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Abstract

Photo-elicitation interview techniques, a method in which researchers incorporate images to enrich the interview experience, have been gaining traction in numerous spheres of research over the last two decades. Little is, however, written about the utility of the technique in studies involving vulnerable populations in clinical contexts. Drawing on research where researcher-generated photographs were used to elicit mothers’ experiences of pain and perceptions about use of pain-relieving strategies in critically ill infants, we aim to demonstrate (a) how the method can be used to generate harmonized and detailed accounts of experiences from diverse groups of participants of limited literacy levels, (b) the ethical and methodological consideration when employing photo-elicitation interview techniques and the (c) possible limitations of employing photo-elicitation interview techniques in clinical research.

Keywords

photo-elicitation clinical research interviews photographs techniques

Introduction

Photo-elicitation is a technique that incorporates photographs into research interviews (Harper, 2002) allowing for reflexivity between image and verbalisation to produce data (Harrison, 2002). Reflexivity in the method manifests in the integration of photographs into the in-depth interviews to trigger participants’ views so as to evoke reflections and generate rich data (Harper, 2002; Meo et al., 2010). The method has assumed different names in the literature, including photo-interviewing (Vila, 2013), photo-voice (Wang et al., 2004) and photofeedback (Serbinski, 2014) depending on the level of participant involvement in the generation and analysis of the images (Close, 2007). Unlike the other variances of the method, photo-voice tends to be participatory oriented, focusing more on the promotion of critical dialogue that brings about change at community and policy level (Bugos et al., 2014; Wang & Burris, 1997). A more detailed description of the other variations is available in the literature (Close, 2007; Hurworth, 2003); and making further distinctions is beyond the scope of this paper. However, for purposes of advancing our arguments, we take photo-elicitation as any form of interviewing that incorporates images in the data generation process (Harper, 2002;Skrzypiec et al., 2013).

Photo-elicitation method was first used in the field of anthropology in the 1950’s (Collier, 1957) before gaining traction in the 80’s and 90’s (Blinn & Harrist, 1991; Chiozzi, 1989; Schwartz, 1992). The last two decades has witnessed an exponential upsurge in use of the method in various fields including sociology (Harper, 2002; Hurworth, 2003; Packard, 2008), education (Douglas, 1998; Meo, 2010; Shaw, 2013), business (Warren, 2005) and public health (Bender et al., 2001; Bukhave & Huniche, 2016; Schrader et al., 2011). Photo-elicitation has also been used in clinical studies with midwives (Copeland et al., 2014), old persons with dementia (Parke et al., 2013) and children (Drew et al., 2010; Epstein et al., 2006; Khair et al., 2013). Evidence on use of the method in infant pain research is scarce. Concerns about power and positionality as well as the intrusiveness of the method could possibly explain the limited and silted use of the method in pain research involving mothers of hospitalized infants (Harper, 1998; Riley & Manias, 2004).

The aim of this paper is to highlight the usefulness of photo-elicitation method in clinical studies involving vulnerable patients, particularly mothers of sick infants. We share our experience using the technique in a study examining the acceptability and feasibility of pain relief strategies with mothers of hospitalized infants (Kyololo et al., 2016). In the study where the technique was used, the researchers intended to explore mothers’ perceptions about infant pain and pain treatment practices in an academic hospital in Western Kenya. In the study, interviews were conducted with 15 mothers in a Level I (Special care nursery) and a Level II (high-dependency) neonatal units in Kenya. More details of this study are available elsewhere (Kyololo et al., 2019). We will reflect on our experience to demonstrate the benefits and shed light on the methodological and ethical issues associated with using the technique in clinical research, especially with vulnerable populations.

A Case for Photo-Elicitation

The study related to this paper was part of a 3-phase mixed-methods research project. We employed a qualitative descriptive design to explore the perceptions of mothers about a cluster of nonpharmacological pain relieving interventions in infants (i.e., breastfeeding, skin-to-skin contact, positioning, pacifiers, and oral sucrose). Photographs of mother-baby pairs using the pain-relief interventions during care procedures (e.g., venous cannulation) were incorporated into the interviews. English and Swahili (one of the official languages in the study site) speaking mothers were interviewed shortly before their infants were discharged from the hospital (Kyololo et al., 2019).

