Strengthening Brain Injury Support Groups Through Photovoice

By Stephanie Lloyd 

People find their voices in many different ways – photovoice is a way to align what I’m thinking through pictures. –BIA-MA Support Group Leader & Photovoice Training Participant  

PhotovoiceWorldwide staff recently facilitated a training with Support Group Leaders from the Brain Injury Association of Massachusetts (BIA-MA), to prepare them to facilitate photovoice with their group members. Participants gained hands-on experience with the method as they took photos related to a prompt, discussed them with their colleagues, developed captions, and identified common themes. All the photos shared in this blog were taken by BIA-MA support group leaders for this training.  

As we have said before, all our trainings are participatory in nature, and thus are slightly different each time based on participants’ needs and interests. This particular group asked questions and thought deeply about how to adapt the photovoice method for their support group members.  

Here are a few different topics and reflections that emerged during the training sessions:  

  • Overall, taking photos and talking about them increases opportunities to hear about what people have to say. And as Caroline Wang originally envisioned, a successful photovoice project can help participants feel that they have been heard. Support group leaders noted that individuals living with brain injury may use photovoice to help family members understand their experience and to be seen by the community in a different way.  
  • Although there are plenty of options for facilitating photovoice remotely, this group expressed preference for the rich experience of facilitating photovoice in-person. Yet facilitating photovoice remotely may grow in importance if the pandemic continues to prevent in-person meetings for the foreseeable future. PhotovoiceWorldwide will be working with BIA-MA staff to develop written materials, screen shots, and videos on Zoom features and photo sharing that can support use of the technology with support groups online.  Experience during the professional development sessions showed that with tailored training and supports, BIA-MA support group leaders can help their diverse participants fully share their photos and join in discussions online. (For information about facilitating photovoice remotely see our related blog post and recorded webinar.) 
A wooden table

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Photo taken by Laura M. 
  • During discussions, a leader offered that photovoice might naturally attract support group members who are interested in photography. She noted that it is important to emphasize photo content over beauty, and that most important is for participants to take photos that express something they want to say. Leaders suggested emphasizing with your group that photovoice is not about being a professional photographer or creating a “display worthy” image, but about sharing ideas and communicating something of significance.  They noted that when participants use film cameras, they don’t have a chance to erase or delete their images, and sometimes a “bad” photo makes for good discussion. At the same time, however, a digital camera can make it easier for people to “get the picture that they want.”  
A close up of a cage

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Photo taken by Cynthia C. 

At the end of our time together, BIA-MA support group leaders expressed their excitement about facilitating photovoice with their group members and the potential for the method to have value for their groups. One leader commented: “I’m truly looking forward to seeing the creativity of all of the participants. It’s a great opportunity to get to know people on another, more personal level.” 

We truly appreciate this collaboration with BIA-MA, and will continue to support their work to strengthen healing and advocacy for people living with brain injury in Massachusetts. To find out more about their work, please visit: http://www.biama.org/.   

If your organization or team might be able to use photovoice in their work, please reach out so we can design a specialized training to meet your needs!  

Critical Thinking Part 2: Strategies and Tools to Facilitate Critical and Creative Thinking with Photovoice

By Erin Bush and Laura Lorenz

In Part 1 we explored critical and creative thinking in photovoice projects. In this sequel, we look at the ways that facilitators and clinicians can use specific strategies and tools to strengthen critical and creative thinking in photovoice projects. As we learned in Part 1, all stages of photovoice entail critical and creative thinking. Participants use these skills when a) choosing photos to take, b) sharing photos and providing feedback on others’, c) writing and sharing captions, d) receiving and considering feedback, and e) making decisions about where and how the work should be presented.

In Part 2, we suggest three practical strategies to foster critical and creative thinking with photovoice: 1) presenting thought-provoking ‘going deeper questions’ to the group, 2) finding words to share experiences and feelings, and 3) practicing low-stakes caption writing.

Going deeper questions

It can be helpful to have some provocative, follow-up questions in your ‘back pocket’ and use them as needed to encourage conversation. Early in your project, some participants will doubt their abilities. Use questions with your group or with individual participants to encourage talking and sharing.

  • How do you see your role in the project?
  • What might be the ideal end product for you? How can you contribute to that?
  • What are you comfortable sharing about yourself?
  • What is something unique that you know or have experienced that is different from the other group members?

These types of questions encourage creative thinking and may help the participant to see what their unique contribution is. Later on, as participants share their photos and captions, rich discussion can ensue! Some participants, however, will feel hesitant to share. Reminding participants of the project’s larger purpose can be helpful:

  • What do people in our community need to know?
  • Which photos will help our cause the most?
  • Which pictures might have the most impact on our audience?
  • Is there something you have always wanted people to know about your situation/condition?

Remind people that there are no right or wrong pictures, that photos can be literal or metaphorical, and that a photo can help to tell a story. Questions to support photo conversations include:

  • Which pictures “say” the most to you?
  • Which pictures are showing something surprising that the audience doesn’t expect?
  • Which pictures tell a story that we want to share?
  • What are some of the points we can make using our pictures?

These questions can also support decisions about which photos to include in your exhibit.

Finding words

Plan ahead to bolster photovoice conversations by creating a list of words relevant to your project topic. When people are struggling or frustrated, pull out your list and use it to facilitate ideas and conversation. With adolescents and participants living with intellectual disabilities use a word-generating exercise as a warm-up activity. Ask participants to say aloud some words that relate to your project topic while you record them on a white board, chalk board, or flip chart. Return to these words during photo discussions or when identifying themes across photos. Participants use creative thinking to generate words, and critical thinking to select a word they feel is best.

