Abstract
Photovoice is an emerging qualitative research method used to engage community members in research that highlights their lived experiences and initiate change. Photovoice offers potential benefits to research conducted by and with Indigenous communities through privileging Indigenous knowledge and perspectives. There is a lack of synthesized evidence about the usage, benefits, and challenges of conducting Photovoice research by and with Indigenous communities, which this systematic methods review aims to address. We specifically focus on Indigenous young people in Canada, Australia, Aotearoa New Zealand, and the United States. Five databases were searched systematically for articles including keywords for ‘Indigenous’ and ‘Photovoice’. Empirical studies and methods papers reporting the use of Photovoice with majority cohorts of young Indigenous participants were included. Relevant data were extracted and Photovoice methods analysed using an integrative approach. Database searches yielded 1402 articles, with 109 reviewed in full and 41 included in the review. These articles represented 37 unique studies, with most from Canada (n = 17), and the United States (n = 14). Our analysis revealed great variability in how Photovoice has been applied across studies with Indigenous young people. However, some notable commonalities include recruitment of participants via community networks, and participant involvement in data collection and analysis. The potential benefits associated with using Photovoice with Indigenous young people included: fostering participant autonomy and authority; photography being familiar and fun; the visual medium being culturally appropriate for Indigenous peoples; and the method being effective for engaging the whole community. Challenges associated with Photovoice included: engagement difficulties between researchers and participants; issues with photography; and ethical complexities. These findings suggest that Photovoice is an appropriate and largely effective method to engage young Indigenous people in research. However, there are logistical and ethical issues associated with the method that require careful consideration.
Keywords
Background
The Photovoice method is an increasingly used qualitative research method, aiming to empower community members to document and share their stories, and communicate their situations and experiences (Castleden et al., 2008; Wang & Burris, 1997). Photovoice has been used in the context of community-based participatory research (CBPR) as it offers a platform for communities to elevate their voices, promote awareness of pertinent issues and drive action to address issues of concern at both community and policy levels (Wang & Burris, 1994, 1997). CBPR can be understood theoretically as a function of community-based research and participatory research, where knowledge construction and research are collaboratively and equitably undertaken by the community and researchers (Baum et al., 2006; Israel et al., 1998). CBPR recognises the diversity of contributions from those within the community, and emphasises co-learning between community and researchers, leading to positive and sustainable, actionable outcomes within and for communities (Wallerstein & Duran, 2006).
Photovoice is a highly flexible method that has been variably applied across CBPR studies. Areas of application are varied and include in disability (Dassah et al., 2017), mental health (Han & Oliffe, 2016), with youth populations (Fountain et al., 2021), in water management (Fantini, 2017) and in people with HIV (Teti et al., 2018). In broad terms, Photovoice involves participants being given a camera, taught how to operate it, and invited to take photographs that highlight their lived experiences relevant to the topic of the project. The topic is usually predetermined by the research team and/or the community. The photographs are then shared with the researchers and/or participant group for the purposes of an individual or group discussion that aims to build a rich, shared narrative around a research topic. Key aspects of the narrative are commonly shared via an exhibition, report or article to raise awareness of the issues and needs of the community and to promote change (Wang & Burris, 1994, 1997). Critics have cast doubt on Photovoice’s methodological rigour (Nykiforuk et al., 2011; Seitz & Orsini, 2022), questioning the method’s efficacy in mitigating power imbalances between researchers and participants (Carlson et al., 2006; Castleden et al., 2008). Despite these concerns, the popularity of the method continues to rise, with the number of citations increasing by 600% between 2010 and 2020. This popularity is likely due in part to the flexibility of Photovoice to meet the unique needs of the communities. However, the heterogeneity of Photovoice application can lead to difficulties in determining exactly what the method comprises.
There is increasing recognition of the need for ethically considered, relevant and Indigenous-led research practices to understand the issues and needs of Indigenous communities. A vast quantity of research has been conducted on Indigenous peoples and communities around the world, which has been wielded in many cases as a tool of domination and disempowerment (Martin, 2008; Ryder et al., 2020; Smith, 1999). This ongoing impacts of trauma associated with research has instilled a deep-seated mistrust of research among many Indigenous peoples (Smith, 1999). While Western hegemony continues to drive much research, there is a mounting body of work conducted by and with Indigenous researchers that seeks to decolonize research practices and prioritize Indigenous voices (Durie, 2004; Martin & Mirraboopa, 2003). Photovoice is increasingly regarded as a culturally-appropriate method for research involving Indigenous communities, as it has the potential to empower Indigenous voices in research (Alberta Centre for Child, Family and Community Research, 2016; Carroll et al., 2018; Castleden & Garvin, 2008; Goodman et al., 2018; Hatala et al., 2020; Lewis & Swoboda, 2016; Minthorn & Marsh, 2016; Mitchell et al., 2020; Morton et al., 2020; Tremblay et al., 2018). It has been argued that Photovoice may reduce some of the barriers that deter Indigenous peoples from engaging in research, by making it more appealing, accessible, and culturally relevant. Moreover, this method has the potential to shift the power dynamic of traditional research methods and empower participants to drive the narrative, outputs, and outcomes of the research (Jull et al., 2017). The scope for participants to tell their story in visual and verbal mediums is a good fit with traditional Indigenous practices of storytelling and art (Atkinson et al., 2021; Hammond et al., 2018; Martin & Mirraboopa, 2003); creating space and scope for Indigenous ways of knowing, being and doing to more manifestly guide research processes (Lewis & Swoboda, 2016; Martin & Mirraboopa, 2003).
While all young people face challenges associated with unprecedented environmental, social and technological change, Indigenous young people face additional challenges stemming from the impacts of colonisation, inter-generational trauma, racism and socioeconomic disadvantage (Azzopardi et al., 2018; Patton et al., 2016). The inclusion of young people in research processes has often been limited to observed participants, rather than active co-researchers. This has resulted in gaps in the literature and often superficial insights into young peoples' experiences (Krane et al., 2021). There have been limited CBPR opportunities for youth (Jacquez et al., 2013; Simpson & Mendenhall, 2022), despite evidence suggesting that youth involvement in research processes can deliver effective and innovative solutions (Langdon et al., 2016; McCalman et al., 2013). Photovoice offers potential means for Indigenous young people to engage in research in a way that is active, accessible and constructive, as well as offering potential to strengthen their identity and agency as changemakers in their communities and society (Ozer, 2017).
While the number of Photovoice studies conducted with Indigenous young people are increasing, no synthesized evidence is available about the application and potential benefits and challenges of using Photovoice in research by and with Indigenous communities. Broadly, this paper presents the findings of a systematic methods review (Gentles et al., 2016) that aimed to explore how Photovoice has been operationalised in research with Indigenous young people in the British colonised countries of Canada, Australia, Aotearoa New Zealand, and the United States – commonly called CANZUS countries. Indigenous populations in CANZUS countries share a long history of unique cultures, rich in tradition, knowledge, and spirituality. They also share some similar experiences such as loss of land and language, racism, and disempowerment resulting from British colonisation (Cooke et al., 2007).
