Participant-generated Photographs Research Articles

Using Photovoice to Explore Determinants of Health among Homeless and Unstably Housed Women.

The lived experiences of homeless and unstably housed women, including their health-related priorities, are understudied in smaller metropolitan and rural communities. In this study, we partnered with a day center for women who experience homelessness in Spokane, Washington. We used Photovoice, a community-based participatory action research method, to explore the health-related concerns, needs, and behavior of women who are homeless or unstably housed. Participant-generated photographs and group interview data were analyzed using thematic analysis. Three themes were generated: "These are my supports", "I'm trying to make my health better", and "[My] choices are very limited". The themes illustrated individual, interpersonal, community, and societal strengths and vulnerabilities aligned with the social ecological model. Participants demonstrated resourcefulness, creativity, and hope as they strived toward health improvement. Trauma-informed, strengths-based approaches that respect the autonomy of homeless and unstably housed women and that amplify their voices are needed to minimize power imbalances in research, policy, and practice. This includes an imperative for healthcare and social work programs to ready graduates to deliver effective, empathic services by increasing their knowledge of social determinants of health and of the stigma faced by marginalized communities. Moreover, collaborating with these communities when designing, implementing, and evaluating services is critical.

Abstract A076: Trial participation in pictures: Using photo elicitation to explore minority patients’ experiences on therapeutic cancer clinical trials

Abstract Background: Much has been published about barriers to research participation for under-represented minority (URM) yet we know little about the experiences, motivations, and decision-making of the URM patients who were successfully treated on clinical trial (CT). The purpose of this study is to draw on the experiences of URM patients as insiders of practical knowledge of CT through photo elicitation  to comprehensively understand the current state of recruitment and treatment of URM patients on interventional cancer CTs across the Mayo Clinic enterprise with a short-term goal of informing mechanisms to enrich CT participation and a long-term goal of building a patient-centered cancer practice and clinical trial patient population that is reflective of the diverse communities served by Mayo Clinic. Method: An Appreciative inquiry approach was adapted for this study which acknowledges that existing strengths and everyday experiences of URM patients has the potential to allow a more nuanced view as it pertains to our cancer populations. A total of 138 URM were invited to participate.  Using photo elicitation technique, patients were asked to take photographs to portray factors that motivated them and/or facilitated their enrollment, barriers to enrollment and recommendations to improve the process for CT recruitment for other URM. Participant-generated photographs (59) and accompanying 13 interview narratives were analyzed using layered analysis. Results: A total of 13 patients (female =9) participated in the photo interviews.  URM detailed their overall experiences around CT participation, motivations for participating in clinical trials; facilitators to clinical trial participation; and opportunities and considerations for increasing minority patients CT participation.  Photo analyses provided symbolic representation of patients’ general experiences around CT including celebrating their “new identity”, finding peace in moments of nostalgia, their journey through the trial, lost times and finances and yet finding a new purpose to live through CT participation.  Importantly patients described decision making in CT participation as a relational approach. Patients suggested opportunities and considerations for increasing minority patients trial participation, which included minimizing logistical barriers, decentralizing cancer clinical trials, increasing awareness via patient narratives, diversifying research staff, minimizing cost, and being clear on purpose and benefit of the trial. Conclusion:  Our study highlights the potential to utilize visual data and narratives from URM in CT recruitment and education programming. It provided valuable insights from the URM community for the URM community on key issues on motivations of CT participation and decision-making in CT participation. Citation Format: Gladys B. Asiedu, Rahma Warsame, Mary O’Shea, Yong-hun Kim, Sara A. Ellingson, Katharine A. Price. Trial participation in pictures: Using photo elicitation to explore minority patients’ experiences on therapeutic cancer clinical trials [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A076.

Searching for a brighter future-Lived experiences of ongoing recovery processes following COVID-19 infection.