Photovoice projects can stimulate a wide range of emotions, and naming feelings can be hard. However, using a word to describe that feeling can help participants to feel understood and even empowered. Consider using an online tool such as the feeling wheel developed by Gloria Wilcoxi, to identify a specific word for an emotion. Wilcox created the wheel using colors to further represent emotions and help people identify and communicate their feelings. All three of the links below lead to feeling or emotion wheels that can support photo conversations:

Low-stakes practice with captions

With Photovoice we are not left to guess what the photo represents because we can read the caption. Writing captions helps participants to communicate what the photos mean to them. Some people feel confident about writing, others will feel apprehensive and vulnerable. Provide low stakes practice with caption writing before asking participants to write their own. One strategy is to bring some general, non-topic photos to the group and ask participants to take turns describing how they might caption it. Start by modeling an example first. We provide two examples below:

Example 1: Practice with low-stakes caption writing

First ask participants to write a “literal” caption, for example “Family time” or “Playing in the backyard” or “Big brother taking care of little sister.” Next, ask participants to write a “metaphorical” caption that describes a time when they felt surprised about something, learned something new about themselves, or surprised other people. For example: “Many people are surprised when I tell them about my head injury, because TBIs are invisible. People can’t usually tell.” Or “I surprised myself when I started enjoying art after my brain injury.”

Example 2: Practice with low-stakes caption writing

Again, ask participants to suggest a literal and a metaphorical caption – or choose one approach. A literal caption might be “my favorite place to go fishing.” A metaphorical one could describe a feeling: “I am finally at peace after 15 years of activism work. I have found serenity like a calm breeze making ripples in water”. Or “I am getting glimpses of new opportunities for the future, like the mountains peeking up behind the trees.”

Caption writing may still be difficult for some participants. A second strategy is to bring some ready-made captions for participants to choose from when discussing a general photo (not taken by a participant). Have a range of captions printed on strips of paper. Ask participants to choose a caption for a sample photo and explain why they chose it. This exercise can prepare participants living with intellectual disabilities, a communication disorder, or any condition that makes caption-writing a challenge, to talk and think about their own photos in a different way.

Participants will feel more excited about photovoice when the tasks are clear and they have a chance to practice. Writing captions is a critical and creative thinking activity that helps participants to take others’ perspectives into account, enrich their message, and enrich the project as a whole!

Conclusion

Photovoice projects cover a wide range of topics, yet challenges that arise are often similar. Project leaders may need to facilitate strategies that encourage creative and critical thinking to help participants feel more comfortable or confident about sharing. Strategies such as ‘going deeper’ questions can encourage group conversations and new ways of thinking about photos and the project topic. Using a feeling wheel to aid in formulating captions and themes can be helpful. Bringing some general photos and even pre-written captions can provide inspiration. Photovoice projects are designed to be inclusive. Everyone participating in your project wants to know – and feel – that their voice is being heard. We encourage you as facilitators and clinicians to use strategies and tools that can support meaningful participation and communication and critical and creative thinking by all.

More ideas for tools and strategies? Please comment below!

Erin Bush is an assistant professor in the Communication Disorders division at the University of Wyoming. Before attending the University of Nebraska Lincoln for her doctorate, Erin worked in medical and rehabilitation facilities as a speech-language pathologist. She teaches and conducts research regarding acquired neurogenic communication disorders, and her work has mostly been with people who have had a TBI, stroke, or other neurological condition such as Parkinson’s disease. She also has a specific interest in qualitative research methodologies. Erin attended the Photovoice Worldwide training in March and has been working with Laura since that time on blogs as well as an upcoming webinar about critical and creative thinking with photovoice!

Laura Lorenz is co-founder and educator at PhotovoiceWorldwide LLC. She has a PhD in health policy and health services research from Brandeis University and a Master of Education (Instructional Design/Adult Education) from the University of Massachusetts at Boston. Laura has been using photovoice since 2001 with girls, youth, people living with brain injury, older adults, and people living with mental illness. She has published in peer-review journals and books on disability, brain injury, health, healthcare, cost-effectiveness, managed care, rehabilitation, research involvement, sociology, visual education, and visual methods. She facilitates the professional development course ‘Talking with Pictures’: Photovoice.

i Wilcox, G. (1982). The Feeling Wheel: A tool for expanding awareness of emotions and increasing spontaneity and intimacy. Transactional Analysis Journal, 12(4), 274-276.

Meet Our New Intern Carson Peters!

Carson Peters graduated from Grinnell College with a Bachelor of Arts in the Biology of Global Health. She is currently a second-year student in a Master’s of Public Health Program with a focus on Epidemiology at the University of Iowa. She is passionate about global public health and advocacy.  She studied abroad in Brazil, India, and South Africa, in an honor’s global health program, where she focused on infectious diseases research including TB, HIV/AIDS, and Zika. Her experiences abroad inspired her to conduct her senior thesis on women’s cancer as a health disparity in Sub-Saharan Africa. Her research experiences include working at the National Institute of Health’s National Institute of Allergy and Infectious Diseases, Harvard Global Health Institute and the Harvard School of Public Health. She has also worked on Capitol Hill for the Honorable Congressman John Lewis, related to her public policy and advocacy interests.

Why are you excited to intern with PhotovoiceWorldwide this summer?

I am excited to work at Photovoice Worldwide this summer because of the organization’s meaningful and innovative impact on global public health communities; which will allow me to further develop my passion of global health and advocacy.

Who is a researcher or photographer that you admire, or has influenced your work? Why?

I am inspired by Dr. Paul Farmer, a global health scholar, who engages in interdisciplinary global health approaches and research particularly in the global south. His scholarship were frameworks for my senior thesis about women’s cancers in sub-Saharan Africa, focusing on systematic barriers and structural violence. As a global health advocate, Dr. Farmer seeks to be a change agent while using community-based research approaches.

What are your plans for next year? (and beyond?)

I plan to complete my Masters of Public Health in Epidemiology at the University of Iowa next year. To further my education, I am interested in attending a Ph.D. program in Epidemiology or Global Health.

What is a fun fact about you?

A fun fact is that I hiked Table Mountain in Cape Town, South Africa that took 5 hours (just one way) despite being a novice hiker. I won a photo contest with the Global Engagement Institute at Grinnell College for a photo taken during this monumental hike.

What do you like to do in your free time?  

In my free time, I like to travel, try new foods (am a self-designated foodie), read and volunteer. I am currently working on a community service initiative to support and show gratitude to essential workers in my area.

We are delighted to have Carson as part of the PhotovoiceWorldwide team!

