Stories,Arts,and Equity: Intergenerational Qualitative Methods for Inclusive Public Health Research

Abstract

Health inequalities persist despite extensive public health research and interventions. Qualitative approaches are increasingly recognized for their ability to capture the nuanced, lived experiences of marginalized populations—an essential perspective in a world marked by complexity and uncertainty. This paper draws on two case studies to examine the role of qualitative methods in public health research, emphasizing the importance of amplifying marginalized voices and fostering intergenerational dialogue. Case Study 1 explores the use of visual methods to elevate the voices of people with dementia, a group often overlooked in traditional health research. Through video storytelling, participants shared their lived experiences, offering deeper insights into the challenges they face and the broader social implications of dementia. This case demonstrates the power of visual storytelling to capture the emotional and social dimensions of health inequalities while providing practical lessons for engaging vulnerable populations in research. Case Study 2 examines an intergenerational co-creation workshop series that used collaborative arts engagement to stimulate climate change dialogue amongst older adults (aged 60 years+) and children (aged 9 to 12). The project highlights the significance of creating spaces for cross-generational conversations and co-creative exploration, illustrating how such engagements can bridge knowledge gaps, address structural inequities such as ageism, and contribute to addressing climate-related health disparities. Together, the two case studies illuminate the potential of qualitative methods to advance health equity by supporting inclusive, relational, and justice-driven approaches to public health research. They underscore the value of participatory engagement in generating useful insights and fostering social change.

Introduction

Despite decades of public health research and interventions, health inequalities persist, disproportionately affecting marginalized populations. Older adults, particularly women and those aged 80 years and older, report lower quality of life and functional health (Singh et al., 2024). Further, “Poverty and inequality still prevent many women, children and adolescents from getting the quality health care they need to survive and thrive” (Government of Canada, 2023). These disparities also intersect with inequities experienced by other equity-deserving groups, including racialized communities, those who are socioeconomic disadvantaged, and people with disabilities, creating systemic barriers to participation in public health research and decision-making (Hung, Wong, et al., 2024; Wallerstein & Duran, 2010). Addressing these overlapping disparities requires targeted interventions that tackle the root causes of health inequities and ensure that health, healthcare support, and health promotion are accessible to all Canadians. Traditional quantitative approaches, such as large-scale surveys and statistical modeling, have provided essential epidemiological insights into health disparities. However, they often fail to capture the lived experiences and social determinants shaping these inequalities (Mays & Pope, 2020). Without understanding the perspectives of those directly affected, policies and interventions risk being misaligned with the needs of marginalized communities (Public Health Agency of Canada, 2024). Quantitative research alone cannot fully account for the complexity of health inequities, which are shaped by intersecting social, economic, and structural factors (Noyes et al., 2019). To address these limitations, there is a growing recognition of the value of qualitative and participatory research methodologies (Cargo & Mercer, 2008; Shelton et al., 2022). Qualitative methods offer a powerful approach to understanding health inequalities by capturing complexity, centering lived experiences, and informing policy (Allen et al., 2024; Renjith et al., 2021). This paper draws on two case studies to examine the role of qualitative approaches in public health research, emphasizing the importance of amplifying marginalized voices and fostering intergenerational dialogue. Both are led by investigators of the University of British Columbia’s Edwin SH Leong Centre for Healthy Aging, and come from complementary Labs (Julia Henderson (JH)’s Elders CREATE Lab and Lillian Hung (LH)’s IDEA Lab) that center research with older adults using participatory, creative methods that aim to counter ageism and foster citizenship and inclusion. In particular, in Case Study One, we examine the method of participatory video storytelling in research with people with lived experience of dementia residing in long term care, and in Case Study Two, we explore an original hybrid method combining participatory, co-creative and arts-based approaches to facilitate climate change dialogue amongst an intergenerational group of older adults and children. Together the two case studies illuminate the potential of qualitative methods to advance health equity by supporting inclusive, relational, and justice-driven approaches to public health research. They underscore the value of participatory engagement in generating useful insights and fostering social change.

Background

Qualitative research methods, such as visual storytelling (Banks, 2012), ethnographic observation (Browne et al., 2016), arts-based engagement (Leavy, 2020), and others, create spaces for underrepresented voices, offering deeper insights into the barriers individuals face, and the community-driven solutions that can promote health equity (O’Day & Killeen, 2002; Shelton et al., 2022). Participatory approaches further ensure that research is conducted with communities rather than on them, fostering agency, trust, and reciprocal knowledge exchange (Hung, Wong, et al., 2024; Ramanadhan et al., 2024). Qualitative research offers valuable insights into how stigma influences the acceptance and adoption of healthcare interventions, and preventive public health approaches, including those based in the community. By exploring personal narratives and experiences, it uncovers the nuanced ways in which stigma serves as a barrier to seeking and engaging with care and cultural programs. For instance, studies have shown that stigma can deter individuals from accessing mental health services due to fears of discrimination and social exclusion (Ahad et al., 2023; Sheikhan et al., 2023). Stigma around climate activism can also deter people from climate action initiatives (Stenhouse & Heinrich, 2019). In this article, then, our interest is in how innovative, qualitative, participatory methods can be used to address the public health issues experienced by two marginalized populations.

Among the most underrepresented groups in research are people with dementia, particularly those residing in long-term care (LTC) settings (Groothuijse et al., 2024). Individuals living with dementia, especially those in long-term care (LTC), often face the suppression of their voices due to misconceptions about their ability to communicate (Volkmer et al., 2023). This erroneous belief stems from the perception that cognitive decline renders them incapable of expressing opinions, preferences, and emotions, or engaging in meaningful relationships. Many people with dementia retain the desire and capacity to engage in meaningful relationships, and communicate and connect with others, even if they encounter challenges in doing so (Mann & Hung, 2019). Traditional research methodologies often exclude this population due to assumptions about cognitive impairment and decision-making capacity, limiting their ability to contribute to studies that directly impact their well-being (Diaz-Gil et al., 2023). For example, a recent Canadian survey using a staff-administered questionnaire found that while 79% of long-term care (LTC) residents reported they could get the services they need most of the time, 51% said staff rarely made time for a friendly conversation or asked how to meet their needs (Office of the Seniors Advocate BC, 2023). This illustrates how traditional methodologies—often mediated through staff and structured formats—can capture service provision metrics while overlooking deeper relational and experiential dimensions valued by residents. To achieve an inclusive approach to public health research, methods must be adapted to ensure that all voices are heard, regardless of cognitive or functional ability. Innovative, person-centered approaches—such as participatory visual storytelling (Fels & Astell, 2011; Hollinda et al., 2023) and adapted communication strategies (Frank et al., 2021) —are essential to capturing the perspectives of people with dementia in meaningful ways.

