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Abstract

The use of Photovoice methods to identify and address public health challenges has evolved since this participatory action research method’s inception in the 1990s. However, there is a notable lack of research on the dissemination of Photovoice findings to promote community action and change. This study evaluates audience and Photovoice participants’ experiences of dissemination events presenting the results of 21 Photovoice projects that supplemented the HEALing Communities Study (HCS), a multistate community-based study of strategies to reduce opioid overdose deaths. The Photovoice projects captured the perspectives of people with lived experience of substance use disorder and front-line providers regarding their communities’ responses to the opioid epidemic. This article describes the multiple artifact types and dissemination formats co-created by HEALing Communities Study researchers and Photovoice project participants to share photographs, captions, and insights. In addition, the study reports the evaluation results from attendees of more than 24 local, state, and national events that exhibited and presented on the Photovoice projects. These evaluations assessed whether attendees’ experiences at the events influenced their critical consciousness of and intention to act to address their communities’ concerns with substance use disorder. Respondents encouraged continued efforts to educate community members, especially policymakers, from the perspective of those most impacted by substance use disorder. Findings from the study suggest Photovoice dissemination events may encourage attendees to engage more deeply in public health topics such as the opioid addiction crisis, which supports the critical consciousness model for assessing community health change initiatives.

Keywords

photovoice substance use disorder policymakers community engagement dissemination evaluation opioid use disorder participatory action research empowerment

Background

Photovoice is a participatory action research method with the goals of (1) capturing community health assets and challenges, (2) promoting critical consciousness of the causes of problems, and (3) encouraging action and policy change (Wang & Burris, 1997). Researchers and practitioners have applied Photovoice methods to various health issues, although projects often have strayed from the participatory action research imperative of including participants in all research steps (Evans-Agnew & Rosemberg, 2016; Seitz & Orsini, 2022). Participatory analysis is an essential Photovoice element to facilitate identification of the key themes and priorities needed to guide dissemination activities (Liebenberg, 2022; Seitz & Orsini, 2022).

In addition, Photovoice participants as part of their project involvement should ideally co-design dissemination activities to share their photographs and findings with others, especially policymakers (Golden, 2020; Seitz & Orsini, 2022; Strack et al., 2022). Gallery-style displays of photography with captions are a traditional Photovoice dissemination method (Switzer, 2019). With digital technology, participants have almost infinite options for being involved in strategically defining target audiences they want to reach with Photovoice and developing multimedia dissemination tools, including but not limited to websites, digital stories, and social media (Teti & Myroniuk, 2022). Yet, evaluations of whether and how Photovoice projects achieve their goal of promoting action and policy change through exhibiting events that engage and influence intended audiences and decision-makers are lacking (Liebenberg, 2018, 2022; Mitchell, 2015; Seitz & Orsini, 2022). Fortunately, measurement tools are now available to empirically validate Carlson and colleagues’ critical consciousness framework for understanding how experiences with Photovoice move audiences from passive adaptation to their communities’ conditions to emotional and cognitive engagement with these issues, leading to change-making action (Carlson et al., 2006; Orsini et al., 2022).

In this study, we aim to evaluate how attendees engaged with Photovoice events and experienced multimedia dissemination strategies in terms of their alignment with the critical consciousness framework as well as the three original Photovoice goals. As part of the supplemental Photovoice protocol for the HEALing Communities Study (HCS), a randomized controlled trial designed to address the opioid epidemic (Balvanz et al., 2024), researchers convened Photovoice projects with participants including people with lived experience of substance use disorder (SUD) and front-line providers, facilitated photography and group discussion about the impact of the opioid epidemic on their communities, and worked with participants to co-design dissemination activities. This study describes the artifacts co-created by Photovoice participants and researchers for dissemination events and the evaluation of event attendees’ engagement with the multimedia Photovoice dissemination strategies. We present findings from analysis of survey data to assess how attendees’ experiences with Photovoice influenced their critical consciousness of concerns related to opioid overdose and recovery.

Method

Study Context and Participants

The HCS engaged 67 communities across four research sites, Kentucky (KY), Massachusetts (MA), New York (NY), and Ohio (OH), in the Communities That HEAL intervention from January 2020 to June 2023. The details of the HCS, including final outcomes, are reported elsewhere (The HEALing Communities Study Consortium, 2024). The intervention entailed multisectoral coalitions in each community selecting and measuring the impact of evidence-based practice strategies aimed at reducing opioid overdose deaths in selected communities. A state-level community advisory board comprising representatives from each HCS community coalition and staff from state agencies supported the research process (Sprague Martinez et al., 2020). In addition, a cross-site Intervention Working Group, including coalition members, researchers, local and state policymakers, and national-level advisors (National Institute on Drug Abuse/Substance Abuse and Mental Health Services Administration), provided study oversight.