Generally, mothers who deliver in Kenyan public hospitals have varied levels of education ranging from none, elementary, to college. Our previous work in Kenyan hospitals had shown that none of the methods we were exploring (e.g., skin-to-skin contact, breastfeeding, swaddling) was being used for pain relief with infants during procedures (Kyololo et al., 2014). In this regard, we opted for the photo-elicitation method on the assumption that mothers may not have lived the experiences we intended to explore and even if they had practiced them (e.g., breastfeeding) they may not have been aware that they were helping their infants cope with pain. Studies in other settings had, however, indicated that these mother-driven strategies were effective in relieving pain in infants (Johnston et al., 2017; Pillai Riddell et al., 2015) and could be used in low-income settings (Cignacco et al., 2010; Clancy, 2014) hence the need to explore their acceptability and feasibility with mothers in the Kenyan hospitals.

We intended to discover the convergence and divergence of views of mothers of diverse literacy and socio-cultural backgrounds. We were, however, cognizant that the diversity might deter participants from articulately expressing themselves about a practice they might not have knowledge of (Samuels, 2004). Furthermore, we felt that it would be challenging to describe the interventions we were investigating in either English or Swahili, especially for participants with limited literacy proficiency. Therefore, we opted for a blend of words and images through photo-elicitation (Harper, 2002) in order to give participants an avenue to express themselves about experiences that would, otherwise, have been difficult to articulate through talk-only interviews (Bender et al., 2001; Kubicek et al., 2012).

Developing the Interview Kit

The process of generating photographs to be used for interviews vary (Riley & Manias, 2004). The popular approach is for participants to take photographs that represent the topic of interest for discussion with the researcher (Bender et al., 2001; Bukhave & Huniche, 2016; Drew et al., 2010; Radley & Taylor, 2003). A less common approach is the researcher taking the photographs that are later used to facilitate conversation during interviews (Parke et al., 2013; Riley & Manias, 2004). The latter is the approach of choice when vulnerability and sensitivity to participants’ needs warrant controlled use of the images (Riley & Manias, 2003). For instance, Copeland et al. (2014) used a photograph of a woman in labour to examine midwives’ decision-making process about using interventions during childbirth. Epstein et al. (2006) photographed children with cancer attending a therapeutic summer camp and used the images to explore children’s perceptions about the healing potential of the camp environment. In both Epstein et al. (2006) and Copeland et al. (2014) studies, by opting to take the photographs, the researchers were able to surmount the ethical challenge related to guaranteeing privacy of the vulnerable participants by having a direct control over when and who was captured in the images.

There are varied ways in which researcher-generated photographs are made. Some researchers who are professional photographers generate the photos (Harper, 2001), some make documentary images of events of interest (Schwartz, 1992) while others use photographs retrieved from existing sources (e.g., archives) (Bugos et al., 2014; Buckley, 2014). Harper (2002) and others (Clark-Ibáňez, 2004; Epstein et al., 2006) caution against using photographs unrelated with the context under study, and which participants cannot relate with, arguing that such images may not elicit reflective and detailed narrative accounts of the phenomenon of interest. Furthermore, locally generated photographs help situate researchers as insiders in the participants’ world (Asselin, 2003; Kanuha, 2000) thus enhancing acceptance, trust and openness during interviews (Dwyer & Buckle, 2009). In line with these arguments, we generated an inventory of images of local mother-infant dyads that formed the basis of the interviews. Initially, we had contemplated hiring models to pose as mothers. We, however, opted out of using models because, in order to minimize the risk of infections, the hospitals had a policy that limited access and handling of hospitalized infants to health care providers directly responsible for the care of the babies and the infants’ parents. In this regard, we resulted to photographing mothers-infant dyads in hospital settings where the study was conducted. In total, 16 mothers consented to be photographed, for their images to be included in the interview kit, and for the images to be used in dissemination of the study findings. Due to length of time (2 months) it took between taking the photographs and getting the interview kit ready, none of the mothers whose images were captured was in the hospital at the time of the interviews and thus none participated in the study. Taking photographs of mothers in a local hospital environment was intended to guarantee that the interview kit contained images that the participants could related to (e.g., skin colour, colour of hospital gown etc.) thus enhancing the potential of the images to elicit detailed reflections (Asselin, 2003; Riley & Manias, 2004). A detailed description of how the images were generated and processed is provided in a subsequent section of this paper.

There are ethical and legal challenges related to intrusiveness of photography in certain sensitive clinical areas (Riley & Manias, 2003) that threaten the anonymity and privacy of participants (Harper, 1998). These ethical issues should be thoughtfully negotiated with the participants being photographed (Banks, 2001) and the institutional ethics committees (Riley & Manias, 2003). To generate the photographs ourselves we had to strike a balance between safeguarding the privacy of the hospitalized infants and their families and minimizing the bias of being viewed as outsiders in the participants’ world (Riley & Manias, 2004).

