Reflection/Commentary on a Past Article: “Photovoice as a Method for Revealing Community Perceptions of the Built and Social Environment”

Introduction

We are honored and delighted to be part of the International Journal of Qualitative Methods’ special issue featuring updates on the top 20 papers from the past 20 years. Here, we offer current reflections on our 2011 paper, Photovoice as a Method for Revealing Community Perceptions of the Built and Social Environment (Nykiforuk, Vallianatos, & Nieuwendyk, 2011). This article reported on one of the methodologies used in our mixed-methods design for a community-based participatory research (CBPR) project that examined ecological and individual facilitators and barriers to physical activity and healthy eating as experienced by four communities in Alberta, Canada (see Nykiforuk et al., 2012). We published our photovoice paper at a time when the public health research community’s interest in “built environment and health” was at an unprecedented high. Yet, at that time, the available methodological literature informing this critical area of inquiry was predominantly quantitative and often concerned with objective measurement of built environment features such as walkability, access to public transit, or proximity to green space. Our full study was among the first to integrate these “objective” quantitative measures of community with nuanced “subjective” knowledge of communities offered by residents, with the intention of using the integrated findings from those pieces to inform the collaborative, community-led development of local interventions to promote the health of residents. Thus, the so-called subjective knowledge of community residents was of paramount importance to the success of the full study, and the “subjective” substudy among the first in the built environment area to employ photovoice as the means for engaging residents to share their knowledge and perceptions of their communities.

Our paper offered a detailed report on our application of C. Wang and Burris’ (1994, 1997) photovoice methods, tailored to the purposes of community (built and social) environment research, with the purpose of communicating this method for capturing and appropriately representing participants’ voices in research about their lives and communities. We contributed a critique of photovoice as a method for revealing community residents’ perceptions of community as a health resource and for health promotion research more broadly. We also included a detailed accounting of our own successes and challenges of using photovoice in a CBPR research project focused on community-based chronic disease prevention.

Thinking back on this publication, we were asked to speak to how it fit into our career paths, how it impacted our work since, how it impacted the field, and our thoughts on one thing that has changed the most in this area since we published our manuscript. We collaborated on the key points that follow, while also reflecting on how our individual work has developed. We identified how our work has benefited from interdisciplinary partnerships, and how incorporation of visual methods is particularly useful for participatory, community-based research endeavors moving forward.

How Did This Publication Fit Into Your Career Path?

We were both early career academics when we developed the original paper and purposefully mindful that a methodological paper of this nature would contribute to defining our respective bodies of work for years—if not decades—to come. We collaborated on the design, implementation, and data analysis of the photovoice component of the “Community Health and Built Environment (CHBE)” project, bringing to bear our respective disciplinary lenses of public health and geography (Candace Nykiforuk) and anthropology and health promotion (Helen Vallianator). From the earliest points of our respective careers, we each valued and embraced interdisciplinary approaches for investigating complex, societal questions (which is why we chose to work together). This publication was instrumental in sharing that value with the international qualitative methods community of research.

CN

The 2011 photovoice paper was one of the early papers published out of the CHBE study, which was my first major research project (as principal investigator) that was successfully funded as a new assistant professor. For me, it was important for the team to publish the methodological work from the study because, at the time, there was great interest in and demand for built environment research that revealed how the built environment impacted people’s health. While this piqued interest in built environment and health research was relatively new, much of the reported work in the area employed conventional methodologies, and of those, the emphasis was heavily on quantitative approaches. While there was corresponding qualitative and CBPR work that discussed health promotion initiatives within communities, there was still little that reported the use of visual methods in this area specifically. However, our team felt that it was critical to employ visual methods, and specifically photovoice, in our study as an effective and impactful means of first collaboratively engaging community residents in the CHBE study and then for authentically sharing their insights with broader research and practice audiences. By way of context, the participatory nature of photovoice was also essential to the successful development, implementation, and evaluation of the community-led initiatives (to promote physical activity and/or healthy eating) undertaken as part of the full CHBE study. Without such powerful contributions from community residents, we would not have had the legitimacy or credibility (as a collaborative team) to work as closely with community organizations and municipal governments as was necessary for the success of the CHBE initiative.

Our photovoice study emphasized the importance of engaging communities in a participatory way to share their experiences of and expertise concerning their communities (see Belon, Nieuwendyk, Vallianatos, & Nykiforuk, 2014, 2016a, 2016b) and set me on a career trajectory devoted to engaged scholarship. My teams and I have continued to use photovoice methods in a series of community environment projects, ranging in focus on preschool play environments to health inequities in access to community services. We have found that the use of photovoice meaningfully engages community members as co-creators and co-analysts of research data and that it also provides very compelling information for local practitioners and policy makers, who often then used the photos and narratives in their own initiatives in response to study findings (of course, with the prior consent from the collaborators who contributed the photo stories).