This systematic methods’ review specifically aimed to explore the following questions: 1. How has Photovoice been operationalised in research with Indigenous young people? 2. What are the reported benefits of using Photovoice with Indigenous young people? 3. What are the reported challenges of using Photovoice with Indigenous young people?
The findings of this systematic methods review will provide a foundation on which to build a collective understanding around the practicalities, benefits, and challenges of using Photovoice in research conducted by and with Indigenous young people to drive change and empowerment.
Methods
Positionality Statement
Recognition of each contributing authors positionality, perspectives, and backgrounds is an important element of reflexive practice (Alvesson & Sköldberg, 2018; Nilson, 2017). The first author (KA) is a non-First Nations Australian senior researcher experienced in conducting collaborative qualitative research with First Nations researchers and communities. The second author (EE) is a non-First Nations junior researcher and health practitioner with experience in First Nations health and research. The third author (KH) is a non-First Nations senior researcher and Professor of Health Economics experienced in conducting qualitative and quantitative research with First Nations researchers and communities. The fourth author (GG) is a senior Aboriginal researcher with extensive research experience in First Nations Health. This manuscript forms part of a broader study on Australian First Nations wellbeing, which has been guided by First Nations advisory groups. This program of work is based within a First Nations health and wellbeing research group comprised of both First Nations and non-First Nations researchers.
Protocol Registration
This systematic methods review was conducted as per the Preferred Reporting Items for Systematic and Meta-Analysis (PRISMA) where applicable and is registered with the international prospective register of systematic reviews (PROSPERO CRD42020216380).
Search Strategy
The search aimed to identify peer-reviewed literature reporting on the use of the Photovoice as a research method with Indigenous young people from CANZUS nations. The search strategy was developed through consultation with experts in qualitative research with Indigenous participants (GG, AG – Indigenous; KA – non-Indigenous). Key search terms included ‘Indigenous’ and ‘Photovoice’ terms (Supplement 1). ‘Youth’ terms, such as “child”, “youth” or “adolescent” were not included in the original search, as this study began without a specific youth focus. After conducting searches and assessing included articles, the scope of this study was narrowed to youth participants to aid feasibility. Indigenous population terms were informed by previously conducted systematic reviews and expert guidance (Angell et al., 2016; Butler et al., 2019; Jongen et al., 2019). Photovoice terms were developed via consulting reviews investigating photography-based research (Catalani & Minkler, 2010; Yang Y et al., 2020). Draft searches were used to confirm keywords and ensure relevant and comprehensive results. Five relevant databases were searched by title/abstract systematically in July 2020 including APA PsycInfo, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Medline, Embase and PubMed, with no limitations on date published. These databases are commonly utilised in systematic reviews focusing on topics of health and social sciences and were deemed to present significant results during draft searches. The human limiter and peer-reviewed limiter were applied to searches where available in the database interface. The search was updated in July 2022.
Inclusion and Exclusion Criteria
Articles were eligible for inclusion if they were empirical studies or methods papers using Photovoice or a similar method with a population of Indigenous people in a CANZUS nation. Similar methods included photo-story, photo elicitation, photo novella and other methods that included participant captured images as a core element of the study method, knowledge creation and results. We opted to include articles that referenced these methods due to their similarities with Photovoice as described by Wang and Burris (Wang & Burris, 1997), and with the knowledge that Photovoice is applied heterogeneously. We did not limit to specific research topics. We included only peer-reviewed articles published in English and excluded case studies, case series, commentaries, editorials, books and book chapters, narrative reviews, conference abstracts, dissertations, theses and other grey literature.
Data Extraction (Selection and Coding)
Following removal of duplicates in Endnote (Clarivate Analytics, Version X8, 2018), all identified articles were double screened for inclusion by title and abstract by two authors in Rayyan Online Software (Ouzzani et al., 2016) (EE, KA). A screening hierarchy of inclusion criteria was developed and agreed upon by the authors to help facilitate this process. Full-text screening of articles was conducted in Rayyan by one author (EE). Where study inclusion/exclusion was unclear, this was discussed with the senior author (KA) and inclusion/exclusion decided by consensus. Citation lists of studies included after full-text review were hand-searched to identify any further articles for inclusion.
In line with the systematic methods review approach (Gentles et al., 2016), data from the methods-relevant sections of each included study was iteratively extracted. The initial extraction included the following fields: publication information, participant information (number, location, Indigenous status, age, gender) and how Photovoice was applied (community engagement, recruitment, training, equipment, facilitators, length of Photovoice sessions, time to take photographs, analysis process, data management, community outputs, perceived benefits and challenges of using Photovoice). These fields were refined and revised by iterative decision-making throughout the analysis to determine and define the sub-topics included in the analysis.
The initial search and data extraction included studies with participants across all age ranges. The data extraction revealed that most retrieved studies were completed with young cohorts. The breadth of the current study was revised at this point, with this review reporting on studies where the majority of participants were aged 25 years or below. The selection of studies for inclusion was completed after the data extraction, based on reported age ranges in each study. Where the age of participants was unclear or not reported, studies were assessed for inclusion based on qualitative descriptions of their cohort that implied a significant proportion of young people.
Data Synthesis
A constant comparative method of analysis (Glaser & Strauss, 1967) was conducted by two authors (KA, EE). This approach has been identified as the most suitable analysis approach for systematic methods reviews (Gentles et al., 2016). An integrative approach (Gentles et al., 2016) to the analysis was used to broadly answer the three questions 1–3.
The comparative method involved a process of constant comparisons and iterative decision-making across the following four steps, which entailed progressive levels of abstraction: data abstraction, development of matrices, development of narrative summaries, and formulation of analytic conclusions.
Aligned with the existing guidance for conducting systematic methods reviews, a separate quality appraisal was not undertaken (Gentles et al., 2016). Partial assessment of quality was undertaken throughout the data and results synthesis through assessment of clarity, consistency and comprehensiveness of each studies reported methodology (Gentles et al., 2016). It has been noted throughout the results where details of methods were not reported.
Results
A total of 119 articles were reviewed in full after title and abstract screening, of which 69 were deemed eligible for inclusion (Figure 1). After narrowing the focus of this systematic methods review to include studies with majority young participants, 41 articles were deemed eligible for inclusion, from 37 unique studies (four articles were excluded from the final analysis based on methodological duplication) (Cooper & Driedger, 2019; Hanemaayer et al., 2022; Morton et al., 2020; Njeze et al., 2020). PRISMA flow diagram of included studies. From: Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021; 372:n71. doi: 10.1136/bmj.n71. For more information, visit: http://www.prisma-statement.org/
Description of Included Studies.
* If any authors listed identified in the article text as Indigenous.
Detailed Operation of Photovoice
a) Study Locations Participants, and Recruitment
17 studies were undertaken in Canada (Cooper, 2022; Genius et al., 2015; Goodman et al., 2019; Hanemaayer et al., 2020; Hatala et al., 2020; Hayhurst et al., 2015; Hudson et al., 2020; Jardine & James, 2012; Jennings et al., 2020; Johnson et al., 2020; Lines & Jardine, 2019; McHugh et al., 2013; Shea J et al., 2011; Sloan Morgan et al., 2022; Tremblay et al., 2018; Victor et al., 2022), 14 in the United States (Aparicio et al., 2021; Banyard et al., 2020; Cueva et al., 2020; Edwards et al., 2022; Helm et al., 2015; Jennings & Lowe, 2013; Kelly, 2017; Markus, 2012; Minthorn & Marsh, 2016; Philip et al., 2022; Uchima et al., 2021; Weinronk et al., 2018; Williamson et al., 2020; Young et al., 2013), four in Australia (Johnston et al., 2012; Kaplun et al., 2016; Liew et al., 2022; Savuro et al., 2022) and two in Aotearoa New Zealand (Faircloth et al., 2016; Jones et al., 2013).