Critical Thinking and Photovoice: Part 1

by Laura Lorenz and Erin Bush 

A colleague recently asked us about critical thinking and photovoice, and her interest prompted us to reflect on this topic and share our thoughts. In part 1 – this post – we identify photovoice tasks that use critical thinking. In Part 2 we will share strategies to strengthen critical thinking with photovoice.    

Overview 

Critical thinking is a cognitive process that influences our thinking, attitudes, and actions. A critical thinking process involves reflecting, observing, experiencing, and communicatingi. Usually we are unaware of this process – it takes place whether we pay attention to it or not! With photovoice we get the chance to intentionally look at our lives and circumstances through the lens of a camera. Critical thinking can open our eyes to aspects of our lives and circumstances that might be helping us or causing us harm.  In our daily lives it is difficult to notice what is right in front of us. Because we see that help or harm every day, it no longer attracts our notice or attention. With photovoice, we practice critical thinking when we reflect on our circumstances with new eyes, capture photos of what matters to us, share them with others, and communicate the thoughts and feelings that the photos represent.  

Paolo Freire (1974) encouraged the practice of critical thinking not to deny a fact, but to “see it differently.”ii With a camera in hand, photovoice participants can observe their lives differently through a camera lens. Paolo Freire also encouraged us to “care about the dignity and worth of every person” through critical thinking.iii Without an overarching sense of caring, critical thinking risks causing harm to people. Seeing personal circumstances with new eyes can mean understanding the structural and systemic inequalities – such as poorly resourced healthcare systems or schools – affecting us, and the role these inequalities play in our lives and circumstances.  

Since the mid-1900s, creative thinking has emerged as a complement to critical thinking.iv,v Creative thinking involves developing new ideas to address the problems or support the strengths identified with photovoice. Critical and creative thinking interact to create understanding and inform action.  

Now let’s consider the photovoice steps and tasks that build participants’ critical and creative thinking skills.  

Critical and Creative Thinking and Photovoice 

Step 1: Answering questions with a camera means reflecting and observing. Critical thinking begins right away with photovoice, as  participants observe their surroundings and use their cameras to take pictures that answer questions, such as: what do I think is a strength or a challenge in my life or community? The questions prompt reflection.  

  • What do I care about?  
  • What do I think or feel? 
  • How can I show this in a photo?  

Step 2: Communicating is basic to photovoice. With photovoice, communication involves not only taking and sharing the pictures, but speaking, listening, and writing about them too.  Critical thinking occurs as photovoice group members bring their photos to the group and explain with they mean by communicating what they see in the photo and, comparing and contrasting their own perspective with another’s.  The photo generates dialogue as people talk about their lives, thoughts, and feelings. Group members may experience new empathy for each other and a sense of altruism or caring. Critical thinking occurs again when participants write photo captions, to communicate with people outside the photovoice group. 

Step 3: Observing commonalities by identifying themes. Photovoice can result in a large group of photos to share with others. One recommended photovoice task is to involve participants in grouping project photos into themes. When discussing photos and experiences during project sessions, common experiences and recurring themes likely arise. Identifying themes and using them to group project photos and captions engages our critical thinking skills.  

  • What do these photos have in common?  
  • What name helps to show their commonality?  

Asking these questions can help us identify and name themes. This important cognitive work helps us to observe our common experiences and feel a greater connection with the project and the group.  An exhibit represents a collective experience  that can help us to think creatively and open our minds to possibilities we had not thought of before. 

Step 4: Communicating to power: Advocacy and outreach. Understanding about advocacy and outreach can evolve during a photovoice project. As the deep connections formed through shared thoughts and feelings emerge, photovoice participants often experience a sense of ownership in the data, and   care and concern for what will become of the photos and captions.  

  • Who will see the exhibit?  
  • Where will it be displayed?  
  • Will the “right” people – who can affect change – get to see it?   

We want our work to be viewed by people who will want to see it, are willing to learn something new, and/or have the ability to create change. As we consider the “right” audiences for our photovoice work we engage in critical thinking to determine logically where the display will be most accessible and effective, and the best way to get people to see it. We put ourselves in policymakers’ shoes – what information will motivate them to create change? Creative thinking plays a role as well, allowing us to go beyond the expected outreach efforts and think of new ones. Photovoice participants further promote their work by thinking creatively about ways to increase its visibility. 

Ever-widening Circles. Another way to think about critical and creative thinking and photovoice is through ever-widening circles, from self-reflection or communication with oneself, to reflection and communication with a peer, in a group, and, finally with the community.  

A step-wise process of self-reflection in ever-widening circles can provide a safe, respectful way for people to dig deeper into themselves and their understanding of their lives and circumstances. The process is bi-directional as we can move thru the circles outward and then reflect again on ways that the circles impact us, in turn. An important role for photovoice facilitators is to support critical and creative thinking processes and the learning they can engender – for individuals, groups, clinicians, and communities. 

Conclusion 

Critical and creative thinking are skills that can be developed by people of any age, any level of education, and any level of cognitive ability. Building these skills is a lifelong endeavor. We travel with our photovoice participants for a short time in their lifelong journeys. Practice with critical and creative thinking during a photovoice project can plant seeds for lifelong learning and growth. With photovoice, critical and creative thinking means helping participants to build the knowledge, awareness, and skills needed to reach their goals and dreams – for themselves, their peers, and their communities.   

Next time we will discuss strategies to encourage practice with critical and creating thinking during photovoice. 

Ever-widening Circles 

Photovoice encourages a step-wise process of self-reflection in ever-widening circles. 

A Photovoice Path 

Practice and learning with critical and creative thinking occur at many different points in the photovoice process, from reflecting on about the project topic, to taking a photo, writing a caption, and identifying audiences for your exhibit. 

Writing is a Critical Part of Photovoice 

Writing photo captions encourages critical thinking. Why is this photo meaningful to me? What do I want to tell others? 

Erin Bush is an assistant professor in the Communication Disorders division at the University of Wyoming. Before attending the University of Nebraska Lincoln for her doctorate, Erin worked in medical and rehabilitation facilities as a speech-language pathologist. She teaches and conducts research regarding acquired neurogenic communication disorders, and her work has mostly been with people who have had a TBI, stroke, or other neurological condition such as Parkinson’s disease. She also has a specific interest in qualitative research methodologies. Erin attended the Photovoice Worldwide training in March and has been working with Laura since that time on blogs as well as an upcoming webinar about critical and creative thinking with photovoice!

