Approaches to participatory action research present unique and nuanced ethical challenges, particularly when working in culturally diverse contexts and with marginalised groups. There is a paucity of literature that considers researchers’ experiences of ethical challenges and a need to enhance this knowledge to alert researchers to potential concerns, and to develop dialogue around ways to strengthen approaches to ethical challenges. This article contributes to the budding international dialogue regarding ethical challenges in participatory action research. This article outlines key ethical challenges I faced, as an Australian (outsider) researcher, conducting a participatory action research study with young people in Samoa. Discussions provide insights and considerations for participatory researchers, as well as procedural ethics committees and funding bodies, working in the Pacific region and more widely. This article encourages exploratory thinking around approaches to mitigating potential complex ethical challenges when using participatory action approaches to qualitative research in culturally diverse contexts, including through consideration of innovative and arts-based methods that are appropriate and familiar within a community and can upset power imbalances between researchers and participants.