For the studies conducted in Canada, Indigenous participants predominantly identified as either Canadian Aboriginal or First Nations (Goodman et al., 2018; Goodman et al., 2019; Hayhurst et al., 2015; Hudson et al., 2020; Jardine & James, 2012; Jennings et al., 2020; Johnson et al., 2020; Lines & Jardine, 2019; McHugh et al., 2013; Shea J et al., 2011; Sloan Morgan et al., 2022). Some studies specifically identified Indigenous groups, with four studies including Cree participants (Genius et al., 2015; Hatala et al., 2020; Tremblay et al., 2018). One study each included Métis and Plains Cree participants (Hatala et al., 2020), Métis participants (Cooper, 2022), Haudenosaunee participants (Hanemaayer et al., 2020), and Neehithuw participants (Victor et al., 2022). The studies conducted in Australia identified participants as Aboriginal (Liew et al., 2022), and Aboriginal and Torres Strait Islander (Johnston et al., 2012; Kaplun et al., 2016; Savuro et al., 2022). In the two Aotearoa New Zealand studies participants were identified as Māori (Faircloth et al., 2016; Jones et al., 2013). For the 14 studies conducted in the United States, participants were identified predominantly as Native American (Banyard et al., 2020; Jennings & Lowe, 2013; Minthorn & Marsh, 2016; Williamson et al., 2020), American Indian (Cueva et al., 2020; Kelly, 2017; Markus, 2012) and Native Hawaiian (Aparicio et al., 2021; Helm et al., 2015; Uchima et al., 2021). One study each specifically included Inupiaq participants (Weinronk et al., 2018), Lakota participants(Edwards et al., 2022), Athabascan participants (Philip et al., 2022), and Asishinabek participants (Young et al., 2013).
Almost all studies reported cohorts mostly aged less than 25 years. Two did not report participant age however clearly included significant youth participants (Sloan Morgan et al., 2022; Weinronk et al., 2018). Most studies recruited both male and female participants, while three studies included female participants only (Hanemaayer et al., 2020; Hayhurst et al., 2015; Shea J et al., 2011), and eight studies did not report the sex of their participants (Jardine & James, 2012; Johnston et al., 2012; Kaplun et al., 2016; Lines & Jardine, 2019; Minthorn & Marsh, 2016; Sloan Morgan et al., 2022; Tremblay et al., 2018; Weinronk et al., 2018). The number of participants varied from 86 participants (Cooper, 2022) to two participants (Johnson et al., 2020).
Some studies recruited specific sub-groups of young people: school students (Jardine & James, 2012; Jennings & Lowe, 2013; Johnston et al., 2012; Jones et al., 2013; Kaplun et al., 2016; Kelly, 2017; McHugh et al., 2013; Morton et al., 2020; Victor et al., 2022) or young people engaged in school-based programs (Cueva et al., 2020; Genius et al., 2015; Helm et al., 2015); college students (Minthorn & Marsh, 2016); young people engaged in community programs or organisations (Goodman et al., 2019; Hatala et al., 2020; Hayhurst et al., 2015; Philip et al., 2022; Savuro et al., 2022); and young people from particular communities (Cooper, 2022; Edwards et al., 2022; Hanemaayer et al., 2020; Hudson et al., 2020; Kaplun et al., 2016; Liew et al., 2022; Shea J et al., 2011; Sloan Morgan et al., 2022; Weinronk et al., 2018) or Nations (Young et al., 2013).
b) Topics of Interest
General health was the focus of five studies (Cooper, 2022; Goodman et al., 2019; Jennings & Lowe, 2013; Lines & Jardine, 2019; Williamson et al., 2020; Young et al., 2013), with some studies focusing on a specific area of health. One study explored the association between food and health (Jennings et al., 2020), three studies investigated sexual health (Aparicio et al., 2021; Banyard et al., 2020; Markus, 2012), and asthma (Jones et al., 2013; Uchima et al., 2021) and deafness (Faircloth et al., 2016) were also investigated. Smoking and drug use were the focus of three studies (Helm et al., 2015; Jardine & James, 2012; Johnston et al., 2012), and food was another common topic (Cueva et al., 2020; Genius et al., 2015; Hanemaayer et al., 2020; Kelly, 2017). Sport related studies included program evaluation (Hanemaayer et al., 2020; Yang Y et al., 2020), barriers and facilitators of physical activity (Liew et al., 2022), experiences with physical activity (Hudson et al., 2020), and relocating for sporting opportunities (Johnson et al., 2020). Two studies each focused on education (Kaplun et al., 2016; Minthorn & Marsh, 2016) and youth wellbeing (Philip et al., 2022; Victor et al., 2022). Other topics included the natural environment (Hatala et al., 2020), family resiliency (Edwards et al., 2022), community (Tremblay et al., 2018), how relationships are impacted by mobility (Goodman et al., 2018), body image (Shea J et al., 2011), sustainable futures (Sloan Morgan et al., 2022), service delivery (Savuro et al., 2022) and research methods (Weinronk et al., 2018).
c) Indigenous Community Engagement and Governance
Our team recognises that Indigenous personage in research teams and among study authors is an important aspect of Indigenous research leadership. As such, we have identified the 16 articles that reported Indigenous personage among their authors (Aparicio et al., 2021; Banyard et al., 2020; Edwards et al., 2022; Faircloth et al., 2016; Genius et al., 2015; Goodman et al., 2018; Hatala et al., 2020; Helm et al., 2015; Hudson et al., 2020; Jennings & Lowe, 2013; Johnson et al., 2020; Jones et al., 2013; Lines & Jardine, 2019; McHugh et al., 2013; Sloan Morgan et al., 2022; Young et al., 2013) to allow our readers to assess where Indigenous perspectives on Photovoice’s effectiveness may be present. Twenty studies did not report on their authorship composition (Cooper, 2022; Cueva et al., 2020; Goodman et al., 2019; Hanemaayer et al., 2022; Jardine & James, 2012; Jennings et al., 2020; Johnston et al., 2012; Kaplun et al., 2016; Kelly, 2017; Liew et al., 2022; Markus, 2012; Minthorn & Marsh, 2016; Philip et al., 2022; Savuro et al., 2022; Shea J et al., 2011; Tremblay et al., 2018; Uchima et al., 2021; Victor et al., 2022; Weinronk et al., 2018; Williamson et al., 2020), and one study reported authorship without any Indigenous identification (Hayhurst et al., 2015).
