PHOTOVOICE

PSY 802

METHOD
MIRIAM AQUINO -MALABANAN
PHOTOVOICE
METHOD
ORIGINS RATIONALE

Photovoice is a This research methodology has its roots in

qualitative research community activism and advocacy where
methodology that first photos are used to influence social change.
came to prominence in By capturing the ‘harsh realities’ of a
the 1990s primarily as a research topic, the belief is that the issue at
result of the work of hand is less likely to be ignored. The focus

2
Caroline Wang. is very much on the visual rather than the
written.
WHAT IS PHOTOVOICE?

Photovoice is a type of participatory action research in which people –

usually those with little power – use photographs and/or video to picture
their environment and experiences and to express their thoughts about
them.

The goals of photovoice:

To provide a voice for To instill critical

To influence policy.
those who have none. consciousness.
WHY SHOULD YOU USE PHOTOVOICE?

The rewards of Photography is both

taking photographs fun and creative.
are immediate.

Taking photographs
or videos of familiar
scenes and people Basic photography is
can change easy to learn and
participants’ accessible to almost
perceptions about everyone.
their social and
physical environment.
WHY SHOULD YOU USE
PHOTOVOICE?

Pictures, by creating a
Images can be clear record of what
Policy makers can’t
understood exists at a particular
deny reality when it’s
regardless of point in time, can be
staring them in the
language, culture, or used to hold policy
face.
other factors. makers and others
accountable.
WHO SHOULD USE PHOTOVOICE?

People • Children and youth in difficult circumstances.

who lack a • Homeless adults and families.

• People with physical and mental disabilities or mental health issues.

voice in the • People with chronic diseases or medical conditions.

• Members of racial, ethnic, language, religious or cultural minorities.
• People whose way of life is threatened.
community • People who are discriminated against because of class, caste, way
of life, or poverty.

or society,
• The rural poor.
• People who live in difficult or unacceptable conditions and want to
change them.

including:
WHO SHOULD USE PHOTOVOICE?
Some types of • Schools and other organizations that
work with children and youth.

organizations • Orphanages, group houses, homeless

shelters, and other living situations for
those who need care.
that could • Organizations that work with people
whose needs and humanity are

benefit by commonly ignored.

• Community health centers and similar

using health providers.

• Organizations that serve people with
physical and mental disabilities or
photovoice mental health issues.
• Advocacy organizations or health and
with human service organizations that
include advocacy in their mission.

participants: • International aid and refugee

organizations.
 WHEN MIGHT YOU USE PHOTOVOICE?

When photovoice can

When change is
change people’s
When a group’s situation When a problem needs necessary, and
opinions about
needs to be publicized. to be publicized. photovoice can help
themselves and their
sway policy makers.
environment.

When you need to

When a community document the process of When you need to hold
assessment is needed or or gather data for an policy makers or others
in progress. evaluation of an accountable.
intervention or program.
HOW DO YOU USE PHOTOVOICE?
• Photovoice should
be a participatory,
collaborative
process from the
beginning.
General • Participants and
staff need training.
guidelines: • Participants need
support.
• The project should
result in some
action.
HOW DOES IT WORK IN PRACTICE?
Participants attend a briefing Participants are co-
session where the project is researchers because
explained. This session is led they take the
by the researcher and usually photographs and
with the help of an artist. They interpret their
are then provided with a meaning for
Participants then take pictures that the researchers. This
disposable camera
express their perspective on, views differs fundamentally
and information on how to use
about and feelings around a from traditional
it. Disposable cameras are research where the
Topic. The pictures are printed and
used as it helps participants power often lies
participants select a couple of
focus on the solely
images to use as a stimulus in a
images rather than the ability with the researcher.
group discussion. Discussion
to take many images which is
focuses
possible using digital cameras
on why the photographs were
or smartphones (although
chosen, what makes them
there is nothing to stop
meaningful and what participants
researchers using these
think
instead).

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about each other’s pictures. The
discussion is recorded and
transcribed.
RESEARCH
EXEMPLAR
Jih J, La Chica T, Antonio LM, Villero OO, Roque MN, Domingo JR,
Landicho JF, Napoles AM, Kaplan CP, Nguyen TT. Application of
Photovoice with Focus Groups to Explore Dietary Behaviors of Older
Filipino Adults with Cardiovascular Disease. J Health Dispar Res
Pract. 2018 Summer;11(2):133-149. PMID: 31745445; PMCID:
PMC6863513.