Similarly, intergenerational experiences and perspectives on climate change are under-researched, missing an important avenue to address the multiple public health challenges related to worsening climate conditions. One aspect of this relates to social discourses surrounding climate change, which tend to polarize age groups, foreground intergenerational conflict, and perpetuate ageism (Roy & Ayalon, 2023). Older generations are often blanketly blamed for climate crisis, rather than discussing their responsibilities in a more nuanced way, or recognizing sustainable practices of past generations (Roy & Ayalon, 2023, 2024). At the same time, children and youth’s voices are often subordinated and dismissed, especially at the level of policy (Lam & Trott, 2024). The result is messages that pit generations against each other, or fail to consider generational connections, and result in overlooking opportunities to meaningfully address climate-related public health challenges from a perspective of intergenerational collaboration. Qualitative participatory methods can bring generations into conversation, help understand the nuances of different perspectives, and foreground under-represented voices (such as those of older adults and children) to more meaningfully inform social and health care policy in addressing climate issues that impact public health.

This paper examines the role of qualitative participatory methods in public health research through two case studies. The first explores the use of visual storytelling to elevate the voices of people with dementia, a population often overlooked in traditional health research. Through participatory video storytelling, defined as “a collaborative technique that aims to involve a community or group in the co-creation of their own film(s)” (Lunch & Lunch, 2006, as cited in Sarria-Sanz et al., 2024), individuals with dementia co-created narratives about their everyday lives. Central to this method is the shift from narrating stories about participants to creating stories with them (Lenette, 2019). Rooted in Participatory Action Research and supported by accessible digital tools, participatory video storytelling enables vulnerable communities to represent their own perspectives (Sarria-Sanz et al., 2024). In this case, individuals with dementia shared their lived experiences, shedding light on the emotional and social dimensions of their condition. This demonstrates how visual storytelling can provide a platform for marginalized populations while informing public understanding and policy development.

The second case study employed an original hybrid qualitative method combining participatory, co-creative and arts-based approaches to stimulate climate change dialogue amongst an intergenerational group of older adults (aged 60+) and children (aged 9 to 12). Through a weeklong series of collaborative, arts-engaged workshops, participants explored climate change issues and discourses, and related personal perspectives. By creating spaces for cross-generational conversations and co-creative exploration, these workshops facilitated reciprocal learning, foregrounded the voices of older adults and children, and empowered both age groups to engage with climate change as a pressing public health issue.

Both case studies were rooted in a constructivist paradigm, a shared philosophical stance discussed and agreed upon by all authors and research teams. This included academic researchers, community partners, students, and older adults. Together, we recognized that there are multiple ways to understand the nature of reality as constructed through human interaction with social and physical environments, and we were motivated by a desire to understand and accurately represent the individual experiences of participants (Hershberg, 2014). Both case studies also adopt participatory research methodology. Participatory Research is an umbrella term housing participatory, collaborative and inclusive research methods and approaches aimed at foregrounding the voices of individuals and communities. It promotes active involvement of research participants in the research process which is rooted in a shared ethical framework (Aldridge, 2015, pp. 7-8). By analyzing these case studies, and in particular, their methodological approaches, this paper demonstrates how qualitative research can amplify marginalized voices (particularly those suppressed by ageism), foster intergenerational dialogue, and contribute to addressing structural inequities in public health. The findings underscore the need for public health policies that integrate participatory and creative methodologies to develop interventions that are inclusive, responsive, and effective in reducing health disparities (Kramer-Roy, 2015; Phillips et al., 2024). Future research should continue to explore how qualitative approaches can complement quantitative findings to create a more holistic and equitable understanding of public health challenges.

Case Study 1: Visual Storytelling With People With Dementia

People with dementia are often marginalized in traditional health research due to cognitive challenges, communication barriers, and the dominance of text-based methodologies (Diaz-Gil et al., 2023; Volkmer et al., 2023). Their exclusion from research skews the evidence base that informs practice, perpetuating health inequities, as their needs, preferences, and rights remain underrepresented in care planning and policy decisions (Keogh et al., 2021). The exclusion can lead to misaligned care and increased social isolation (Novek & Wilkinson, 2019), that heightens the risk of poor mental health and reduced quality of life. This case study explores the use of visual methods to elevate the voices of people with dementia, a group whose perspectives are often overlooked in traditional health research. Through participatory video storytelling, participants shared their lived experiences, offering deeper insights into the challenges they face and the broader social implications of dementia. This approach demonstrates the power of visual storytelling to capture the emotional and social dimensions of health inequalities while providing practical lessons for engaging vulnerable populations in research. Older people in the LTC home gained a sense of value by being given the opportunity to speak about what matters to them, rather than speaking about what other people think matters to them.

Research Team and Positionality

The Case Study 1 research team included a nurse researcher LH and two graduate students Joey Wong (Nursing) and Lily Ren (Interdisciplinary Studies), who collaborated closely with participants, bringing varied skills in communication, storytelling, and video production. The students received training by LH in dementia-inclusive research practices, including adapted communication strategies, guided conversations, visual prompts, and familiar storytelling cues to support engagement.

Our motivation for this work is grounded in both professional practice and personal connection to people living with dementia. Several members of the research team have long-standing experience in nursing, gerontology, and community-based dementia care, where we have witnessed first-hand the impacts of social isolation, stigma, and underrepresentation in decision-making. These experiences have shaped our commitment to creating spaces where the voices of people with dementia are heard, valued, and acted upon.

