Participatory Visual Methodologies in Global Public Health

Claudia Mitchell, Marni Sommer, Claudia Mitchell, Marni Sommer

• Publisher: Routledge
• Year: 2018
• ISBN:
  9781351755368
• Edition: 1
• Topic: Medicine
• Subtopic: Health Care Delivery

Participatory Visual Methodologies in Global Public Health focuses on the use of participatory visual methodologies such as photovoice, participatory video (including cellphilming or the use of cell phones to make videos), drawing and mapping in public health research. These approaches are modes of inquiry that can engage participants and communities, eliciting evidence about their own health and well-being, as well as modes of representation and modes of production in the co-creation of knowledge, and modes of dissemination in relation to knowledge translation and mobilization. Thus, the production by a group of girls or young women of a set of photos or videos from their own visual perspective can offer new evidence on how, for example, they see sexual violence. Unlike other data such as those collected through surveys or even conventional interviews, the images they have produced not only inform the empirical evidence, but also do not need to remain in a laboratory or the office of a researcher. They can, through exhibitions and screenings, reach various audiences: school or health personnel, parents and community members, and perhaps also policy-makers. This collection offers a critical overview for students, practitioners, researchers and policy-makers working in or concerned with the use of participatory methodologies in public health around the globe. This book was originally published as a special issue of Global Public Health.

Research as intervention? Exploring the health and well-being of children and youth facing global adversity through participatory visual methods

Miranda D’Amico^a, Myriam Denov^b, Fatima Khan^c, Warren Linds^d and Bree Akesson^e

^aDepartment of Education, Concordia University, Montréal, Canada; ^bSchool of Social Work, McGill University, Montréal, Canada; ^cDepartment of Integrated Studies in Education, McGill University, Montréal, Canada; ^dDepartment of Applied Human Sciences, Concordia University, Montréal, Canada; ^eLyle S. Hallman Faculty of Social Work, Wilfrid Laurier University, Kitchener, Canada

ABSTRACT

Global health research typically relies on the translation of knowledge (from health professionals to the community) and the dissemination of knowledge (from research results to the wider public). However, Greenhalgh and Wieringa [2011. Is it time to drop the ‘knowledge translation’ metaphor? A critical literature review. Journal of the Royal Society of Medicine, 104(12), 501–509. doi:10.1258/jrsm.2011.110285] suggest ‘that while “translation” is a widely used metaphor in medicine, it constrains how we conceptualize and study the link between knowledge and practice’ (p. 501). Often the knowledge garnered from such research projects comes from health professionals rather than reflecting the lived experiences of people and communities. Likewise, there has been a gap in ‘translating’ and ‘disseminating’ the results of participatory action research projects to policymakers and medical practitioners. This paper will look at how using participatory visual methodologies in global health research with children and youth facing global adversity incorporates the multiple functions of their lived realities so that research becomes a means of intervention. Drawing from a literature review of participatory visual methods as media, content and processes of global health research, this paper raises practical, theoretical, and ethical questions that arise from research as intervention. The paper concludes by exploring what lessons emerge when participatory visual methodologies are integrated into global health research with children and youth facing global adversity.

Introduction: marginalised youth and visual methods

Globally, many children and youth face challenges to their development and well-being through exposure to extreme adversity. Global adversity for children and youth can be broadly characterised to include structural conditions such as poverty and marginalisation, as well as life disruptions such as violence, disaster, and war. Children and youth living within these contexts of global adversity may be threatened not only with the potential for loss of life, but a myriad of long-term, adverse psychosocial issues (Betancourt & Khan, 2008; Pedersen, 2002; Pfefferbaum & North, 2013).

While practitioners have carried out numerous health interventions in conflict zones, there is a substantial gap between translating and disseminating research results at the policy and practitioner level. Participatory visual methodologies, which use visual and experiential art to understand, address, and engage with the lived experiences and realities of children and youth facing profound adversity, can be a form of research intervention that is ‘collaborative, relevant, cost-effective, and generate[s] “innovations”’ (Greenhalgh & Wieringa, 2011, p. 507).