Laura Lorenz is co-founder and educator at PhotovoiceWorldwide LLC. She has a PhD in health policy and health services research from Brandeis University and a Master of Education (Instructional Design/Adult Education) from the University of Massachusetts at Boston. Laura has been using photovoice since 2001 with girls, youth, people living with brain injury, older adults, and people living with mental illness. She has published in peer-review journals and books on disability, brain injury, health, healthcare, cost-effectiveness, managed care, rehabilitation, research involvement, sociology, visual education, and visual methods. She facilitates the professional development course ‘Talking with Pictures’: Photovoice.

What is your purpose?

By Stephanie Lloyd

Last week members of the PhotovoiceWorldwide community, from around the globe, joined together to talk about “purpose” in their lives. Each person shared a photo (or two) that they had selected and talked about their vision of purpose. Their photos represented responses to the following questions:

  • How do you define purpose?
  • What drives your purpose?
  • Where have you found purpose lately?
“Purpose is a work in progress – something I am always working towards but never sure of arriving.” photo by Laura Lorenz

The conversation moved from outdoor spaces to family to food. Some of the outside photos shared included: hiking spaces, a lake, and a mural on an empty city street. For the participants, these natural images represented connection and a way to decompress in nature to find purpose. One photo shared was a way to talk about finding purpose through a beautiful 5-day hiking journey from Bologna to Florence.

“On the Way of Gods, from Bologna to Florence by foot.” photo by Laura Si​rabella

One participant shared a photo of herself on her first day of teaching as she held hands with her daughter on her first day of Kindergarten. Another participant shared a picture taken of two photos of her grandfather as a child and a grown man, and part of a camera, as he was a photographer, like her. These interesting reflective photos seem to show us that purpose can cross generations.

Prompted by a photo of Jamaican Dukunu (Blue Draws), a corn meal snack wrapped in banana leaves, the group talked about how food brings us together as a connector. Other participants compared the Jamaican dish to Columbian or Costa Rican Tamales, Venezualan Arepas, Chilean humitas, and Polish galumpke. Through our discussion, we decided that “joining around the table is communal, and bridges many gaps.”

At the end of the conversation, we reflected on how photos can be used as a journaling tool, and can also inspire long conversations that teach us. At PhotovoiceWorldwide, we offer these photo sharing conversations as a way for people to shift from formal Zoom meetings and talk through current highlights and concerns, share and learn with others, and inspire positive action. We hope you can join us for the next one at the end of June! 

“We are in it together!” photo by Stephanie Lloyd

Small Course Size Means Focusing on Participants’ Interests

by Stephanie Lloyd

Photo by Anna Shvets from Pexels

Last week we wrapped up another successful online ‘Talking with Pictures’: Photovoice course!

During this session, learners chose “belonging to a community” as the photo-taking theme for the hands-on exercise. Their photos and captions related to the reality of living in different areas of the United States during COVID-19. Later, while analyzing their photos and bringing in social exchange theory, the discussion touched on costs and rewards of closing public spaces and the other measures taken to ensure social distancing and reduce infection.

A nice thing about smaller course size, is that it allows learners to bring in their own research interests and focused questions for facilitators and participants to explore together. May course participants prompted further research and discussion on these topics:

  • Examples of using photos in a primary way to explore their own lives as an auto-ethnographic approach as a learning practice for graduate students. See Elizabeth Chaplin’s chapter “The Photo Diary as Autoethnographic Method” in the SAGE Handbook of Visual Research Methods, edited by Eric Margolis and Luc Pauwels (2012).
  • Options for collecting, organizing, and storing Photovoice Data using photo databases, qualitative analysis software (e.g. Atlas.ti or Nvivo), VoiceThread, Box, or Excel.

As of today, over 140 individuals throughout the U.S. and around the world have taken the foundations course ‘Talking with Pictures’: Photovoice, and learned how to successfully develop and manage a photovoice project.

We still have seats available for our June and July courses. Visit: http://www.photovoiceworldwide.com/training to join us!

Photovoice with Holga Cameras: Create Social Change with a Click

By Stephanie Lloyd

On May 12, PhotovoiceWorldwide was excited to host a webinar for its ‘Talking with Pictures’: Photovoice course alumni. In the webinar, “Photovoice with Holga Cameras: Create Social Change with a Click,” Lisa Powers talked about her experiences using Holga cameras and working with Dr. Caroline Wang on photovoice projects in the 1990s and early 2000s. 

Here are some things we learned! 

HOLGA CAMERAS 

In most of her work, Lisa has used Holga cameras in her own picture taking and teaching. These types of cameras allow photographers to create multiple exposures, where two or more images are layered over each other. The 120mm film also allows a photographer to take pictures without advancing the film the entire way, which yields a panoramic image. Because these plastic cameras only have basic light and aperture settings, the images they produce sometimes include light leaks and other mysterious and playful shadows. Using these cameras for photovoice projects allows participants to focus on composition and what emotions an image evokes, rather than more technical aspects of photography.  

Holga is a medium format 120 film camera, made in Hong Kong, known for its low-fidelity aesthetic. The Holga’s low-cost construction and simple meniscus lens often yield pictures that display vignetting, blur, light leaks, and other distortions. 
IMPORTANT FEATURES OF THE PHOTOVOICE PROCESS 

Photovoice projects are about the photographer sharing their point of view, and how they see or experience something. Lisa says: “Along the way, art starts to shape us.” Making images may change the way we see or how we view a certain condition. All photographs from a project may not end up on the wall at the show, but all are important because they add to the discussion. When you do the hard work of organizing a photovoice project you are not always sure how it will turn out but somehow it all comes together.  