Community engagement was reported in all but five studies (Jardine & James, 2012; Kelly, 2017; Minthorn & Marsh, 2016; Tremblay et al., 2018; Victor et al., 2022). Several studies were led by or included researchers who were Indigenous community members (Aparicio et al., 2021; Faircloth et al., 2016; Johnston et al., 2012; Lines & Jardine, 2019), with some engaging community members as Photovoice facilitators (Banyard et al., 2020; Edwards et al., 2022; Uchima et al., 2021). Some studies had significant community engagement prior to research commencement (Cooper, 2022; Edwards et al., 2022; Genius et al., 2015; Hudson et al., 2020; Jennings & Lowe, 2013; Kaplun et al., 2016; Sloan Morgan et al., 2022), with others initiated by or in partnership with the community (Hudson et al., 2020; Jardine & James, 2012; Jennings et al., 2020; Kaplun et al., 2016; Markus, 2012). The type of community engagement reported varied, including: governance from a community advisory group or council (Faircloth et al., 2016; Hanemaayer et al., 2020; Hatala et al., 2020; Hayhurst et al., 2015; Jennings et al., 2020; Liew et al., 2022; Philip et al., 2022; Shea J et al., 2011; Uchima et al., 2021; Williamson et al., 2020; Young et al., 2013); engagement with community leaders/Elders (Helm et al., 2015; Jennings et al., 2020; Jones et al., 2013; Kaplun et al., 2016); allowing for feedback to and from the community (Jennings et al., 2020; Kaplun et al., 2016; Liew et al., 2022; Philip et al., 2022; Uchima et al., 2021; Young et al., 2013); and including participants as co-researchers (Edwards et al., 2022; Faircloth et al., 2016; Johnston et al., 2012; Weinronk et al., 2018).
Many studies reported building relationships with schools, health services and other community groups (Cooper, 2022; Genius et al., 2015; Goodman et al., 2018, 2019; Hanemaayer et al., 2020; Hayhurst et al., 2015; Jennings & Lowe, 2013; Johnson et al., 2020; McHugh et al., 2013; Savuro et al., 2022; Tremblay et al., 2018), or building on existing relationships (Banyard et al., 2020; Cueva et al., 2020; Edwards et al., 2022; Hudson et al., 2020; Weinronk et al., 2018) for the study.
d) Methodology
Most studies referenced CBPR or participatory action research as a component of their design (Aparicio et al., 2021; Banyard et al., 2020; Cooper, 2022; Cueva et al., 2020; Edwards et al., 2022; Faircloth et al., 2016; Genius et al., 2015; Goodman et al., 2018; Goodman et al., 2019; Hanemaayer et al., 2020; Hatala et al., 2020; Hayhurst et al., 2015; Helm et al., 2015; Hudson et al., 2020; Jardine & James, 2012; Jennings & Lowe, 2013; Jennings et al., 2020; Johnston et al., 2012; Jones et al., 2013; Kelly, 2017; Liew et al., 2022; Lines & Jardine, 2019; Markus, 2012; McHugh et al., 2013; Philip et al., 2022; Savuro et al., 2022; Shea J et al., 2011; Sloan Morgan et al., 2022; Tremblay et al., 2018; Victor et al., 2022; Weinronk et al., 2018; Young et al., 2013). One study noted that a participatory approach was used only for analysis (Uchima et al., 2021). Other studies deduced that Photovoice possesses inherent qualities which qualify it as a participatory method (Banyard et al., 2020; Goodman et al., 2018; Jennings & Lowe, 2013; McHugh et al., 2013; Shea J et al., 2011).
Most studies used Photovoice qualitative methodologies only (Aparicio et al., 2021; Banyard et al., 2020; Cueva et al., 2020; Edwards et al., 2022; Faircloth et al., 2016; Genius et al., 2015; Goodman et al., 2019; Hanemaayer et al., 2020; Hatala et al., 2020; Hayhurst et al., 2015; Helm et al., 2015; Hudson et al., 2020; Jardine & James, 2012; Jennings & Lowe, 2013; Jennings et al., 2020; Johnson et al., 2020; Johnston et al., 2012; Kelly, 2017; Liew et al., 2022; McHugh et al., 2013; Minthorn & Marsh, 2016; Savuro et al., 2022; Shea J et al., 2011; Sloan Morgan et al., 2022; Tremblay et al., 2018; Weinronk et al., 2018; Williamson et al., 2020; Young et al., 2013). A small number used mixed methods (Cooper, 2022; Lines & Jardine, 2019; Markus, 2012; Philip et al., 2022) (Goodman et al., 2018; Jones et al., 2013; Kaplun et al., 2016; Lines & Jardine, 2019; Uchima et al., 2021; Victor et al., 2022).
e) Participant Recruitment and Training
Only one study did not describe their recruitment methods (Faircloth et al., 2016). Many participants were recruited from schools, colleges and school based programs (Cueva et al., 2020; Genius et al., 2015; Helm et al., 2015; Jardine & James, 2012; Jones et al., 2013; Kelly, 2017; Minthorn & Marsh, 2016; Sloan Morgan et al., 2022; Tremblay et al., 2018; Victor et al., 2022; Weinronk et al., 2018); service and community organisations (Goodman et al., 2018; Goodman et al., 2019; Hayhurst et al., 2015; Jennings et al., 2020; Markus, 2012; Savuro et al., 2022; Shea J et al., 2011); or via convenience or snowball sampling and community connections (Banyard et al., 2020; Cooper, 2022; Edwards et al., 2022; Hatala et al., 2020; Hudson et al., 2020; Jennings & Lowe, 2013; Johnston et al., 2012; Liew et al., 2022; McHugh et al., 2013; Williamson et al., 2020). Fewer studies recruited participants from community events and programs (Aparicio et al., 2021; Hanemaayer et al., 2020; Philip et al., 2022; Uchima et al., 2021), cultural activities and camps (Lines & Jardine, 2019), and via a larger research study (Johnson et al., 2020; Kaplun et al., 2016).
Many studies did not describe the type of training, if any, provided to participants before commencing Photovoice participation (Banyard et al., 2020; Cooper, 2022; Goodman et al., 2018; Hudson et al., 2020; Jardine & James, 2012; Johnson et al., 2020; Kaplun et al., 2016; Lines & Jardine, 2019; McHugh et al., 2013; Minthorn & Marsh, 2016; Sloan Morgan et al., 2022). For those that did, most provided an initial training session, which commonly included instruction on operating cameras, photography principles, ethical considerations (including gaining consent to take photos of people), and discussion around the topic of interest (Aparicio et al., 2021; Banyard et al., 2020; Cueva et al., 2020; Edwards et al., 2022; Faircloth et al., 2016; Genius et al., 2015; Goodman et al., 2019; Helm et al., 2015; Jennings & Lowe, 2013; Jennings et al., 2020; Johnston et al., 2012; Jones et al., 2013; Kelly, 2017; Markus, 2012; Philip et al., 2022; Savuro et al., 2022; Shea J et al., 2011; Tremblay et al., 2018; Uchima et al., 2021; Victor et al., 2022; Weinronk et al., 2018). Two studies reported only outlining the vision or context of the project (Hatala et al., 2020; Liew et al., 2022; Young et al., 2013), while one provided guidance on things not to photograph (Hayhurst et al., 2015).