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RATIONALE
Filipino Americans have high rates of
cardiovascular disease (CVD) and
associated risk factors such as obesity,
diabetes and hypertension.
Using the World Health Organization
(WHO) Asian body mass index (BMI)
categories, the prevalence of
overweight/obesity in Filipinos is the
highest among Asian subgroups, exceeds
that of non-Hispanic Whites (NHW), and
similar to that of African Americans and
Latinos (Jih et al., 2014).
Diet is key to the prevention and
management of CVD and may be
modifiable through patient-
centered interventions. Cultural
beliefs and values affect both
dietary practices and perceptions of
how diet relates to CVD
To develop interventions
to reduce CVD among
Filipino Americans, there
is a need to
understand psychosocial
and cultural influences on
dietary choices in this
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population.
This community-based observational study
uses Photovoice-guided focus groups to
explore attitudes and beliefs of dietary
behaviors of Filipino Americans in San
Francisco, California.
Study Procedures.—Eligible participants attended
an orientation session held at the community
organization to complete a written survey in
English/Tagalog and then receive instruction on
Photovoice, which involved using a disposable
camera to depict their “food experience.” Food
experience was defined as daily dietary choices
and activities such as mealtime experiences,
grocery shopping and food preparation.
Recruitment.—Bilingual staff members from the
Veterans Equity Center recruited participants
through word-of-mouth and flyers posted at
the community center and community
locations such as churches and stores. Inclusion
criteria were a) self-identification as Filipino or
Filipino American; b) age 55-84; and c) self-
METHODS
report of having CVD or risk factors defined as
coronary artery disease, myocardial infarction,
heart failure,
angina, hypertension, hyperlipidemia,
diabetes, and stroke or transient ischemic
attack.
Participants were asked to take 2-3 photos daily in
a 10-day period. They returned the used camera 1
week prior to the focus group so that the film
could be developed prior to the group discussion
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Measures:
Written survey included questions about CVD
and medical history, socio-demographics, and
eating habits and opinions, including the 6-
item U.S. Adult Food Security Survey Module
Analysis:
Used an iterative, grounded theory approach to
analyze the transcripts.
Through this iterative process, they developed a
detailed codebook and their definitions.
Preliminary results were presented in a community
forum attended by study participants and
community organization staff. Feedback from this
community forum and from academic-community
research team meetings that included the coders
were discussed and incorporated in the iterative
refinement of the codebook
Focus Groups.—A total of 6 audio-recorded
focus groups, conducted primarily in
Tagalog and each 1.5 hours long, were
completed by an experienced bilingual
(English/ Tagalog) facilitator with the aid of at
least 1 bilingual research assistant.
METHODS
The academic community research team
participated in several meetings to discuss
themes, reach consensus and identify photos to
illustrate key themes presented in this manuscript.
Separate, structured content analysis of photos
was not conducted.
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Mean age of participants was 69.6
years old and 52.6% were female.
All were immigrants, residing in the
U.S., an average of 16.8 years. More
than half of participants reported LEP.
Almost two-thirds had at least a high
school diploma and about 75% of the
participants reported an annual
household income of less than
$30,000.
Mean self-reported BMI was 25.3
kg/m2 which is within the overweight
range as defined by the WHO Asian
BMI cut-points
Hypertension (89.5%), hyperlipidemia
(60.5%), and heart disease (31.6%)
were the most prevalent self-reported
CVDs. One-fourth of participants
reported a history of diabetes. Half
were food insecure.
Six themes influencing dietary behaviors, organized
by the socio-ecological framework,
were identified (Table 2). The themes are presented
from the macro- to micro-level factors according to the
framework: community-level, household-level, physical
environment, interpersonal-level and individual-level
factors.
RESULTS
The six identified themes were:
1) importance of traditional foods to Filipino cultural
identify (community-level);
2) cultural influences on health beliefs (community
level);
3) balancing household members’ dietary
preferences that conflict with a heart healthy diet
(household-level);
4) constraints of living environment and financial
resources (physical environment);
5) physician influence on changes in CVD health
behaviors (interpersonal-level); and
6) beliefs that traditional dietary practices increase
risk of CVD (individual-level).
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THE APPROACH
* It recognizes the need for more imaginative
STRENGTHS OF approaches.
•It utilizes the strengths of service users through
innovative participatory photography.
•Participants feel empowered and enriched by being
involved in a creative research project.
•To avoid fears such as ‘I can’t draw’, or ‘I’m not creative’
participants are supplied with the means of taking
photos.
•Participants learn new skills which enable them to tell
their stories and communicate these to each other and
the wider public.
•Photographs capture the lived experience of
participants and give insight and deeper understanding
about their world.
THE APPROACH
STRENGTHS OF •Visual images can be a powerful communication tool,
challenging stereotypes and providing a platform for more
intense and emotionally engaging reflection.
•Service users gain some distance from their ordinarily
routines and share taken-for-granted practical knowledge
•Visual images are a powerful way of enabling social
relations between the researcher and the individuals/group
being researched.
•Participants choose the most important images with
optional caption.
•Codes and themes emerge from the transcribed
discussions/ images using grounded theory method.
•Participants feel free to identify for themselves the captions
and the meanings they attached to those photographs.
CHALLENGES • This approach is sometimes viewed with suspicion as taking
photographs can be seen as invasive. Ethical approval necessarily
stressed the boundaries, which included no photographs of
people or identifiable places.
• Recruitment of participants was an issue and careful
explanation, and a supportive environment were required, as the
method is powerful, and participants can sometimes feel exposed
if not in a nurturing situation.
• Due to the time-lag between taking the photographs and the
focus groups sometimes the co-researchers were not available or
able to attend the focus group discussion, sometimes be cause of
the chaotic nature of their lives. This could be overcome by doing
all the working a one-day workshop format, but this would be a
very intensive and tiring experience for all involved.
REFERENCES Wang CC. Photovoice: a participatory action research strategy
applied to women's health. J Womens Health. 1999
Mar;8(2):185-92. doi: 10.1089/jwh.1999.8.185. PMID:
10100132.
https://files.eric.ed.gov/fulltext/EJ1250278.pdf
https://bmcpublichealth.biomedcentral.com/articles/10
.1186/s12889-018-5335-7
https://brill.com/view/journals/bire/2/1/article-
p136_136.xml?language=en
https://kaltura.uga.edu/media/t/1_wyvxl2cn
THANK mamalabanan@lpubatangas.edu.ph

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