A signature feature of photovoice, as co-creators Caroline Wang and Mary Ann Burris designed it, is to reach policymakers. Although a project may have important implications for participants, first and foremost is giving them a voice to raise awareness of issues to those who can make change. One example Lisa described was the impact of the Language of Light photovoice project on a vote to move the homeless shelter further outside of town and next to a dump. The photovoice exhibit and media coverage meant a different outcome, as voters and politicians chose instead to build a new shelter two blocks from the old one. Secondary to bringing light to an important issue, is to promote critical dialogue and empower individuals. Lisa described how good it can feel for a participant who is homeless, for example, to be seen as a photographer and an artist, and not just as a homeless person.  

Another important part of photovoice is to allow ample time for reflection and to encourage documenting assets or strengths, not just challenges or problems. After participants take their photos, it is important to make sure they have enough time to write captions, discuss, and reflect. Lisa recommends that the project leader design the timeline with this aspect in mind. And finally, the facilitator will want to be mindful of keeping copies of the photographs produced during a project (and of course remember to obtain consent to share them in other places). 

Lisa advancing the film and showing the back of a Holga camera.
Q&A WITH LISA POWERS 

In some ways, the Holga seems to be able to “alter” or portray reality differently. Do you encourage participants to use filters or change photographs in other ways?  

Giving participants a chance to portray what they think, and their own reality is most important. If the participant wants to use filters to express who they are and what they see around them, then the project leader should let them do so.   

In your project in Romania, did you have an interpreter or co-collaborator who spoke Romanian? (or maybe you speak it?!) 

Yes, there have been several projects that included translators, including the one in Romania. When you have interpreters, the pace is slower and its harder to get the nuances. Luckily, art is universal, everyone can express themselves and participate in a project.   

How much time did you spend with project participants explaining how to work with light and other photographic techniques? 

In many projects, participants are on the street with mentors and photographers, talking about light elements and experimenting with light. Having photographer mentors helps provide one-on-one instruction in taking photos, in addition to the group work.   

Other than “fake panorama,” are there other distortions possible using the Holga? 

The Holga image possibilities might be endless. Photographers can play with the places on the negative where there is darkness and bring a new image in. For example, you could double expose so that where a person’s face is, there is another object. With the Holga camera, a lot happens by surprise, and it is important to be open to the element of surprise and not have too much of an expectation of control.

What is a favorite example of stakeholder response to photovoice participants’ presentations that you have been involved in? 

In my work in Solano county with the ‘Welfare to Work’ mothers, the project funders were county staff workers/social workers and others who were constantly dealing with whether this was a valid expectation. The photovoice project produced photographs and a slideshow to present to the community, that gave them a lot more information. Sometimes anecdotal evidence is more powerful and easier to understand than empirical and quantitative data. The photographs and text relieved the county workers because they conveyed positive impact of the program from participants’ perspectives.   

Could you comment on your experience using photovoice in a developing country or with a disadvantaged population?  

Since the Holga isn’t a fancy camera (and it’s plastic) it’s considered pretty basic. This camera was thought of as an art tool. Because it is plastic, participants refer to it as a toy camera, and find it less intimidating than other cameras. We felt comfortable giving it to homeless individuals because it did not look expensive or put people at risk of the camera being stolen. It is something to think about when choosing a camera for a project.  

Could you comment on your process of getting film developed? 

Twenty years ago, there weren’t many digital options. So, although film and film processing can be expensive and the film must be kept cool, film was our best option. However, with Medium format you can look at the negatives and do a free write from them, and then only scan the negatives and print the images you want to use for the show, which can reduce the cost. Although digital has changed all this and the darkroom printer business has dried up for now, it might come back as a competitive option later as film photography gains fine-art status.  

Do you recommend projects start with group photo taking? 

Yes, I always recommend mentors of all types (e.g. volunteer photographers, writers, grad students, and people in the community) to be a part of projects. There is a lot of affirmation and encouragement when mentors are present. Photo mentors can be the eyes that help the facilitator point out the positive and document the workshop as it happens. It is helpful to have people take photos of students in action and the process.  

Lisa Powers taking a selfie with her Holga camera during the webinar.

Can I Do a Photovoice Project Remotely? Yes, You Can!

By Stephanie Lloyd and Laura Lorenz

Are you planning a photovoice project in this midst of these uncertain and stressful times? Were you ready to do a photovoice project and now are re-considering – because your participants can’t go outside, get their project cameras, or meet with you face-to-face? No need to put your project on hold! Photovoice is a highly dynamic and adaptable method. Consider making adjustments that will still provide valid data for interpretation and analysis. Although your ideal photovoice approach may no longer be an option, here are some suggestions for how to adjust your projects during these uncertain times. 

Alternatives to photo-taking

Photovoice photos do not need to be taken for your project specifically. Allow participants to use photos that have been taken previously or by someone else. Right now, while people are being asked to stay at home, encourage participants to look through old photo albums, phone camera rolls, or even on the internet to select photos to discuss with you and others. The important point here is that the photos respond to your project’s prompt or questions, and represent the genuine thoughts, experiences and feelings of your participants.

Participatory visual methods – create art

Because of its many benefits, photovoice may be the ideal method for your study. In light of current events, you can’t give project cameras to your participants, or provide them with photography training or support they may need. Instead, ask your participants to create visuals – drawings, photographs, murals, or videos – to discuss with you (Lorenz and Kolb, 2009). Drawings and other art representations may be helpful to represent feelings and ideas that cannot be captured via photograph during the current times.

Participant drawing from a photovoice project done in South Africa.
Mdantsane Township, Eastern Cape, South Africa, 2001.

Online or virtual focus group sessions

Online or virtual focus groups have increased in popularity as a way to: capture ideas and opinions from a wider demographic, allow greater accessibility for certain populations, and minimize costs and scheduling challenges. Using online software (such as Zoom, GoToMeeting, Join.Me, Google Hangouts, etc.) individuals can participate in an online focus group for free. As long as they are able to access a computer and reliable internet, web conferencing tools allow your participants to talk to each other, see the moderator (and each other if they want), and view a shared picture or document on screen. With online focus groups you have access to the recording and can create a transcript at the end of the conversation, which can support data interpretation and analysis. Make sure you ask participants for permission to record the conversation, whether audio or video!