In December 2021, three HCS researchers in KY, MA, and OH with Photovoice or qualitative research experience proposed the addition of an optional supplement using Photovoice to reach people with lived experience of SUD and front-line providers to obtain their perspectives on local barriers to and facilitators of addressing the opioid epidemic. The NY site declined to participate. Participating sites developed a shared protocol that allowed flexibility in completing Photovoice projects based on local contexts and intervention priorities while also supporting cross-site analysis to understand cross-cutting themes.

From January 2022 to December 2023, the HCS Photovoice research team—HCS researchers and HCS staff trained as facilitators—approached interested HCS-associated community coalitions and recovery centers to recruit participants based on similarities in roles and experiences. Project groups included Photovoice participants who were either primarily people with lived experience of SUD or front-line providers, although some (e.g., peer support specialists) identified with both roles (McGladrey et al., 2025). Each Photovoice project involved multiple sessions guided by a HCS facilitator to produce photography and captions, group photo discussion transcripts, and thematic analysis. Each project concluded with sharing analysis results and planning for dissemination events. This final session also involved participants’ consideration of which photographs best captured themes from photograph discussions and what captions should accompany selected photographs. The complete common HCS Photovoice protocol has been detailed elsewhere (Balvanz et al., 2024). The study was approved by Advarra Inc., the HCS single Institutional Review Board (Pro00038088).

Dissemination Materials and Events

During the final session, facilitators encouraged participants to present their project results to the community’s HCS coalition and the HCS state-level Community Advisory Board. The projects brainstormed other dissemination activities to share results using the protocol’s dissemination toolkit, including various artifact templates such as Microsoft PowerPoint presentation slides, printed posters for gallery displays, and postcards to distribute (Balvanz et al., 2024). In addition, facilitators helped projects creatively tailor templates or co-create artifacts based on their dissemination goals. A dissemination event refers to any activity, presentation, or gallery exhibit where the HCS Photovoice research team and/or Photovoice participants shared project(s) results with an audience. Audience is defined as those in attendance at events who had not contributed to the HCS Photovoice projects.

Dissemination Event Evaluations and Analysis

The HCS Photovoice research team designed an evaluation instrument for dissemination events (Supplement 1). The evaluation included multiple-choice and open-ended questions and prompts to capture demographic information (age, gender, race/ethnicity, education, role in the community, or connection to the opioid epidemic). Three prompts representing the foundational goals of Photovoice presented statements with Likert-type-scale responses from “strongly agree” to “strongly disagree.” This evaluation tool was designed to assess Photovoice method fidelity; data collection took place before the four-factor critical consciousness scale was published (Balvanz et al., 2024; Orsini et al., 2022). Additional questions qualitatively captured respondents’ experiences of events. Each site administered the anonymous evaluation as a paper survey or digitally (Qualtrics.com) during or immediately following dissemination events to audience members and Photovoice participant attendees. Each site compiled anonymized results before combining data across sites for analysis.

The HCS Photovoice research team conducted descriptive analysis of the data in Microsoft Excel and collapsed the Likert-type-scale responses into three categories: “agree” (from responses “somewhat agree,” “agree,” and “strongly agree”), “neither agree nor disagree,” and “disagree” (from responses “somewhat disagree,” “disagree,” and “strongly disagree”). The first author, with coauthors’ review, deductively coded the open-ended responses using the conceptual definitions from the four-factor critical consciousness scale for passive adaptation, emotional engagement, cognitive awareness, and intention to act (Orsini et al., 2022). For analysis of two-word responses describing attendees’ experiences, the research team used NVivo14 to capture the frequency of words to create a word cloud.

Results

There were 21 HCS Photovoice projects ranging from four to eight participants per group. Results include descriptions of the co-designed dissemination events, artifacts used, and analysis of evaluation data.

Dissemination Events Descriptions

From May 2022 to February 2024, the HCS Photovoice research team, often along with self-selected Photovoice participants, presented and exhibited projects at more than 24 in-person and virtual formal dissemination events that varied in format across communities (Table 1). Some events included presentations that ranged from 5-minute PowerPoint presentations of project topics, photographs, and captions during local HCS community coalition meetings to an hour-long interactive presentation of the Photovoice process and results. Some events involved more typical gallery exhibits where Photovoice participants presented their captioned photographs as posters. In others, such as the community art show, project participants exhibited the Photovoice project’s artifacts at tables or on stage.