Method and Procedures

This study was conducted through LH’s lab. The study began with co-design workshops with 30 residents living with mild-to-moderate dementia from two LTC homes in British Columbia, Canada. In this paper, as guided by the methods of Hung, Chen, et al., 2024, we use “co-design” to describe structured, collaborative workshops in which researchers and participants work together to develop ideas, tools, or creative outputs, drawing on participants’ lived experience to guide decision-making. Co-design was embedded within a broader participatory action research framework, ensuring that participants influenced not only the outputs but also the process and direction of the research. The residents were recruited through program coordinators using purposive sampling to reflect diversity in ethnicity, gender, and age (68–102 years). In these participatory video storytelling sessions (Sarria-Sanz et al., 2024), residents co-created narratives about their everyday lives in the care home, such as growing plants, making tea, and garden walks.

In addition to the 30 residents living with mild-to-moderate dementia, the sample included 16 caregivers—six family members (adult children) and ten long-term care staff (recreation and nursing staff) who supported participants during the study. Family caregivers were identified and invited by participating residents, while staff caregivers were recruited by program coordinators based on their existing relationships with residents and their interest in supporting research engagement. This purposive selection ensured that caregivers were familiar with participants’ communication styles, routines, and preferences, enabling them to facilitate storytelling, provide contextual background to the research team, and offer emotional reassurance during filming.

Caregivers, including family members and LTC staff, played a facilitative role by helping residents recall stories, providing contextual information to the research team, and offering emotional reassurance during filming. Three co-creation sessions per participant (60–90 minutes each) were facilitated in comfortable and familiar environments, such as participants’ rooms, gardens, or shared community spaces, to encourage natural self-expression. The videos were then reviewed and edited collaboratively with participants and caregivers, allowing for iterative co-creation, ensuring that the final narratives reflected participants’ authentic voices. Then the film was shared with other residents and staff in the home. Being seen in the film, literally visible on a big screen, affirms their presence and identity. Visibility is more than appearance; it is about having a voice in public. When these films are shared on a big screen or projected on a wall, residents experience public expression, fostering pride, dignity, and social recognition. This process builds confidence, strengthens relationships, and challenges ageist narratives by placing older adults at the center of storytelling.

Data were analyzed using reflexive thematic analysis (Braun & Clarke, 2022) by the lead researcher (LH) and two graduate student co-researchers (LR and JW). The two graduate student research assistants were LH’s PhD students, recruited based on their interest in dementia care and community-based participatory research. Prior to this project, neither had formal expertise in visual storytelling, but both brought strong communication skills, experience engaging with older adults, and a willingness to learn creative methods. Both students were actively involved throughout the project, including participant recruitment, relationship-building, filming, collaborative editing sessions, and data analysis. Equipment for this project included a GoPro HERO9 camera and laptops equipped with Final Cut Pro editing software.

Participant perspectives on the process were captured through conversational check-ins during each session, reflective discussions during collaborative video review, and conversational interviews at the project’s conclusion. Field notes were used to document observed behaviours and interactions, which were later triangulated with participants’ verbal feedback. The process involved multiple stages: familiarization with data through repeated viewing of video recordings, manual coding of the transcripts, collaborative theme development in regular weekly research team meetings, and iterative refinement of themes through peer debriefing and member feedback. Weekly reflection meetings and debriefing sessions with all trainees, facilitated by the supervisor (LH), provided a structured space to discuss emerging interpretations, challenge assumptions, and address any ethical or methodological concerns in real time. All team members kept reflexive journals to document their interpretive decisions, which were discussed collectively to ensure transparency and rigor.

Key Findings and Lessons Learned

Avoiding Assumptions

Traditional research often assumes that people with dementia cannot meaningfully contribute due to cognitive decline (Diaz-Gil et al., 2023). This study challenged that assumption, by demonstrating that with the right support, individuals could actively share rich, emotional, and insightful stories about their lived experiences. For example, one participant’s video showcased how growing a small garden in the care home gave them “a reason to get up in the morning,” providing with a sense of purpose and belonging, reinforcing the importance of social engagement in maintaining well-being. Their story highlighted how leisure activities and hands-on engagement played a crucial role in their quality of life, drawing attention to the broader social determinants of health that sustain joy and belonging. Although some participants were initially unfamiliar or uncomfortable using the GoPro camera, several became confident over time. As one resident participant explained during a review session, “I didn’t think I could use it, but now I like filming my friends. It makes me feel part of something.” Field notes documented similar moments: Participant smiled broadly after filming another resident making tea, patting the camera gently as if proud of the accomplishment.

Supporting People to Contribute Their Best by Adapting Methods

Visual storytelling was a highly adaptable method in the study that accommodated different communication styles and cognitive abilities. We took a relational approach, prioritizing warmth, familiarity, and flexibility in how stories were gathered. The students built rapport and used a relational approach to encourage storytelling. Filming sessions were scheduled at times that naturally fit into participants’ daily routines, ensuring that their meals, rest periods, and other personal activities were not disrupted. This respect for their schedules helped create a sense of comfort and control over the process. One resident expressed appreciation for this flexibility, saying, “I like that you come after my nap, my brain works better then.” To create a welcoming and reciprocal environment, students brought small tokens of appreciation, such as treats, flowers, or potted plants, reinforcing a sense of mutual respect and gratitude. As noted in field notes: “Resident stroked the petals of the plant gifted to her, then began telling a story about her childhood garden, leading naturally into filming.” These gestures helped establish trust and connection, making the research process feel more like a shared experience rather than an intrusion. Additionally, filming took place in familiar settings with trusted individuals present, reducing anxiety and encouraging authentic participation. By prioritizing comfort and familiarity, the study ensured that participants felt valued, supported, and able to engage meaningfully in sharing their stories.

