Photovoice

= Photovoice: //A Picture is Worth a Thousand Words// =

Overview
toc Photovoice is a method of data collection in which researchers ask participants to use photographs to document aspects of their lives and experiences. These experiences should speak to a specific research question designated by the community and/or researcher. The researcher then leads the participants through an interview process to evoke the narratives to accompany the collection of photographs.

Photovoice allows researchers to gain access to graphic and artistic representation of participants' lived realities. The analysis phase of this method provides researchers with a unique way to evoke participants' unique reflections, thoughts, and feelings.Photovoice places cameras in the hands of community members so they capture their perspectives on issues, discuss them communally and advocate for positive local change to policy and decision-makers. This research method can be employed by anthropologists, epidemiologists, public health researchers, social workers, teachers and other social scientists to actively engage informants/participants in the research process.

“Photovoice is a process by which people can identify, represent, and enhance their community through a specific photographic technique. It entrusts cameras to the hands of people to enable them to act as recorders, and potential catalysts for chance, in their own communities. It uses the immediacy of the visual image to furnish evidence and to promote an effective, participatory means of sharing expertise and knowledge.”

Relevant Characteristics
The photovoice method was established by Caroline Wang and Mary Ann Burris in 1997 as a health promotion practice, which asked study participants to take photographs representative of their lives. It is a community-based participatory research (CBPR) approach that integrates photography with critical discussion to investigate issues from the perspective of “‘resident experts’—the people living, working, playing and praying in a targeted context”. Photovoice is considered a visual methodology for multi-scalar social change (De Lange and Mitchell 2007). Through the use of photovoice, community members are able to develop a working, grounded theory of their reality and impart this information with relevant stakeholders to facilitate change based on their shared findings. Photovoice is methodologically founded on anti-oppressive practice principles ; it has been employed worldwide among many diverse populations in various geographic regions, including Chinese village women, homeless populations , people who live with intellectual disabilities, African-American breast cancer survivors and refugee populations.

Photovoice is an ideal choice for community-based research, participatory action research, and other research projects that wish to actively engage participants. Researchers and participants can use photovoice to work collaboratively throughout the various states of the research process. The researcher can use photovoice as an exploratory tool to distill themes, while participants can assist in data collection, analysis, interpretation, and publication by sharing their photographs and interpretations with researchers.

Photovoice has received growing attention in health education and related fields because it promotes group discussion about issues important to patients, clients, and community members, and has the potential to affect policy. Similarly, photovoice is methodologically beneficial to researchers interested in participatory action research, applied work, and activism.

Goals of Photovoice include: (adapted from Booth & Booth, 2003)
 * Encourage people to reflect on and record aspects of their own identity and experience
 * Enable/encourage personal strength (individually) and/or to find common cause with others (in group settings)
 * Project a vision of their lives that might educate or inform others
 * Advocate for positive change

These goals reflect photovoice’s consistency with foundational ideas surrounding community-based participatory research. In particular, photovoice emphasizes “ individual and community strengths, colearning, community capacity building, and balancing research and action” (Catalani and Minkler 2010:424).

Photovoice Made Easy


1) Build relationships in the community and establish rapport with potential participants  2) Establish goals for the research & central questions 3) Recruit participants & gain informed consent 4) Distribute cameras & offer training if necessary 5) Take photographs – don’t forget to set a time limit & a follow-up meeting!  6) Contextualize the photos by having participants explain their photos. The interview process can be oral or written. Encourage VOICE (Voicing Our Individual and Collective Experiences) 7) Code themes that come out in the interview (or identify a message for your potential audience) 8) Incorporate findings into broader research (or target an audience for publication)

(adapted from Booth & Booth, 2003)