The local research ethics review board recommended working with the legal and public relations (PR) departments of the hospital to develop strategies for safeguarding privacy of patient information during the photography. The legal and PR departments were particularly concerned about the possibility of the photographs reaching unintended audience (e.g., the media) or inadvertently recording images of other patients by virtue of their proximity to those being photographed. To address these concerns, the PR department assigned the research team a professional photographer, an employee of the hospital, to take the photographs under the direction of the research team. The PR department remained the custodian of all the photographs; the researcher team was only given digital copies of the photographs that had been selected to be incorporated into the interview.

A total of 124 digital coloured photographs of the interventions of interest were taken. The photographs depicted infants (a) on the breast, (b) being held skin-to-skin, chest-to-chest by the mother (kangaroo care), (c) using a pacifier, (d) being positioned using hands (facilitated tucking) and (e) being swaddled. The photos were taken from close-up and long-range distance, and from different perspectives (i.e., eye-level, low-level, raised view) in order to create “the unusual angle” (Harper, 2002, p. 20). Four photographs that depicted each intervention more clearly, from different angles and perspectives, were selected for incorporation into the interviews. The photographs were printed on white Kodak professional glossy paper measuring four inches by six inches (10 cm × 15 cm) such that two photos could fit into size A4 paper (or Letter size paper). The photographs were laminated in clear sleeves such that they could be used in multiple interviews and to allow for cleaning and disinfection between interviews. The photographs were then assembled in a large hole-punch photo-binder that was partitioned with coloured labels such that the photos could be easily located and removed for discussion during interviews.

Developing the Interview Guide

A description of the process of developing the unstructured interview guide used in the study is found elsewhere (Kyololo et al., 2019). The questions in the guide were framed to allow for collection of rich data on the acceptability and feasibility of using pain relief interventions on infants during routine clinical procedures (Kyololo et al., 2016). The primary interview questions were interspersed with probes designed to clarify points and to further illuminate interviewees’ perspectives. To introduce photographs into the interviews, questions were posed to draw the attention of participants that the focus of the interview was the images (e.g. “to what extent do you relate with what is happening in this picture?”). The questions sequentially increased in complexity as more pictures were introduced, drawing participants to higher level of reflection (e.g. “what do you think should be done by the staff in this unit to help you embrace and routinely use this intervention [referring to the specific photo or set of photos being discussed] on your baby when a procedure is being performed on him?”).

The Interviews

The location where interviews are conducted is critical in “breaking the frame” (Harper, 2002, p. 20) of participants’ views. Bugos et al. (2014) recommend conducting the interviews in locations that facilitate reflection on the taken-for-granted aspects of experiences and guarantee safety and privacy of interviewees. Epstein et al. (2006) found that participants tended to provide more detailed accounts when interviewed in familiar environments. For instance, interviews that were conducted within the hospital environment were shorter (20–35 minutes), and often interrupted, compared with those that were conducted at home (1–2 hours) (Epstein et al., 2006). A detailed description of how the interview related to the study were conducted is available elsewhere (Kyololo et al., 2019). Although, based on Epstein’s (2006) observation it would have been desirable for the interviews to be conducted from the home environment, this was not possible because the mothers came from very geographically diverse regions (up to 150 miles radius) from the study hospitals. Due to the inability to conduct the interviews in the participants’ homes on account of the distance, coupled with the desire to capture views of mothers from diverse socio-demographic and ethnic extractions (Polkinghorne, 2005; Teddlie & Yu, 2007), we opted to interview the mothers from the hospital. The interviews were conducted shortly before the infants were discharged from the hospital in a private, quiet and well-lit room adjacent to the lodge rooms where the mothers had been boarding during the hospitalisation period. The choice of location for the interviews was informed by the need to provide a familiar environment that would enable the participants to benefit from memories of their hospitalisation experience while guaranteeing privacy (Bugos et al., 2014; Epstein et al., 2006).