Acknowledging Knowledge Informed by Lived Experience

People with dementia are often seen as passive subjects rather than active knowledge contributors (Skovdahl & Dewing, 2017). In the study, they are positioned as co-creators of knowledge, ensuring their perspectives are meaningfully integrated. For instance, one participant described, “Music helps me remember who I am… it brings back the good times.” This firsthand account reinforced research on music therapy’s role in enhancing mood, memory, and social connection (Hung et al., 2021). Field notes described a moment when a participant, after viewing her completed video, sat upright and declared, “That’s my life—you got it right.” This affirmation underscored how the process validated personal narratives and positioned participants as authoritative voices in their own stories. Co-producing films with older adults in the LTC home empowers them by recognizing that residents hold the deepest knowledge of their own lives and community. By engaging them as co-creators, we affirm their expertise in the everyday realities of aging—both the joys and the challenges.

Meeting Regularly in Familiar Spaces

Building trust and rapport was essential for meaningful engagement. Students met with participants several times before filming to establish relationships, often sharing casual conversations over tea. One participant reflected, “I like that you come back—it means you care about what I have to say.” Field notes recorded: “During filming in the lounge, resident waved to peers passing by, inviting them to join in, creating an impromptu group scene.” These interactions challenged ageist assumptions by showcasing older adults as socially engaged, collaborative, and creative. The research team adapted the research approach based on participants’ needs and ensured participants felt comfortable with the storytelling process. This approach empowered participants and reduced anxiety, reinforcing the idea that research should be a reciprocal relationship, not an extractive process (Maiter et al., 2008). Filming in familiar LTC spaces helps residents feel at ease, fostering open expression and creativity. This process enhances agency, builds confidence, and promotes social connection, while challenging ageist narratives. Through film, their voices and experiences become visible, meaningful, and capable of driving change.

Incorporating Everyday Ethics

Ethical considerations were woven into every interaction, ensuring that the research process was not only procedurally sound but also relationally ethical. Consent was treated as an ongoing, relational process rather than a one-time agreement, with researchers revisiting it in each session to ensure participants remained comfortable and willing to engage. One participant, when asked mid-session if they wished to continue, replied, “Yes, but only if we do it by the window, I like the light there.” Care was taken to respect routines and personal preferences. If a participant appeared tired, filming was postponed without pressure. Field notes described: “Resident rubbed her eyes during filming; session ended early, and she smiled in thanks.” Small acts of kindness, bringing favourite snacks, acknowledging birthdays—reinforced dignity and reciprocity. Autonomy and dignity were prioritized by allowing participants to choose what aspects of their lives they wished to share, giving them control over their narratives and how they were represented. Additionally, participants’ comfort and well-being were always the primary concern—if someone appeared tired or uninterested, filming was postponed without pressure to continue. By embedding everyday ethics—such as respecting routines, acknowledging personal preferences, and offering small acts of kindness—the project reinforced that people with dementia deserve the same participatory rights as any other population (Diaz-Gil et al., 2023). More importantly, it demonstrated that ethical research is not just about following protocols but about fostering relationships, practicing care, and ensuring respect in every interaction.

Case study 1 demonstrates that visual storytelling, when approached relationally and ethically, can meaningfully engage people with dementia in research. By integrating everyday ethics and a relational approach, researchers were able to amplify the voices of a population, reinforcing their agency and contribution to knowledge (See Table 1 for examples showcasing how everyday ethics were incorporated by the research team). Through this creative collaboration, residents become storytellers, enabling them to be the creative beings that they want to be and knowledge contributors to community life. The study underscores the potential of visual storytelling to challenge assumptions, foster inclusion, and reshape how dementia is understood in narratives (Hollinda et al., 2023). The findings offer practical lessons for engaging vulnerable populations, demonstrating that with adapted methods, trust-building, and ethical engagement, people with dementia can actively shape research and inform policies that better reflect their needs.

Table 1.

Example Questions and Actions Incorporating Everyday Ethics From Case Study 1

Everyday ethics principle	Example questions/actions	Purpose
Ongoing consent	We are here to make the VR videos together. Would you like to continue our filming today?	Reaffirms voluntary participation at each session
Autonomy and control	Which part of your garden would you like to show?	Allows participants to choose content and setting
Comfort & well-being	Offer tea/coffee before starting; spend time to connect; adjust lighting or seating to participants’ preference	Creates a relaxed and respectful environment
Respect for routines	Scheduling sessions around mealtimes, rest periods	Avoids disruption to daily life
Agency	Showing edited footage and asking “Does this reflect your story as you want it told?” “How do you want to use the videos here in the care home?”	Ensures final output aligns with participant’s wishes

Case Study 2: Intergenerational Arts-Based Engagement on Climate Change

This second case study also involved vulnerable populations impacted by cultural ageism, specifically older adults and children, and sought to develop a new participatory arts-based methodology for fostering intergenerational solidarity in climate research. The effects of climate change are felt worldwide; in Canada, they impact all areas of the country (Government of Canada, 2013). Human activities have unequivocally caused global warming (Calvin et al., 2023), with significant costs to human health and well-being. Health risks caused by climate change are associated with extreme weather, higher temperatures, and poorer air quality, and include increased risk of infectious diseases, including heat stroke, heart disease, respiratory disease and allergies (Government of Canada, 2013). Climate change is undermining many of the social determinants of good health, such as livelihoods, equality, and access to health care and social support structures. These climate-sensitive health risks are disproportionately felt by the most vulnerable and disadvantaged, including women, children, ethnic minorities, poor communities, migrants or displaced persons, older populations, and those with underlying health conditions (World Health Organization, 2023). According to the World Health Organization (WHO), “between 2030 and 2050, climate change is expected to cause approximately 250,000 additional deaths per year” (World Health Organization, 2023, Key Facts section), alongside other health concerns, like long-term disorders, post-traumatic stress disorder (PTSD), and anxiety (World Health Organization, 2023). Our best chance for coping with the vast scale of climate threats is through intergenerational collaboration and solidarity.

