Photovoice

1. Photovoice

2. What is it? • A method of working with people in communities that are typically under-represented or excluded in our society. • Photovoice is a type of action research and involves asking participants to represent their lives, point of view, and experience using photographs and narratives. • Photovoice allows us to gain "the possibility of perceiving the world from the viewpoint of people who are leading lives that are different from those traditionally in control of the means for imaging the world“ • It entrusts cameras to the hands of people to enable them to act as recorders of their own story or lived experience

3. What it isn’t • Photovoice is NOT a photography project, art therapy, or photojournalism. • Photovoice IS…a multi-step process that combines equal parts photography, research, group process, storytelling, social action, and development of awareness of personal and community issues.

4. Goals of • It enables people to record their community's strengths and problems. • It promotes dialogue about important issues through the use of photographs. • It can be used to engage policy-makers.

5. Stages of Photovoice • Conceptualizing the problem • Defining broader goals and objectives • Recruiting policy makers as the audience for photovoice findings • Training the trainers • Conducting photovoice training • Devising the initial theme/s for taking pictures • Taking pictures • Facilitating group discussion • Critical reflection and dialogue (next slide) • selecting photographs for discussion • contextualizing and storytelling • codifying issues, themes, and theories • Documenting the stories • Conducting the formative evaluation • Reaching policy makers, donors, media, researchers, and others who may be mobilized to create change • Conducting participatory evaluation of policy and program implementation

6. Training and Process • People using photovoice engage in a three-stage process that provides the foundation for analyzing the pictures they have taken: 1. Selecting – choosing those photographs that most accurately reflect the community's concerns and assets - people can lead the discussion, it is they who choose the photographs. They select photographs they considered most significant, or simply like best, from each roll of film they had taken. 2. Contextualizing – telling stories about what the photographs mean - This occurs in the process of group discussion, suggested by the acronym VOICE, voicing our individual and collective experience. Photographs alone, considered outside the context of their own voices and stories, would contradict the essence of photovoice. People describe the meaning of their images in small and large group discussions. 3. Codifying – identifying the issues, themes, or theories that emerge - gives multiple meanings to singular images and thus frames the third stage, codifying. In this stage, participants may identify three types of dimensions that arise from the dialogue process: issues, themes, or theories.

7. So…Typical Use • The participants told to take pictures to represent what it was like for them to live with … • Take pictures - returned cameras photos developed. • Meet with each participant who returned the camera. - interviewed the participants individually for about an hour to understand the meaning of the pictures. Each participant was asked to select four pictures and explain the meaning for them. • Interviews were taped and transcribed.

8. Studies • Making Visible the Invisible: Using Photovoice to Understand Living with Brain Injury - Laura S. Lorenz, ABD, MA, MEd, Barbara Webster, Laura Foley • http://www.bu.edu/cpr/research/ongoing/rtc2009/photovoice/photovoice-transcript.rtf

9. The drain calls to me because of all the hurtful things people have said to me over the decades about my mental illness. In sum, I have been told that I am a drain on the nation, a drain on society, and a drain on multiple individuals’ resources. Over the years, I have come to believe this, which has been a drain on me. Education about mental illness (and the effects of trauma) should be able to reach out to the general public, as well as healthcare professionals. Knowledge and understanding can be powerful weapons in combating stigma.

10. Individual Stories • Annette is a 49-year-old Caucasian woman who had been diagnosed with generalized anxiety disorder and obsessive-compulsive disorder. She has a history of abuse and betrayal, resulting in a strong need for safety. She withdraws into her bedroom for 14 hr each day in order to feel safe. She described feeling invisible, faceless, and misunderstood. "It's like I am there, and I try to come out, and I am asked a question, and I try to answer it. It's just like it is passed over me, and the person starts talking to someone else. I am not seen”. Annette expresses a need to be acknowledged; however, her frequent withdrawal from others might suggest ambivalence regarding being seen. • Annette questions why she has mental illness without finding a satisfactory answer. The tone of her interview indicates that she feels alone, grim, and has a very unhappy existence. She is focused on the past and the present. She would like healthcare providers to know that she is more than a diagnosis, and she wants them to see her as an individual. "I wish the rest of the world could see that seeking help for mental health is not a bad thing or something to joke about or judge me." She expressed positive regard for her current therapist and uses positive coping skills, such as humor. "If I can make a joke about what's wrong with me, it makes me feel lighter." She shared a photo of a tee shirt she wears that has "The voices aren't real but they have some good ideas" written on the front. "You can't be negative all the time, you know." She uses negative coping skills, such as withdrawal, and experiences dissociation when she feels threatened. "In my family nobody really identifies with my problem. It isn't talked about, and that is hard."

11. Individual Stories • Bob is a 42-year-old Caucasian man who had been diagnosed with depression and obsessive-compulsive disorder. He values his self-identity as a responsible contributor and uses healthy coping skills, such as tracking his symptoms and forming honest, supportive relationships. The tone of his interview indicates adaptation to limitations, functioning from personal strengths rather than weaknesses, and a strong connection with people. "And I am appreciative of the deacons giving me this responsibility to fix things around the church and help them in other ways. In my computer, I keep a journal on a disc and I have designed a scale from zero to ten. Nine to ten is a good day. Eight to seven is average and so on. I try to update it periodically. I write in there like I am talking to one of my church families" His therapist learned that Bob had devised this emotional self-monitoring diary while reading the interview transcript. Bob is focused on the present. He would like healthcare providers to know that medications work differently for different people and to be aware of how different medications interact.