Table 1

Information on Photovoice dissemination events.

Target audience—Site and location/Organization	Artifact display type	Number of Photovoice projects exhibited	Number of Photovoice project participant attendees	Approximate number of audience attendees^a
National HEALing Communities Study (HCS) Intervention Working Group—KY, MA, OH	Virtual PowerPoint presentation with project themes, photographs, captions	14	2	60
KY statewide HCS Community Advisory Board	In-person gallery posters of photographs and captions; postcards with photographs and captions	10	35	50
KY—Recovery Center Event	In-person table with postcards with photographs and captions	1	1	Unknown
KY—Community Agency for Substance Abuse Policy Coalition	In-person PowerPoint presentation of photographs, captions, and themes; postcards with photographs and captions	1	1	Unknown
KY Public Health Association	In-person PowerPoint presentation of photographs, captions, and themes; postcards with photographs and captions	1	3	20
KY—Recovery Center Event	In-person with table with postcards with photographs and captions	1	1	Unknown
MA Policymakers and visitors at State House	In-person gallery posters of photographs with quoted captions and poster board of opioid overdose statistics; one pagers on main findings from each community, speakers including State rep, MADPH commissioner, study PI, community members.	8	30	Over 100
Coalition members from six separate MA community meetings	Virtual PowerPoint presentation of primary barriers and facilitators mentioned during sessions, accompanied with photographs and representative quotes	One project per meeting (six meetings total)	Participant attendance depended on community	Over 100 (range from 15 to 30 per meeting)
MA—Community Art Show	In-person gallery display of photographs with explanatory quote from discussion	1	1	Unknown
MA—Public Library Event	In-person display of photographs with explanatory quote from discussion	1	1	50+
MA—Community Arts Walk	In-person stage presentation with posters	1	Multiple	Unknown bystanders
Coalition members from five separate OH community meetings	Hybrid (in-person and virtual) PowerPoint presentations themes, photographs, captions; gallery posters of photographs and captions	One project per meeting (five meetings total)	Participant attendance depended on community	Over 100 (range from 10 to 35 per meeting)
OH statewide HCS Community Advisory Board	Virtual PowerPoint presentation of themes, photographs, captions; interactive breakout activities; video montage	2	5	30
OH statewide governmental council—Recovery Ohio	In-person PowerPoint presentation themes, photographs, captions, video; gallery posters of themes, photographs, captions	2	2	13
OH—Mental Health Community Event	In-person gallery display of photographs and captions	1	1	75

Complete and accurate data on audience are limited due to the nature of some event formats (e.g., virtual presentations where audience attendance numbers were not available and events where attendees observed displays but did not necessarily interact with a HCS Photovoice team member or Photovoice participant).

We conducted initial dissemination events virtually due to the COVID-19 pandemic, although later presentations were hybrid or in-person. Most events were locally focused, where a single community-based Photovoice project shared results within their community or with their community’s HCS-affiliated coalition. Each site’s HCS Photovoice research team and some project participants presented results from multiple projects with broader, statewide audiences, such as the site’s Community Advisory Board. In addition, the research team and self-selected project participants presented early cross-site results to the HCS Intervention Working Group spanning all four HCS sites. In Table 1, we report the target audience, description of artifacts displayed, number of projects, number of project participant attendees, and approximate number of audience members at each formal event. We estimate more than 500 people attended HCS Photovoice dissemination events.

Dissemination Event Artifacts

Each dissemination event entailed at least one co-designed artifact type (Figure 1). All artifacts featured a combination of project photographs with associated captions and representation of broader themes or quotes transcribed from photograph discussions. Project participants and facilitators co-created artifacts as stand-alone, unattended gallery displays or to accompany informal or formal oral presentations and exhibits where the HCS research team and project participants interacted with the audience alongside the photographs.

Figure 1

Photovoice Project Artifacts and Dissemination Events

All three sites produced printed photographs with captions as gallery posters. In addition, each site used PowerPoint slides for presentation of results, photographs, and captions with virtual and in-person audiences. The KY Photovoice projects designed printed postcards to distribute at the statewide dissemination event and later circulated the postcards at local events. In MA, the Photovoice projects created a handout with general Photovoice information and findings, and each project designed a one-page brief describing their results and suggested action items. At the MA statewide dissemination event, audience members, including lawmakers, received these briefs. Individual MA projects displayed posters at community recovery centers, and five projects created books, with one distributing their book to more than 200 community members. The OH HCS Photovoice research team created videos of projects’ co-created themes, photographs, and captions. Videos were available on YouTube (youtube.com) for viewing during meetings or for distribution to those unable to attend.