Utility of Including Photographs in Interviews

Collier’s (1957) seminal study on efficacy of photo-elicitation showed that inclusion of pictures made interviews significantly longer and more detailed than the conventional word-only interviews. Interviews using photographs are more stimulating and effective in “getting below the surface” of informants’ perspectives (Auken et al., 2010, p. 381). Additionally, incorporation of photographs into interviews helps bridge the gap between the worldviews of the researcher and the researched making it possible to understand complex participant experiences (Harper, 2002). Inclusion of photographs during interviews nudge participants to reflect more deeply about their experiences than they would in response to verbal questions (Douglas, 1998; Harrison, 2002). Photographs help build trust and rapport and improve communication during interviews (Bender et al., 2001; Shaw, 2013; Van Auken et al., 2010), especially when emotionally charged experiences are involved (Affleck & Macdonald, 2012), by diverting the conversation from personal experiences to the images (Bugos et al., 2014; Jurkowski & Paul-Ward, 2007). Incorporation of images addresses concerns related to power and positionality that often characterize interactions between researchers and participants (Van Auken et al., 2010; Mandleco, 2013). Epstein et al. (2006) as well as Harper (2002) argue that use of photographs jolt subjects into a new awareness of their social existence enabling them to deconstruct the taken-for-granted assumptions. Moreover, incorporation of photographs into interviews enhance participants’ abilities to reflect upon and explain their experiences and perspectives (Auken et al., 2010) resulting in data-rich accounts (Auken et al., 2010; Samuels, 2004) which enhance the validity and reliability of the findings (Harper, 2002).

Our interviews were quite detailed; participants took time to explore the set of photographs and to provide an elaborate account of what they perceived was taking place in the photographs and to reflect on their experiences in relation to what was captured in the pictures. From the interviewer’s perspective, the interviews became very friendly when the photographs were introduced (Kyololo et al., 2019). When the participants were handed in the interview kit, they became more relaxed and answered the questions very calmly; focusing more on talking about what was depicted in the pictures rather than presence of the interviewer which, at the beginning of the interview, had caused some tension. Participants and the interviewer sat on the same side of the table as they discussed the photographs “in a task similar to viewing a family album” (Schawrtz, 1989, p. 152). The participants would remove the photographs from the binder, hold them jointly with the interviewer and finger-point at the images as they emphasized on a point obviously obliterating the positionality issues prevalent in other forms of interviews (Van Auken et al., 2010). Moreover, as anticipated initially, interaction with the photographs during the interviews seemed to have created a camaraderie and relaxed atmosphere during the interviews (Clark-Ibáňez, 2004; Hurworth, 2003; Kyololo et al., 2019).

The pictures helped participants reflect on and make sense of previous care practices they had engaged in. For instance, by looking at the pictures mothers were able to recall being encouraged by health care providers to hold or breastfeed their infants after a procedure; a practice that they initially did not know was meant to help their infants cope with pain. Furthermore, as a result of inclusion of photographs participants were able to discuss aspects of their experiences that would otherwise have been challenging to describe through traditional interviews. For instance, it was challenging for participants to describe the skin-to-skin contact as a method of pain relief even though it was a routine practice for nurses to demonstrate to mothers how to do it for warmth and bonding. However, with inclusion of the photographs, participants articulatively described the procedure as “putting the baby to sleep on my chest” (Kyololo et al., 2019, p. 54).

Ethical Challenges

There are critical ethical issues related to generating and using photographs in clinical research (Close, 2007; Riley & Manias, 2004). For instance, maintaining privacy, anonymity and confidentiality of patients in photo-elicitation interviews, especially those captured in the photographs (Smith et al., 2012; Wang et al., 2000), is very challenging (Harrison, 2002; Riley & Manias, 2004). The threat to participants’ privacy is compounded when the photographic materials constitute the data presented in public (Bugos et al., 2014; Close, 2007; Heacock, Souder, & Christian, 1996). These challenges become more profound when photographs of vulnerable participants (e.g., mothers and hospitalized infants) are used. For this reason, researchers are encouraged to obtain separate consent for taking the photographs (Riley & Manias, 2003) and for using the images in public presentations such as in conferences and publications (Heacock et al., 1996; Mandleco, 2013).

Gaining ethical approval for this study was not easy; ethics committee members were concerned about the intrusiveness of photography in the neonatal intensive care unit (NICU) and using the photographs in interviews with different set of mothers. One of the ethics committee members recommended adoption of a layered-staged consenting process (Bunnik et al., 2013) when taking the photographs. Participants separately consented to be photographed and for the photos to be used (a) for the interviews, (b) during dissemination of findings (thesis and publications), and (c) for development of training materials. For instance, participants could consent to be photographed and their pictures used during the interviews but decline for the pictures to be used in publications and conference presentations. Furthermore, we reached a “conventional agreement” (Smith et al., 2012, p. 380) with participants who were photographed not to use the pictures in a manner likely to portray them in negative light (Wiles et al., 2008). Working within the institutional policy on access and use of identifiable patient information and allowing the legal and PR departments in the hospital to take, generate and store the photographs was helpful in safeguarding the privacy of participants.