Research in Denmark indicates that approximately 30% of people with confirmed COVID-19 infection experience at least one physical symptom 6-12 months after the acute infection. The lived experiences of undergoing prolonged recovery processes and how these processes unfold need further attention. To contribute in-depth knowledge about recovery, as experienced over time by people living with the post COVID-19 condition. Within a qualitative research design, nine women and six men were interviewed. Ten of them gave a follow-up interview. Prompt cards and participant-generated photographs were included. A phenomenological-hermeneutic approach inspired by Ricoeur's theory of interpretation guided the data analysis. Living with long-term health problems associated with the post COVID-19 condition involved recovery processes where participants struggled with reduced capacity, new unpredictability and uncertainty in everyday life. Participants continuously searched for improvement and aimed for regaining former health and well-being. Lack of knowledge, acknowledgement and support made it difficult to find clear directions for improvement. Participants created a protective shield and struggled, often jointly with family and friends, to cope with bodily, cognitive, emotional, existential and social challenges. Over time, some participants realised that they might not be able to fully return to their earlier habitus. However, some of them gained a new foothold and sense of hope for the future. This study provides in-depth insight into the experience of changing and open-ended recovery processes while living with the post COVID-19 condition. Over time, some participants learned to rebuild their lives, adapting to their reduced capacities. Future care and rehabilitation models for these patients must address the complex and challenging nature of recovery processes associated with living with post-COVID-19 condition.

(Un)sustainable everyday practices sociomateriality shaping sustainability in an urban district

Urban areas are often seen as central sites for sustainability transformations, and in many parts of the world, cities are striving to be recognised for their sustainability initiatives. An example of a new urban district with a sustainability profile is Rosendal, in Uppsala, Sweden. Based on semi-structured interviews supported by participant-generated photographs, I let the everyday practices residents of this district associate with sustainability be the starting point for studying the different ways in which they understand and enact (un)sustainability. My analysis builds upon a practice theoretical framework, viewing practice as mundane, routinised behaviour shaped by ‘materials’, ‘competences’ and ‘meanings’. By focussing on a set of practices brought forth by the interview participants, namely, growing vegetables, showering and cycling, I pay specific attention to the different roles of materials and how these are co-constitutive of the sociomaterial practices of which they form part. Based on the analysis, I contend that the sociomaterial urban assemblage enables and restricts what comes to count as sustainable, as well as which (un)sustainable practices are performed in everyday life. Further, the ability to think of alternative ways of enacting sustainability in everyday life is both enabled and restricted by present practices due to the situated nature of imagination. If urban districts are to play a central role in sustainability transformations, I argue that living environments should be planned in ways so that new ideas and practices for enacting sustainability may emerge.

A PhotoVoice Exploration of Pharmacists’ Lived Experiences Working During the COVID-19 Pandemic

Introduction:Pharmacists’ pivotal role during the COVID-19 pandemic has been widely recognized, as they adapted to continue to provide an even higher level of care to their patients. We sought to gain deeper understanding of frontline pharmacists’ lived experiences of the COVID-19 pandemic and its impact on their roles and professional identity (what they do and what it means to them).Method:Photovoice was used, a visual research method that uses participant-generated photographs to articulate their experiences, and semi-structured interviews. This approach allowed us to explore the subjectivity of professional identity from the pharmacists’ lived experiences. Participants were asked to provide 3-5 photos that reflected on how they see themselves as a pharmacist and/or represents what they do as a pharmacist. The semi-structured interview guide asked open-ended questions about their photos, included a photo-elicitation exercise, and additional questions based on a recent scoping review. We recruited frontline community pharmacists who provided direct patient care during the COVID-19 pandemic in Alberta, Canada through social media and relevant pharmacy organizations. Data analysis incorporated content, thematic and visual analysis and was facilitated using NVivo software. Ethics approval was obtained from the University of Alberta ethics board.Results:Five primary themes emerged from the photographs and interviews: (1) autonomy, (2) clinical courage, (3) leadership, (4) safety, and (5) value and support. The photographs identified symbols participants associated with their lived experiences (e.g., worn shoes illustrate the relentless pace of pharmacists, a messy bed representing work-life balance out of control).Conclusion:This study identified that pharmacists’ felt the pandemic made them visible to the public and made them feel valued as a trusted resource and a safe-haven for ongoing healthcare. Additionally, it was highlighted how participants demonstrated clinical courage and led their communities by adapting their roles and using their autonomy to fulfil community needs.