f) Facilitators
Photovoice facilitators employed included: researchers (Aparicio et al., 2021; Cooper, 2022; Faircloth et al., 2016; Genius et al., 2015; Hanemaayer et al., 2020; Hatala et al., 2020; Helm et al., 2015; Hudson et al., 2020; Jardine & James, 2012; Jennings & Lowe, 2013; Johnson et al., 2020; Jones et al., 2013; Kelly, 2017; Liew et al., 2022; Lines & Jardine, 2019; McHugh et al., 2013; Philip et al., 2022; Sloan Morgan et al., 2022; Uchima et al., 2021; Young et al., 2013); community researchers/members (Banyard et al., 2020; Cooper, 2022; Cueva et al., 2020; Edwards et al., 2022; Faircloth et al., 2016; Goodman et al., 2019; Hanemaayer et al., 2020; Hatala et al., 2020; Hayhurst et al., 2015; Helm et al., 2015; Jardine & James, 2012; Jennings & Lowe, 2013; Kaplun et al., 2016; Liew et al., 2022; McHugh et al., 2013; Savuro et al., 2022; Uchima et al., 2021; Victor et al., 2022; Weinronk et al., 2018; Young et al., 2013); and trained facilitators (Jennings et al., 2020; Johnston et al., 2012). This was not reported for one study (Markus, 2012).
g) Taking Photos
Sixteen studies reported giving participants digital cameras for the project (Banyard et al., 2020; Edwards et al., 2022; Faircloth et al., 2016; Goodman et al., 2018; Goodman et al., 2019; Hanemaayer et al., 2020; Hatala et al., 2020; Helm et al., 2015; Hudson et al., 2020; Jennings & Lowe, 2013; Liew et al., 2022; Markus, 2012; Shea J et al., 2011; Victor et al., 2022; Williamson et al., 2020; Young et al., 2013); seven gave disposable cameras (Cueva et al., 2020; Genius et al., 2015; Jardine & James, 2012; Johnston et al., 2012; Jones et al., 2013; Kelly, 2017; McHugh et al., 2013); and the use of mixed methods (video-recorder and/or digital camera (Lines & Jardine, 2019); mobile phones and digital camera (Uchima et al., 2021) was reported by two studies. One study provided mobile phones to participants to capture images (Aparicio et al., 2021). One study did not define the type of camera participants used (Minthorn & Marsh, 2016), and ten did not report details of equipment used to take photographs (Cooper, 2022; Hayhurst et al., 2015; Jennings et al., 2020; Johnson et al., 2020; Kaplun et al., 2016; Philip et al., 2022; Savuro et al., 2022; Sloan Morgan et al., 2022; Tremblay et al., 2018; Weinronk et al., 2018).
While not reported in several studies (Cooper, 2022; Cueva et al., 2020; Faircloth et al., 2016; Genius et al., 2015; Hanemaayer et al., 2020; Hayhurst et al., 2015; Hudson et al., 2020; Jennings & Lowe, 2013; Johnson et al., 2020; Johnston et al., 2012; Jones et al., 2013; Lines & Jardine, 2019; Minthorn & Marsh, 2016; Savuro et al., 2022; Sloan Morgan et al., 2022; Tremblay et al., 2018), the length of time participants were allocated to take their photos ranged from less than a day (Kaplun et al., 2016; Shea J et al., 2011; Young et al., 2013), to several days or weeks (Aparicio et al., 2021; Banyard et al., 2020; Edwards et al., 2022; Goodman et al., 2018, 2019; Hatala et al., 2020; Helm et al., 2015; Jardine & James, 2012; Jennings et al., 2020; Kelly, 2017; Liew et al., 2022; Markus, 2012; McHugh et al., 2013; Philip et al., 2022; Uchima et al., 2021; Victor et al., 2022; Weinronk et al., 2018; Williamson et al., 2020). One study ran for 1 year, including seasonal cycles of photo-taking and sharing (Hatala et al., 2020). Many studies required participants to cull photographs and/or select a limited number for discussion and inclusion in the study (Aparicio et al., 2021; Banyard et al., 2020; Cueva et al., 2020; Goodman et al., 2018, 2019; Hanemaayer et al., 2020; Helm et al., 2015; Hudson et al., 2020; Jennings & Lowe, 2013; Jennings et al., 2020; Johnson et al., 2020; Markus, 2012; McHugh et al., 2013; Minthorn & Marsh, 2016; Tremblay et al., 2018; Uchima et al., 2021; Young et al., 2013). While the number of photos per participant was usually 10 photos or less, one study requested participants include between 20–30 photos (Hatala et al., 2020; Njeze et al., 2020). Many studies did not report restriction of photo number for discussion (Cooper, 2022; Edwards et al., 2022; Faircloth et al., 2016; Genius et al., 2015; Jardine & James, 2012; Johnston et al., 2012; Jones et al., 2013; Kaplun et al., 2016; Kelly, 2017; Lines & Jardine, 2019; Savuro et al., 2022; Shea J et al., 2011; Sloan Morgan et al., 2022; Weinronk et al., 2018; Williamson et al., 2020).
h) Discussion of Photos and Analysis
The exploration of participants’ views regarding their photos and the topic of interest was facilitated via individual interviews (Aparicio et al., 2021; Faircloth et al., 2016; Goodman et al., 2018; Hanemaayer et al., 2020; Hatala et al., 2020; Hayhurst et al., 2015; Johnson et al., 2020; Jones et al., 2013; Kelly, 2017; Shea J et al., 2011), group discussion (Cooper, 2022; Cueva et al., 2020; Edwards et al., 2022; Goodman et al., 2019; Helm et al., 2015; Hudson et al., 2020; Jardine & James, 2012; Markus, 2012; McHugh et al., 2013; Philip et al., 2022; Savuro et al., 2022; Sloan Morgan et al., 2022; Tremblay et al., 2018; Uchima et al., 2021; Young et al., 2013), and a mix of group and individual discussions (Jennings et al., 2020; Liew et al., 2022; Minthorn & Marsh, 2016; Victor et al., 2022; Weinronk et al., 2018; Williamson et al., 2020). One study used a pile sort approach to grouping topics (Kelly, 2017) and six studies used the SHOWeD framework designed by Wang and Burris (Wang & Burris, 1997) (What do you
Two studies explicitly reported using an Indigenous research framework to guide their approach (Hatala et al., 2020; Johnson et al., 2020). The analytic approaches used by were thematic analysis (Angell et al., 2016; Azzopardi et al., 2018; Carlson et al., 2006; Carroll et al., 2018; Catalani & Minkler, 2010; Cooke et al., 2007; Cooper, 2022; Edwards et al., 2022; Goodman et al., 2019; Johnson et al., 2020; Jones et al., 2013; Kaplun et al., 2016; Liew et al., 2022; Markus, 2012; Ouzzani et al., 2016; Philip et al., 2022; Savuro et al., 2022; Tremblay et al., 2018; Uchima et al., 2021; Victor et al., 2022; Wang & Burris, 1994; Weinronk et al., 2018; Yang Y et al., 2020), content analysis (Hudson et al., 2020), interpretative phenomenological approach (Jones et al., 2013), and grounded theory approach (Hatala et al., 2020; Weinronk et al., 2018). Several studies used analytic processes of member checking with facilitators, community researchers or participants (Banyard et al., 2020; Cooper, 2022; Cueva et al., 2020; Goodman et al., 2018; Goodman et al., 2019; Hudson et al., 2020; Jardine & James, 2012; Jennings & Lowe, 2013; Johnson et al., 2020; Jones et al., 2013; Liew et al., 2022; McHugh et al., 2013; Shea J et al., 2011; Sloan Morgan et al., 2022; Young et al., 2013). Most studies used transcripts as the primary data for analysis, however some reported that the photos were included as a core data set (Aparicio et al., 2021; Goodman et al., 2019; Hanemaayer et al., 2020; Hayhurst et al., 2015; Johnson et al., 2020; Minthorn & Marsh, 2016; Philip et al., 2022). Two studies did not report whether or how photos were discussed (Banyard et al., 2020; Genius et al., 2015).
