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

Who should do Photovoice?

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

A common question we are asked in our courses is “What populations and purposes are appropriate subjects for Photovoice projects?”  With a quick google search on Photovoice projects, you will find a wide variety of projects done with youth, women, homeless populations, veterans, seniors, people with chronic conditions and disabilities, groups in urban or rural settings, and groups of workers within an organization.  You will find projects performed all over the world, for research purposes or for community action.  Even with such a variety, though, we can find a simple answer –  Photovoice can be used for any group that you want to know more about.

Photovoice helps people to tell stories and communicate with others. As course participants and the literature have noted, it’s not always easy to communicate with words. This method is another way to explore perspectives – another type of intelligence gathering, if you will.

Photovoice helps people to advocate for their needs, preferences, and goals.  It generates data that provide a more complete or holistic view, and can complement other data.  Some Photovoice projects can be done for the purpose of providing insight into the lives of people whose voice and perspective have not been previously heard.  The photographs cross boundaries and help to “level the playing field” where there is a power imbalance, helping create actionable story-telling for social and political change.

For example:

  • Photovoice was developed by Wang and Burris in the 1990’s for a regional development project in China with funding from the Ford Foundation to incorporate the views of village women10
  • The method has been used with homeless populations11
  • With youth in the US13 and many other countries
  • To understand the unique challenges and opportunities faced in rural nursing8

In the clinical setting, Photovoice can be used by people living with chronic health conditions and disabilities or facing other challenging circumstances – and by professionals and caregivers as well.  Photovoice can help contribute to our understanding of the continuum of care and what people are going through at all stages of the continuum – from helping us to understand people’s experiences with medical care and community services and supports, to social determinants that may contribute to prevention or exacerbate risk. In turn, findings from Photovoice projects can educate medical care professionals, policymakers, and also peers, family and the community. 

For example:

  • Understanding lived-experience of brain-injury survivors in Massachusetts7
  • Informing HIV prevention practices among recent US immigrants9
  • The Department of Veteran Affairs has used Photovoice to explore their successes and identify areas for improvement in delivering patient centered care with two different studies: one focused on providers and their perceptions3, and a second study on patients’ views2.
  • Improving water and sanitation practices in Kenya4

Photovoice has been applied to process improvement in the workplace to gain perspectives of diverse stakeholders within an organization.  Purposes of studies have included reducing workplace injuries and incidents among custodians5, stimulating resilience among nurses to reduce burnout and promote retention1, and to suggest quality improvements to enhance retention among nursing faculty at a university6.

In summary, there is a range of purposes for Photovoice projects, and they can be performed with any population or subpopulation for which you wish to gain a deeper understanding.  These purposes can include:

  • Understand lived experience of the studied population
  • Gain perspectives of local stakeholders and populations
  • Raise awareness—among community members, policymakers, patients
  • Inform or initiate action to improve prevention, policy, and practice
  • Promote healing—of communities and individuals

To learn more about Photovoice including educational opportunities and consultations, visit www.photovoiceworldwide.com

References

  1. Shin Yuh Ang  Thendral Uthaman  Tracy Carol Ayre  Siew Hoon Lim  Violeta Lopez A Photovoice study on nurses’ perceptions and experience of resiliency.  First published: 09 October 2018 https://doi.org/10.1111/jonm.12702
  2. Balbale, S. N., Morris, M. A., & LaVela, S. L. (2014). Using Photovoice to explore patient perceptions of patient-centered care in the Veterans Affairs Health Care System. The patient, 7(2), 187-95.
  3. Balbale, S. N., Turcios, S., & LaVela, S. L. (2014). Health care employee perceptions of patient-centered care. Qualitative health research, 25(3), 417-25.
  4. Elijah Bisung, Susan J. Elliott, Bernard Abudho, Diana M. Karanja, and Corinne J. Schuster-Wallace, “Using Photovoice as a Community Based Participatory Research Tool for Changing Water, Sanitation, and Hygiene Behaviours in Usoma, Kenya,” BioMed Research International, vol. 2015, Article ID 903025, 10 pages, 2015. https://doi.org/10.1155/2015/903025.
  5. Flum, M. R., Siqueira, C. E., DeCaro, A., & Redway, S. (2010). Photovoice in the workplace: A participatory method to give voice to workers to identify health and safety hazards and promote workplace change-a study of university custodians. American journal of industrial medicine, 53(11), 1150-8.
  6. Kirkham A.  Enhancing Nurse Faculty Retention Through Quality Work Environments: A Photovoice Project. Nurse Econ. 2016 Nov-Dec;34(6):289-95.
  7. Lorenz, LS and Kolb, B. (2009 September). Involving the public through participatory visual research methods. Health Expectations, 12, pp 262-274.
  8. Challenges and Opportunities of Rural Nursing Preceptorship: A Photovoice Perspective Author/Creator Oosterbroek, Tracy, A – phd dissertation
  9. Rhodes, S.D. and Hergenrather, K.C., “Recently arrived immigrant Latino men identify community approaches to promote HIV prevention,” American Journal of Public Health, vol. 97, no. 6, pp. 984–985, 2007.
  10. Wang CC, Burris MA, Ping XY. Chinese village women as visual anthropologists: a participatory approach to reaching policymakers.  Soc Sci Med. 1996 May;42(10):1391-400.
  11. Wang CC, Cash JL, Powers LS. Who Knows the Streets as Well as the Homeless? Promoting Personal and Community Action Through Photovoice. Health Promotion Practice, 2000, 1 (1), 81-89
  12. Wang, C. C., Morrel-Samuels, S., Hutchison, P. M., Bell, L., & Pestronk, R. M. (2004). Flint Photovoice: community building among youths, adults, and policymakers. American journal of public health, 94(6), 911-3.