Chapter 17: Photovoice

What is photovoice?

Photovoice was first conceptualised in the mid-1990s as a community based, participatory action research methodology (see Chapter 7). It is grounded in the use of photographs produced by participants.¹ Photovoice most often seeks to engage individuals and communities who are underrepresented in research. It uses visual imagery to understand the subjective experiences of vulnerable and marginalised people, in order to provide insights into their perspectives and the meanings they make about the world.¹ Engagement in the process of photography encourages photovoice participants to critically reflect on the issues and barriers they are confronted with, both individually and as part of their broader community; the visual image therefore becomes a symbolic representation of their lived experience.²

In their article first introducing photovoice, Wang and Burris outlined that the three main goals of photovoice are ‘(1) to enable people to record and reflect their community’s strengths and concerns, (2) to promote critical dialogue and knowledge about important community issues through large and small group discussion of photographs, and (3) to reach policymakers.’^1(p370) Put simply, photovoice offers an opportunity to promote critical conversations on the problems or barriers experienced by underrepresented communities. In doing this, the overarching objective is to build awareness of their needs, with the intention of advocating for social change at the policy level.

How has photovoice been applied in research?

Early research was primarily conducted within the context of public health and social justice.³ The first photovoice study sought to explore the reproductive healthcare needs and experiences of women living in Yunnan, China, to inform local healthcare quality improvement in rural communities.^1,4-6 Other early photovoice studies sought to understand the everyday life conditions of homeless people⁷, the family and maternal health concerns of community residents⁸, and young people’s concerns about community safety and neighbourhood violence.⁹ Since its conceptualisation by Wang and Burris¹, photovoice has been applied to explore concerns about social justice for underrepresented communities, including research in education¹⁰; civic engagement¹¹; disability and inclusion¹²; neurodiversity¹³; indigenous and First Nations communities¹⁴; gerontology and ageing¹⁵; mental health¹⁶; caregiving¹⁷; gender-based violence¹⁸; occupational therapy¹⁹; sustainability and climate change²⁰; and its continued use in public health more broadly.³ Table 17.3 provides an overview of two photovoice studies.

What are the steps involved in conducting a photovoice study?

Wang outlined nine core steps that are critical in conducting a photovoice study (Table 17.1).⁶ Since the first conceptualisation of photovoice, researchers have adapted, condensed and shifted the order of the steps involved in photovoice projects.²¹ The importance of continuing consultation with participants and community members at each stage of photovoice should be emphasised, and the protocol should be adapted accordingly to their needs.²² Participants in photovoice studies are often referred to as ‘co-researchers’, to reflect their active role in generating knowledge and directing social change.²³

Table 17.1. Wang’s nine steps in conducting a photovoice study

Step 1: Identifying policymakers

One of the main goals of photovoice is to communicate the lived experiences of underrepresented communities to policymakers who can mobilise social change.¹ Intentional action planning that extends beyond simple dissemination of research findings is therefore recommended.²⁴ A first step in influencing social and policy change is to identify a target audience of policymakers who can enact the desired change.⁶ Although researchers may initially conceptualise a photovoice project with a predetermined topic, and may also have an existing network of policymakers or a preconceived notion of whom the findings will reach⁶, the desired policy change and target audience are best selected and refined with full involvement of participants throughout the project.²⁵ Examples of policymakers who may be engaged in photovoice research include key stakeholders working across various levels of government, community service organisations, health departments or educational institutions.²⁴

Step 2: Recruiting participants

Purposive sampling is recommended as a starting point, to target specific groups who are likely to have the relevant knowledge, insights and experiences that relate to the research topic.²⁶ It is useful for recruitment to be coordinated by someone who already has a strong relationship with the community and can approach potential participants to gauge their interest.²⁵ A sample of 7 to 10 participants is often sufficient⁶; however, larger groups may also be recruited.³

Steps 3 and 4: Introducing the methodology and obtaining informed consent

Introducing the methodology typically involves an initial group ‘orientation’ meeting with the participants, to provide information about the photovoice methodology.⁶ Researchers must ensure that they communicate all aspects of the methodology, with a particular focus on the risks and benefits, intention to inform policy change and unique ethical considerations in photovoice.²⁷ In communicating these aspects, the researchers are also seeking informed consent. A broader discussion around obtaining informed consent can be found in Chapter 30; however, obtaining informed consent in photovoice research also involves ethical considerations specific to the use of visual imagery, including asking participants to (1) agree to participate in the research project; (2) give permission for the release of photographs (i.e. by signing photograph release forms); and (3) obtain consent from others who may appear in photographs (sought by the participant themselves).²⁸

Step 5: Posing an initial theme

In the initial meeting with participants, researchers should facilitate a discussion to brainstorm concepts and pose a specific question (or theme) to guide participants in taking their photographs.⁶ The themes that guide photography assignments need to be specific enough that they can be captured and represented in a photograph, yet broad enough that they can capture a diverse range of experiences.²⁵ In this space, the researcher can also facilitate conversation between participants on what they might want to capture in their photographs. It is imperative that participants’ ideas drive this discussion.