Evaluation Results

From the 24 formal Photovoice dissemination events, 99 attendees, including project participants and audience members, responded to the evaluation by answering at least one question (Table 2). There were 78 attendees who reported their demographic information, most of whom were white (88.5%), women (70.5%), and had professional occupations (80.8%). Nearly 20% of respondents had at least one family member or friend who experienced SUD, and 16.7% of respondents self-identified as a person with lived experiences of SUD. More than half of the respondents were members of HCS-affiliated community coalitions. When answering questions about whether their experience at the dissemination event aligned with the original three goals of Photovoice, nearly 86% of respondents agreed that the Photovoice projects helped them understand the community’s concerns and strengths related to the opioid epidemic, and more than 91% agreed that the project made them think more critically about the opioid epidemic. Almost 90% of respondents agreed that the Photovoice projects increased their intention to act (Table 3). The most common words reported by the 86 respondents who shared at least one word describing their experience were “powerful,” “inspiring,” “impactful,” and “eye-opening” (Figure 2).

Table 2

Characteristics of attendees of Photovoice dissemination event who completed evaluation (N = 78)^a.

Category	n (%)
Age
18–44	29 (37.2%)
45–49	18 (23.1%)
50–64	23 (29.5%)
65 plus	5 (6.4%)
Missing	3 (3.8%)
Gender
Male	20 (25.6%)
Female	55 (70.5%)
Genderqueer	1 (1.3%)
Missing/Preferred not to answer	2 (2.6%)
Race/Ethnicity^b
African American/Black	7 (9.0%)
Asian, American Indian/Alaskan Native	2 (2.6%)
Hispanic/Latino/a	2 (2.6%)
White	69 (88.5%)
Missing/Preferred not to answer	3 (3.8%)
Connection to substance use disorder (SUD)^b
Professional/Professional in field	63 (80.8%)
Advocate	20 (25.6 %)
Family/Friend connection to SUD	15 (19.2%)
Personal lived/living experience of SUD	13 (16.7%)
Missing	5 (6.4%)
Member of a HEALing Communities Study community coalition
Yes	42 (53.8%)
No	28 (35.9%)
Not sure	5 (6.4%)
Missing	3 (3.8%)

Kentucky Photovoice participants (n = 21) were asked demographic questions during orientation not evaluation, so their demographics are not represented in this table.

Numbers do not add up to 100% as respondents could choose multiple categories.

Table 3

Responses to statements by Photovoice dissemination event attendees (Photovoice participants and audience) (N = 99).

Statement	Agreen (%)	Neither agree nor disagreen (%)	Disagreen (%)	Missing
The Photovoice project increased my intention to take action to raise awareness and advocate for policies to address the opioid epidemic and improve community health.	89 (89.9%)	3 (3.0%)	4 (4.0%)	3 (3.0%)
The Photovoice project helped me understand community strengths and concerns related to the opioid epidemic	85 (85.9%)	10 (10.1%)	1 (1.0%)	3 (3.0%)
The Photovoice project made me think more critically about how and why communities experience the opioid epidemic.^a	42 (91.3%)	1 (2.2%)	1 (2.2%)	2 (4.3%)

Ohio respondents (n = 53) were not asked this question and are not included in this data.

Figure 2

Word Cloud Visualization of Frequency of Words Reported by Photovoice Event Attendees Created in NVivo 14 (Lumivero.com)

Consistent with an evaluation of Photovoice project dissemination using the validated critical consciousness scale (Li et al., 2025), the 82 open-ended responses about the biggest takeaway from the events did not indicate passive adaptation among audience members, likely because attendees self-selected to participate in these events focused on community health. However, the other three domains of the critical consciousness framework—emotional engagement, cognitive awareness, and intention to act—were evident in attendees’ responses to the experience.

Emotional Engagement

Many attendees reported feeling emotionally moved by events. Some attendees focused on the “creativity,” “artistic” aspects, and “[p]assion of participants.” One respondent questioned, “A picture is worth 1,000 words?” and another that the event “[g]ives a voice that sometimes outweighs statistics.” Other responses focused on the emotions from seeing drug misuse and recovery from participants’ perspectives. For example, one respondent explained that “you could feel . . . all the emotions in the photos, and it really helps you to see a slice of their life through their eyes. helps to bring compassion and awarness [sic]. which I think and hope was the goal.” For some, the main emotion was captured in the word “hope.”

