D.
        • Schwartz C.E.
        Toward a theoretical model of quality-of-life appraisal: Implications of findings from studies of response shift.
        Health and Quality of Life Outcomes. 2004; 2: 1-12
        • Ravens-Sieberer U.
        • Kaman A.
        • Erhart M.
        • Devine J.
        • Schlack R.
        • Otto C.
        Impact of the COVID-19 pandemic on quality of life and mental health in children and adolescents in Germany.
        European Child & Adolescent Psychiatry. 2021; 1-11
        • Russo-Netzer P.
        • Shoshani A.
        Authentic inner compass, well-being, and prioritization of positivity and meaning among adolescents.
        Personality and Individual Differences. 2020; 167 (Article 110248)
        • Sanglard L.F.
        • Oliveira L.B.
        • Massignan C.
        • Polmann H.
        • De Luca Canto G.
        Evaluating pain, fear, anxiety or stress/distress using children’s drawings in paediatric dentistry: A scoping review.
        European Archives of Paediatric Dentistry. 2022; 23: 199-222
        • Schwartz C.E.
        • Michael W.
        • Rapkin B.D.
        Resilience to health challenges is related to different ways of thinking: Mediators of physical and emotional quality of life in a heterogeneous rare-disease cohort.
        Quality of Life Research. 2017; 26: 3075-3088
        • Sheridan J.
        • Chamberlain K.
        • Dupuis A.
        Timelining: Visualizing experience.
        Qualitative Research. 2011; 11: 552-569
        • Snyder J.
        Visualizing personal rhythms: A critical visual analysis of mental health in flux.
        in: Proceedings of the 2020 ACM Designing Interactive Systems Conference. 2020: 269-281
        • Stewart-Tufescu A.
        • Huynh E.
        • Chase R.
        • Mignone J.
        The life story board: A task-oriented research tool to explore children’s perspectives of well-being.
        Child Indicators Research. 2019; 12: 525-543
        • Supkoff L.M.
        • Puig J.
        • Sroufe L.A.
        Situating resilience in developmental context.
        in: Ungar M. The social ecology of resilience. Springer, 2011: 127-142
        • Szanton S.L.
        • Gill J.M.
        Facilitating resilience using a society-to-cells framework: A theory of nursing essentials applied to research and practice.
        Advances in Nursing Science. 2010; 33: 329-343
        • Tusaie K.
        • Puskar K.
        • Sereika S.M.
        A predictive and moderating model of psychosocial resilience in adolescents: Clinical scholarship.
        Journal of Nursing Scholarship. 2007; 39: 54-60
        • Ungar M.
        Social ecologies and their contribution to resilience.
        in: Ungar M. The social ecology of resilience. Springer, 2011: 13-32
        • Ungar M.
        Designing resilience research: Using multiple methods to investigate risk exposure, promotive and protective processes, and contextually relevant outcomes for children and youth.
        Child Abuse and Neglect. 2019; 96
        • World Health Organization
        Mental health: Strengthening our response.