Online closed groups

When working across global time zones, it might be helpful to use a private Facebook Group, Slack Channel, or other online tool that allows participants to post their photos and respond to prompts at a time that is easiest for them. These channels allow you to work at a different pace as participants access the project “channel” any time they wish, not only in “real time.” With these “channels,” you can specify a time frame (at least a week) for participants to take pictures, share them on the closed group, and post comments. A longer time period allows for more interaction, for example follow-up questions from you (or other group members), and additional photo-taking prompts to narrow down or delve deeper into themes. In their study using Facebook and Photovoice with English teachers, Rubrico and Hashim (2014) concluded that: “The participants found Facebook to be (a) an innovative, fun, and non-threatening venue for engagement, (b) a convenient and broader learning space unbounded by time, and (c) an efficient medium of communication and bonding.”

Jill Nault Connors and Laura Lorenz co-facilitated a photovoice project with individuals living with anxiety disorder that had an online component (Connors et al, 2019). As face-to-face photovoice time was limited, the project used a Slack channel to work together between their face-to-face meetings. Focus group discussions during project time were recorded, and draft captions derived from these conversations were uploaded to Slack along with their related photos. Participants could visit Slack any time to revise their captions, revise their photos, and comment on each other’s work. Connors et al (2019) provides a description of the project’s methods including the online component.

Participant photograph from a project using Slack.

This picture represents the majority of days that I have with anxiety in that there are many days where the steps in front of me look insurmountable. …the bad days with anxiety help me to really appreciative the days where I am stress free. On the good days I am at the top of these steps looking down at the beautiful view.
–Participant, Indiana University, Emergency Medicine, Leveling the Playing Field for Anxiety Disorders, 2018

VoiceThread is another format that groups can use to view each other’s work and use one of five formats to leave comments on selected photos. These formats include microphone, webcam, text, phone, and audio-file upload. The advantage of using VoiceThread is offering participants opportunities to comment, to uploaded photos, and to engage in theme development asynchronously. In her work with young people with IDD exploring experiences and advice related to enrolling in college, Maria Paiewonsky has used photovoice and VoiceThread to enable students throughout Massachusetts to connect with each other and share their experiences. The students developed print and online materials to inspire their peers to consider enrolling in college (Paiewonsky, 2011; Paiewonsky & Lorenz, 2016).

Participant photograph and caption from a project using VoiceThread.

Check out these photovoice project links from Maria Paiewonsky – for both projects participants and facilitator/lead investigator worked remotely using photovoice and other participatory visual methods: Housing First Evaluations: BRIDGES: https://wabridges.weebly.com/ and Mental health and housing:  CT MHTG: https://ctmhtghealth.weebly.com/results.html . Be sure to check out the methods tabs for these excellent examples of project websites.

In creating a safe space for young people to participate in photovoice online, Lauren Lichty and colleagues (Lichty et al, 2019) worked with participants over several months to encourage critical thinking. They adopted an online approach to enable students in widely separate locations to participate in a project together, save project resources, and be culturally appropriate. They also incorporated an online evaluation component into their project. They used a WordPress blog and also used private off-blog communicates for additional support. Over the several weeks of the project, these methods allowed participants to reflect deeply on root cause analysis of problems and make sense of their contexts. Lichty et al (2019) provide an excellent description of their online approach.

Things to keep in mind

Overall, the answer is “yes” to doing photovoice remotely – allowing alternatives to photo-taking, creating art, using “real time” meeting software, and using closed online groups – in the correct context.  The biggest thing to keep in mind when adapting your photovoice project to a remote or virtual meeting space, is to make sure all participants will have equal access and opportunity. So, when thinking about some of the amazing tech solutions out there, be mindful of the population you are working with and the necessary requirements (e.g. computer, high-speed internet, a camera phone with a data plan) that may not be standard for individuals living in different contexts. Additionally, support participation with a “test run” or provide training on the technology, so that everyone is comfortable prior to the actual data collection time frame. Consider trying the technology in a pilot effort with one or two people to start, and expand as you and your participants gain in confidence. And perhaps most important of all – have fun and enjoy your conversations with participants, however they take place!

Finally, it is important to remember that despite our best efforts, not every photovoice project will result in outcomes we anticipated, whether or not they have a remote component. Participants might need encouragement to take photos and they may or may not remember what they purpose of the photo mission is. They may struggle with the technology options you have decided on. Despite these potential challenges, every photovoice project results in increased awareness of participants’ perceptions,  through initial conversations, brainstorming a list of potential photos and even through a discussion of the challenges to complete the work.

Your Turn

Do you have other ideas or questions about conducting photovoice projects remotely? Have you made adjustments to photovoice so you can work remotely? Feel free to reply below or reach out to us at info@photovoiceworldwide.com.

References

Connors, JD, Conley, MJ, & Lorenz, LS. (2019). Use of Photovoice to engage stakeholders in planning for patient-centered outcomes research. Research involvement and engagement, 5, 39-39. https://doi.org/10.1186/s40900-019-0166-y   

Lichty, L., Kornbluh, M., Nortensen, J., and Foster-Fishman, P. (2019). Claiming Online Space for Empowering Methods: Taking Photovoice to Scale Online. Global Journal of Community Psychology Practice: Promoting Community Practice for Social Benefit. 10(3), September. https://www.gjcpp.org/en/article.php?issue=33&article=201

Lorenz, L.S. and Kolb, B. (2009), Involving the public through participatory visual research methods. Health Expectations, 12: 262-274. https://doi.org/10.1111/j.1369-7625.2009.00560.x 

Lorenz, LS and Paiewonsky, M. (2015). Chapter 13 “Sharing the results of visual methods research: Participation, Voice, and Empowerment,” Disability and Qualitative Inquiry: Methods for Rethinking an Ableist World (pp 209-220). (Ed. Berger, RJ and Lorenz, LS). London: Ashgate. https://www.routledge.com/Disability-and-Qualitative-Inquiry-Methods-for-Rethinking-an-Ableist-World/Berger-Lorenz/p/book/9781472432896

Nykiforuk, Candace & Vallianatos, Helen & Nieuwendyk, Laura. (2011). Photovoice as a Method for Revealing Community Perceptions of the Built and Social Environment. The International Journal of Qualitative Methods. https://doi.org/10.10.1177/160940691101000201.