Cognitive Awareness

The responses from some attendees moved beyond emotional engagement to intellectual understanding of root causes of SUD that the Photovoice projects exposed, including the “complexity” of the problem at the community-level. A respondent shared, “Different communities are affected by the same thing, but in different ways.” Furthermore, respondents emphasized the systemic causes of the epidemic, as one noted, “The system is flawed in all aspects” and another recognized the “many ‘angles’ there are to the opioid epidemic and its impact/responses.” Some respondents understood that the complexity of SUD requires multilevel responses: “The interconnectedness of all parts of life—investment in communities, opportunities to enjoy life (through family, play, or work), and pathways toward regaining health—are all needed to combat addiction, of any substance.”

Intention to Act

Event experiences for some participants sparked desire for additional Photovoice dissemination, calls for community action, and individual intentions to act. Some of the respondents put the onus for action on the HCS to conduct additional Photovoice projects and events. For example, one respondent wrote, “Very impactful, how else can this be shared? Important to get this in front of others.” Some respondents wanted more dissemination to decision-makers, as in this comment: “Policy makers [sic] need to see this.” For others, they made a collective call to action, such as, “We must reduce stigma.” Finally, for some, they reported their own motivation to act, as this respondent shared: “That someone must step up and do something. It might as well be me, the/a person who lived the lifestyle.”

When asked what they might do because of attending the event, not all respondents had a concrete answer. Those that did said that they planned to share their experience with family, friends, or others within their organizations. A few respondents described specific actions, with one reporting, “I’m going to emphasize dental care in the MAT [medication for addiction treatment] center we just opened!”

Following the Photovoice dissemination events, we received anecdotal evidence that some policy and programmatic changes occurred. Transportation issues highlighted in one Photovoice project informed purchase of a vehicle driven by a recovery coach for appointments and gas cards for people during the reentry process. Dental issues displayed from another project led to the provision of toothbrushes to people on buprenorphine while incarcerated. Finally, a Photovoice participant leveraged a project’s photographs and quotes emphasizing a community’s dilapidated public basketball court to fund recreational infrastructure improvements.

Discussion

This study describes and evaluates dissemination events co-designed by project participants and researchers sharing artifacts from HCS Photovoice projects. The artifacts and dissemination event formats varied based on local contexts and project participants’ priorities. Results from dissemination event evaluations indicated that the Photovoice projects reached attendees working with and/or having prior personal experience of the opioid epidemic. Furthermore, responses suggested that attendees found dissemination efforts effective in increasing understanding and emotional engagement with SUD stigmatization by experiencing the viewpoints of those most impacted by it. This is similar to other studies that found social-contact-based education effective in reducing prejudice and stigma (Livingston et al., 2012). Findings qualitatively validate the interconnection of emotional engagement and cognitive awareness in inspiring intention to act in the critical consciousness framework (Orsini et al., 2022).

From the project’s inception, the HCS Photovoice research team aimed to fully realize the Photovoice goals of engaging participants in policy or practice change as Wang and Burris (1997) envisioned. Following recommendations for arranging dissemination strategies early in the process (Wang et al., 2000), the research team leveraged built-in connections to community and decision-makers through the HCS community coalitions, statewide Community Advisory Boards, and national policymakers, which may have limited full participant-guided dissemination decisions (Creighton et al., 2018; Smith et al., 2024; Sutton-Brown, 2014). However, participants determine how, where, to whom, and what to highlight in dissemination events. This participant-guided approach was a response to criticism that Photovoice projects often fail to achieve this level of participation beyond data collection (Evans-Agnew & Rosemberg, 2016; Golden, 2020) while being mindful of the ways Photovoice participation and disclosure may trigger vulnerability for people with lived experience of SUD (Smith et al., 2024; Teti & Myroniuk, 2022). As such, we attempted to balance encouraging dissemination within HCS, facilitating project participants’ creativity around virtual and more long-lasting dissemination ideas, and supporting the autonomy of participants to determine their involvement in every step of the Photovoice process, including options not to use their photographs or participate in dissemination events (Creighton et al., 2018; Smith et al., 2022).

