Our community in focus: the use of photovoice for youth-driven substance abuse assessment and health promotion

The successful development and implementation of prevention curricula requires seeking strategies that combine the strengths of researchers and community members. Because young people are considered to be the experts in their own lives, it is important to determine effective ways to engage them in substance abuse assessment and prevention initiatives. The community-based participatory action research methodology of photovoice is one way to engage youth in assessment of this public health issue. "Our Community in Focus" was a project that used the photovoice methodology to engage high school youth in a community-based assessment of adolescent substance use and abuse. Through the photovoice method, youth were able to reflect their community's strengths and concerns with regards to adolescent substance abuse, as they took photographs to answer the question "What contributes to adolescents' decisions to use or not to use alcohol and other drugs?" The youth and the community were highly receptive to the project and its methodology, and photographs taken by photovoice participants presented a compelling argument for action.     

Family,Maternal, and Child Health Through Photovoice

OBJECTIVE: (1) To introduce photovoice, a participatory action research methodology, for use by MCH program managers to enhance community health assessments and program planning efforts, (2) to enable community people to use the photovoice methodology as a tool to record, reflect, and communicate their family, maternal, and child health assets and concerns, and (3) to educate community leaders about family, maternal, and child health issues from a grassroots perspective. METHODS: Photovoice is based upon the theoretical literature on education for critical consciousness, feminist theory, and community-based approaches to documentary photography. Picture This Photovoice project took place in Contra Costa, an economically and ethnically diverse county in the San Francisco Bay area. Sixty county residents of ages 13-50 participated in 3 sessions during which they received training from the local health department in the techniques and process of photovoice. Residents were provided with disposable cameras and were encouraged to take photographs reflecting their views on family, maternal, and child health assets and concerns in their community, and then participated in group discussions about their photographs. Community events were held to enable participants to educate MCH staff and community leaders. RESULTS: The photovoice project provided MCH staff with information to supplement existing quantitative perinatal data and contributed to an understanding of key MCH issues that participating community residents would like to see addressed. Participants' concerns centered on the need for safe places for children's recreation and for improvement in the broader community environment within county neighborhoods. Participants' definitions of family, maternal, and child health assets and concerns differed from those that MCH professionals may typically view as MCH issues (low birth weight, maternal mortality, teen pregnancy prevention), which helped MCH program staff to expand priorities and include residents' foremost concerns. CONCLUSIONS: MCH professionals can apply photovoice as an innovative participatory research methodology to engage community members in needs assessment, asset mapping, and program planning, and in reaching policy makers to advocate strategies promoting family, maternal, and child health as informed from a grassroots perspective.     

Engaging youth through photovoice

The photovoice process aims to use photographic images taken by persons with little money, power, or status to enhance community needs assessments, empower participants, and induce change by informing policy makers of community assets and deficits. This article describes a youth photovoice project implemented in an after-school program that attempted to adapt the photovoice method to youth participants, test the effectiveness of the method with youth, and develop and refine a curriculum for replication. A process such as photovoice provides youth the opportunity to develop their personal and social identities and can be instrumental in building social competency. Youth should and need to be given the opportunity to build and confirm their abilities, to comment on their experiences and insights, and to develop a social morality for becoming a positive agent within their communities and society. For more examples of photos taken by the youth during this project, visit http://www.jhsph.edu/youthphotovoice.     

The minigrant model: a strategy to promote local implementation of state cancer plans in Appalachian communities

East Tennessee State University (ETSU) was awarded a grant through an interagency agreement between the Centers for Disease Control and Prevention and the Appalachian Regional Commission to promote cancer control activities between state comprehensive cancer control (CCC) coalitions and local Appalachian communities. We invited representatives from CCC coalitions and Appalachian communities to a forum to develop a plan of action. The attendees recommended a minigrant model that uses a request for proposals (RFP) strategy to encourage CCC coalitions and Appalachian communities to collaboratively conduct forums and roundtables locally. They set criteria to guide the development of the RFPs and the agendas for the roundtables and forums that ensured new communication and collaboration between the CCC coalitions and the Appalachian communities. We established the roundtable agenda to focus on the presentation and discussion of state and local Appalachian community cancer risk, incidence, and death rates and introduction of state cancer plans. The forums had a more extensive agenda to present cancer data, describe state cancer plans, and describe successful cancer control programs in local Appalachian communities. This article describes the ETSU minigrant model that supports forums and roundtables and reports how this strategy improves cooperative partnerships between CCC coalitions and Appalachian communities in the local implementation of state cancer plans in Appalachia.     

