Chapter 17: Photovoice

Kostas Hatzikiriakidis

Learning outcomes

Upon completion of this chapter, you should be able to:

  • Know when it is most appropriate to use photovoice in qualitative research.
  • Understand the steps involved in conducting a photovoice study.
  • Create a study protocol for a photovoice project.


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

Steps Tasks
1 Select and recruit a target audience of policymakers or community leaders.
2 Recruit a group of photovoice participants.
3 Introduce the photovoice methodology to participants and facilitate a group discussion.
4 Obtain informed consent.
5 Pose an initial theme for taking pictures.
6 Distribute cameras to participants and review how to use them.
7 Provide time for participants to take pictures.
8 Meet to discuss photographs.
9 Plan with participants a format to share photographs and stories with policymakers or community leaders.

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

Table 17.2. The SHOWeD technique for eliciting meaning from photographs

SHOWeD Question
S What do you see here?
H What’s really happening here?
O How does this relate to our (your) lives?
We Why does this problem, concern, or strength exist?
D What can we do about it?

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


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.

Table 17.3. Characteristics of a select sample of photovoice studies

Title The challenges of managing diabetes while homeless: a qualitative study using photovoice methodology Yet we live, strive, and succeed: using photovoice to understand community members’ experiences of justice, safety, hope, and racial equity
First author and year Campbell, 2021 Wendel, 2019
Copyright CC BY NC 4.0 CC BY 4.0
Country Canada United States
Aim To explore and understand the challenges of managing diabetes from the perspectives of individuals with lived experience of homelessness To explore the common experiences and perspectives of community residents, to facilitate collective dialogue and action for social change in West Louisville, Kentucky
Participant characteristics People with lived experience of both diabetes and homelessness Community residents with diverse identities
Recruitment methods Community groups and posters displayed on community boards and in shelters Through local agencies, community organisers, community centres and civic groups.
Sample size 8 43
Photography instruments Point-and-shoot digital cameras Personal cellphones or digital cameras, or supplied disposable cameras
Photography training Training provided by a professional photographer and additional sessions to discuss ethical considerations Technical training on how to use a camera and training on ethics and safety
Discussing photographs

• SHOWeD method– participants first considered the questions individually, then reflected as a group

• Participants developed narratives for each of their photographs
• Adapted SHOWeD method– group dialogues with participants sharing stories about their photographs

• Participants selected or provided a narrative to accompany photographs
Analysis Inductive thematic analysis (themes discussed and decided with participants) Content and thematic analysis (participants involved in codifying photographs and reviewing themes)
Themes 1. Effects of homelessness on emotional and mental health and on diabetes self-management

2. Barriers to healthy eating in shelters

3. Benefits and challenges to diabetes management after getting housed

4. Access to diabetes care professionals and prescription medications
1. Systemic inequalities are apparent and oppressive

2. Those who have power in the city do not care

3. Despite the rest of the city’s ambivalence, Black lives and Black history matter

4. Collective community action is needed
Dissemination to
Photographs and narratives presented at a public exhibition held at a research institute, followed by exhibitions at scientific conferences and in public spaces across 8 locations in Canada (participants present to discuss photographs). Photographs and narratives presented at a 2-year exhibit open to the public (participatory opening event), and incorporation of the exhibit into local community meetings and events.


1. Wang C, Burris MA. Photovoice: concept, methodology, and use for participatory needs assessment. Health Educ Behav. 1997;24(3):369-387. doi:10.1177/109019819702400309

2. Harper D. Talking about pictures: a case for photo elicitation. Vis Stud. 2002;17(1):13-26. doi:10.1080/14725860220137345

3. Catalani C, Minkler M. Photovoice: a review of the literature in health and public health. Health Educ Behav. 2010;37(3):424-451. doi:10.1177/1090198109342084

4. Wang C, Burris MA. Empowerment through photo novella: portraits of participation. Health Educ Quart. 1994;21(2):171-186. doi:10.1177/109019819402100204

5. Wang C, Burris MA, Ping XY. Chinese village women as visual anthropologists: a participatory approach to reaching policymakers. Soc Sci Med. 1996;42(10):1391-1400. doi:10.1016/0277-9536(95)00287-1

6. Wang CC. Photovoice: a participatory action research strategy applied to women’s health. J Womens Health. 1999;8(2):185-92. doi:10.1089/jwh.1999.8.185

7. Wang CC, Cash JL, Powers LS. Who knows the streets as well as the homeless? Promoting personal and community action through photovoice. Health Promot Pract. 2000;1(1):81-89. doi:10.1177/152483990000100113

8. Wang CC, Pies CA. Family, maternal, and child health through photovoice. Matern Child Health J. 2004;8(2):95-102. doi:10.1023/B:MACI.0000025732.32293.4f

9. Wang CC, Morrel-Samuels S, Hutchison PM et al. Flint photovoice: community building among youths, adults, and policymakers. Am J Public Health. 2004;94(6):911-913. doi:10.2105/ajph.94.6.911

10. Ciolan L, Manasia L. Reframing photovoice to boost its potential for learning research. Int J Qual Methods. 2017;16:1-15. doi:10.1177/1609406917702909