Although research has begun to document the importance of using arts-based methodologies (Kanji & Cameron, 2010; Mitchell, De Lange, Moletsane, Stuart, & Buthelezi, 2005), information on their applicability with children and youth facing different forms of global adversity remains in its infancy. Nonetheless, emerging research has highlighted that arts-based methods may allow children and youth to represent their experiences in contexts of reduced stress (Harris, 2007), promote activism and empowerment (Moletsane et al., 2007), and be particularly successful with younger children who have limited vocabulary to verbalise their feelings (Gangi & Barowsky, 2009).

For the purposes of our discussion, we draw from Panter-Brick, Lende, and Kohrt (2012)’s definition of children facing global adversity as ‘young people who face significant economic poverty, life disruption, violence, and social inequality within larger-scale processes of sociopolitical crises or rapid socioeconomic transformation demanding intervention’ (p. 603). Further, for the purposes of our paper, we define children and youth affected by marginalisation, poverty, violence, disaster, and/or war as ‘children and youth facing global adversity’. Based on this delineation, we ask:

• What is the role of these participatory visual methodologies in research as intervention with children and youth facing global adversity?
• Within the ‘toolbox’ of arts-based methods, what approaches are most appropriate to studying this population?
• What are the strengths and limitations of employing arts-based methods?
• What ethical, practical, and theoretical questions arise when research is also a form of intervention?

To answer these questions, we first interpret the notion of research as intervention. We then examine methods such as photovoice, participatory video (PV), drawing, Image theatre, and digital storytelling, and their potential to enhance the quality of data collected and to engage and empower child and youth participants. After reviewing these approaches, we provide a discussion on the strengths and limitations of employing arts-based methods, as well as the conceptual, ethical and practical questions that arise when research is also a form of intervention.

Research as intervention?

In reviewing research on promoting heart health, Haalboom, Robinson, Elliott, Cameron, and Eyles (2006) suggest that research can also contribute to capacity building in health promotion: ‘Research as intervention entails purposefully using aspects of a research process and results feedback to contribute to desired changes in knowledge and practice of research participants and stakeholders’ (p. 292). Research then becomes not only a means to gather data, but also a potential health intervention.

McNamee (1988) examined research as intervention in a systems context. Here, research is focused on facilitating change, not just observing or accounting for how change occurs. This requires an understanding and application of systems theory, termed ‘systemic epistemology’ (Bateson, 1972). McNamee underlines that if we look at research as a social intervention, the role of the researcher-as-intervener becomes complicated. When the process of researching as an intervention in the system being studied is at the centre, the researcher’s active participation in the system is emphasised, which subsequently allows us to think that a researcher can stand outside of another social system and observe it objectively. Systems theory, coined and developed by cyberneticist Norbet Wiener (1948), is particularly relevant here. The emphasis in a systems perspective is on how the whole arises from the interrelations among the parts. Minute changes, operating in feedback loops, evoke systemic changes. Arts-based research as intervention is an example of a feedback loop evoking systemic change through art.

How might this play out in real communities with real health issues? Barndt (2009) writes that, when talking about community arts as research and intervention, ‘[t]he researcher/artist may structure processes to engage participants in creative inquiry, but if the process is to draw on the knowledge, skills and visions of community members, there must be space for this to happen’ (p. 360). Put more simply, research using the arts can facilitate change while at the same time provide evidence of such changes. Participatory visual methodologies engage participants by producing a representation of their experiences of health and well-being, while also exploring what these representations mean and how they may contribute to change. In this way, the arts in general and participatory visual methods in particular become both the medium and the representation through which to investigate health and well-being.

Arts-based research with children and youth

Advances in research methodologies with children and youth call for innovative and adapted research techniques while emphasising their competence. Given the myriad ethical issues involved in conducting research with children and youth affected by global adversity, employing suitable methodologies to meet their diverse needs is vital (Boyden & de Berry, 2004). Historically, methodological approaches to research with children have tended to view children in largely passive ways as merely ‘objects of research’ or as ‘vulnerable’ and ‘incompetent’ (Clark, 2010). Drawing on a rights-based approach, which recognises children and youth as capable of making sense of and affecting the world around them, this paper seeks to examine research methodologies that seek to both empower and actively engage children and youth in the research process through participatory and arts-based methods. More specifically, we trace the potential of photovoice, PV, drawing, Image theatre, and digital storytelling as both method and intervention.