Limitations

Although photo-elicitation has numerous advantages (Harper, 2002; Mandleco, 2013; Samuels, 2004; Van Auken et al., 2010), the approach, as with any method, has limitations. Developing a qualitative study protocol in and of itself is a relatively complex and iterative process that requires thoughtful reflection on issues around the most appropriate design, access to the study site and recruitment and retention of participants (Thummapol et al., 2019) and photo-elicitation adds another complex layer to this process (Hatten et al., 2013). Furthermore, the risk of breaching privacy of participants is pronounced, particularly when doing interviews with vulnerable populations in sensitive clinical settings (Oliffe & Bottorff, 2007; Radley & Taylor, 2003; Riley & Manias, 2004).

The method also requires a fair amount of resources in terms of time and money for generating the photographs and developing the interview kit (Clark-Ibáňez, 2004; Riley & Manias, 2004). Researchers often have very limited time to complete projects, especially when the projects are academic in nature or when investigating experiences whose memory could wane over time. For this reason, the numerous administrative processes required in generating the photographs may limit the utility of the method in clinical research. The method does not always meet the researcher’s expectations. Instead of evoking detailed accounts, the photographs may result in irrelevant responses or silence the participant (Tinkler, 2015). Alternatively, the photographs may prompt lengthy, rambling accounts that are irrelevant to the subject of interest.

Developing the interview kit was a long and tedious process. There were many administrative approval processes and bureaucracies that we had to follow before we could be allowed to take the photographs and to use them for the interview kit. Unlike in conventional interviews where researchers would proceed with data collection immediately after the institutional review board (IRB) approvals, it took more than 2 months to have the interview kit ready for the interviews. Additionally, although the mothers whose images were included in the interview kit were neither in the hospital at the time of the interview nor interviewed, it is possible that the participants may have recognized some of the mothers whose photographs were included in the interview kit thus compromising on their privacy. Efforts were made to only capture those images that were required for the study. However, in some instances, faces of the mothers (e.g., when doing skin-to-skin) and infants were inadvertently captured (e.g., during breastfeeding) thus compounding the risk of breach of privacy. Furthermore, we observed that the interviews took substantially long; participants tended to be over-elaborative when images portraying a practice they could relate with (e.g., breastfeeding, skin-to-skin contact) were being discussed.

Conclusion

When used appropriately, photo-elicitation technique can be a very useful tool in clinical research. The technique enables researchers to collect rich data in contexts that may not have been feasible with conventional interview methods. Clinical researchers could, therefore, benefit from adopting creative and innovative approaches that encourage participation, and especially by vulnerable groups, in clinical research. The significance of promoting the use of photo-elicitation as a method of enriching participants’ experiences of taking part in clinical studies cannot be overemphasized. Our understanding of the usefulness of the method, and strategies for overcoming its limitations, would continue to evolve when the method is used in more clinical studies and when the lessons learned are shared with other researchers.

Footnotes

Acknowledgement

We thank the mothers whose photographs were included our study.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

O’Brien M. Kyololo

References

Affleck

Glass

Macdonald

M. E.

(2013). The limitations of language: Male participants, stoicism, and the qualitative research interview. American Journal of Men’s Health, 7(2), 155–162. https://doi.org/10.1177/1557988312464038

Asselin

M. E.

(2003). Insider research: Issues to consider when doing qualitative research in your own setting. Journal for Nurses in Staff Development: JNSD: Official Journal of the National Nursing Staff Development Organization, 19(2), 99–103. https://doi.org/10.1097/00124645-200303000-00008

Banks

(2001). Visual method in social research. Sage.

Bender

D. E.

Harbour

Thorp

Morris

(2001). Tell me what you mean by “Sí”: Perceptions of quality of prenatal care among immigrant Latina women. Qualitative Health Research, 11(6), 780–794. https://doi.org/10.1177/104973230101100607

Blinn

Harrist

A. W.

(1991). Combining native instant photography and photo-elicitation. Visual Anthropology, 4(2), 175–192. https://doi.org/10.1080/08949468.1991.9966559

Buckley

(2014). Photography and photo-elicitation after colonialism. Cultural Anthropology, 29(4), 720–743. https://doi.org/10.14506/ca29.4.07