Over the course of my career, I have since worked with many trainees and communities who were interested in using photovoice for their own work. Many of my graduate students received hands-on training in photovoice as project research assistants, which they were then able to employ in their thesis research. Each of them has applied photovoice methodology to a complex, nuanced, interdisciplinary question ranging in topic from health benefits of natural areas in urban environments to exploration of how photovoice could be used in built environment studies in Brazil. In one current example, a doctoral trainee has introduced photovoice as a method for generating information as part of an institutional ethnography (Puddu, Boyle Street Community Services, & Nykiforuk, 2017). She is currently collaborating with homeless youth to explore their experiences of living on the streets during extensive urban core revitalization. Using photovoice, youth created stories of their lives in the shadow of the redevelopment and, together, they are currently sharing it with other community members through a photo book, interactive displays at city hall, media uptake, and community presentations.

HV

As a newly minted assistant professor working on a research program investigating how people understand food, health, and their bodies and, in turn, how this affects their food and health practices, I wanted to find more effective means to elicit people’s thoughts on these taken-for-granted topics. Visual methods, particularly when participants produce the images, provide a way of finding assumptions centered on food and health practices. For example, in a project investigating family “healthy” food practices, both photo elicitation and participatory photography (or photovoice) were used (see Beagan et al., 2015). It was through these images, what was present and absent, that opportunities were provided to deepen discussions. In some cases, the images revealed food practices that weren’t revealed during interviews. One example was the lack of images of meals, just foods and supplements. This allowed me to follow up with the participant, and the discussion revealed a lifestyle where sit-down meals were rare, as the family was typically running between work, school, and activities. Other images led to deeper discussions around gender roles and expectations centered on household food work.

The power of the visual has led me to incorporate such methods in a variety of projects and with people of diverse ages. These projects have included work with immigrants, who may find visual methods useful when faced with linguistic or cultural translation challenges, and with younger children, who may not have the linguistic skills developed to express themselves solely through words.

I have worked with various undergraduate and graduate students, training them in this method, as they have assisted in the data collection and analysis process. In all cases with undergraduate students, this was an introduction to research in general. Working with me on this method allowed these students to develop research skills, but it was arguably a more evocative process as the power of the images, connected with participants’ words, captured their hearts and minds. For graduate students, all had their first introduction to visual methods and photovoice while working with me as research assistants. While none applied photovoice to their own work, developing their expertise in another method strengthened their skills as they pursued their own career paths. In all cases, their participation resulted in publications external to their own theses, thus strengthening their resumes (e.g., Hammer, Vallianatos, Nykiforuk, & Nieuwendyk, 2015).

How Did This Publication Impact Your Work?

Further to our reflections above, overall, this publication has impacted our work in that it has crystallized for us that when working on interdisciplinary teams, it is imperative that methods are clearly explained and applied. Disciplines each have a cultural history that incorporates specific ideas, languages or terms, and approved ways of creating knowledge. This publication provided a means of indicating to colleagues the value and recognition of our knowledge in methods, and photovoice in particular, across disciplines.

How Did This Publication Impact the Field?

The origins of photovoice entailed the merging of different approaches to knowledge, specifically education literature on critical consciousness, feminist theory, and documentary photography (C. Wang & Burris, 1994, 1997). Our work built on these origins, as we incorporated anthropological with critical public health approaches to improve understandings of how environments impact health and wellness. Working in four diverse communities, each with a variety of subgroups, it was challenging to find opportunities to bring these diverse people together. Consequently, we adapted Wang and Burris’ method to allow us to interview people individually, at times convenient to their own schedule demands. In order to keep the crucial community-building component, where through discussion of the photos participants move toward identifying ways to move forward, we developed alternate means to share the photos and elicit discussion not just with participants, but with the community at large. This involved posting select photos with the associated quotations or stories in public spaces, such as public libraries, recreation centers, and the open spaces of community organizations. Opportunities for the general public to provide feedback on the issues raised through the photos were also provided. For example, in some cases, this involved public presentations to municipal councils (where the general public were also able to ask questions), while in other cases, members of the public explored interactive displays of the photo stories during events where team members (academic and community collaborators) were on hand to discuss questions, issues, or community member stories that emerged from that exploration.