i) Sharing Findings and Exhibition of Photos
While all studies (excluding methods focused papers) presented the results of the Photovoice project as a journal article, many of the studies also exhibited the participants photos as a research translation activity. A number of studies held community events or photo exhibitions where the study findings were communicated and/or the participants’ photographs exhibited (Aparicio et al., 2021; Banyard et al., 2020; Cooper, 2022; Cueva et al., 2020; Edwards et al., 2022; Goodman et al., 2018; Helm et al., 2015; Jennings & Lowe, 2013; Liew et al., 2022; Markus, 2012; Philip et al., 2022; Sloan Morgan et al., 2022; Tremblay et al., 2018; Uchima et al., 2021; Young et al., 2013) (Faircloth et al., 2016). Three studies produced photobooks which were disseminated back to participants and stakeholders (Jardine & James, 2012; Jones et al., 2013; Williamson et al., 2020).
Benefits of Photovoice
a) Fosters Participant Autonomy and Authority
Many studies noted a prominent benefit of Photovoice is its ability to engage participants as co-researchers which facilitates greater autonomy and authority of young participants over the research (Minthorn & Marsh, 2016). The ability to direct the content of the photographs, and thereby the research, provided young people with greater control over the scope of the research topic, how their concerns and knowledge were privileged, and how their experiences were interpreted (Aparicio et al., 2021; Cueva et al., 2020; Goodman et al., 2019; Hudson et al., 2020; McHugh et al., 2013; Shea J et al., 2011). Using participatory action photography enabled youth to creatively center their lived experiences in their surrounding social, political, and economic context, to make meaning of these experiences with their peers as the primary creators of knowledge, and to begin to identify mechanisms for change (Aparicio et al., 2021).
Some studies reported that the method enabled broader and more nuanced data to be captured, thereby yielding richer data than traditional qualitative methods (Aparicio et al., 2021; Cueva et al., 2020; Faircloth et al., 2016). One study reported elicitation of more valid and credible results due to increased participant comfort with the research method, and the preference of talking with other young people rather than ‘outsider’ adult researchers (Jardine & James, 2012). The ability to undertake member-checking practices were highly valued in allowing the participants’ voices and priorities to be privileged (Aparicio et al., 2021; Jardine & James, 2012; Johnson et al., 2020; Shea J et al., 2011; Tremblay et al., 2018). In addition, participant voice was centered at every stage of the process (including data collection, member-checking of themes and subthemes, agreed-upon dissemination processes, and disseminated content) (Aparicio et al., 2021).
b) Photography is Familiar and Fun
The familiar visual medium of photography appealed to young participants, allowing them to connect creatively with the research topic and share personal experiences and insights comfortably (Aparicio et al., 2021; Hatala et al., 2020; Sloan Morgan et al., 2022; Young et al., 2013). Further, the creative medium of photography was a fun way to engage young people (Hatala et al., 2020), and prompted engagement and critical dialogue in the discussion phase (Helm et al., 2015; Savuro et al., 2022). In debriefing sessions, [young people] also indicated that the photography component should be retained because it was fun and useful in facilitating critical thinking, dialog, and writing (Helm et al., 2015). By uncovering and amplifying Indigenous youth perspectives … through photography, this method not only served as an empowering approach for youth, but also worked as a powerful tool to visualize Indigenous concerns and facilitate discussions on needs assessments of Indigenous youth in urban settings” (Hatala et al., 2020).
c) Visual Medium is Culturally Appropriate
Photovoice was said to be beneficially child-friendly and engaging across many age groups (Jones et al., 2013; Philip et al., 2022; Sloan Morgan et al., 2022). This allowed more detailed data to be elicited from young people in comparison to focus groups only (Uchima et al., 2021). The visual and story-telling elements of Photovoice were noted as a culturally appropriate way to gather and discuss Indigenous perspectives (Johnson et al., 2020; Jones et al., 2013). The photovoice methodology also allowed participants and the researchers to dig deeper into their attitudes and beliefs than would likely be learned through more typical formative research methods, such as focus groups or surveys (Kelly, 2017).
d) Engaging the Whole Community
Photovoice was said to foster enhanced ability for community participation in, and direction of, research (Hanemaayer et al., 2020). Where the research was more researcher-driven, the method successfully engaged participants and co-researchers in taking positive action around issues important to them (Genius et al., 2015; Hanemaayer et al., 2020). The methods’ flexibility allowed participants to dictate their level of research involvement (Edwards et al., 2022. Photovoice was found to be as effective as a participatory action research-based strategy, where social justice aims could be embraced and seen out in community (Helm et al., 2015). Each stage of this study has been directed by community members, who have been partners and champions of this work (Hanemaayer et al., 2020).
The engagement of researchers in the community, often prior to data collection, allowed communities to build relationships, and become comfortable with, the research team (Goodman et al., 2019; Williamson et al., 2020). Some studies noted that the formation of genuine relationships were a key outcome of the research itself (Weinronk et al., 2018). Other outputs of Photovoice, such as photobooks and community gatherings, were seen as valuable community outputs and opportunities to reflect on findings (Goodman et al., 2019; Kelly, 2017; Tremblay et al., 2018). These were also seen to broaden opportunities for research dissemination (Aparicio et al., 2021; Tremblay et al., 2018). One study reported the value of Photovoice in effectively engaging young people in beneficial behaviour change, thereby influencing communities (Kelly, 2017). The photo exhibit is an important component of the Photovoice process as it recognizes participants’ efforts, promotes awareness of the youths’ concerns and experiences, and facilitates dialogue (Goodman et al., 2019).
Challenges of Photovoice
a) Difficulties Engaging with Participants
Engaging participants to comment on findings after the data collection phase was reported as difficult (Hayhurst et al., 2015; McHugh et al., 2013). Life circumstances, such as homelessness, were noted as a barrier to maintaining engagement (Goodman et al., 2018; Sloan Morgan et al., 2022). In some communities, competing priorities around community events and family commitments impacted engagement (Edwards et al., 2022; Hudson et al., 2020; Liew et al., 2022). Hayhurst attempted to confirm themes emerging from the data via email with interviewees; however, due to time constraints, graduation from VAFCS programme and other barriers, corresponding with the young women proved difficult in terms of verifying the categories and themes (Hayhurst et al., 2015).