Step 6: Photography instruments and training

Appropriate training (as part of a group or one-on-one) is delivered to participants regarding how exactly they are going to be taking their photographs.⁶ Researchers need to consider which photography instruments to select, based on factors such as their advantages and disadvantages, available resourcing (i.e. funding) and technological literacy. Participants may be provided with:

• Disposable cameras – they are easy to learn and cost-effective; however, photographs cannot be reviewed before being developed.
• Digital cameras – these are reusable for future projects and capture higher-quality photographs than disposable cameras, but are more expensive and more complicated to use.
• Personal smart devices – there is no cost to researchers and minimal training is required; however, participants from resource-poor communities may not own such devices.

The amount of time spent training participants will vary according to the complexity of the selected instrument and participants’ familiarity with the device. The intention is to provide participants with training on only the most basic of camera operations, as priority is given to the meaning of the photograph rather than its quality.

Step 7: Time to take photographs

Once trained, participants are allocated a timeframe to capture their photographs (e.g. 2-3 weeks).⁶ This timeframe may be predetermined by the researchers; however, consulting participants to gauge the feasibility of the chosen timeframe is encouraged. It is also important to set expectations about:

• Checking in with the participant; that is, whether reminders will be sent, how frequently and in what format (e.g. text, email, phone call); offering additional time as needed; and finding out whether they are experiencing difficulties.
• Setting a maximum number of photographs to aim for; participants should be advised that only a limited number of photographs can be discussed and analysed.
• Sharing photographs and what methods they will use to do this. Participants may share photographs in real time (by text or email) or during their follow-up discussion.

Step 8: Discussing photographs

The focus of this step is to elicit the meaning that participants have attributed to their photographs and to understand the underlying message that they are intending to convey.⁶ In meeting the second primary goal of photovoice, researchers facilitate a discussion that encourages interaction between participants, similar to a focus group (see Chapter 14).¹ For example, the researcher might ask, ‘Did anyone else take a similar photograph or has anyone had a similar experience to what was just discussed?’. Separate to group discussion, some participants may prefer semi-structured interviews, but some level of group interaction is recommended, based on the photovoice methodology. The group dynamic contributes to a shared and collective representation of the community’s lived experience.²²

The SHOWeD technique is a commonly adopted line of questioning that researchers use at this stage (see Table 17.2).²⁹ This technique is applied for each photograph; however, participants may be asked to select only a small sample depending on the feasibility of discussing all photographs. At this stage, researchers are also encouraged to elucidate individual experiences by exploring how participants felt about participating, what they learned about themselves and their wider community, how they have (or will) apply the knowledge they gained and whether they encountered any challenges.³⁰

Step 9: Disseminating findings to policymakers

Researchers work closely with participants to develop recommendations to be communicated to policymakers.²⁵ The desired outcomes can range from improved efforts for advocacy, capacity-building initiatives, distribution of funding, development of interventions, community resourcing, accessibility of services and the introduction of new policies.²⁴ Lofton and Grant explored how photovoice studies have intentionally engaged in action planning, and common methods of dissemination have included public forums, exhibitions and galleries open to policymakers and the community; presentations to local organisations; meetings with key stakeholders; presentations at academic conferences; radio or television events; and social media campaigns.²⁴ It is also important to note that policy change is a time-consuming process that often requires additional data to adequately support the need for change, and continuing collaboration is needed between researchers, policymakers and the community following the conclusion of a project.⁸

Data analysis

The underlying principles of qualitative data analysis (see Section 4) apply similarly to photovoice studies; that is, data are transcribed, immersed, coded and themes generated. Visual data can introduce complexities to the process of analysis, and researchers may use triangulation between photographs, transcripts and other data sources (e.g. photograph titles, captions, journals, biographies, field notes).³¹ Capous-Desyllas and Bromfield sought to develop a practical guide for analysing photovoice data; they proposed that analysis involves ‘(1) a within-case analysis of each participant’s transcript, (2) a cross-case analysis comparing all of the participants’ transcripts together, and (3) creating visual art to gain a deeper understanding of the transcript data and corresponding photographs’.^31(p4) Depending on feasibility, resourcing and the target population, researchers may involve participants in codifying the data through analysis workshops.³²

Summary

Photovoice is a community based, participatory action research methodology that uses visual imagery to understand the subjective, lived experiences of underrepresented communities. The goal of photovoice is to inform social change through policy reform, by drawing attention to the collective needs and challenges faced by marginalised groups of people.

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