Abstract
When conducting photo elicitation interviews (PEI), researchers introduce photographs into the interview context. Although PEI has been employed across a wide variety of disciplines and participants, little has been written about the use of photographs in interviews with children. In this article, the authors review the use of PEI in a research study that explored the perspectives on camp of children with cancer. In particular, they review some of the methodological and ethical challenges, including (a) who should take the photographs and (b) how the photographs should be integrated into the interview. Although some limitations exist, PEI in its various forms can challenge participants, trigger memory, lead to new perspectives, and assist with building trust and rapport.
Introduction
The purpose of this article is to open for discussion the various ethical and methodological issues that arise through the use of the photo elicitation interview (PEI) with children. Until recently, most researchers and clinicians have used proxy reports to obtain information about children. Consequently, children have been excluded from research and from many aspects of decision making because they are considered less experienced, less rational, more dependent, and less competent than adults (Bluebond-Langner, 1978; Christensen, 1997; Franklin, 1995). In contrast, the “new” social studies of childhood have advocated for a shift to conceptualizing children as active and contributing persons (James, Jenks, & Prout, 1998; Mayall, 2000). Based on this conceptualization, researchers have illustrated that children with chronic illnesses and disabilities are able to describe their experiences in critical and rational ways (Garth & Aroni, 2003; Horstman & Bradding, 2002; Sloper & Lightfoot, 2003).
Although there is a trend toward using interviews with children “to hear” children's thoughts, these traditional verbal interviews can be problematic and raise several ethical and methodological concerns. For example, Clark (1999) explained that verbal interviews rely on linguistic communication, and for very young children, verbal language limits the issues and questions that the researcher can explore. Clark also argued that in their everyday life, children seldom take part in sharing information in question-and-answer sessions; thus, the question-and-answer interview is outside their sociolinguistic repertoire. Finally, the verbal interview accentuates the adult authority as an expected feature of adult-child communication. Thus, reliance only on verbal interviews with children might limit the research value of interviews. Using photographs during an interview with children, on the other hand, might address some of these issues but not without challenges.
Three sections are included in this article. The first will include a brief review of the use of photos in the context of qualitative research. In the second section, we will summarize the research project in which PEI was the focus of data collection, and the third section would include our experience using the PEI.
Using photos in qualitative research
Several researchers have offered various refinements of verbal interviews that focused on minimizing the power relationship between the researcher (the adult) and the participant (the child). For example, some researchers have called for placing interviews with children into their everyday or larger activities, such as “show and tell” activities (Tammivaara & Enright, 1986) or puppets show (Beardslee, 1996; Eder, 1990). Eder & Fingerson (2003) suggested using group interviews with children rather than one-on-one interviews. Several other researchers (e.g., Cappello, 2005; Clark, 1999; Horstman & Bradding, 2002) encouraged researchers to integrate visual methods of data collection (e.g., photos, drawing) into interviews to make interviews fun and not like a test in school.
Visual research methods have theoretically played a minor role in social research, because sociological research has been a “word-based” discipline, and the capacity of images to reveal “the truth” has been questioned (Harper, 2002; p. 17). Recently, however, visual research has become a common technique because of its user-friendly and relatively inexpensive technology (e.g., disposable camera). In addition, by using photographs and playing with content (what is in the photo) and process (how photos were presented), researchers can probe participants to discuss social relationships (Rasmussen, 2004; Smith & Barker, 2004).
Figure 1
Recently, PEI has been employed in various disciplines, including nursing (Riley & Manias, 2003), social work (Weinger, 1998), psychology (Salmon, 2001), education (Rasmussen, 2004), and geography (Smith & Barker, 2000). PEI has been used with various populations as well. Originally, it was used by Collier (1967), an anthropologist who studied migration caused by technological and economic change. Collier highlighted that using photos with interviews sharpened participants' memories and elicited longer and more comprehensive interviews. Sociologists Harper (1997, 2002) and Banks (2001) have also contributed to our understanding and use of PEI as a research method. Although Collier, Banks, and Harper researched adults primarily, a new group of researchers using PEI with children is emerging (Smith & Barker, 2004; Rasmussen, 2004)
PEI has focused on photos taken by the researcher as an “ice breaker” activity to create a comfortable space for discussion and to open opportunities to involve children so as not to limit their responses (Collier, 1987; Hazel, 1996). PEI has been used mainly in ethnographic and social studies research (Banks, 2001; Harper, 1997) and has involved “using photographs to invoke comments, memory, and discussion in the course of a semi-structured interview” (Banks, p. 87). Researchers using PEI have also adopted various terms depending on who takes the photos. For example Reflexive photography or autodriving photography (Clark, 1999) indicate that the interview is driven by the participants who took the photos. Nursing researchers have use the term hermeneutic photography (Hagedorn, 1994). The term photo elicitation interviews has been used mainly in ethnographic and social studies research (Banks, 2001; Collier 187; Harper, 1997). This study, the focus will be on photos taken by the researcher, and the term PEI will be used.