Advantages
__**Participant and Community Advantages:**__ **__Research Process Advantages:__**
 * Photovoice is ideal for community-based research. Depending on the research design and desires of the community, participants can become empowered through active involvement in various parts of the research process.
 * Researchers interested in compensating their research participants may wish to consider giving photographs and cameras as compensation. Since the researcher often supplies the community with the tools necessary for research, these tools may also be transformed into gifts for participants upon completion of the research.
 * Photovoice is ideal for involving individuals who process information differently. For instance, a researcher wishing to collect information from children or people with learning or other disabilities might consider the flexible nature of photovoice beneficial to his/her project. Researchers working with deaf communities may wish to consider using photovoice since this method draws on visual skills-- a strength of deaf children and adults.
 * The Photovoice method may help researcher establish rapport with informants/participants. Since discussion is facilitated through the analysis of photos, photovoice allows the researcher and participants to become acquainted.
 * Photovoice can be used to create focus groups within a community, when used in the initial stages of a project. Since photovoice promotes discussion of difficult topics, group interaction may establish rapport among members and facilitate a sense of community among the informants.
 * Photovoice can be used for needs assessment (Wang and Burris 1997). If used as an exploratory tool, the researcher may use the analysis of photographs to establish concerns among a community. These concerns may be used to guide research questions and inform the research process.
 * Since photographs provide us with a unique documentation technique, photovoice might be employed in longitudinal or comparative studies, such as documenting changes in a person's posture or stature as a result of physical therapy or nutritional interventions. Students may use photographs to document work on an extensive project, or track their own growth and development.
 * Photovoice is a well-suited method for applied work, advocacy, and/or activism. Photovoice involves the community and has the potential to communicate with large numbers of people (i.e. the media, policy makers, the wider community). Researchers and community leaders can work together to put the resources created through the photovoice process to work toward community improvements and action.

Limitations
__**Participant and Community Disadvantages:**__ __**Research Process Disadvantages:**__
 * Researchers working with human subjects should always obtain informed consent from their research participants. Informed consent involves a thorough explanation of the possible consequences of participation in the research endeavor. Photovoice may present some difficulties with regard to informed consent among research subjects, as well as photographic subjects. If individuals can be identified in the photographs, but have not given their informed consent, there may be potential future consequences. This may be of critical concern among vulnerable populations such as children, people with disabilities, or otherwise potentially endangered communities.
 * Researchers should also consider the full scope of anonymity issues. since the researcher may not be able to speak with all human subjects who may be photographs. The potential exists for an invasion of privacy, particularly for the subjects in the participants’ photos who may not have given their permission to be photographed. The researcher should explicitly plan for how to handle such situations.
 * Photovoice may not be ideal for research among particularly vulnerable populations. Communities experiencing discrimination, wartime conditions, and populations negatively affected by stigma may be further endangered if they can be identified in photographs. It is the researchers' responsibility to consider all potential scenarios and act in ways that protect the safety and integrity of the communities in which they work. Researchers should always consult their Internal Review Board (IRB) as well as their professional code of ethics. The American Anthropological Association provides clearly stated ethics which anthropologists should always observe ([]).
 * While anthropologists and other researchers may be interested in exposing uncomfortable realities or inhumane conditions, as professionals, they should also be aware of the risk of voyeurism and the potential for inadvertently exploiting communities. Research and project objectives should be carefully constructed as to avoid unnecessarily shocking, painful, or brutal images, particularly if they are to be shared with a wider public. Researchers should prioritize the involvement of community leaders and give attention to local customs and beliefs when deciding on how these images should be handled and stored.
 * Collaborative efforts between communities and researchers need to be negotiated in ways that benefit all stakeholders. Intellectual property rights should be discussed prior to commencing research, and candid discussions about who owns the photographs and interpretations of those photographs should take place to avoid potential conflicts.
 * Since researchers often provide cameras and film for participants themselves, photovoice can be a relatively expensive research method. Planning and funding should take into account cameras and equipment as well as printing options, photograph paper and any editing or publishing materials and tools.
 * Photovoice has the potential to be more time consuming than other methods. Researchers should plan time for training their participants, especially those who have never handled a camera. The researcher should anticipate varying response times and should clearly establish deadlines and goals with participants. The analyses and discussions that take place surrounding the photographs should give ample time for participants to contribute in a way that is satisfactory to both participant and researcher.
 * Photovoice is not a stand-alone method; should be paired with other research methods.
 * As with any research method involving multimedia and technology, there is always the potential for unanticipated technological setbacks. Researchers should be familiar with the equipment used in photovoice and should employ or consult experts when necessary.

Analysis
Researchers typically analyze their data during and after collection to look for patterns and themes that help to answer their research questions. A truly community-based project may wish to consider involving community members in the analysis process. As discussed, photovoice provides an authentic way for informants and community members to participate in various aspects of the research process. Several community-based and action research methods allow for informant participation in the initial research stages, but collaboration is often restricted when it comes to the results and presentation of a research endeavor (an ethnography, for example).