Peer Reviewed: The Minigrant Model: A Strategy to Promote Local Implementation of State Cancer Plans in Appalachian Communities

East Tennessee State University (ETSU) was awarded a grant through an interagency agreement between the Centers for Disease Control and Prevention and the Appalachian Regional Commission to promote cancer control activities between state comprehensive cancer control (CCC) coalitions and local Appalachian communities. We invited representatives from CCC coalitions and Appalachian communities to a forum to develop a plan of action. The attendees recommended a minigrant model that uses a request for proposals (RFP) strategy to encourage CCC coalitions and Appalachian communities to collaboratively conduct forums and roundtables locally. They set criteria to guide the development of the RFPs and the agendas for the roundtables and forums that ensured new communication and collaboration between the CCC coalitions and the Appalachian communities. We established the roundtable agenda to focus on the presentation and discussion of state and local Appalachian community cancer risk, incidence, and death rates and introduction of state cancer plans. The forums had a more extensive agenda to present cancer data, describe state cancer plans, and describe successful cancer control programs in local Appalachian communities. This article describes the ETSU minigrant model that supports forums and roundtables and reports how this strategy improves cooperative partnerships between CCC coalitions and Appalachian communities in the local implementation of state cancer plans in Appalachia.     

Photovoice ethics: perspectives from Flint Photovoice.

Photovoice is a participatory health promotion strategy in which people use cameras to document their health and work realities. As participants engage in a group process of critical reflection, they may advocate for change in their communities by using the power of their images and stories to communicate with policy makers. In public health initiatives from China to California, community people have used photovoice to carry out participatory needs assessment, conduct participatory evaluation, and reach policy makers to improve community health. This article begins to address ethical issues raised by the use of photovoice: the potential for invasion of privacy and how that may be prevented; issues in recruitment, representation, participation, and advocacy; and specific methodological techniques that should be used to minimize participants' risks and to maximize benefits. The authors describe lessons learned from the large-scale Flint Photovoice involving youth, adults, and policy makers.     

Partnering with communities to improve health: The New York City turning point experience

Concurrent with the New York City Department of Health’s reorganization efforts, the Robert Wood Johnson and W.K. Kellogg Foundations launched Turning Point, a national initiative designed to strengthen the nation’s public health system. The Turning Point initiative has emphasized broad-based partnership building and planning as key prerequisites for improving public health practice. In response to the foundations’ request for proposals, the department formed a New York City Public Health Partnership, which in turn applied for and was granted a Turning Point planning grant. This funding allowed New York City Turning Point to initiate a public health planning process, part o f which involved convening forums in each of the five boroughs. With over 1,100 community participants, these forums provided both a starting point for establishing public health priorities and an interactive setting for sharing health and demographic data. Included among the issues that emerged as priorities were: access to care, environmental health, mental health, housing, asthma, education, and dietary issues. Building on the forum outcomes, the New York City Public Health Partnership developed a public health system improvement plan. The goals delineated in this plan are: (1) to create and support public health partnerships at the community, borough, and citywide levels; (2) to identify community health concerns and develop strategies responsive to these concerns; and (3) to develop policies to support and sustain a community health approach to improve health status. This article also discusses possible roles for local health departments in promoting a community health approach to address public health concerns.     

Visions and Voices: indigent persons living with HIV in the southern United States use photovoice to create knowledge, develop partnerships, and take action

Little is known about the experiences of persons living with HIV/AIDS (PLWHA) in some regions of the United States that are disproportionately affected by HIV/AIDS. "Visions and Voices: HIV in the 21st Century" was an exploratory study to gain insight into the life experiences of 15 indigent PLWHA. The study used photovoice to uncover the realities of living with HIV/AIDS though photographic documentation and Freirean-based critical dialogue and facilitate a process for PLWHA to reach local community members and leaders, policy makers, and advocates to develop plans of action and effect change. From the participants' photographs and words, seven themes emerged and were presented during a community forum. Three main outcomes occurred, including a participant-developed and locally funded gallery exhibition to address HIV/AIDS misinformation and stigma; a new partnership with the public health department to use PLWHA in their prevention programming; and increased community efforts to address substance use.     

Dialogue to deliberation: expanding the empowerment education model

OBJECTIVE: To explore the importance of a theoretical framework, the Empowerment education model (EEM), that can be used in participatory research. A deliberative project in one community in eastern Kentucky exemplifies the use of the EEM in participatory research. METHODS: Research techniques include surveys, focus groups, community forums, and photovoice. RESULTS: This project presents preliminary evidence that participatory projects might benefit if the dialogue phase of the EEM is followed by a deliberative phase. CONCLUSION: The theoretical underpinnings of the EEM could be expanded to include dialogue and deliberation in participatory efforts.     