The research project
We set out to explore children with cancer's perspectives on and responses to a specialized summer camp. The concept of therapeutic landscape (TL) (Gesler, 1991, 1992) guided the study. The overall purpose of the study was to explore the extent to which children describe the landscape of a camp as therapeutic. Gesler posited that the physical (built and natural) environments and social conditions (interpersonal relationship [fields of care] and signs and rules at camp [public symbols]) combined to produce an atmosphere that is conducive to healing. In this study, camps for children with cancer were considered a type of therapeutic landscape. Adults have decided what buildings to include at camp, and certain physical structures in the camp have been developed by adults to appeal to children (e.g., Adventure Course). Furthermore, adults superimposed these buildings on a natural environment. The camp is also constituted by social environments, however, which include the people who make up the camp community (fields of care). Safety rules and signage are communicated by reminders posted around camp (public symbols).
An exploratory, retrospective qualitative design was used to elicit children's perspectives on and responses to a summer camp for children with cancer. The children were aged 6 to 16 years, spoke English or French, and lived in Ontario. Children who had severe neurological and/or sensory impairments, were receiving palliative care, or had participated in counselor-in-training or adolescents' programs were excluded. The consent and assent forms and permission to audiotape were signed prior to the beginning of the interviews. Data were collected in individual, semistructured interviews using photo elicitation interview with 35 children within 7 days following a 1-week or 2-week session at camp at a location that was convenient for the child and family (e.g., home, hospital clinic). The interviews lasted between 30 and 120 minutes (average of 40 minutes). The data were analyzed deductively based on an initial coding scheme using the TL concepts. We divided each of the two constructs (social and physical environments) into two sections: fields of care, public symbols (social), and built and natural environments (physical).
Who should take the photos?
The question of who should take the photos focused mainly on whether to use photographs taken or owned by participants or by the researchers. Letting children take photos of their everyday places allows them to make decisions about what to include in or exclude from the photographic records of their lives, thus letting them control the images that are presented of their everyday world (Smith & Barker, 2004). There are several variations in studies in which the child took the photos. For example, some researchers gave a single camera to a group of children to document their lives (Morrow, 2001); others have taken photographs with the children together on “neighborhood walks” (Bryant, 1985). Most researchers gave a camera to each child (Berman, Ford-Gilboe, Moutrey, & Cekic, 2001; Clark, 1999; Clark-Ibanez, 2004; Hanna & Jacobs, 1993; Jackson, 2005; Rasmussen, 2004; Smith & Barker, 2000).
However, some researchers decided to take the photos, and these studies shared several characteristics. Researchers who were also professional photographers chose to take the photos (Collier, 1987; Harper, 1997); researchers who were guided by a particular conceptual frameworks also took the photographs, as they were aiming at exploring a particular concepts (Diamond & Hestenes, 1996; Foster, Hoge, & Rosch, 1999; Weinger, 1998). As well, researchers who investigated younger children (3–12 years) usually took the photos (Aschermann, Dannenber, & Schulz, 1998; Salmon, 2001). Finally, researchers who were exploring particular places (e.g., rural home care) took the photos, as the photos served not only to facilitate conversation but also as a mapping observation to represent particular features of the area (Magilvy, Congdon, Nelson, & Craig, 1992).
In this study, taking photos of camp was appropriate because of our particular interest in the children's perspectives on and responses to the physical and social environments. Although originally we intended to use participants' photographs, we were faced with some ethical issues related to who should take the photos. First, the camp organizers suggested not giving the children cameras at camp, because that would be considered “extra work” during their camp stay. They explained that these children are always involved in research, and going to camp should not include extra work. In addition, children might photograph other children at camp who were not part of the study, which would require obtaining consents from everyone at camp, a process that would be time consuming and restrictive. For those reasons, we decided to take the photographs.