Since interpretation and explanation are integral elements of photovoice, research participants can be involved in the analysis and therefore influence how their work and their communities are represented. Participants, when they are asked to interpret their photographs, offer their unique insights thereby identifying what is most important to them. Informants can also be taught coding skills and work with the researcher(s) to interpret the data. "Photovoice involves giving people cameras and using the pictures they take to amplify their place in and experience of the world. It puts people in charge of how they represent themselves and how they depict their situation"

The analysis stage of research is important in reporting research findings, interpretation, and representation. "The findings [of the //Realidad Latina// project] gave a platform for this marginalized group of Latino adolescents to express their concerns and push for change. Because every aspect of Realidad Latina was driven by photographs, quotations, and themes generated by the participants, their issues and assets could not be disqualified by the principal and other teachers". As the //Realidad Latina// project (discussed below) demonstrates, photovoice provides ample scientific rigor because issues brought about in the research are presented in a way that cannot easily be disputed.

Photovoice can be a tool for empowering communities through communication. Furthermore, it can also serve as an avenue for inspiration and a platform for expression. While photovoice is a valid research method for data collection, it is also a creative pursuit. “Viewed as works of art, photographs are thought to embody the personal concerns of the photographer-artists. These concerns can range from the exploration of formal aesthetic issues to the expression of the photographer’s inner emotions. Viewed as records, photographs are thought to reproduce the reality in front of the camera’s lens, yielding an unmediated and unbiased visual report” (Shwartz, 1989:120).

Method in Context
**Photovoice in Research with Adolescents:**

Streng et. al (2004) demonstrate another effective use for photovoice: inovolving adolescents in an interdisciplinary, community-based research they called //Realidad Latina//. These researchers describe how they employed photovoice with a group of Latino immigrant students to help uncover some of issues important to these youth. Adolescent students were asked to participate in a series of four photographic assignments. Students were asked questions that related to their perceptions, experiences, and ideas about potential solutions. They were then asked to respond to these questions through a photographic assignment. For example, one of the assignments read:”What is it like to be a Latino adolescent living in Centerville, North Carolina?” (Streng et. al 2004:406). The researchers‘ aim was to identify the effects of immigration on health-status, drop-out rates, and other troubling statistics surrounding Latino youth in schools.

The researchers were able to identify themes that were of particular importance to the teens. Some of the themes that were uncovered from the participants’ photographs included feelings of rejection, school and institutional racism, a valued Latino identity, and limited use of English. The culminating activity was a photographic exhibition that aimed to “raise awareness of their themes among parents of Latino high school students, local community leaders, service providers, school teachers, and school administrators” (Streng et al 2004:413).

The authors of this study highlight one of the strengths of photovoice: “ The use of [community-based participatory research] and photovoice minimized the potential for researchers’ prioritized issues to trump those expressed by participants and influence the project’s results… photovoice helped establish a trusted relationship among participants, practitioners, and researchers” (Streng et. al 2004:413). If our aim as scientists is to strive for a sense of objectivism, photovoice is a method that offers and alternative to positivistic, traditional research designs. Furthermore, anthropologists have a keen appreciation for the role that rapport with participation plays. The connections we make with our informants is of crucial importance, and photovoice offers a unique way to diversify our interactions with informants. Photovoice encourages confidence and hopefully provides a medium where candid information can be shared.

Photovoice may be particularly suited for use with people who have learning difficulties and/or other disabilities, making this research method well-suited for educators, researchers in disabilities studies, communication disorder sciences, mental and other health professionals, and medical anthropologists. Visual images are combined with individual and group discussion, helping to actively engage respondents and community members who may lack verbal fluency.

Booth and Booth (2003) used the photovoice technique with a group of mothers with learning disabilities. Their research demonstrates how this method can be a powerful tool for accessing insights in individuals who may otherwise have more difficulty communicating in a research or therapy session. Their conceptualization of photovoice articulates well how it can be set apart from traditional research methods which may unintentionally exclude people with disabilities. “Photography as an activity emphasizes action over cognition (we ‘take’ photos after all): it provides a means of concretising issues and concerns in a way that corresponds more closely to the thinking of people with learning difficulties than other more abstract modes of expression” (Booth and Booth 2003:432).