Bugos

Frasso

FitzGerald

True

Adachi-Mejia

A. M.

Cannuscio

(2014). Practical guidance and ethical considerations for studies using photo-elicitation interviews. Preventing Chronic Disease, 11(E189), E189. http://dx.doi.org/10.5888/pcd11.140216

Bukhave

E. B.

Huniche

(2016). Photo-interviewing to explore everyday occupation: Benefits and issues. Journal of Occupational Science, 23(1), 96–107. https://doi.org/10.1080/14427591.2015.1070742

Bunnik

E. M.

Janssens

A. C. J. W.

Schermer

M. H. N.

(2013). A tiered-layered-staged model for informed consent in personal genome testing. European Journal of Human Genetics: EJHG, 21(6), 596–601. https://doi.org/10.1038/ejhg.2012.237

10.

Chiozzi

(1989). Photography and anthropological research: Three case studies. Visual Sociology, 4(2), 43–50. https://doi.org/10.1080/14725868908583636

11.

Cignacco

Axelin

Stoffel

Sellam

Anand

K. J. S.

Engberg

(2010). Facilitated tucking as a non-pharmacological intervention for neonatal pain relief: Is it feasible? Acta Paediatrica, 99(12), 1763–1765. https://doi.org/10.1111/j.1651-2227.2010.01941.x

12.

Clancy

M. A.

(2014). Difficulty, despair and hope–an insight into theworld of the health professionals treating paediatric pain in sub-Saharan Africa. Journal of Research in Nursing, 19(3), 191–210. https://doi.org/10.1177/1744987113486472

13.

Clark-Ibáňez

(2004). Framing the social world with photo-elicitation interviews. American Behavioral Scientist, 47(12), 1507–1527. https://doi.org/10.1177/0002764204266236

14.

(2007). The use of photography as a qualitative research tool. Nurse Researcher, 15(1), 27–36. https://doi.org/10.7748/nr2007.10.15.1.27.c6052

15.

Copeland

Dahlen

H. G.

Homer

C. S. E.

(2014). Conflicting contexts: Midwives’ interpretation of childbirth through photo elicitation. Women and Birth: Journal of the Australian College of Midwives, 27(2), 126–131. https://doi.org/10.1016/j.wombi.2013.11.004

16.

Douglas

K. B.

(1998). Impressions: African American first-year students’ perceptions of a predominantly white university. The Journal of Negro Education, 67(4), 416–431. https://doi.org/10.2307/2668141

17.

Drew

S. E.

Duncan

R. E.

Sawyer

S. M.

(2010). Visual storytelling: A beneficial but challenging method for health research with young people. Qualitative Health Research, 20(12), 1677–1688. https://doi.org/10.1177/1049732310377455

18.

Dwyer

S. C.

Buckle

J. L.

(2009). The space between: On being an insider-outsider in qualitative research. International Journal of Qualitative Methods, 8(1), 54–63. https://doi.org/10.1177/160940690900800105

19.

Epstein

Stevens

McKeever

Baruchel

(2006). Photo elicitation interview (PEI): Using photos to elicit children’s perspectives. International Journal of Qualitative Methods, 5(3), 11. https://doi.org/10.1177/160940690600500301, Article 1Retrieved from. http://www.ualberta.ca/∼iiqm/backissues/5_3/pdf/epstein.pdf.

20.

Harper

(1998). An argument for visual sociology. In Prosser

(Ed.), Image-based research: A sourcebook for qualitative researchers (pp. 24–41). Falmer Press Taylor and Francis Group.

21.

Harper

(2001). Changing works: Vision of lost agricultures. University of Chicago Press.

22.

Harper

(2002). Talking about pictures: A case for photo-elicitation. Visual Studies, 17(1), 13–26. https://doi.org/10.1080/14725860220137345

23.

Harrison

(2002). Seeing health and illness worlds–using visual methodologies in a sociology of health and illness: A methodological review. Sociology of Health and amp; Illness, 24(6), 856–872. https://doi.org/10.1111/1467-9566.00322

24.

Hatten

Forin

T. R.

Adams

(2013). A picture elicits a thousand meanings: Photo elicitation as a method for investigating cross-disciplinary identity development. 120th American Association of Engineering Education, June 23-26.

25.

Heacock

Souder

Chastain

(1996). Subjects, data, and videotapes. Nursing Research, 45(6), 336–338. https://doi.org/10.1097/00006199-199611000-00005

26.

Hurworth

(2003). Photo-interviewing for research. Social Research Update, Sociology at Surrey, 40(1), 1–4. https://sru.soc.surrey.ac.uk/SRU40.PDF

27.