Transforming normative, ableist, and biomedical orientations to living well and quality of life in nursing: Reimagining what a ventilated body can do.

A goal of living as well as possible is central to practice and research with young adults living with home mechanical ventilation (HMV). Significant effort has been put into conceptualizing and measuring the quality of life (QOL) as a proxy for living well. Yet, dominant understandings of QOL have been influenced by normative, ableist, and biomedical discourses about what constitutes a good life that, when applied in practice and systems with those living with HMV, can contribute to exclusion and constrain opportunities to live well. Inquiry into what certain understandings of living well can do is critical to opening up possibilities to reimagine living well with HMV. This paper draws on findings from a critical narrative inquiry that explored the experiences of five young adults (ages 18-40 years) living with HMV. Data wereco-constructed virtually through an initial interview and photo-elicitation using participant-generated photographs. A critical narrative analysis of participants' stories made visible the ideological effects of ableist, biomedical, and individualist discourses and how the young adults reproduced and resisted these dominant discourses. Their stories further opened up possibilities for nurses and other healthcare providers to see living well and QOL differently.

BLACK WOMEN, WHITE COATS: BLACK WOMEN UNDERGRADUATE STUDENTS' USE OF COMMUNITY CULTURAL WEALTH TO PERSIST IN HEALTHCARE CAREERS

In this qualitative, participatory action research study, we examine how six Black women undergraduate students develop, cultivate, and sustain their healthcare career aspirations while examining challenges Black women undergraduate students experience during their pursuit of a healthcare career. Using community cultural wealth to frame our study, we collected two interviews per participant along with participant-generated photographs. We found that student participants experienced multiple forms of oppression, financial challenges, and lack of access to academic resources, but they were able to persist through support from family, faculty, and peers, along with faith-based practices and creative arts. Findings provide insights for higher education leaders, STEM and health sciences faculty, and the healthcare industry to advance equity for Black women pursuing healthcare careers.

A Multi-methods Approach to Qualitative Inquiry to Explore the College Journeys of Mexican American Women

ABSTRACT This qualitative study highlights how the use of several interpretative-methods helps to better capture the journey of the participants’ transition from low-income, immigrant households to first-generation college students of color at a top-tier research university. I examine a wide range of interpretive practices, from traditional to innovative educational methods in the field of qualitative inquiry, when exploring the lived experiences of students who have been historically excluded in higher education. I reflect on the benefits and limits when employing these methods. I argue for the particular strength of employing multiple qualitative methods to study complex life situations such as college transitions. The pilot study’s preliminary findings suggest that four first-generation college-going students utilized their family as a resource to help their transition to college. Specifically, the use of participant-generated photographs helped capture meaningful aspects of their everyday life as a college student. Scholars who aim to understand lived experiences of Mexican American women or other excluded groups are encouraged to employ multiple-interpretive methods to gain more textured accounts of their college experiences.

Ambivalence and moral dilemmas in women's lived experiences of obesity and pregnancy: Qualitative insights for maternal lifestyle interventions.

Maternal obesity is a global health concern that is associated with significant effects on both short- and long-term health of both mother and child. However, maternal lifestyle interventions tend to focus solely on diet and physical activity in ways that disembody and disengage the social context in which women live their lives. The aim of this study was to explore the lived experiences of maternal obesity and delve into how experiences of the body and motherhood affect women's motivation for participating in a postpartum lifestyle intervention. A qualitative study using in-depth semi-structured interviews based on participant-generated photographs was used to allow the women to openly express their lived experiences of maternal obesity. The study emanated from a gynaecological department of a major Danish hospital, and five pregnant or postpartum women living with obesity participated. Interviews were audio recorded, transcribed and analysed using an Interpretive Phenomenological Approach. The analysis identified an overall theme of ambivalence and four subthemes among the participating women. The themes reflected contrasting feelings where the obese body was simultaneously an arena for aesthetic failure, functional success and moral dilemmas. Experiences of weight stigma and moral accusations in healthcare settings further increased the women's sense of ambivalence and challenged their strong desire to lose weight. This study highlights an ambivalent and vulnerable situation of maternal obesity which makes moral sensitivity towards weight and body concerns crucial to consider in future maternal health interventions. Our data suggest that an emphasis on functionality and capability rather than aesthetics and measured ideals would be useful in providing care and support in postpartum lifestyle interventions for women living with obesity.