**Photovoice in Addiction:**

Photovoice has been used effectively with individuals who are addicted to narcotic substances. The study by Heery (2013) uses this method to have a better “perspective, insight and dimension of feelings, perception in connecting with those who fee disconnected” (Heery 2013:450). The recovery process for those individuals with addition problems is complicated and consists of multiple stages. The main idea behind using this particular method versus other ethnographic methodology is that drug abusers have difficulties in expressing feelings in writing. Thus, using this method was an essential way to help individuals with addiction to recognize patterns that are seen important in the personal recovery process. It helps them in what expressing those factors that influence their decision to choose recovery. Photovoice help those people to understand the “hidden consciousness of their experiences” (Heery 2013:455).

**Classic use of Photovoice method:**

Freedman et al. (2012) used photovoice “to record and reflect on the elements of the community that influence health and well-being, promote critical dialogue and knowledge about community issues, and develop a grounded theory of socio-environmental factors that facilitate or hinder a healthy community environment. Results from this study provide a grounded theory of the social dynamics perceived to influence health and well-being among the targeted public-housing residents.” Purposeful sampling was used to recruit two age groups: 12-17 and 18 and over. The project involved 30 hours of group sessions. Each session lasted approximately 2.5 hours. All participants used a digital camera that they were allowed to retain if they attended all the sessions. Participants took pictures that best captured community-level concerns, which influenced health and well-being. In-group session’s photos were displayed and were analyzed through group discussion using a modified version of the ‘SHOWeD’ technique, an acronym for trigger or discussion questions. Wang (2003) gives more details on this methodology. The guiding questions that groups discussed were:

(i) What do you see happening here? (Describe what the eye sees) (ii) What is actually happening here? (What is the unseen story behind the picture? What does the heart see?) (iii) What does this photo tell us about life in your community?

After group discussion, participants developed titles and captions for their pictures. Participants selected 172 final photos, titles and captions that were included in their project collection. An example of a photo and caption is included below.

Researchers (Freedman et al. 2012) took the 172 photos selected by the community and used a grounded theory approach (an approach in which the data guides thematic analysis of qualitative content), to construct five main theoretical constructs. These thematic findings are illustrated below.

**Photovoice in combination with other methods:**

Woolford et al (2012) used photovoice in combination with semistructured interviews to understand how personally relevant images can be used as part of a mobile intervention to increase treatment adherence in obese teens who are weight clinic patients. Results indicated that friends and family play an influential role in treatment adherence to weight programs for obese teens. Participants also enjoyed the process of reflection triggered by the photovoice assignments. This method of intervention is a promising mode of helping struggling teens to continue with their weight loss program. This study is novel in that it utilized photovoice as a means of collecting data on weight-related topics in obese teens. It provides a mode of intervention, when usually photovoice is solely a method of data collection.

There is very little data in this area and as such, this project is an exemplary means of addressing the gap in the literature. Participants were given a list of photo assignments listed below in Table 1. In place of the group discussions that are traditionally conducted as part of the photovoice method, a semi-structured interview was used. The interview guide explored (Woolford et al., 2012): “(1) Participants’ rating of the experience of participating in the project (2) Participants’ perspectives regarding whether and how the pictures might help their weight loss efforts (3) The ways in which the pictures taken by the participants addressed the topics in the photograph assignments.”

Photovoice, as a method of intervention, has the potential to enhance weight management for teens, as suggested by the stimulation of joy participants experienced as they submitted assignments.

In most weight loss programs, it is challenging to get adolescents to engage in the reflective process that forms an integral part of their weight loss journey. Self-monitoring activities such as logging are considered useful since they can facilitates reflection on dietary intake. Photovoice encourages introspection, possibly due to the process linking pictures thought provoking question. It is critical to select question carefully, as to guide participants appropriately in order to support their weight loss effort (Woolford et al., 2012). Photovoice assignments can be used intermittently throughout a multidisciplinary program, particularly when their motivation may be waning. Photovoice can also stimulate memories or provide encouragement for adolescents who want to lose weight. Thus “Photovoice assignments might not only promote healthy behaviors but also increase engagement and retention in weight management programs.” (Woolford et al., 2012)

Online Resources
Teens Document their Communities []

Photovoice: Reframing the World http://www.photovoice.org

A Practical Guide to Photovoice: Sharing Pictures, Telling Stories and Changing Communities []