Emotions and Ethical Considerations of Women Undergoing IVF-Treatments

Women who suffer from fertility issues often use in vitro fertilization (IVF) to realize their wish to have children. However, IVF has its own set of strict administration rules that leave the women physically and emotionally exhausted. Feeling alienated and frustrated, many IVF users turn to internet IVF-centered forums to share their stories and to find information and support. Based on the observation of Dutch and Greek IVF forums and a selection of 109 questionnaires from Dutch and Greek IVF forum users, we investigate the reasons why users of IVF participate in online communities centered on IVF, their need for emotional expression and support, and how they experience and use the information and support they receive through their participation in the online community. We argue that the emotional concerns expressed in such forums should be taken into account by health care ethics committees for IVF-related matters in order to promote more patient-oriented care and support for women going through IVF.     

Public involvement. Contributory factors

A joint project involving a community health council, primary care trust and GPs identified more than 100 people keen to become involved in local services. The venture has led to a shadow patients' forum being set up. GPs and practice managers have proved important in involving the local population.     

Photovoice as a social process of critical consciousness

The reluctance of some communities to participate in research and researchers' lack of penetration into the community are major stumbling blocks to successful community-based approaches. The authors'purpose is to determine how a photovoice project in a lower income, African American, urban community was able to generate a social process that resulted in active grassroots participation in a community-campus partnership. Through this partnership initiative, the authors asked neighborhood residents to take photographs of things in the community of which they were proud and the things they wanted to change, and to tell the story of why these were important. The authors used strategies from visual anthropology to analyze the 54 photographs, stories, and dialogue produced. Their analysis identified three distinct levels of cognitive-emotional interpretations that moved participants out of helplessness toward authentic engagement and participation. The authors discuss implications and lessons learned for community-based participatory research.     

Engaging communities to improve mental health in African and African Caribbean groups: a qualitative study evaluating the role of community well‐being champions

Over the last decade, Britain has undergone reforms to promote engagement in local structures of governance. These reforms have encouraged the promotion of active citizenship and have been central to the government's public service modernisation agenda. This article presents the findings from a study evaluating a pilot outreach intervention which adopted a community engagement model to address the mental health needs of African and African Caribbean groups, which entailed a partnership between faith‐based organisations, local public services and community organisations to co‐produce the pilot project. Lay people were trained to raise awareness about mental health among these communities in South London. Between 2012 and 2013, a qualitative participatory approach was used to evaluate the pilot project, which enabled a researcher to take part in the engagement phase of the pilot project, and the project co‐ordinators to be involved in the research process. Semi‐structured, one‐to‐one interviews were carried out with 13 community and well‐being champions (CWBCs) recruited from African and African Caribbean communities (seven male and six female). This study examines the impact of the relationship between the intervention and community through the participants’ engagement in the pilot outreach project and the action undertaken as champions. We found that although CWBCs used circles of influence to share ideas about mental health and well‐being and to encourage change, they encountered resistance on the part of the people they engaged with, which resulted from a lack of knowledge about mental health, taboos and ascribed stigma. We argue that CWBCs acted as healthy examples to communicate mental health knowledge to those approached, but that they needed to be equipped with bespoke communication skills to be able to talk about such sensitive issues as mental health.     

The impasses of unconditional poverty: the experience of Collective Ombudsman in the Leopoldina region, Rio de Janeiro (RJ, Brazil)

The experience of Collective Ombudsman developed in the Leopoldina region, city of Rio de Janeiro, enlarges the traditional vision of health vigilance and consists in organizing a system of qualitative evaluation of the sanitary vigilance able to identify the health problems of the population and the methods utilized in the attempt to overcome these problems. Health professionals, religious and community leaders congregated in monthly forums to present and discuss living conditions perceived in the communities in which they carry on their activities. From the point of view of the social dimensions involved in the health-illness processes, this work aims to discuss the way that poverty compromises the popular classes' health, especially for the mental health and the "diffuse suffering". The methodology allowed us to organize, in a systematic way, the listening and favored the recognition of local knowledge, constructed from the life experiences of the people who deal with the suffering, the illness and their determinants on the life conditions of the poor population. The precarious living conditions for a significant part of the population were perceived as generating impasses in the resolution of their health problems. The results point towards the importance of understanding the health problems of the population, the resources utilized to face them and proposals for possible solutions in the field of health.     