Engagement of participants was reported as limited by one study, leading authors to question whether this approach was a true decolonising methodology (McHugh et al., 2013). The participants’ level of engagement within this research was somewhat limited and therefore we are not convinced that our photovoice approach was reflective of the decolonising research approach that has been described by Castleden et al. (2008) (McHugh et al., 2013).
Engagement with only small numbers of participants were noted (Banyard et al., 2020; Johnson et al., 2020; Johnston et al., 2012), with older youth noted as easier to engage in Photovoice (Kelly, 2017), which influenced generalisability of findings. This [older] group was selected for practical considerations, with the understanding that the age group selected could carry out the independent photography and conceptual aspects of the research yet effectively represent their younger peers’ interests and motivations around food intake (Kelly, 2017).
Time was reported as an issue. One study reported the extensive time commitment impacted the level and depth of participation (Hanemaayer et al., 2020), while another implicated time limitations in the quality of photographs taken by participants (Jardine & James, 2012).
b) Issues with Photography
Obtaining photographs themselves was a reported issue, with poor photo quality (Genius et al., 2015) and ‘convenient photo taking’ (Jardine & James, 2012) cited as specific difficulties. Some participants required support to use their camera well (Williamson et al., 2020), with authors recommending that the method requires great flexibility in its application from both the researchers and the participants themselves. Students were given 1–2 days to take pictures, thereby limiting opportunities and possible creativity. The younger participants tended to take pictures that were ‘‘convenient’‘; it was amusing to see swarms of children taking pictures of cigarette butts on the ground in the area around the school on the day the cameras were distributed (Jardine & James, 2012).
Another study referenced difficulty in optimising guidance provided to participants in what to capture in their photographs, with too little guidance leaving participants unsure, and too much unduly influencing participant’s photograph selection (Jones et al., 2013).
The ability to take photographs of specific subjects was also challenging in some circumstances, due to issues associated with risk, distance and social acceptability. Attendance over the course of a 6-week project was challenging at times due to mobility and other life circumstances. The youth also expressed other challenges (e.g., not photographing images that could put them at risk or breach of parole, transportation to photograph beyond their immediate surroundings) (Goodman et al., 2018).
Some researchers noted that the content of the photographs may have been affected by social desirability bias, where young people took photos that they believed would be socially desirable and accepted by their peers, but may not necessarily reflected their true lived experience (Tremblay et al., 2018).
c) Ethical Challenges
Photography can be ethically challenging when used with young people in research. Studies reported concern around participants potentially photographing other people, cultural icons or recognisable places in the community (Faircloth et al., 2016; Hudson et al., 2020). Protecting anonymity of persons in photographs was a noted issue (Hudson et al., 2020). The importance of going beyond the traditional school walls was demonstrated to us by the youth in this study as they began to take more and more ownership for this project. While this raised ethical issues about photographing individuals, as well as cultural icons and spaces outside the school, our work with the cultural advisory groups, as well as dialogue and discussion with the school staff and the trilingual interpreter, who was also a part of our team, helped us to develop protocols to ensure these youth were taking photographs in ways that honoured and respected the privacy and mana (honour) of those being photographed (Faircloth et al., 2016).
Restrictions in young people’s ability to photograph ceremonies in the community limited sharing of important aspects of their lived experience and reduced the depth of the resulting data (Genius et al., 2015). Another limitation was the cultural restriction on taking photographs at traditional ceremonies, a common context for traditional foods (Genius et al., 2015).
Discussion
This systematic methods review aimed to explore how Photovoice has been used with Indigenous young people across CANZUS nations and to identify the benefits and challenges associated with its use in research. While these findings are specific to Indigenous youth populations in CANZUS countries, there are likely to be elements within these findings that are relevant to other populations and may assist researchers in applying Photovoice with other groups. We encourage researchers to consult with the community they are engaging with to ensure appropriateness of the methods’ application.
We found great heterogeneity across the included studies, both in terms of the application of the method and in the diversity of research topics. Many approaches were used to engage with communities and participants, however the approach taken by most studies aligned strongly with the CBPR methodology (Dudgeon et al., 2020; Wang & Burris, 1997). Participatory approaches act to centre participant knowledge and lived experiences as valid and legitimate (Fletcher, 2003; Jull et al., 2017) and to facilitate collectively determined research agendas to be actioned (Bishop, 1995). This contrasts with Western hegemonic research that commonly dismisses Indigenous ways of knowing as outside of academic methods and understandings (Fletcher, 2003; Jull et al., 2017), and young people as being too inexperienced to contribute as active agents in the research process (Morgan et al., 2002; Punch, 2002). The focus on participatory principles in the included studies speaks to key elements of Photovoice: empowerment of communities to document and share their stories (Wang & Burris, 1997).
While participatory approaches were valued, the realities of undertaking data collection with Indigenous communities, who have often been subjected to unethical research practices (Rigney, 1999), sometimes proved difficult to enact. Some communities expressed concerns about the photography of cultural icons and ceremonies, the identification of culturally significant places within small communities, as well as taking photos of other people (Faircloth et al., 2016; Hudson et al., 2020; Jardine & James, 2012). Indigenous communities globally have been subjected to the visual capture of their circumstances through colonial histories and research priorities (Lydon, 2014). This has often led to the misrepresentation of their communities, and exploitation of their privacy, identity and culture. Complexities associated with the photographic medium include differing cultural protocols among Indigenous groups around the appropriateness of photographing and exhibiting photos of people and sites (Lydon, 2014). Researchers should remain cognisant of such concerns within the community, consult broadly with the community on their perspectives, and understand the implications this may have when using Photovoice (Henry & Gabel, 2019).
Maintaining engagement with participants throughout projects was often cited as difficult, due to the significant investment of time required to build and maintain strong relationships and engagement, and the personal obligations and competing commitments of participants (Edwards et al., 2022; Goodman et al., 2019; Hanemaayer et al., 2020; Hudson et al., 2020; Jardine & James, 2012; Liew et al., 2022). In Indigenous communities, where the burden of research on community members is already so great (Smith, 2021), the question of whether Photovoice can be applied in accordance with a decolonising methodology is perhaps moot. While Photovoice has the potential to empower communities, the need for more research must be carefully considered, and benefits to the participants and the community weighed against potential risks. Further, continued engagement of participants was sometimes cited as difficult. Researchers should consider how they can navigate continued engagement and participation throughout the entirety of the research process, thereby ensuring that Indigenous voices are elevated and truthfully represented in research outcomes.
The adaptive nature of Photovoice principles was seen through the variety of research techniques applied. The flexibility in the researcher's role, and the opportunity to engage community members as co-researchers and facilitators, provides opportunities for capacity building, and enables the community to develop trust and a meaningful relationship with the research team. Opportunities for employment and development of vocational and practical photography skills can offer tangible and sustainable benefit to Indigenous individuals and their communities (Shea J et al., 2011). Such benefits must be incorporated into Photovoice research protocols and discussed with communities in the participatory process to ensure these skills are valued and desired by the community (Canadian Institutes of Health Research, 2008; Council, 2018; Zealand, 2010).