Paiewonsky, M. 2011. “Hitting the Reset Button on Education: Student Reports on Going to College.” Career Development for Exceptional Individuals 34 (1): 31–44. https://doi.org/10.1177/0885728811399277.

Paiewonsky, M., Hanson, T. & Dashzeveg, O., and Western Massachusetts Student Researchers (2017). Put Yourself on the Map: Inclusive Research With and By College Students with Intellectual Disability/Autism. Student Reports: A Think College Transition Brief. Boston, MA: University of Massachusetts Boston, Institute for Community Inclusion. https://pyotm.weebly.com/

Rubrico, Jessie Grace & Hashim, Fatimah. (2014). Facebook-Photovoice Interface: Empowering non-native pre-service English language teachers. Language Learning and Technology. 18. 16-34. https://scholarspace.manoa.hawaii.edu/bitstream/10125/44378/1/18_03_action.pdf

Options for Photovoice photo-taking

By Stephanie Lloyd, MA

Photovoice, a participatory method that has been used with a variety of populations across the globe since the early 90’s, provides participants with the opportunity to take pictures, and discuss issues they care about most. When planning a photovoice project, it is critical to consider the individuals involved as well as the local context in order to decide on the type of cameras and photo-viewing method to use in your project. Depending on the population of participants (e.g. youth, homeless individuals, people with disabilities, seniors, residents of a low-income neighborhood, etc.) that you are working with, different cameras might make more sense. And given today’s technology, in some contexts it may be appropriate to have participants use their cell phones to take pictures and post them to a closed social media group, as opposed to providing cameras and making physical prints. 

In the seminal photovoice project led by Wang and Burris with village women in rural China, “All participants learned to care for, load, and unload a Ricoh YF-20 autofocus, autorewind camera” They completed rolls of 36-exposure color film were “shuttled to county or provincial sites for one-hour developing” and then brought back to the group for discussion.

In the early days of photovoice there were only film cameras with the option to develop a limited number of exposures. However, more recently, photovoice projects around the world have used a diversity of cameras and photo formats. Here is a brief review of several photovoice papers, published since 2000 and involving a range of participants and cameras.

Wang, C. C., & Redwood-Jones, Y. A. (2001). Photovoice Ethics: Perspectives from Flint Photovoice. Health Education & Behavior28(5), 560-572. https://doi.org/10.1177/109019810102800504

Youth, youth leaders, adult neighborhood activists, policymakers and community members took pictures that advocated for funding and investment in Flint neighborhoods. Participants were given Holga cameras and black-and-white film, because “the Holga… allows the photographer to take double and multiple exposures, enabling one to literally layer meanings.” This project also employed local professional photographers who provided “technical assistance, advice, and encouragement” during sessions, and focus group discussions. Tip: When using Holga cameras you may want to provide additional sessions focused on camera use and techniques.

Strack, Robert & Magill, Cathleen & McDonagh, Kara. (2004). Engaging Youth through Photovoice. Health Promotion Practice. 5. 49-58. https://doi.org/10.1177/1524839903258015.

In this project, youth, aged 11-17, from a predominately low-income, urban neighborhood were provided with 35-mm point-and-shoot cameras and memo-sized notebooks to document their lives, as well as community assets and deficits. After hearing about the project, a local camera shop owner donated rolls of film and developed them for a reduced rate. However, “Camera difficulties early on due in part to misuse of relatively inexpensive cameras also slowed the process.” The authors also recommend that a project with youth include “photo expeditions” to support photo-taking with an unfamiliar camera, and a couple of sessions facilitated by a professional photographer to provide instruction and critique as part of the curriculum. Tip: A skill-building photography approach in your project may be appealing to teens and also to any age group.

Sands, Catherine & Reed, Lee & Harper, Krista & Shar, Maggie. (2009). A Photovoice Participatory Evaluation of a School Gardening Program through the Eyes of Fifth Graders. Practicing Anthropology. 31. 15-20. 10.17730/praa.31.4.a13w33753g12t4kn.

Sixteen fifth graders in rural Massachusetts were given the opportunity to act as researchers and “document their perspectives of the garden and local foods curriculum…” in order to share their understanding of food related to health outcomes. The authors reflected that, “The students in both classes were excited to use digital cameras.” And, using digital cameras was ideal in this context because of the limited time constraints of the project. Tip: With digital cameras, your logistics investment will be lower.

Balbale, Salva Najib & Morris, Megan A., & LaVel, Sherri L. (2014). Using photovoice to explore patient perceptions of patient-centered care in the Veterans Affairs health care system. Patient. 2014 ; 7(2): 187–195. doi:10.1007/s40271-014-0044-5

Veteran patients from two VA sites were given “a five megapixel digital camera, a two gigabyte secure digital memory card…and instructions for participation…. Technical training was provided to ensure that participants were comfortable with using a digital camera and taking photographs.” The participants took photographs that described their view of patient-centered care, and then mailed the envelop back to the researchers at the end of the specified time frame. Later researchers interviewed participants to discuss the photo prints. Tip: If there is time between when participants take photos and then discuss them with you, ask participants to look through their photos and sort them before you begin the photo interview.

Moya Eva Margarita, Chavez-Baray Silvia M., Loweree Jacqueline, Mattera Brian, Martinez Nahomi. (2017). Adults Experiencing Homelessness in the US–Mexico Border Region: A Photovoice Project. Frontiers in Public Health. 5. 113. 10.3389/fpubh.2017.00113.

A total of 12 persons adults who reported a history of homelessness or lived in a shelter were provided with disposable cameras, in order to share their experiences. “Participants were asked to carry consent forms and cameras with them for a period of 4–5 weeks and to shoot one or two rolls per week.” At the end of the project, the themes identified by participants led to a Call to Action for policymakers. Tip: Disposable cameras may be safer for participants who could be vulnerable when taking photos or storing their camera.

