Trust-based healthcare communication with marginalized youth: A meta-ethnographic synthesis

BACKGROUND: Effective communication between healthcare providers and marginalized youth and adolescents is essential for promoting equitable care. However, existing models of care reinforce adult-centric and biomedical norms that overlook the diverse developmental and sociocultural realities faced by these youth. AIM: This review aimed to synthesize the perceptions and experiences of healthcare communication by marginalized youth and adolescents. METHODS: We used Noblit and Hare's meta-ethnographic approach. Six electronic databases were searched from their inception date till 31 December 2025. The included studies were assessed using the Critical Appraisal Skills Program tool. RESULTS: We synthesized findings from 42 included studies and identified four main findings: (1) Building trust in healthcare encounters is a relational process; (2) Shared agency in communication is key; (3) Marginalized youth construct a coherent sense of self through an iterative process; (4) Structural conditions shaping communication must not be overlooked. CONCLUSION: Drawing on the findings of this review, we developed a conceptual framework - the Culturally Safe and Relational Approach Tool (CARAT) - to support culturally safe, relational communication with marginalized youth. The framework positions marginalized youth as active agents and highlights the role of healthcare providers in either bridging bureaucratic health systems or functioning as gatekeepers to care. It underscores the importance of cultural safety, scaffolded autonomy, and relational continuity within healthcare systems. Reorienting communication practices to recognize youths' strengths and lived realities, alongside policy and practice reforms that center marginalized youths' voices, will strengthen trust and inclusivity across healthcare settings.