11. Greene S, Burke KJ, McKenna MK. A review of research connecting digital storytelling, photovoice, and civic engagement. Rev Educ Res. 2018;88(6):844-878. doi:10.3102/0034654318794134

12. Macdonald D, Dew A, Boydell KM. Representation and knowledge exchange: a scoping review of photovoice and disability. J Appl Arts Health. 2019;10(2):185-201. doi:10.1386/jaah.10.2.185_1

13. Courcy I, Koniou I. A scoping review of the use of photo-elicitation and photovoice with autistic and neurodiverse people. Moving towards more inclusive research? Disabil Soc. 2022:1-22. doi:10.1080/09687599.2022.2137391

14. Hammond C, Gifford W, Thomas R et al. Arts-based research methods with indigenous peoples: an international scoping review. AlterNative: Int J of Indig Peoples. 2018;14(3):260-276. doi:10.1177/1177180118796870

15. Mysyuk Y, Huisman M. Photovoice method with older persons: a review. Ageing Soc. 2020;40(8):1759-1787. doi:10.1017/S0144686X19000242

16. Han CS, Oliffe JL. Photovoice in mental illness research: a review and recommendations. Health: Interdiscip J Soc Study Health Illn Med. 2016;20(2):110-126. doi:10.1177/1363459314567790

17. Illagan C, Akbari Z, Sethi B et al. Use of photovoice methods in research on informal caring: a scoping review of the literature. J Hum Health Res. 2020;1(3):1-14. doi:10.14302/issn.2576-9383.jhhr-20-3573

18. Christensen MC. Using photovoice to address gender-based violence: a qualitative systematic review. Trauma Violence Abus. 2019;20(4):484-497. doi:10.1177/1524838017717746

19. Lal S, Jarus T, Suto MJ. A scoping review of the photovoice method: implications for occupational therapy research. Can J Occup Ther. 2012;79(3):181-190. doi:10.2182/cjot.2012.79.3.8

20. Derr V, Simons J. A review of photovoice applications in environment, sustainability, and conservation contexts: is the method maintaining its emancipatory intents? Environ Educ Res. 2020;26(3):359-380. doi:10.1080/13504622.2019.1693511

21. Nykiforuk CI, Vallianatos H, Nieuwendyk LM. Photovoice as a method for revealing community perceptions of the built and social environment. Int J Qual Methods. 2011;10(2):103-124. doi:10.1177/160940691101000201

22. Liebenberg L. Thinking critically about photovoice: achieving empowerment and social change. Int J Qual Methods. 2018;17:1-9. doi:10.1177/1609406918757631

23. Seitz CM, Orsini MM. Thirty years of implementing the photovoice method: insights from a review of reviews. Health Promot Pract. 2022;23(2):281-288. doi:10.1177/15248399211053878

24. Lofton S, Grant AK. Outcomes and intentionality of action planning in photovoice: a literature review. Health Promot Pract. 2021;22(3):318-337. doi:10.1177/1524839920957427

25. Sutton-Brown CA. Photovoice: a methodological guide. Photogr Cult. 2014;7(2):169-185. doi:10.2752/175145214X13999922103165

26. Campbell S, Greenwood M, Prior S et al. Purposive sampling: complex or simple? Research case examples. J Res Nurs. 2020;25(8):652-661. doi:10.1177/1744987120927206

27. Hannes K, Parylo O. Let’s play it safe: ethical considerations from participants in a photovoice research project. Int J Qual Methods. 2014;13(1):255-274. doi:10.1177/160940691401300112

28. Wang CC, Redwood-Jones YA. Photovoice ethics: perspectives from flint photovoice. Health Educ Behav. 2001;28(5):560-572. doi:10.1177/109019810102800504

29. Wallerstein N, Bernstein E. Empowerment education: Freire’s ideas adapted to health education. Health Educ Quart. 1988;15(4):379-394. doi:10.1177/109019818801500402

30. Budig K, Diez J, Conde P et al. Photovoice and empowerment: evaluating the transformative potential of a participatory action research project. BMC Public Health. 2018;18(1):432. doi:10.1186/s12889-018-5335-7

31. Capous-Desyllas M, Bromfield NF. Using an arts-informed eclectic approach to photovoice data analysis. Int J Qual Methods. 2018;17:1-14. doi:10.1177/1609406917752189

32. Sitter KC. Taking a closer look at photovoice as a participatory action research method. J Prog Hum Serv. 2017;28(1):36-48. doi:10.1080/10428232.2017.1249243

33. Campbell RB, Larsen M, DiGiandomenico A et al. The challenges of managing diabetes while homeless: a qualitative study using photovoice methodology. Can Med Assoc J. 2021;193(27):E1034-E1041. doi:10.1503/cmaj.202537

34. Wendel ML, Jackson T, Ingram CM et al. Yet we live, strive, and succeed: using photovoice to understand community members’ experiences of justice, safety, hope, and racial equity. Collab: J Community-Based Res Pract. 2019;2(1):1-16. doi:10.33596/coll.23

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