Ashley Walker, Gavin Colquitt, Steve Elliott, Morgan Emter & Li Li (2019) Using participatory action research to examine barriers and facilitators to physical activity among rural adolescents with cerebral palsy, Disability and Rehabilitation, DOI: 10.1080/09638288.2019.1611952

In this study, adolescents with cerebral palsy were given a tablet with a camera “to improve ease of use” and parent participants were given digital cameras to take pictures of barriers and facilitators to frequent physical activity. The participants were given 14 days to complete the photo assignment, and then brought the camera or tablet back to the researcher for an interview. “The photographs were transferred from the digital camera and tablet to the conference room or classroom computer, and the pictures were projected onto a screen.” The researchers advised the participants to take at least eight photos, which would serve as the basis for conversation, theming, and content for a community forum. Tip: A tablet can help to facilitate success for people with physical issues when taking photos and sharing them with others.

While this is not a comprehensive review of cameras used with diverse populations in photovoice projects, the  papers described above shed light on options and decisions for planning a photovoice project. In table below, we list some advantages and considerations for several types of cameras based on their use in published studies. While earlier projects always used film cameras, here we focus on projects since 2000 when digital cameras and tablets became more readily available.

Camera Options and Considerations

In sum: As noted in the table above, there are a range of viable camera options available for photovoice project leaders. While this is not a comprehensive review, this is a way to consider camera options for photovoice projects based on the context and population.

  • Disposable cameras are cheaper, easier to use, and may encourage thoughtful photo-taking (given the limited exposures). This may be a good option if it is useful to use hard copies during the photo discussions, and if the researcher can negotiate the timing and logistics involved with getting film developed quickly in time for sessions with participants.
  • Cameras that include manual settings provide the opportunity for participants to learn a new skill and to look at photos on a projection or computer screen (in addition to print copies). In some cases, researchers have provided participants with the instruction manual or brought in professional photographers to facilitate a few sessions.
  • Both point and shoot and digital cameras with manual settings are more expensive and may be heavier or more challenging for participants to carry with them. When using cell phones and tablets, the participants will not need training on technical use or to return film for processing, but have the option to email or post photos in a closed social media group regularly throughout the project.
  • Using tech items that include cameras may be expensive or prohibitive for some participants.

References:

Wang, C. C., & Redwood-Jones, Y. A. (2001). Photovoice Ethics: Perspectives from Flint Photovoice. Health Education & Behavior, 28(5), 560-572. https://doi.org/10.1177/109019810102800504 

Strack, Robert & Magill, Cathleen & McDonagh, Kara. (2004). Engaging Youth through Photovoice. Health Promotion Practice. 5. 49-58. https://doi.org/10.1177/1524839903258015. 

Sands, Catherine & Reed, Lee & Harper, Krista & Shar, Maggie. (2009). A Photovoice Participatory Evaluation of a School Gardening Program through the Eyes of Fifth Graders. Practicing Anthropology. 31. 15-20. 10.17730/praa.31.4.a13w33753g12t4kn. 

Balbale, Salva Najib & Morris, Megan A., & LaVel, Sherri L. (2014). Using photovoice to explore patient perceptions of patient-centered care in the Veterans Affairs health care system. Patient. 2014 ; 7(2): 187–195. doi:10.1007/s40271-014-0044-5  

Moya Eva Margarita, Chavez-Baray Silvia M., Loweree Jacqueline, Mattera Brian, Martinez Nahomi. (2017). Adults Experiencing Homelessness in the US–Mexico Border Region: A Photovoice Project. Frontiers in Public Health. 5. 113. 10.3389/fpubh.2017.00113.  

Ashley Walker, Gavin Colquitt, Steve Elliott, Morgan Emter & Li Li (2019) Using participatory action research to examine barriers and facilitators to physical activity among rural adolescents with cerebral palsy, Disability and Rehabilitation, DOI: 10.1080/09638288.2019.1611952 

What is the Difference Between Photovoice and Photo elicitation?

By Laura Lorenz, PhD, MEd and Olivia Iovino, MSN, ARNP-C

We are commonly asked about the differences between these two methods, Photovoice and Photo elicitation, but let’s first talk about how they are similar.  Both Photovoice and Photo elicitation use photographs for gathering information about a focus group or population either for research, education, advocacy, or healing.  With Photovoice, the participants will take photos and bring them back to the group for discussion.  After discussing the photo, the participants will write captions or narratives describing why they took the photos, and the group can put the photos into categories and potentially exhibit them for community education or advocacy.  Photo elicitation is performed one on one between the facilitator and the participant.  In some circumstance, the facilitator will have the participant take photos for discussion, but in other cases, the facilitator may use a pre-selected set of photographs such as photos of a particular location or historical photos.  The facilitator will interview the participant to understand their reaction to the photos.  Let’s discuss some reasons to pick one method over the other depending on the goals of your project and the resources available to you.

Because Photovoice is a group process, individual members of the group can feel empowered by the project.  The members provide support for each other, for example with photo ideas and caption or narrative writing.  Through sharing their experiences, the participants gain an understanding they are not alone in the subject they are going through.  Laura discovered on a Photovoice project conducted in 2006 with an already established support group for people with acquired brain injury that the project benefited the participants so much, they have continued to build on the original project to this day.  Some members of your group will also develop or enhance their leadership abilities.

In other circumstance, photo elicitation project might make more sense for you.  If your study population is separated by a large distance without easy transportation to a meeting point, the one on one interviews may be more feasible.  Also, your focus may be on an issue where confidentiality is very important, in which case sharing in a group may not be ideal.  If your topic only has a small pool of people available for study, the sample size might lead you to choose photo elicitation as well.  This could also be better on a tight budget.  Finally, if there are severe communication issues beyond the simple fix of having a translator, this method could be the right choice for you.

If you like both methods, though, you can use both if you have the means and desire.  You might start with a group Photovoice project, and then do one on one interviews with some of the participants afterwards.  Or if your group is spread over a big distance, you could do photo elicitation with the members, then bring them together for just one group discussion session after the captions have been written, to share about the experience and group the photos into themes.

To learn more about the Photovoice project on acquired brain injury go to:  http://photovoiceworldwide.com/projects

To learn more about training and consultation opportunities go to: http://photovoiceworldwide.com/lectures