Johnston

C. C.

Campbell-Yeo

Disher

Benoit

Fernandes

Streiner

Inglis

Zee

(2017). Skin-to-skin care for procedural pain in neonates. Cochrane Database of Systematic Reviews, 16(2), CD008435. https://doi.org/10.1002/14651858.CD008435.pub2

28.

J. C.

(1957). Photography in anthropology: A report on two experiments. American Anthropologist, 59(5), 843–859. https://doi.org/10.1525/aa.1957.59.5.02a00100

29.

Jurkowski

J. M.

Paul-Ward

(2007). Photovoice with vulnerable populations: Addressing disparities in health promotion among people with intellectual disabilities. Health Promotion Practice, 8(4), 358–365. https://doi.org/10.1177/1524839906292181

30.

Kanuha

V. K.

(2000). “Being” native versus “going native”: Conducting social work research as an insider. Social Work, 45(5), 439–447. https://doi.org/10.1093/sw/45.5.439

31.

Khair

Collier

Meerabeau

Gibson

(2013). Multimethodology research with boys with severe haemophilia. Nurse Researcher, 20(6), 40–44. https://doi.org/10.7748/nr2013.07.20.6.40.e318

32.

Kubicek

Beyer

Weiss

Kipke

M. D.

(2012). Photovoice as a tool to adapt an HIV prevention intervention for African American young men who have sex with men. Health Promotion Practice, 13(4), 535–543. https://doi.org/10.1177/1524839910387131

33.

Kyololo

O. M.

Stevens

Gastaldo

Gisore

(2014). Procedural pain in neonatal units in Kenya. Archives of Disease in Childhood. Fetal and Neonatal Edition, 99(6), F464–F467. https://doi.org/10.1136/archdischild-2014-306003

34.

Kyololo

O. M.

Stevens

Gastaldo

Songok

(2016). Acceptability and feasibility of behavioural and sweet-tasting solution interventions for procedural pain treatment in neonatal units in Kenya (Unpublished doctoral dissertation). University of Toronto.

35.

Kyololo

O. M.

Stevens

B. J.

Songok

(2019). Mothers’ perceptions about pain in hospitalized newborn infants in Kenya. Journal of Pediatric Nursing, 47(6), 51–57. https://doi.org/10.1016/j.pedn.2019.04.015

36.

Mandleco

(2013). Research with children as participants: Photo elicitation. Journal for Specialists in Pediatric Nursing: JSPN, 18(1), 78–82. https://doi.org/10.1111/jspn.12012

37.

Meo

A. I.

(2010). Picturing students' habitus: The advantages and limitations of photo-elicitation interviewing in a qualitative study in the city of buenos aires. International Journal of Qualitative Methods, 9(2), 149–171. https://doi.org/10.1177/160940691000900203

38.

Oliffe

J. L.

Bottorff

J. L.

(2007). Further than the eye can see? Photo elicitation and research with men. Qualitative Health Research, 17(6), 850–858. https://doi.org/10.1177/1049732306298756

39.

Packard

(2008). ‘I'm gonna show you what it's really like out here’: The power and limitation of participatory visual methods. Visual Studies, 23(1), 63–77. https://doi.org/10.1080/14725860801908544

40.

Parke

Hunter

K. F.

Strain

L. A.

Marck

P. B.

Waugh

E. H.

McClelland

A. J.

(2013). Facilitators and barriers to safe emergency department transitions for community dwelling older people with dementia and their caregivers: A social ecological study. International Journal of Nursing Studies, 50(9), 1206–1218. https://doi.org/10.1016/j.ijnurstu.2012.11.005

41.

Pillai Riddell

R. R.

Racine

N. M.

Gennis

H. G.

Turcotte

Uman

L. S.

Horton

R. E.

Ahola Kohut

Hillgrove Stuart

Stevens

Lisi

D. M.

Lisi

D. M.

(2015). Non-pharmacological management of infant and young child procedural pain. The Cochrane Database of Systematic Reviews, 2015(12), CD006275. https://doi.org/10.1002/14651858.CD006275.pub3

42.

Polkinghorne

D. E.

(2005). Language and meaning: Data collection in qualitative research. Journal of Counseling Psychology, 52(2), 137–145. https://doi.org/10.1037/0022-0167.52.2.137

43.

Radley

Taylor

(2003). Images of recovery: A photo-elicitation study on the hospital ward. Qualitative Health Research, 13(1), 77–99. https://doi.org/10.1177/1049732302239412

44.