Visualising urban redevelopment: Photovoice as a narrative research method for investigating redevelopment processes and outcomes

The use of participatory visual methods has gained significant momentum in visual, urban, planning, and geography research. This article provides methodological understanding of how the photovoice method can contribute to urban redevelopment studies, particularly for producing and narrating interpretive data on the processes and outcomes of urban redevelopment. Photovoice as participant-generated photographs was used to explain and explore the individual experience of involvement in redevelopment projects within selected urban areas in Tehran. Resident research participants captured photographs representing the area and the places within them, and were then individually interviewed in-depth about the significance of the photographs and their own experiences. Other stakeholders, including developers and local authorities, were also interviewed. A total of 36 interviews and 65 photovoice contributions were thematically analysed.Within the urban redevelopment context, photovoice is a multi-faceted resource that can verify the processes and outcomes of urban change. Using this method enabled the scrutiny of the tangible and intangible meanings that the research participants attached to their entities—objects, places, communities, and practices—revealing a certain set of power relations and patterns of controls in urban redevelopment processes. The findings demonstrate the utility and application of photovoice in understandings of place making and heritage value, as well as those of visual narratives of spatial transformation, and residents’ perceptions and attachment. The study also discusses the particular epistemic and methodological limitations of photovoice within the urban redevelopment context, including the research process, its potential, and associated challenges.

Second Grade Students’ Perspectives of Their Classrooms’ Physical Learning Environment: A Multiple Case Study

The study employed a qualitative multiple case study approach to investigate second-grade students’ perceptions of their classrooms’ physical learning environment. Data were collected through interviews, participant-generated photographs, and observations. Participants in the study were 16 students in four classrooms in three school districts. A physical learning environment tool, Assessing the Pillars of the Physical Environment for Academic Learning (APPEAL), developed by Evanshen and Faulk and published in 2019, was used to select classrooms to participate in the study. According to the scale, the top-scoring classrooms were more learner-centered (more constructivist) than the lowest-scoring (more traditional) classrooms. Generally, participants believed that classroom physical learning environments that were best for them were meaningful, offered easy access to resources and materials, and provided active learning and social engagement opportunities. Both physical and emotional comfort were important to participants. There were more similarities than differences between the participants’ perceptions in the classrooms that scored highest on the APPEAL and the classes that scored lowest. The findings suggested that young children’s perceptions of the environment can be influenced by their experiences or contexts and their differences. The results encourage teachers of young children to think about their students as actively affected by their environment and challenge them to design classroom physical learning environments that support the diverse needs of students within these spaces.

Photography as a Research Method with Learners in Compulsory Education: A Research Review

Abstract This article offers a review of thirty-one research articles from 2001–2019 on the use of photography as a research method with learners in compulsory education. Understood within the scope of ‘visual’, ‘participatory’ and ‘arts-based’ research methods, many scholars have linked the increased use of the photographic method to greater awareness of the rights of the child and changing understandings of children as full ‘human beings’ with agency rather than simply vulnerable ‘human becomings’. Nevertheless, photography is still a relatively under-utilised approach in research with learners in school-based compulsory education and its use is not widespread globally. Against the background of the history of visual and photographic methods in general and in education in particular, this article highlights two key themes in the empirical research literature: why the photographic method is used (dealing with representation, participation and emancipation); and how the photographic method and the photos themselves are used (pre-generated and participant-generated photographs). It closes with a reflection on what may be holding back its expansion, including key ethical concerns, and a proposal for encouraging its use in education.