Participant Recruitment to a Randomized Trial of a Community-Based Behavioral Intervention for Pre- and Interconceptional Women: Findings From the Central Pennsylvania Women''s Health Study

BACKGROUND: Community-based health studies rely on the ability of researchers to successfully recruit and retain participants from target populations, rather than from clinical settings. Many prior women's health studies have recruited in urban and suburban areas, but rural populations pose specific challenges. We describe the recruitment strategies employed in the Central Pennsylvania Women's Health Study to recruit 692 women in 15 low-income rural communities to a randomized trial of a behavioral intervention for pre- and interconceptional women. METHODS: The organization of the project is described. Qualitative (e.g., focus groups of local project facilitators) and quantitative methods (e.g., surveys of participants) were used to assess the effectiveness of various recruitment techniques and the characteristics of the final enrolled sample. RESULTS: A triangular recruitment approach was used in 15 communities, which included partnering with local community organizations and use of both active and passive recruitment techniques. The most effective recruitment methods were (1) actively recruiting women in social service and childcare settings, (2) use of a toll-free project telephone number printed on all passive recruitment material, and (3) the combination of passive and active recruitment in educational settings. Together, these methods successfully achieved the recruitment goals: enrolling participants who were more likely to be rural, poor or near poor, non-white, and to have less access to health care than their counterparts residing in the target communities. CONCLUSIONS: Successful recruitment of typically hard-to-reach women, such as low-income rural women, is possible through implementation of a triangular recruitment approach in local communities.     

Citizens’ Perspectives on Disinvestment from Publicly Funded Pathology Tests: A Deliberative Forum

BackgroundDeliberative forums can be useful tools in policy decision making for balancing citizen voice and community values against dominant interests.ObjectiveTo describe the use of a deliberative forum to explore community perspectives on a complex health problem—disinvestment.MethodsA deliberative forum of citizens was convened in Adelaide, South Australia, to develop criteria to support disinvestment from public funding of ineffective pathology tests. The case study of potential disinvestment from vitamin B₁₂/folate pathology testing was used to shape the debate. The forum was informed by a systematic review of B₁₂/folate pathology test effectiveness and expert testimony.ResultsThe citizens identified seven criteria: cost of the test, potential impact on individual health/capacity to benefit, potential cost to society, public good, alternatives to testing, severity of the condition, and accuracy of the test. The participants not only saw these criteria as an interdependent network but also questioned “the authority” of policymakers to make these decisions.ConclusionsCoherence between the criteria devised by the forum and those described by an expert group was considerable, the major differences being that the citizens did not consider equity issues and the experts neglected the “cost” of social and emotional impact of disinvestment on users and the society.     

Flint Photovoice: community building among youths, adults, and policymakers

Flint Photovoice represents the work of 41 youths and adults recruited to use a participatory-action research approach to photographically document community assets and concerns, critically discuss the resulting images, and communicate with policymakers.At the suggestion of grassroots community leaders, we included policymakers among those asked to take photographs. In accordance with previously established photovoice methodology, we also recruited at the project's outset another group of policymakers and community leaders to provide political will and support for implementing photovoice participants' policy and program recommendations.Flint Photovoice enabled youths to express their concerns about neighborhood violence to policymakers and was instrumental in acquiring funding for local violence prevention. We note salutary outcomes produced by the inclusion of policymakers among adults who took photographs.     

Developing healthy local communities at local government level: lessons from the past decade

Abstract: There have been many approaches by the health sector to developing healthy communities based on local government areas in Australia in the past decade. Each has struggled with the need to establish realistic goals and to find ways of working more effectively with local government. This paper outlines four of these approaches–Healthy Cities, the Healthy Localities project, municipal health plans, and programs to address specific health problems or issues. Although the picture is one of huge diversity in the ways in which the issue is defined and action taken, a number of dimensions to a healthy community are emerging. However, if we are to be able to monitor change within and between the health of communities over time, indicators need to be developed and goals set. This will require a shift away from defining goals and targets in terms of populations (people), towards goals based on changes in organisations and systems. Engaging local government in this process will be vital and will require the health sector to develop a better understanding of the ways in which local government defines its role in creating healthy communities. It will also involve learning from local government the strategies that they have found most effective in dealing with complex problems that require action at many levels.     

An exploratory study of canadian aboriginal online health care forums

Internet-based discussion forums provide access to health information and social support, and serve as a resource for others. This investigation analyzed health-oriented Aboriginal Internet discussion forum (Forum A; Forum B) conversations. The findings were framed with Nutbeam's model of health literacy. Discussions within Forum B were centralized around issues of political activism and advocacy regarding Aboriginal health care. Activity in Forum A encouraged the development of "virtual" social capital, with health care discussions providing a "just-in-time" model for health education. Members of Forum A functioned as a smoking cessation self-help group and as health educators. The Internet provided a venue for the dissemination of health information and also served as a virtual voice for lifestyle coaching, political action, community building, and advocacy.