Riley

R. G.

Manias

(2003). Snap shots of live theatre: The use of photography to research governance in operating room nursing. Nursing Inquiry, 10(2), 81–90. https://doi.org/10.1046/j.1440-1800.2003.00166.x

45.

Riley

R. G.

Manias

(2004). The uses of photography in clinical nursing practice and research: A literature review. Journal of Advanced Nursing, 48(4), 397–405. https://doi.org/10.1111/j.1365-2648.2004.03208.x

46.

Samuels

(2004). Breaking the ethnographers’ frames: Reflections on the use of photo elicitation in understanding Sri Lankan monastic culture. American Behavioral Scientist, 47(12), 1528–1550. https://doi.org/10.1177/0002764204266238

47.

Schrader

S. M.

Deering

E. N.

Zahl

D. A.

Wallace

(2011). Visually storying living with HIV: Bridging stressors and supports in accessing care. Health Education Research, 26(4), 638–652. https://doi.org/10.1093/her/cyr023

48.

Schwartz

(1992). Waucoma twilight: Generations on the farm. Smithsonian Press.

49.

Serbinski

(2014). Growing up in families that foster: Exploring the emotions of young adult sons and daughters of foster parents. University of Toronto. Published doctoral dissertation https://tspace.library.utoronto.ca/handle/1807/68241

50.

Shaw

(2013). A new look at an old research method: Photo-elicitation. TESOL Journal, 4(4), 785–799. https://doi.org/10.1002/tesj.108

51.

Skrzypiec

Harvey-Murray

Krieg

(2013). The photostory method as a legitimate research tool in evaluations: More than a nice story. Australasian Journal of Early Childhood, 38(3), 25–35. https://doi.org/10.1177/183693911303800305

52.

Smith

E. F.

Gidlow

Steel

(2012). Engaging adolescent participants in academic research: The use of photo-elicitation interviews to evaluate school based outdoor education programmes. Qualitative Research, 12(4), 367–387. https://doi.org/10.1177/1468794112443473

53.

Teddlie

(2007). Mixed methods sampling: A typology with examples. Journal of Mixed Methods Research, 1(1), 77–100. https://doi.org/10.1177/1558689806292430

54.

Thummapol

Park

Jackson

Barton

(2019). Methodological challenges faced in doing research with vulnerable women: Reflections from fieldwork experiences. International Journal of Qualitative Methods, 18(Jan-Dec), 160940691984302. https://doi.org/10.1177/1609406919843022.

55.

Tinkler

(2015). Talking about photos: How does photo-elicitation work and how can we use it productively in research? International Institute of Qualitative methodology, University of Alberta.

56.

Van Auken

P. M.

Frisvoll

S. J.

Stewart

S. I.

(2010). Visualising community: Using participant-driven photo-elicitation for research and application. Local Environment, 15(4), 373–388. https://doi.org/10.1080/13549831003677670

57.

Vila

(2013). The importance of photo interviewing as a research method in the study of identity construction processes: An illustration from the US-Mexico border. Visual Anthropology, 26(1), 51–68. https://doi.org/10.1080/08949468.2013.735187

58.

Wang

Burris

M. A.

(1997). Photovoice: Concept, methodology, and use for participatory needs assessment. Health Education and Behavior: The Official Publication of the Society for Public Health Education, 24(3), 369–387. https://doi.org/10.1177/109019819702400309

59.

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

60.

Wang

C. C.

Morrel-Samuels

Hutchison

P. M.

Bell

Pestronk

R. M.

(2004). Flint photovoice: Community building among youths, adults, and policymakers. American Journal of Public Health, 94(6), 911–913. https://doi.org/10.2105/ajph.94.6.911

61.

Warren

(2005). Photography and voice in critical qualitative management research. Accounting, Auditing and Accountability Journal, 18(6), 861–882. https://doi.org/10.1108/09513570510627748

62.

Wiles

Prosser

Bagnoli

Clark

Davies

Holland

Renold

(2008). Visual ethics: Ethical issues in visual research. ESCR National Centre for Research Methods.

Photo-Elicitation Technique: Utility and Challenges in Clinical Research

Abstract

Keywords

Introduction

A Case for Photo-Elicitation

Developing the Interview Kit

Developing the Interview Guide

The Interviews

Utility of Including Photographs in Interviews

Ethical Challenges

Limitations

Conclusion

Footnotes

Acknowledgement

Declaration of Conflicting Interests

Funding

ORCID iD

References