Previous intergenerational climate-related research has often focused on intergenerational inequality (for example, Arnot et al., 2024; Gibbons, 2014), conflict, or differences (Ayalon et al., 2023; Choi, 2023). Much generational climate research also focuses on a single generation, leaving out the intergenerational nature of climate activism, and not recognizing similar consciousness and environmental concerns across generations (Lam & Trott, 2024). Lam and Trott call for the use of critical methodologies and related decolonial research practices that emphasize arts-based and participatory methods and facilitate intergenerational solidarities (2024, p.1). This, they believe, will foster intergenerational collaboration and coordinated action needed to promote structural change. The Intergenerational Arts for Climate Action Study (IACA) responded to this call.

Research Team and Positionality

Case Study 2 involved a three-person, interdisciplinary research team. Principal investigator, JH is a registered occupational therapist with clinical experience in mental health practice. She also has a background as a professional actor, a visual artist, and holds a PhD in theatre. Her 15-year research career has focused on cultural ageism; she has led numerous arts-based collaborative research projects with older adults, and is an experienced qualitative researcher. CG is a community-based artist, with an M.Ed. in Art for Social Change, and has extensive international experience doing arts-engaged research with children on climate-related topics, including working with many Indigenous communities and incorporating decolonial approaches. KM, at the time, was an MA student in theatre studies, worked as a behavioural interventionalist with neurodiverse children, and had a great deal of experience working artistically with children through University of British Columbia camps. Collectively, the three researchers shared strong values about the importance of collaboration, reciprocal relationality, accessibility and inclusion, representation of participant voices, creativity as a universal quality (and not just the purview of ‘artists’), and the power of art to promote health, intergenerational connection, and social change. All researchers centered participatory, inclusive approaches across their research and artistic practices. In the early stages of this study the research team all produced reflexivity statements, reflecting on co-determined questions about their beliefs about children and older adults, aging, climate change, intergenerational collaboration, and the value of the arts and creativity. Returning to these statements throughout the creative workshops and data analysis process helped the researchers remain attentive to a range of perspectives beyond their own, and helped ensure data analysis captured the experiences of participants as closely as possible.

Methods and Procedures

The project was led by above the three researcher-artist-facilitators through JH’s Elders CREATE lab. The primary workshops with participants took place in August 2024, in Vancouver, British Columbia, and involved 10 children aged 9 to 12 years old, and 8 adults aged 60+ as participants. Using an original hybrid qualitative design, the study addressed the following research objectives; it sought to: (1) to understand children’s and older adults’ perspectives on climate change (including their similarities and differences); (2) to promote conversation and creative exploration of topics related to climate change in order to build intergenerational solidarity; and (3) to promote community engagement and share knowledge on intergenerational approaches to climate action and the use of sustainable, eco-conscious collaborative creation practices; (4) to develop and test research methods, processes and procedures, and make community connections, that would lend strong support to implementing the project on a larger scale.

For one week, the group met daily from 9 am to 3 pm at a local neighbourhood organization to engage in a series of collaborative, arts-based creative exploratory workshops that stimulated discussions and learning about perspectives and facts related to climate change and climate action. At the end of the week, the group shared their artistic creations and teachings in a public sharing event Sea-to-Sky: Curious and Concerned at Kitsilano Neighbourhood house. This event included five art exhibits and a performance that involved a devised shadow puppet show and a collaboratively written song. The project employed a Climate Wellbeing, Healing and Resilience lens (Wise, 2021) to offer hope and minimize the risk of increasing climate anxiety and distress. Methodologically, the study integrated participatory research (Aldridge, 2015; Perkins, 2023; Schubotz, 2020; Stuart & Maynard, 2022), arts-based research practices (Leavy, 2020), co-creativity (Zeilig et al., 2019) and research-creation (Loveless, 2020).

Perkins (2023) argues that participatory research can help to build community-based climate resilience, making it an appropriate method for community-based intergenerational climate research. Lam and Trott (2024) also advocate for participatory and arts-based research approaches to cultivate intergenerational solidarities for climate healing. In this project, the participatory approach was aimed at including both children’s and older adults’ voices, and equalizing power differentials between them. We sought to democratize decision making as we co-planned the workshops and the final public sharing event. The participatory approach employed was strongly arts-based. Arts-based approaches are rooted in a shared epistemology that adopts the beliefs that: “art has always been able to convey truth(s) or bring about awareness (both knowledge of the self and knowledge of others)”; “the use of the arts is critical in achieving self/other knowledge”; “preverbal ways of knowing” are of value; and “multiple ways of knowing such as sensory, kinesthetic, and imaginary” are legitimate forms of knowledge” (Leavy, 2020, pp. 20-21). In this project, arts-based methods guided our artistic explorations and shaped what was considered data, and how it was collected and analysed. We were not only interested in participant perceptions and interactions, but also how they expressed them through their artistic choices. As Lam and Trott (2024) have argued, we found that the use of participatory arts-based methods and decolonial research practices (to the extent we were able to incorporate them), helped resist binary logics that divide generations and encouraged intergenerational solidarity, laying groundwork for structural transformation and climate healing.

Closely linked to participatory arts-based approaches is the concept of co-creativity. Co-creativity is an emergent concept that advocates for participants to engage in creative exploration for its own sake and not with the intention of producing any sort of outcome or product (Zeilig et al., 2019). In this project, co-creative research methods (which are inherently collaborative and participatory) guided certain creative engagements when we sought to explore ideas, feelings and relationships without the pressure of producing an end project. This approach was useful in generating reciprocity in relationships across the generations.

Finally, research-creation (Loveless, 2020) is a complementary approach to co-creativity that attends to artistic outputs. Research-creation is defined as:

an approach to research that combines creative and academic research practices, and supports the development of knowledge and innovation through artistic expression, scholarly investigation, and experimentation. The creation process is situated within the research activity and produces critically informed work in a variety of media (art forms) (Social Sciences and Humanities Research Council, 2025, Research-creation section).

Research-creation was a way to critically engage with and analyse artistic outputs, allowing participants to reflect on and share the meanings behind their artistic works, and how their creative choices (form, media, composition etc.) were intended to convey their ideas. In research-creation, artworks can be used to convey discoveries to the public, and also engage with audience responses to those works.