In this review, the Photovoice method enabled participants to share their stories and perspectives through a visual medium that delivers a richness of data that is difficult to collect in verbally-based methodologies. Autonomy over the visual data that is collected and shared is a powerful moderator of typical researcher-participant power dynamics. Concerns around researcher influence over participants, or lack thereof, should be noted. This is particularly relevant for younger participant groups, who may be more easily influenced by peer-related social desirability or less able to deduce meaning from researchers’ instructions. Researchers must consider that the audience viewing the participant photographs, often including the researchers themselves, may influence the content shared by participants. In this way, in spite of the potential for empowerment in the Photovoice method, traditional power dynamics may persist and erode the participatory process, preventing young participants from having true autonomy over the photographs they take and share (Prins, 2010).
Concerns around the ethics of Photovoice with Indigenous populations and young people have been previously explored (Castleden et al., 2008; O’Hara & Higgins, 2017), highlighting the need for training sessions, explicit details regarding the use of photographs, and opportunities for member-checking to be built into research protocols. The current review showed variable employment of such strategies (Goodman et al., 2019; Hatala et al., 2020; Johnson et al., 2020; Kaplun et al., 2016; Lines & Jardine, 2019; McHugh et al., 2013; Minthorn & Marsh, 2016), and inconstant ethical instruction to participants (Cueva et al., 2020; Goodman et al., 2019; Johnston et al., 2012; Jones et al., 2013; Markus, 2012; Shea J et al., 2011; Tremblay et al., 2018; Weinronk et al., 2018; Williamson et al., 2020; Young et al., 2013). It is important for young people to be informed and aware of potential consequences emerging from contentious data being captured, particularly those that are social and/or legal in nature (Oakes et al., 2022), to shift power into the hands of young participants. This may be achieved by comprehensive research protocols, overt participants instructions (both written and verbal), and engagement of young people in creative ways regarding the ethics of photography.
The findings of this review reveal that the use of Photovoice with Indigenous young people can offer a highly engaging method for young people to be involved in research and to have greater control over the nature and scope of their engagement than is possible with traditional qualitative data collection methods like interviews and focus groups. While Photovoice can render research participation less onerous and boring for young people, the findings of this review also highlight some challenges and areas of concern that draw attention to important considerations for those contemplating using or participating in a Photovoice project. The logistical issues associated with the method, while not negligible, are not dissimilar to other data collection methods and should not pose insurmountable obstacles to a successful Photovoice project. This said, the particular logistical challenges associated with the nature and quality of the photography are likely to be common and will require careful planning to avoid. The ethical challenges that emerged in the findings of this review are not quite as simple to manage, and likely only just scrape the surface of the ethical complexities involved in Photovoice use with Indigenous young people. Ethical concerns when conducting research with Indigenous communities begin at inception of the research. We have included details of authorship by and engagement with Indigenous communities in our results, with many studies not providing details on authorship in their manuscript. While the presence of these reflexive and reflective paragraphs on authorship has been increasing in recent years, their inclusion has also been a topic of discussion in this area of research for over a decade (Finlay, 2002; Nicholls, 2009). In completing this review, we consider that articles a decade old have included this information, while some only a year old have not. Understanding what perspectives have shaped the research is important for the reader, however we appreciate that identifying specific Indigenous contributions is not always possible. We also note discrepancies in the detail of how community engagement is reported amongst included studies. Increased transparency in who is conducting the research, and how, is essential for improvements in the ethics of research with Indigenous people, with any methodology (Hayward et al., 2021; Huria et al., 2019). We note that increased detail on Indigenous authorship, project inception, and community engagement and governance is needed. This would also assist in determining where the perceived benefits of Photovoice use lie: with the researcher or with the participant. When considering specific issues surrounding Photovoice, the issues of personal and cultural privacy and confidentiality arise. Consideration of how to navigate such issues in discourse and partnership with the community, and with extensive ethical protocols, may be the best solution. Researchers must also appraise how data ownership and sovereignty is determined, as to negate any potential harmful outcomes of the research (Canadian Institutes of Health Research, 2008; Council, 2018; Zealand, 2010). This is especially relevant if the community has agreed to capturing images of significant cultural practices or sites. While complex, such considerations do not negate the potential positive outcomes of using Photovoice. With careful deliberation of the above issues, researchers should be able to work with Indigenous young people to elicit rich and varied data on their perspectives and make meaningful traction toward specific issues.
Strengths and Limitations
The great strength of this systematic methods review is our rigorous application of a constant comparative method of data synthesis (Gentles et al., 2016). A limitation of the review is that relevant studies may have been missed through the requirement of peer-review for included studies and searching on Western databases and in Western journals. Moreover, due to the heterogeneity of Photovoice, missing relevant studies may have implications for the completeness of our review. We also recognise that searching within Western databases may exclude literature that exists in decolonised spaces, which in turn may reduce includible contributions from Indigenous research groups and authors. Moreover, the framework used by our team to synthesize the methods across the studies is not an Indigenous framework, and therefore might not naturally orientate to issues relevant to Indigenous peoples. Our team sought to ameliorate this shortcoming through guidance in interpreting and reporting the findings from the senior Indigenous author (GG). The results of the current study must be interpreted with caution when applying them to specific Indigenous groups. There is an imbalance between North American and Oceanic countries in our review, which has implications for the comprehensiveness of results for Australia and Aotearoa New Zealand. We advise researchers to consult closely with local Indigenous groups, regardless of continental positioning, and strongly consider CBPR and co-design approaches before undertaking Photovoice studies (Anderson et al., 2022; Rolleston et al., 2022). The results of this study are additionally unlikely to be generalisable to Indigenous youth populations outside of Northern America.
Conclusions
The present study provides a broad overview of the operationalisation of Photovoice with Indigenous young people in CANZUS nations. This review highlights that Photovoice remains a participatory strategy through which young people can be effectively engaged, where their experiences and perspectives can be privileged, and where insights into their lives can be realised. Researchers must adapt their application of Photovoice in close consultation with the community with which the research is being conducted. Attention must be paid to the ethical and procedural components of the method, to ensure the facilitation of power sharing between participants and researchers, thereby enabling more ethical research partnerships with Indigenous young people and their communities.
Supplemental Material
Supplemental Material - A Systematic Methods Review of Photovoice Research with Indigenous Young People
Supplemental Material for A Systematic Methods Review of Photovoice Research with Indigenous Young People by Kate Anderson, Elaina Elder-Robinson, Kirsten Howard and Gail Garvey in International Journal of Qualitative Methods
Footnotes
Acknowledgments
We would like to thank Ms Rachael Jaenke, Ms Zyana Gall, Ms Elisha Clements-Anderson and Dr Alana Gall for administrative support.
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
This study was undertaken under the auspices of The What Matters 2 Youth Research Project, which is funded by a Medical Research Future Fund (MRFF) Indigenous Health Research Fund 2020 grant (APP1199854). Its researchers are also supported by the NHMRC funded Centre of Research Excellence (CRE) in Targeted Approaches To Improve Cancer Services for Aboriginal and Torres Strait Islander Australians (TACTICS; #1153027). G.G. salary was supported by an NHMRC Investigator Grant (#1176651). The views expressed in this publication are those of the authors and do not necessarily reflect the views of the funding agencies. We acknowledge that this research project was initiated at and supported by Menzies School of Health Research.
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Appendix
References
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