A TYPICAL WEEK WITH MILD COGNITIVE IMPAIRMENT: A PHOTO-ELICITATION STUDY

Mild cognitive impairment (MCI) is an important precursor to dementia syndromes and carries with it both public and personal health significance, yet affected individuals may experience stigma, fear, and reluctance to participate in research or access services. Identifying the experience of people with MCI may help develop research agendas, interventions, and other supports to better match patients’ needs. To this end, we conducted photo-elicitation interviews with 11 community-dwelling adults aged 57-79 years with diagnosed MCI. Interviews took place remotely using teleconferencing software to reduce access barriers. Each semi-structured interview used 5-10 participant-generated photographs to elicit the experience of living with MCI, barriers to daily activities, and facilitators and supports. Interviews were transcribed, coded, and analyzed using Dedoose software. Qualitative analysis revealed themes of important activities, including physical activity, social engagement, and cognitive stimulation. Barriers presented by MCI included difficulty with former routines (e.g., cooking, finances), reduction of activities, and perceived stigma or fear of disclosure. Facilitators of daily activities included increased use of new strategies and environmental supports (e.g., calendars, smartphones), in addition to social and familial support. Multiple participants noted that the diagnosis of MCI led to opportunities for inner reflection and seeking a sense of inner calmness. Incorporating participant-generated images aided in data collection and facilitated discussion of sensitive topics with a cognitively impaired sample. Clinicians and researchers should support engagement in meaningful activities, assess barriers to important daily activities, and consider support to match the experience and needs of those with MCI.

Palliative care nurses' strategies when working in private homes-A photo-elicitation study.

To explore palliative care nurses' work experiences caring for patients at the end of life in private homes. The home continues to be a desired place for care and dying; however, professional competence is needed and specialist palliative care nurses play a crucial role, often highly valued by patients and their family members. The private home as a physical work environment for nurses is explored, with both positive and negative aspects being described. To ensure future high-quality end-of-life care, there is a need to describe how palliative care nurses work in private homes. Interpretative descriptive. Participant-generated photographs were used in conjunction with follow-up interviews with ten palliative home care nurses. Interpretive description was used for analysis. This study follows the COREQ checklist. The analysis process resulted in four constructed themes, presented here as strategies used by palliative care nurses: adjusting interactions and actions depending on the environment when entering each unique private home; supporting patients and family members in finding a balance between self-care, independence and safe care; guiding patients and family members towards and through environmental changes supporting end-of-life care at home; and using transitions between homes to reflect, recuperate and prepare. Working as a palliative care nurse in private homes clearly requires a variety of skills and competences, here operationalised in different strategies used to promote high-quality care. Palliative care nurses' considerations, insights and competence when performing end-of-life care in the diverse environments of private homes can contribute to the development of clinical practice. Knowledge about strategies can be used in nursing practice during everyday work, in nursing education and in the organisation of care, and can inform policy to ensure future high-quality palliative home care.

Women's voices made visible: Photovoice in visual criminology

The voices of women subject to the criminal justice system are often ignored and unheard. This article considers the effectiveness of photovoice, a form of participatory photography research, as a visual method of enabling and communicating marginalised women’s experiences in criminological research. By utilising the potentially empowering technique of photovoice in two research projects, the narratives of women who inject drugs in Hungary and women who have experienced supervision in England are conveyed through their own participant-generated photographs. These images convey the pains and aspirations of the participants' lives and show how photovoice is a useful method for visual criminological research and exposes the shared problems faced by two vulnerable populations across two countries in Europe.

From photographs to findings: visual meaning-making and interpretive engagement in the analysis of participant-generated images

Although the use of visual research is gaining increased acceptance, there remains a lack of attention directed to how to rigorously analyse visual images. A framework of ‘interpretive engagement’ is proposed to describe analytic processes for meaning-making of participant-generated visual images. The ‘interpretive engagement’ framework comprises three stages of meaning-making; these are meaning-making through participant engagement (Stage 1), through researcher-driven engagement (Stage 2), and through re-contextualising (Stage 3). These three stages on their own are limited, but in combination provide rich and comprehensive visual analysis. The ‘interpretive engagement’ framework involves five key elements, namely, the researcher, the participant, the image and the context of its production and the audience/s. Each plays a significant role, contributing to the overall analysis. To illustrate the framework, a research example using participant-generated photographs from young people with chronic illness is used. This enables the visual analytic work we advocate to be evident and tangible for the reader, illustrating how interpretive engagement can support the development of substantive findings. Although multifaceted, we argue this analytic framework is predominantly researcher-driven with an emphasis on close inspection and engaging with the details of each image to determine overarching elements of the images as a collection. It involves systematically and deliberately interpreting the material followed by articulation of an analytic story which accommodates participant intentions, researcher interpretations, theoretical underpinnings and emerging knowledge claims. Implementation of this interpretive framework offers the potential for rich and thorough visual analysis and interpretations.