Throughout the project, data was collected through researcher fieldnote observations of workshop sessions, brief written and illustrated reflections by participants, and recorded and transcribed formal participant focus groups in which they reflected on their beliefs about climate change and their participatory experiences within the study. We held two focus groups, one-hour in length, at the end of the week, one with child participants and one with older adult participants. At the final public sharing event, audience responses were also collected through a guestbook. All of the above data was analysed using Braun and Clarke’s six-step reflexive thematic analysis (2022) to identify overarching, unifying themes. The artwork and performances produced throughout the project were also considered research data, and were analysed using a combination of visual methods (Martin, 2015; Rose, 2022), performance analysis (Fuchs, 2004; Reinelt & Roach, 2007), and research-creation methods (Loveless, 2020) to understand how the artworks and performances expressed the participants ideas, feelings, hopes, fears, understandings, and relationships related to climate change and climate action. Throughout the process, researchers also kept methodological memos which allowed for reflective analysis of methodological processes within the study.

Through its unique qualitative design, Case Study 2 developed knowledge about how collaborative, creative arts-engagement can create meaning, promote intergenerational understandings, and develop creative products that promote climate action and justice. The findings of the study related to the first three research objectives will be shared in another article, but here we share some of our key methodological learnings that speak to our fourth research objective. These offer guidance to future projects that might wish to employ similar methods to address the public health challenges of climate change through an intergenerational lens.

Key Findings and Lessons Learned

Collaborative and Relational Approach

Overall, a collaborative approach, that foregrounded relationship building, was central to the research methodology. One strategy we used to facilitate this approach was creating a collaborative community agreement at the start of the project. As a team, project members came up with the values and expectations for how the group would interact, communicate, and engage in creative explorations. This agreement, which included items such as: “respect [others]”, “encourage different points of view”, “safety to express yourself and share emotions” and “no racism/ageism/sexism/homophobia,” facilitated our ability to navigate difficult topics, deal with disruptive behaviours, and mediate any tensions that emerged throughout the project. For example, there were a number of times where subtle expressions of ageism arose (children referred to the style of an artwork as “old person’s art” and older adults openly discussed how children “do not know how to write anymore”). We were able to engage in meaningful discussions about ageism, interweave how they are implicated in climate discourses, and re-centre relationship building through the values set out in our community agreement. This helped build trust and intergenerational solidarity. The art activities, which focused on collaboration, also provided many opportunities for sharing ideas, negotiating, engaging in mutual teaching and learning, and having unstructured intergenerational discussions about climate change and action.

As this was a pilot study, we also missed opportunities for relationship building. In our final focus groups, participants reported they would have liked even more opportunities to get to know one another. Some older adults felt they would have liked to share more about their artistic and advocacy backgrounds. In some collaborative activities, the children wanted their ideas to be heard more. Both groups identified some of the formal relationship building exercises we did (such as meet-and-greet bingo) to be meaningful and would have liked more such activities. Future projects should continue to centre relationality. This might be facilitated if the project took place over a longer period of time. Due to an ethics delay and the funding deadline, we had to shift our original plan from running the project for half days over two weeks, to running it full days over one week. This shift was related to the rental availability of the space and the availability of project researchers as we started the project a month later than originally planned. While this intensity was exciting, we would not repeat it. It was tiring for everyone, but especially the older adults, and the researchers had to work long hours to prepare for each day.

Another aspect of our collaborative, relational approach was the importance of flexibility. We scheduled our daily activities from 9 am to 3 pm to align with a lot of other summer programming, to make the morning drop-off accessible for working parents of our child participants. However, we implemented a “soft-start” policy, where the first hour of each day was flexible and participants could arrive whenever they wanted, and work on self-chosen art activities individually or in small groups. We made a host of art supplies available (including iPads with creative apps), and helped facilitate whatever participants chose to work on. Sometimes participants finished their reflection from the day before, sometimes they worked on finishing previous projects, and sometimes they created new, original works. This daily activity proved to be very valuable, allowing for self-direction and self-expression, optional collaboration, casual conversation, time to finishing breakfast for those who needed to, and most importantly, it removed the pressure of arriving “on time.” We ended up creating an exhibit of “Soft Start Art” at our public sharing event. Recognizing that participating in a week-long full-time study was a big commitment, we were flexible about attendance, accepting participants who could be present for the majority of the study activities. We also offered flexible approaches to all engagements; participants were never pressured to engage in an activity or discussion they did not want to join, and we offered options if a participant wanted to do something different (this mostly occurred with the children). This included offering flexible options for collecting research data. For example, participants were offered the option to write, dictate, illustrate, or voice record their brief reflections. Overall, flexibility was a core aspect of the participatory, collaborative method, and it not only made the project more accessible to participants, it also demonstrated to them the reciprocity and inclusivity that are key to intergenerational solidarity.

Employing a Climate Wellbeing, Healing and Resilience Lens

Climate anxiety is a growing concern and public health challenge, especially amongst children and youth (Mateer, 2024). A degree of climate anxiety is expected and can even be productive in spurring people into action (Mateer, 2024). However, in climate change research with vulnerable populations, especially children, it is important not to tip the balance toward climate despair, as “feelings of alarm, dread, anxiety, grief, helplessness, hopelessness, anger, disassociation, paralyzing fear” (Wise, 2021, p. 7) can cause distress, trauma and inaction (Mateer, 2024). To mitigate this risk, we employed a Climate Wellbeing, Healing and Resilience lens (Wise, 2021) in our project. This involved holding space for complex feelings and recognizing not all negative feelings are unhealthy, creating spaces for conversation and differences of opinion and experience, stressing that climate changes effects everyone but not everyone is affected equally, cultivating respect and curiosity, and building trust. It also meant “pair[ing] coping strategies, solution-based thinking and pathways to action as part of climate change [explorations]” (Wise, 2021, p. 7). Interweaving notions of resilience meant we were attentive to the interconnectedness of whole systems, community cohesiveness (including intergenerational solidarity), collaboration and participant voices, future thinking, and a mental wellness outlook that centred hope (Wise, 2021, p. 18). Strategies used to nurture hope included educating, collaborating, being attuned to emotions, and discovering shared ways of coping. We found that employing this lens was an effective means of creating a safe research space that supported intergenerational climate solidarity, and foregrounded participant voices. It was an appropriate lens for addressing the public health challenges of climate change because the framework suggests that “Identifying and talking about causal relationships between climate change, systems, and public wellbeing can also help build awareness and personal investment in policies and needed systemic changes that mitigate risks associated with climate change processes and impacts.” (Wise, 2021, p. 7).