At the beginning of the study, we were concerned about the idea that the photos were taken from our perspective and not the children's, and that there might be a tendency on our part to focus on “visually arresting images” (Harper, 2002, p. 20) rather than what is meaningful to the children. We were also concerned that our photos might not evoke deep reflection from participants because they reflect our perspective and, as Harper (2002) explained, such photos might not “break the frame” (p. 20) of participants' view and might not lead to a new view of their social existence.
Nevertheless, taking the photos of places that children visited most frequently and paying particular attention to (a) the form and content of the photos, (b) pretesting the photos, and (c) considering the location of the PEI contributed to breaking the frame. Using the photographs also influenced our relationship with the children in a positive way, even though we took the photographs. In the next section of this article, we will share some of the ways we used to break the frame and integrate the photographs into the interview process.
How the photographs were integrated into the interview
The form and content of the photos
Banks (2001) advised social researchers to distinguish between the form of a visual image and its content. Images can be read externally (form: what we see in the photo) or internally (content: what message has been sent to us). Consideration was given not only to what images were included in the photo but also to how the image was presented. Harper (2002) emphasized the notion of “breaking the frame” (p. 20), according to which photographs should be presented from an “unusual angle” to allow participants to explore a new view of their social world.
Using different sequences in presenting the photos could contribute to breaking the frame. Few researchers have reported the sequencing of their photos, however. Diamond and Hestenes (1996) investigated the ways in which preschool children conceptualized different disabilities. During the interview, children were shown five different black and white photographs, one at a time. Each showed a preschool girl with one of the following disabilities: physical disability, visual impairment, hearing impairment, and Down syndrome. The fifth photograph was of a preschooler without any visible disability. Furthermore, the photographs were taken from books that were not familiar to the children, so participants could not relate to the children in the photos. Weinger (1998) explored children's perspectives on the social environment, in particular whether children from financially disadvantaged families were aware that their wealthier peers' chances for success might be greater than their own. Each interview began with the researcher showing the child two opposite photos (one depicted a rundown home, the other showed a suburban-style ranch home). Weinger argued that she portrayal was helpful, in that it generated discussion about social relationships.
In this study, we used a set of 13 colored, 8.5 × 112(21 × 28 cm) photographs of the camp as a background to stimulate conversation with the children about camp. All photographs used in this study are minimized in Table 1. The photos were assembled into a photo interview kit (Cappello, 2005) and were directly related to the research questions and conceptual framework (see Table 2 for a sample of questions used). They included six photos of physical structures (rock wall, zoom in and zoom out; and buildings—History Hut; cabins, inside and outside; Med Shed, inside and outside) and three photos of natural environments (e.g., views of the lake and forest trail) to reflect the physical environment. They also included four photos of social environments (e.g., a phone and attending the flagpole activity).
The 13 photos included both close-up (e.g., rock wall) and distance (e.g., flagpole circle, lake) views to create “the unusual angle”. (Harper, 2002; p. 20) We chose buildings with opposite functions or features; thus, photos of the cabin (residence) and Med Shed (treatment facility) as well as inside and outside of buildings were used. All photos were assembled in a large binder and protected by clear sleeves so the children could easily remove and talk about them.
Paying attention to the content and form of the photos had influenced the children's reports of their perspectives of camp. For example, our photos of camp stimulated opportunities for the children to bring their “own photos” to the interview to fill the gaps and talk of “things and people that were missing” in our photos. Although in some situations, the angle of the photos we used did not include recognizable people or other buildings, such as the dining hall, children mentioned some of the other buildings and the people during the interviews. Also, all commented on how things had changed at camp since we had taken the photos (e.g., the tree near the Med Shed had been cut), which provided additional opportunities to explore “changing things.”
Pretesting the Photos
Trying out the photos (pretesting) could be another way of overcoming the question of whether the photos that were taken by the researcher would break the frame or provoke participants' response. Weinger's (1998) shortened her questionnaire after she piloted the photos with the corresponding questions to ensure that the questions were clear and encouraged thoughtful responses from her own children, aged 6 and 9. Diamond and Hestenes (1996) also pretested their photographs to be certain that the photographs represented each disability in a way understood by adults. Although the researchers were examining preschoolers' perception of disability, they tested the photos on college students, asking them to describe the child with disability in the photograph. These studies highlighted the challenges to pretesting but also its value.