This study also responded to critiques of the lack of participant engagement in dissemination (Gabrielsson et al., 2022) with the researcher–participant co-design of various artifacts and types of dissemination events. Although some have discussed the use and potential limitations of virtual platforms to collect Photovoice data (Breny & McMorrow, 2022; Call-Cummings & Hauber-Özer, 2021), little is known about the effects of virtual Photovoice dissemination events. Photovoice project participants attended virtual meetings where multimedia videos and PowerPoint slides enabled them to communicate results to a broader audience, such as during the national-level HCS meeting. In addition, the distribution and circulation of postcards, flyers, videos, and books allowed Photovoice participants to keep and share project artifacts with others beyond event audiences, increasing the likelihood of further dissemination (Mitchell, 2015).

Limitations

Our study attempted to use Photovoice projects to initiate policy and practice change and evaluate the impact of these projects on exhibit audiences (Liebenberg, 2018; Lofton & Grant, 2021; Mitchell, 2015; Seitz & Orsini, 2022). However, our evaluation was limited because Orsini and colleague’s (2022) four-factor critical consciousness scale was published after our data collection began so it could only inform qualitative coding definitions. In addition, despite anecdotal evidence of policy changes made because of event attendance, any actions inspired by the Photovoice experience happened after the evaluation; therefore, a linear dose–response relationship between Photovoice “exposures” and policy changes cannot be assumed. Further in-depth interviews or longitudinal study of decision-maker motivations and behavior is needed to understand how intentions to act inspired by experiences with constituents such as during Photovoice events translate into actual policy and programming proposals considering the complex political determinants of health that influence policymaking (Dawes et al., 2022).

We were unable to collect information on all dissemination activities that may have occurred, particularly informal sharing. In addition, we are unable to report evaluation response rates because of missing data on accurate attendance and lack of survey distribution at some events, so the results may be affected by selection bias. Unfortunately, because evaluations were anonymous, we are unable to identify which events the 99 respondents attended. Respondents who reported demographics were mainly homogeneous; thus, the sample does not represent the diversity of the communities where dissemination events took place. The timing of dissemination events and budgets for compensation for attending events did not allow every Photovoice project participant to attend events, particularly those who had child care or work responsibilities during daytime events that involved decision-makers. These constraints also limited the involvement of Photovoice participants in analysis of the data for the study.

Implications for Practice

Disseminating information to audiences who can act on it remains a major barrier in public health research attributed to inappropriate dissemination approaches (Brownson et al., 2018). The results of our study suggest that effective dissemination is possible with a participatory multimedia approach to engaging communities and decision-makers. However, the time, design expertise, and travel expenses for participants and practitioners to co-develop and co-deliver strategies to disseminate their Photovoice results to audiences, especially influential decision-makers, may be an additional burden for many Photovoice projects. For larger, well-resourced projects, we suggest the inclusion of health promotion specialists to support Photovoice dissemination. We imagine these dissemination support specialists with expertise in graphic design, health education, strategic communication, and campaign evaluation could function as the champions needed to proactively diffuse innovative Photovoice ideas and priorities to relevant decision-makers at local, state, and national levels (Rogers et al., 2009).

Conclusion

This study demonstrates how HCS Photovoice dissemination events co-designed by researchers and participants inspired community members and decision-makers to understand and address the root causes the opioid epidemic. Our findings suggest Photovoice events and artifacts, as health promotion tools, can evoke measurable changes in audiences’ critical consciousness and intentions to act to improve stigmatized issues like SUD. In future projects, researchers and their funders should consider including dissemination event evaluations to continue building the evidence for how Photovoice promotes consciousness-raising among audiences as the basis for policy and program change.

Supplemental Material

sj-docx-1-hpp-10.1177_15248399251411295 – Supplemental material for “Policymakers Need to See This!”: Dissemination and Evaluation of a Multisite Photovoice Project on the Opioid Epidemic

Supplemental material, sj-docx-1-hpp-10.1177_15248399251411295 for “Policymakers Need to See This!”: Dissemination and Evaluation of a Multisite Photovoice Project on the Opioid Epidemic by Ramona G. Olvera, Peter Balvanz, Owusua Yamoah, Kesla Klingler, Marisa D. Booty, Sylvia A. Ellison, Amy Farmer, Amy K. Kuntz, Hilary L. Surratt, Carrie B. Oser and Margaret L. McGladrey in Health Promotion Practice

Footnotes

Authors’ Note:

The authors are grateful for the National Institute on Drug Abuse and the HEALing Communities Study Steering Committee and the Massachusetts, Kentucky, and Ohio community advisory committees (CABs) for considering and approving the use of Photovoice in the HCS. We would like to acknowledge the contributions of the HCS community coalitions, Photovoice participants, and attendees at our Photovoice events whose involvement made this project possible. In addition, we want to thank Hakimo Abdikadir for her assistance in this article development. This work was supported by the National Institutes of Health (NIH) and the Substance Abuse and Mental Health Services Administration (SAMHSA) through the NIH HEAL (Helping to End Addiction Long-term®) Initiative under award numbers UM1DA049406, UM1DA049412, UM1DA049417 (ClinicalTrials.gov Identifier: NCT04111939). Marisa Booty’s effort on this article was supported by the National Institute on Drug Abuse (NIDA) under award number R36DA061317. This study protocol (Pro00038088) was approved by Advarra Inc., the HEALing Communities Study single Institutional Review Board. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health, the Substance Abuse and Mental Health Services Administration, or the NIH HEAL Initiative®.

ORCID iDs

Ramona G. Olvera

Peter Balvanz

Owusua Yamoah

Sylvia A. Ellison

Amy Farmer

Hilary L. Surratt

Carrie B. Oser

Margaret L. McGladrey

Supplemental Material

Supplemental material for this article is available at .

References

Balvanz

Olvera

R. G.

McGladrey

Booty

Beard

Ellison

McClay

Nouvong

Oser

C. B.

Yamoah

Martinez

L. S.

(2024). Leveraging local knowledge to contextualize the opioid epidemic within HEALing Communities Study communities: A Photovoice protocol. Journal of Substance Use & Addiction Treatment, 165, Article 209460. https://doi.org/10.1016/j.josat.2024.209460

Breny

J. M.

McMorrow

S. L.

(2022). Research engagement in a virtual world: Strategies for maintaining the power and impact of photovoice research online. Health Promotion Practice, 23(2), 235–240. https://doi.org/10.1177/15248399211065713

Brownson

R. C.

Eyler

A. A.

Harris

J. K.

Moore

J. B.

Tabak

R. G.

(2018). Getting the word out: New approaches for disseminating public health science. Journal of Public Health Management and Practice, 24(2), 102–111. https://doi.org/10.1097/PHH.0000000000000673

Call-Cummings

Hauber-Özer

(2021). Virtual photovoice: Methodological lessons and cautions. The Qualitative Report, 26(10), 3214–3233. https://doi.org/10.46743/2160-3715/2021.4971

Carlson

E. D.

Engebretson

Chamberlain

R. M.

(2006). Photovoice as a social process of critical consciousness. Qualitative Health Research, 16(6), 836–852. https://doi.org/10.1177/1049732306287525

Creighton

Oliffe

J. L.

Ferlatte

Bottorff

Broom

Jenkins

E. K.

(2018). Photovoice ethics: Critical reflections from men’s mental health research. Qualitative Health Research, 28(3), 446–455. https://doi.org/10.1177/1049732317729137

Dawes

D. E.

Amador

C. M.

Dunlap

N. J.

(2022). The political determinants of health: A global panacea for health inequities. In Oxford Research Encyclopedia of Global Public Health. https://doi.org/10.1093/acrefore/9780190632366.013.466

Evans-Agnew

R. A.

Rosemberg

M.-A. S.

(2016). Questioning photovoice research: Whose voice? Qualitative Health Research, 26(8), 1019–1030. https://doi.org/10.1177/1049732315624223

Gabrielsson

Cronqvist

Asaba

(2022). Photovoice revisited: Dialogue and action as pivotal. Qualitative Health Research, 32(5), 814–822. https://doi.org/10.1177/10497323221077300

10.

Golden

(2020). Reframing photovoice: Building on the method to develop more equitable and responsive research practices. Qualitative Health Research, 30(6), 960–972. https://doi.org/10.1177/1049732320905564

11.

The HEALing Communities Study Consortium. (2024). Community-based cluster-randomized trial to reduce opioid overdose deaths. New England Journal of Medicine. Advance online publication. https://doi.org/10.1056/NEJMoa2401177

12.

Gulley

Booty

Firchow

McGladrey

M. L.

(2025). Using photovoice to improve engagement in community health assessments addressing behavioral health. The Journal of Behavioral Health Services & Research, 52(2), 213–230. https://doi.org/10.1007/s11414-024-09885-4

13.

Liebenberg

(2018). Thinking critically about photovoice: Achieving empowerment and social change. International Journal of Qualitative Methods, 17(1), 160940691875763. https://doi.org/10.1177/1609406918757631

14.