Necessity of Skilled Artist-Researcher Team

Having a knowledgeable and skilled artist-researcher team was essential to creating a safe space for climate discussions, to effectively facilitating artistic explorations, and to planning and carrying out the research practices of the study. The research team described above (JH, CG, and KM) had combined extensive experience working with older adults and children using arts-based approaches, high level skills in theatre and visual art, experience facilitating group discussions through arts engagement, and considerable climate change knowledge. They also had training in cultural safety and humility, decolonial practices, research ethics, and trauma-informed care. We also brought in two experts with experience using artistic approaches to explore climate issues – one in creative writing and one in collaborative song writing. We tried to also include an Indigenous storyteller but availabilities did not line up. The collective expertise of our study staff allowed us to approach and facilitate discussions and artistic expressions of climate change and intergenerationality from different angles and this contributed to a broader understanding of participant perspectives.

During most project activities, two research team members facilitated, while one took field notes. The facilitating team members recorded field notes immediately after the sessions. The skills of the research team were essential to the success of the research methods. They were invaluable in planning the project activities, making sure climate discussions were rooted in evidence, and in flexibly facilitating in the moment. Our level of project staffing was restrained by our budget, and this is definitely the minimum number of staff that could effectively run a project like this. More research assistants would be preferrable to collect more detailed fieldnote observations (as it would be easier to observe a smaller number of people), and also to better facilitate some of the art activities.

Adjusting the methods to include the video recording of participant activities is an option to consider in future projects where budgets limit the size of the research team. We chose not to for several reasons: the space in the room did not allow for camera setup, we believed cameras might make participants feel self-conscious and surveilled which was counter to our goal of building trust, and the video footage of such lengthy workshops would be onerous to analyze. However, video recording shorter workshops in a larger space might be effective in capturing nuances of intergenerational interactions that we may have missed through one-time observations.

Overall, in this kind of research, an effective and ethical research team has the following: skills in participatory collaborative arts-based research practices, hands-on artistic skills, knowledge of cultural ageism, advanced knowledge of climate change issues, and understanding of trauma-informed approaches. Knowledge and skills in decolonial practices would further enhance the work; this was something we were able to incorporate to some degree, but in future would seek to expand through collaboration with Indigenous researchers and participants.

Modelling Sustainability and Ecological Practices

Not only did the project discuss issues of climate change and climate action, but it also sought to demonstrate ecological consciousness and sustainable research approaches through its practices. Almost all art products were recycled or repurposed. We obtained donations from colleagues who had left over art supplies from other projects or their personal collections, and we obtained a large donation from a Neighbourhood House that was closing. We purchased some recycled paper, and bought some supplies (like scissors, paints, and markers) that will be reused in future projects with JH’s Elders CREATE Lab. We also sought to buy locally made products art materials whenever possible, but this was in tension with the higher cost of locally made supplies. This is an important value to build into the budgets of future arts-based climate action projects. We also purchased low-waste, locally made and grown food for refreshments from a local farmers’ market and bakery, which were served daily as snacks throughout the project, as well as at the public sharing event. The fact that the project took place in summer and fresh local produce was available supported this. However, again the cost was higher than imported food and should be factored into budgets.

Public Sharing

Planning a public sharing event for the end of the project was a key aspect in creating motivation and excitement within the group, as well as demonstrating intergenerational solidarity in climate action to the wider public. Participants were asked if having a planned event created too much pressure to produce artistic outcomes, and whether it would have been preferrable to explore creatively without that end goal. They unanimously responded that the public sharing event was important to them. The child participants, in particular, found meaning in sharing their work with their families. Locating the event at a busy local Neighbourhood House meant it attracted a public audience, and the location’s large hall provided an appealing and welcoming aesthetic. Attended by about 40 people, the event was effective in passing on the groups’ shared messages to a wider public. Through entries in the guest book and observations of audience reactions at the event (including some who were moved to tears), it was clear that the art exhibits and performance were particularly effective in conveying the importance of a collaborative intergenerational approach to climate action through participants’ voices. We also created a short documentary film about this event (which most participants enthusiastically took part in) and a music video of our collaboratively written song, both of which will be used for further knowledge translation.

Overall, Case Study 2 demonstrates that arts-based participatory research methods that integrate co-creativity and research-creation offer strong support for countering ageist climate discourses, better understanding intergenerational perspectives on climate-related health disparities, generating intergenerational solidarity toward climate action, and bridging knowledge gaps.

Discussion

As Allen et al. (2024) have argued “qualitative research provides public health with valuable, complex theories, as well as profound insights into behaviour and experiences of health, disease, and healthcare” (p. 3). The two case studies discussed here—visual storytelling with people with dementia and intergenerational collaborative creative workshops on climate change—demonstrate the potential of participatory, arts-based methods to advance health equity. Although situated in different contexts, both projects share common goals: fostering social inclusion, resisting stigma, and reimagining dominant narratives that marginalize specific populations.

A central approach across both studies is participatory engagement. In the dementia video storytelling project, individuals with dementia were positioned as co-creators of knowledge (Hung, Wong, et al., 2024), using visual media to share lived experiences often silenced by traditional research paradigms. Similarly, the intergenerational workshops brought older adults and children together in creative dialogue, enabling shared learning and mutual respect. As Lehnert et al. (2023) propose, alliances across generations can build cooperation and opportunities for resource-sharing, and facilitate aligned action toward structural change. These participatory approaches disrupted hierarchical models of knowledge production and validated diverse forms of expression beyond verbal and written communication, laying groundwork for addressing public health issues related to stigma, ageism, and the climate change crisis.