Use of Participant-Generated Photography in a Research Contribution Course

This paper describes the use of small, qualitative studies focused on interviews done with participant-generated photographs as an effective and efficient way of teaching research to entry-level masters students. A comparison of using time-use diaries vs. participant-generated photography is presented to explicate the research process and demonstrate the advantages of using photography, including ease of data collection and data sharing. Over a three-year period of using participant-generated photographs as a guide for semi-structured interviews, students have consistently expressed enjoyment of the research process and increased empathy with their research participants.

Use of Participant-Generated Photographs versus Time Use Diaries as a Method of Qualitative Data Collection

A small qualitative research study was chosen as a time efficient way to allow students to participate in and complete a research project during a 16-week long semester course. In the first year of the research contribution course, student researchers asked participants with diabetes to complete time use diaries as a part of their initial data collection. The time use diaries were found to be an ineffective way to collect data on self-management of diabetes and were not useful as a basis for subsequent interviews with the participants. A review of the literature suggested reasons for this lack of effectiveness; in particular, participants tend not to record frequently done daily activities. Further review of the literature pointed toward the use of participant-generated photography as an alternative. Subsequent participants were asked to take photographs of their daily self-management of their diabetes for initial data collection. These photographs provided a strong basis for subsequent interviews with the participants. A comparison of the data collected and the emergent themes from the two different methods of initial data collection demonstrated the improved ability to answer the original research question when using participant-generated photography as a basis for participant interviews. The student researchers found the use of participant-generated photographs to elicit interviews with participants in the context of a research contribution course to be effective and enjoyable.

‘Show me what health means to you!’–Exploring children’s perspectives of health

School health promotion aims to empower children to gain control over and improve their health. In contrast to many health promotion activities in schools focussed on predefined health issues, giving children a voice to define their own health needs is in itself an empowering process. Utilising a photography methodology, this research aimed to capture children’s perspectives of health in a New Zealand primary school by giving them an active voice. This qualitative research inquiry included participant-generated photographs, individual interviews, and a focus group, with six participants aged 8-10 years of mixed gender. Results showed that children held a variety of health concepts, but centred on ‘healthy’ activities and food. Energy and fun were key motivators, and availability of ‘unhealthy’ food was the main barrier to being healthy. Teachers engaged in ‘healthy’ activities, and school policies prompted ‘healthy’ actions from participants. This research suggests that children are competent and knowledgeable in expressing their views, and can be involved in the development of school programmes and policies. This bottom-up research inquiry was consistent with a democratic, participatory approach in health promotion, with the children in this study feeling empowered to reflect on what health meant to them.

The Experience of Transition from Hospital To Home Hospice: Unexpected Disruption (768)

1.Describe the lived experience of patients and families transitioning from hospital to home hospice care in the Midwest.2.Explore the feasibility of qualitative research methods and photography in a hospice setting. Little is known about the complex and unique challenges associated with the transition between hospital dismissal and onset of hospice services from the patient/family perspective. The specific aim of this phenomenological study was to describe the lived experience of patients and families transitioning from hospital to home hospice care. 19 patient and family units transitioning from hospital to home hospice care in the Midwest participated in this study. They photographed objects, people, and events during the hours or day(s) of this transition. Semi-structured interviews occurred usually one day after the first home visit by hospice personnel. Data collection and analysis were concurrent, using validated transcripts and field notes, coded with NVivo software. Patients and families experienced Unexpected Disruption during the transition from hospital to home hospice, due to lack of clarity regarding hospice, their scramble to get ready, and issues related to the sense of “open house” once they arrived home. Their scramble to get ready included the procurement and placement of a hospital bed in the home if needed, obtaining medications and finalizing the medication regimen. Participant-generated photographs highlighted and supported the study themes. In this study, most families were uncertain about what hospice care would entail. There were disruptions in their lives at home and in their preconceived expectations about hospice. Additionally, the full transition experience may extend beyond the initiation of hospice care.