Photovoice: enabling empowerment, healing, and group cohesion

The use of photography in research has become recognised as a means of empowerment among marginalised youth and ‘groups of people who do not normally get to speak’ (Mitchell, 2011, p. 51). Within the toolbox of photographic methods, photovoice has emerged as an important methodological and community empowerment tool. Photovoice is a community-based participatory research method that combines photography, community awareness building, group discussions, and social action (Wang & Burris, 1994, 1997). First developed and implemented by Wang and Burris in research with women villagers in rural China, the method draws on ‘community photography’ (Spence, 1995), a way in which ordinary people photograph each other and their social environment.

Photovoice has three main objectives. First, participants receive training to become community researchers and ethically conscious photographers. In these new roles, they document, through photos images, issues of personal and community concern. Therefore, it seeks to enable individuals and groups, particularly those who face marginalisation and disempowerment, to record and reflect upon their community’s strengths and challenges through photography. Second, using group discussions of participants’ photographs, written photo narratives or captions of the photos, photovoice aims to promote critical dialogue and knowledge about important community issues. Through the ongoing data collection process, via photography, participants come together as a group to discuss and analyse what they have documented and to support each other. Finally, through the dissemination of their photographs to the wider community, and through such practices as exhibitions of the photographs, photovoice seeks to reach policy-makers who have the power to implement changes within that community (Wang & Burris, 1997).

De Lange, Mitchell and Stuart (2007) position photovoice within the broader category of ‘visual methodologies for social change’ and document the transformative possibilities of the process as photographs help people to ‘reflect on their own lived experiences … framing their ideas for change’ (as cited in Burke, 2008, p. 26). Photovoice has been documented as a powerful research tool to engage communities and enable a deeper understanding of the lives of marginalised youth (Burke, 2008). Photovoice may also hold powerful ‘intervention’ capacities with marginalised youth. First, it has the capacity to serve as a platform from which youth are able to develop skills such as photography techniques, team building, cooperation, leadership, and critical thinking skills (Wang & Burris, 1997). Second, given its emphasis on group work and team building, photovoice offers a format that can alleviate the sense of isolation often associated with social marginalisation (Denov, Doucet, & Kamara, 2012). Through group meetings and discussions inherent to the photovoice process, youth participants can begin to develop and nurture a sense of belonging and collective identity and foster a sense of empowerment within the project. Third, photovoice, and arts-based projects in general, can provide a venue to deal with emotions rarely addressed in conventional research methods, such as shame, guilt and feelings of accountability (Harris, 2010). Moreover, sensitive issues may be easier to address through the lens of a camera, allowing as much proximity or distance from the topic as necessary. Finally, photovoice allows participants to create and establish the research agenda, ensuring greater control over the methodological process (Burke, 2008).

The intervention capacity and potential of photovoice has also been highlighted by various researchers. Denov et al. (2012), for example, conducted a photovoice project with a group of former child soldiers in Sierra Leone living in an urban settlement community, who reported experiencing various forms of rejection, stigma and marginalisation in the post-war period. The study highlighted the post-conflict lives of former child soldiers and their complex experience of reintegration into mainstream society. Denov et al. noted that at the end of the project, all participants reported that the project fostered a gradual change in community members’ perception of them. They reported that community members began referring to them as ‘professional photographers’, which instilled pride and confidence. Other participants noted that prior to the project, they did not have ‘good reputations’ in the community; the photovoice process helped to show sceptical community members the positive potential of participants, thereby challenging preconceived views. Blackman and Fairey (2007) argue that photovoice holds much promise in terms of intervention. They maintain that participants in photovoice projects gain confidence in their ability to assert ideas and engage in self-advocacy, hav...