The co-created videos from Case Study 1 were shared not only with participants and their caregivers but also with a wider audience to support knowledge translation. The videos were shown for LTC staff in the provincial practice conference, family councils, and leadership teams within the participating facilities, sparking dialogue about resident engagement and person-centred care. The videos were also presented at community dementia cafes, regional health authority meetings, and academic conferences, where they were used to illustrate the value of participatory approaches in dementia care. In addition, a toolkit was developed for LTC staff to model strategies for fostering meaningful resident interaction. Case Study 2 co-created a public sharing performance event that artistically promoted its messages of intergenerational climate solidarity. It also created a 13-min documentary video of this sharing event, and a music video of a collaboratively written song entitled “Climate Action Strong and Bold,” both of which are available publicly on YouTube. These videos have been shared at local and international conferences, and public talks and exhibitions, and will become part of an educational package. These dissemination activities were targeted to ensure that the lived experiences and perspectives captured in the knowledge translation materials could inform practice improvements, influence policy discussions, offer educational guidance, and contribute to broader public understandings of dementia and intergenerational climate action.

Both case studies also foreground social inclusion. People with dementia and older adults are frequently excluded from health discourse due to ageism, cognitive bias, and assumptions about capacity. Similarly, older adults are often positioned as greedy and selfish in climate change discourses, leaving out their voices and reinforcing ageism; adultist tendances, likewise, tend to dismiss children and youth’s voices in climate activism (Roy & Ayalon, 2023; Trott, 2024). By creating accessible, inclusive spaces for creative expression, these case studies challenged those exclusions and allowed participants to be seen as active contributors. Burke et al. (2021) have argued that co-creative spaces can lead to shifts in awareness that turn art process and products into assets for wellbeing. In our case studies, collaborative arts-engaged processes and products offered powerful resistance to stigma, whether the stigma of dementia or the broader societal tendency to dismiss the voices of both older people and children in climate discourses. This holds strong potential for enhancing individual and collective well-being, as well as orienting public health increasingly toward considerations of planetary wellness.

Knowledge co-creation was another shared outcome. Both projects demonstrated that when young and older participants are engaged as collaborative partners, new insights emerge that challenge dominant discourses and expand understandings of health and wellbeing. These co-created narratives offered useful accounts, connecting emotional, social, environmental, and intergenerational dimensions of public health issues. The co-created videos from Case Study 1 were shared with LTC leadership teams, regional health authority decision-makers, and the provincial and national Alzheimer Society staff, creating opportunities for adding residents’ perspectives to directly inform service planning. The videos produced as knowledge translation tools in Case Study 2, along with a summary of study findings, will be shared with climate-based community organizations and policy makers in hopes of influencing both climate activism, and policies for addressing climate change education. Outputs across the two case studies have strong potential for integration into staff training modules, public awareness campaigns, health care and climate education, and policy consultations on person-centred care standards and preventive population health approaches. Participatory visual storytelling can operationalize the commitment to including the voices of people with dementia in policy development. Intergenerational collaborative arts engagement on climate action can contribute knowledge to advance public discourses and policies that foreground and support intergenerational climate solidarity. By presenting lived experiences in an accessible and emotionally resonant format, the narratives captured across the two case studies challenge misconceptions, highlight unmet needs, contribute to educational content and strategies, and guide resource allocation. In particular, Case Study One’s findings offer guidance in areas such as meaningful engagement programming, staff-to-resident interaction expectations, and environmental design. Case Study Two proffers evidence that intergenerational solidarity is a meaningful orientation toward climate action, shares methodological guidance for future research studies, and supports the implementation of intergenerational arts-based approaches in prevention-based public health campaigns. In future, such methods and issues as those described in these case studies could be embedded into formal policy review cycles, ensuring that those most affected are active contributors to shaping regulations and guidelines.

Qualitative research played a crucial role in both studies by illuminating the structural inequities that shape lived experience and limit participation. As Frers and Meier (2022) suggest “troublings of hierarchies during the research process are considered as eminently productive for the analysis of social inequalities and for maintaining a precarious ethics of care in the research process” (para. 1). In our case, rather than treating participants as data sources or observable subjects, the qualitative methods enabled researchers to centre voices, meaning, and context for socially just inquiry. We were able to shift traditional power dynamics by valuing the knowledge and agency of participants, ensuring that their voices were heard and considered throughout the research process. This work affirms the value of qualitative, participatory approaches in advancing social justice and responding to complex health disparities that are shaped by systems of exclusion and inequality. We have learned that researchers should approach their work with intentionality and reflexivity. In our studies, we demonstrated how principles of equity and justice can be meaningfully integrated throughout the research process. Drawing on our prior research experience, we offer practical insights and lessons learned not as prescriptive guidelines, but as aspirational examples to inspire others in cultivating inclusive, responsive, and transformative qualitative inquiry.

In future research, participatory arts-based methods should be further explored and integrated to include marginalized voices in meaningful and ethical ways. Expanding focus on decolonial approaches (as argued by Lam & Trott, 2024) would increasingly challenge dominant Western epistemological practices, and further challenge exclusionary knowledge systems. These approaches can inform more inclusive and responsive health initiatives that recognize diverse understandings and lived experiences. Creating opportunities for creative engagement, especially across generations, can strengthen community resilience, reduce stigma, and promote more equitable health outcomes.

Conclusion

These case studies underscore the vital role of participatory, arts-based qualitative methods in advancing equity and social justice in health research. By engaging people with dementia, and an intergenerational group of older adults and children, in meaningful, creative, and inclusive ways, both studies disrupted dominant narratives, resisted stigma, and fostered knowledge co-creation across generations and cognitive differences. Our findings demonstrate that when qualitative research is approached with deliberate attention to equity, it can serve as a powerful tool for amplifying marginalized voices and addressing structural inequities. We must move beyond traditional paradigms and actively commit to methods that are inclusive, creative, and justice-oriented—approaches that not only generate knowledge but also drive meaningful change in policy, practice, and community life.