Liebenberg

(2022). Photovoice and being intentional about empowerment. Health Promotion Practice, 23(2), 267–273. https://doi.org/10.1177/15248399211062902

15.

Livingston

J. D.

Milne

Fang

M. L.

Amari

(2012). The effectiveness of interventions for reducing stigma related to substance use disorders: A systematic review. Addiction (Abingdon, England), 107(1), 39–50. https://doi.org/10.1111/j.1360-0443.2011.03601.x

16.

Lofton

Grant

A. K.

(2021). Outcomes and intentionality of action planning in photovoice: A literature review. Health Promotion Practice, 22(3), 318–337. https://doi.org/10.1177/1524839920957427

17.

McGladrey

M. L.

Booty

Olvera

Balvanz

Surratt

H. L.

Matthews

Stitzer

Yamoah

Ellison

Campbell

Farmer

Gealy

Greenwell

Harris

Kuntz

Szelagowski

Shouse

Oser

C. B.

(2025). Using photovoice to define “community” in substance use disorder research engaging service users, providers, and policymakers. SSM—Qualitative Research in Health, 7, Article 100531. https://doi.org/10.1016/j.ssmqr.2025.100531

18.

Mitchell

(2015). Looking at showing: On the politics and pedagogy of exhibiting in community-based research and work with policy makers. Educational Research for Social Change, 4(2), 48–60.

19.

Orsini

M. M.

Ewald

D. R.

Strack

R. W.

(2022). Development and validation of the 4-Factor Critical Consciousness Scale. SSM—Population Health, 19, Article 101202. https://doi.org/10.1016/j.ssmph.2022.101202

20.

Rogers

E. M.

Singhal

Quinlan

M. M.

(2009). Diffusion of innovations. In Stacks

D. W.

Salwen

M. B.

(Eds.), An integrated approach to communication theory and research (2nd ed., pp. 418–434). Routledge.

21.

Seitz

C. M.

Orsini

M. M.

(2022). Thirty years of implementing the photovoice method: Insights from a review of reviews. Health Promotion Practice, 23(2), 281–288. https://doi.org/10.1177/15248399211053878

22.

Smith

Carter

Walklet

Hazell

(2022). Investigating recovery from problem substance use using digital photovoice. Journal of Community Psychology. Advance online publication. https://doi.org/10.1002/jcop.22957

23.

Smith

Carter

Walklet

Hazell

(2024). Exploring the methodological benefits and challenges of utilising a photovoice methodology with individuals in recovery from problem substance use. Qualitative Health Research. Advance online publication. https://doi.org/10.1177/10497323231217601

24.

Sprague Martinez

Rapkin

B. D.

Young

Freisthler

Glasgow

Hunt

Salsberry

P. J.

Oga

E. A.

Bennet-Fallin

Plouck

T. J.

Drainoni

M.-L.

Freeman

P. R.

Surratt

Gulley

Hamilton

G. A.

Bowman

Roeber

C. A.

El-Bassel

Battaglia

. (2020). Community engagement to implement evidence-based practices in the HEALing communities study. Drug and Alcohol Dependence, 217, Article 108326. https://doi.org/10.1016/j.drugalcdep.2020.108326

25.

Strack

R. W.

Orsini

M. M.

Ewald

D. R.

(2022). Revisiting the roots and aims of photovoice. Health Promotion Practice, 23(2), 221–229. https://doi.org/10.1177/15248399211061710

26.

Sutton-Brown

C. A.

(2014). Photovoice: A methodological guide. Photography and Culture, 7(2), 169–185. https://doi.org/10.2752/175145214X13999922103165

27.

Switzer

(2019). Working with photo installation and metaphor: Re-visioning photovoice research. International Journal of Qualitative Methods, 18, 1609406919872395. https://doi.org/10.1177/1609406919872395

28.

Teti

Myroniuk

(2022). Image to action: Past success, ongoing questions, and new horizons for photovoice exhibits. Health Promotion Practice, 23(2), 262–266. https://doi.org/10.1177/15248399211054774

29.

Wang

C. C.

Burris

M. A.

(1997). Photovoice: Concept, methodology, and use for participatory needs assessment. Health Education & Behavior, 24(3), 369–387. https://doi.org/10.1177/109019819702400309

30.

Wang

C. C.

Cash

J. L.

Powers

L. S.

(2000). Who knows the streets as well as the homeless? Promoting personal and community action through photovoice. Health Promotion Practice, 1(1), 81–89. https://doi.org/10.1177/152483990000100113

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