After REB (ethics board) approval and 4 weeks before commencing data collection, we pretested the photos with a group of adolescents with cancer who met the inclusion criteria but who would be not participating in the study because they had attended the adolescent session and were excluded from the study. The purpose of the pilot was to explore the length of the interview and whether the PEI method was feasible and acceptable. The clinical nurse specialist (CNS)/nurse practitioner/chair of the camp board assisted in selecting 4 adolescents from various age groups, cancer diagnoses, gender, and treatment histories at camp. These adolescents put us in contact with 2 of their friends, increasing the pilot sample to 6 adolescents. All children were White, spoke English, and came from families with married parents. Four children were interviewed at home, and 2 were interviewed at the outpatient clinic. Each adolescent received a movie pass coupon as a token of appreciation. The pilot sample data were not integrated into the analyses.
Pretesting was helpful for several reasons. First, the photographs with the questions stimulated conversation between the researcher and participants; consequently, questions in the interview guide were not changed. Second, one photograph of a telephone was added, because the adolescents mentioned “the phone rule.” Third, the sharing of photos extended the length of the interview; thus, discussion of the interview time was emphasized and reinforced throughout the interview. Fourth, as the adolescents also brought their own photos, we learned that the best place to showcase all photographs and discuss them was on the floor. All of these experiences were integrated in the study's PEI.
Interview guide linked to the TL concepts
The Location of the PEI
Paying attention to the settings of the interviews was also an important way of breaking the frame, because individuals might feel more comfortable to speak in some places than in others. In this study, 19 interviews were conducted in the children's homes, and 16 interviews were conducted at the hospital in one of the treatment rooms in the oncology outpatient clinic. Interviews that were conducted at the hospital were usually shorter (most lasted about 20–35 minutes) because of care requirements, and consequently, not all of our photos and questions (usually only 8 out of a possible 13 photos) were explored. In addition, some of these interviews were conducted between appointments and so were frequently interrupted.
Interviews conducted at home were longer (on average about 1–2 hours), and in some situations, the child asked the researcher to spend more time playing games on the computer as well as looking at their camp album and souvenirs (e.g., camp button). Most interviews were conducted in the kitchen or the living room. Four interviews were conducted in the backyard. The child and the parent could select the place of the interview, although usually the parent decided where the interview would be. At home, the flow of the conversation was also affected by frequent pauses for phone calls, the presence of siblings during the interviews, children checking e-mail, or visitors. However, in the home, all 13 photos were explored with all children, and in half of the interviews, children brought their own photos to add to ours to articulate their points better. In both the home and the hospital, the children chose to discuss the photo of the rock wall (n = 33) most frequently and the History Hut photo least frequently (n = 12).
The location of the interview also included consideration of the seating arrangements. To minimize the power relationship between the participants and the researcher (some might argue that a hierarchical relationship always exists in an interview, as in all human interaction; Nunkoosing, 2005), attention was given to the seating arrangement during the interview (Elwood & Martin, 2000). Participants were given the choice to sit on the carpet or on a chair (a different chair of their choice and which they considered comfortable) with the researcher to discuss the photos. If the child was able to sit on the floor, both the child and the researcher sat on the floor. We arranged on the carpet (or a table) 13 colored photographs that we had selected depicting aspects of the camp. Elwood and Martin have argued, “different locations [of interviews] might situate participants differently in terms of their power in the research process” (p. 654).
Paying attention to the location of the interviews and the seating arrangements was practical (can easily showcase all the photos) and created a comfortable atmosphere. Furthermore, almost every child who was interviewed at home or in the hospital moved around the room freely during the interview. Using the photos created a relaxed atmosphere that allowed the child to enter and leave the interview place (at home, some children stopped the interview to bring a souvenir from camp). Thus, the photographs made interviewing children a less formal process, as it and not the children became the focus.
Conclusion
In this research, photo elicitation interview was a data collection technique that focused on photos taken by the researcher as an ice breaker activity to create a comfortable space for discussion and to open opportunities to involve children in different ways so as not to limit their responses. We have attempted to describe the use of PEI within a study that set out to explore children's perspectives on a camp for children with cancer. Ethical and methodological concerns permeated the research process and the application of the PEI. Using the PEI influenced my relationship with the children in a positive way, even though we took the photographs. It allowed us to invite the children to take the lead in the interview; the photos created a relaxed atmosphere that allowed the child to enter and leave the interview place; and the photos stimulated opportunities for the children to bring their own photos to the interview to fill the gaps and talk of things and people that were missing in my photos. Nevertheless, the particular limitation of using PEI is that children's photos and artifacts that were spontaneously brought to the interview were not included in the analysis. This raises the question of whether we missed an opportunity to explore children's photographs.