We hypothesize that others have appreciated the increased flexibility in utilizing photovoice that our approach provided, given that our paper has been downloaded directly from the IJQM over 950 times (at the time of this writing). In addition to contributing to work by others in applied public health, health promotion, and related studies in built environment (e.g., Annang et al., 2016; Nimegeer et al., 2018; Ronzi, Pope, Orton, & Bruce, 2016; Walker et al., 2015), we were surprised at the breadth of scholarly attention that our publication has received. A cursory search of our publication’s citations revealed consideration in such diverse fields as, for example, occupational therapy (e.g., Lal, Jarus, & Suto, 2012), intercultural relations (e.g., Peña-Purcell, Cutchen, & McCoy, 2017; Q. Wang & Hannes, 2014), health psychology (e.g., Haaken & O’Neill, 2014), visual studies (e.g., Nash, 2014), the intersection of youth studies and geography (e.g., Harris, 2017; Power, Norman, & Dupré, 2014; Walsh, Hewson, Shier, & Morales, 2014), disaster science (e.g., Schumann, Binder, & Greer, 2018), climate change research (e.g., Lemelin et al., 2015), communication research (e.g., Borron, 2013), the indigenization of photovoice (e.g., Goodman, Snyder, & Wilson, 2018; Lemelin et al., 2015; Thompson, Miller, & Cameron, 2016), and in several dissertations spanning disciplines from social sciences, the humanities, and public health. Our publication also earned mention in recent photovoice methods papers (e.g., see Murray & Nash, 2017; Simmonds, Roux, & Avest, 2015) and qualitative research methods textbooks (e.g., Castleden, Morgan, & Franks, 2016; Delgado, 2015; Hinds, 2017), including one authored by a seminal author in the field (see Thorne, 2016). Further, alongside L. Nieuwendyk, our coauthor on the 2011 photovoice paper (and a former trainee), we have delivered numerous presentations to community organizations instructing on the use of the method to support their local work.

What Is One Thing That You Think Has Changed the Most in This Area Since You Published the Manuscript?

HV

Visual methods have a long history in anthropology. Cameras were taken to the field almost as soon as this technology was available. A classic example of this early use of photography is Margaret Mead’s and Gregory Bateson’s book Balinese Character: A Photographic Analysis (1942). While the images were produced by the researchers, thus unlike photovoice, they were not simply documenting the field site and the places and people in Bali; rather, the images were taken strategically with a theoretical analysis in mind. Similarly, the images in the aforementioned text—all 759 of them—were arranged according to Mead and Bateson’s theoretical analysis. For a further discussion and overview on the development of visual methods within anthropology, see Vallianatos (2017b).

Despite this rich history of visual methods in anthropology, photovoice as a distinct method has not been as widely used. In my experience, colleagues with expertise in some forms of the visual have been unaware of this method; others practiced related techniques that involved photography done by participants, but these participatory methods do not necessarily involve the multiple interviews and community sharing that is the cornerstone of photovoice. Nevertheless, in the past few years, more and more anthropology scholars are aware of, and choosing to use, this method. An indicator of the increasing popularity of this method is the inclusion of a unique, stand-alone chapter in a recent methods text (see Vallianatos, 2017a). Because of the participatory roots of the method, photovoice is a powerful tool for anthropologists working on social justice issues throughout the world.

CN

At the time of our 2011 paper, the use of photovoice was relatively new to public health, and its reported applications were limited. A systematic review published the year prior revealed only 37 unduplicated publications reporting the use of photovoice in public health and related fields (Catalani & Minkler, 2010). Less than a decade later, the literature shows us that current use of the method in public health is widespread, and rapidly growing, informing intervention development, methodological innovation, as well as helping researchers to critically reflect on theories underpinning investigations in this field. (This latter domain is one, in my opinion, that offers the greatest potential for public health moving forward.) Despite this, I feel that the value of photovoice—and the powerful contributions that can emerge from analysis of photovoice data—is not well understood and is underrecognized across the breadth of the field, in some ways, still languishing in the shadow of more conventional public health research methodologies.

Photovoice’s roots in social justice are highly relevant in today’s applied public health research climate, where considerations of equity, inclusion, and respect for diversity are paramount. Photovoice continues to offer a means to reveal the stories behind the numbers, in participants’ own voices, carried by their images and their words and sharing with us the deep roots of meaning behind some of the most demanding public health questions of contemporary times. When used appropriately, and with due rigor, it is my experience that the use of this method can help bridge the “knowledge translation” and “knowledge mobilization” gaps that still hinder the uptake of important research findings among practitioners and decision makers.

Final Thoughts

As we reflected on our publication’s impact on our careers and on the field more broadly, we are encouraged by the wide community of qualitative researchers who, like us, work to apply C. Wang & Burris’ (1997) photovoice method in ways that are meaningful for research and community alike. Because this method assists participants in illustrating concepts, feelings, and perspectives that might be challenging to articulate solely through words, we continue to find value in this approach. The importance of still images persists despite the growth of video sharing and other digital venues, offering meaningful capture of moments in time that offer timeless meaning, and from the undiluted perspective of the participant. Furthermore, working across disciplinary fields, we value the origins of this method that explicitly brought together different ways of knowing and, thus, continue to use the method in our research programs. We both look forward to the further evolution of this method and its application over the coming decades.