An Overview of Photography as a Creative Modality in Qualitative Research

1. An Overview of Photography as a Creative Modality in Qualitative Research By Sheila Linz, PMHNP-BC

2. Why look at images in nursing research ? • Hodges, Keeley, and Grier (2000) write that the visual image has been used to describe what is most important to humans throughout history and is able to evoke emotions, abstract ideas, and the shared human experience. • Hodges, Keeley, and Grier (2000) used the visual image in a qualitative hermeneutic phenomenological study in order to analyze perceptions of illness in nurses, nursing students, and the elderly.

3. Why look at photographic Images in nursing research ? • In a paper on the use of photo elicitation, Harper (2002) writes “Images evoke deeper elements of human consciousness than do words; exchanges based on words alone utilize less of the brain’s capacity than do exchanges in which the brain is processing images as well as words”(p. 13). • Photographic images taken by marginalized people have the potential for societal change. Poudrier and Mac-Lean (2008) used photo-voice in a qualitative, participatory research study. They loaned cameras to Aboriginal Canadian women in order to describe visually, their experience with breast cancer.

4. Where and when did utilizing a photographic methodology in research begin? • Photo elicitation was first mentioned by Collier(1957), a researcher and a photographer who used the camera to document the housing of his study’s subjects. The research questioned the environmental basis of psychological stress. • Photo research methods began with the environmental sciences and visual anthropology. (Hansen-Ketchum & Myrick, 2008).

5. Photography as a visual methodology in narrative inquiry • In a paper describing the use of photography in narrative inquiry, Harrison(2002) writes that photographs can be seen as a form of story telling, exploring narrative, and providing insight into memory and identity construction (Harrison, 2002). • Photographic images may be produced by the investigator or by those being researched (Harrison,2002). • Photographic images may be produced during the research process, as in research generated photo diaries , or the images may have been produced in the past, such as in the use of old family photo albums. Family albums reveal much about the participants history (Harrison, 2002).

6. Photography in narrative inquiry(cont’d.) • Photography as auto-biography may be used to address the core question of “who am I”(Harrison, 2002). • The photographs do not stand alone but are used in conjunction with interview (Harrison, 2002). • Harrison (2002) described a study by Thoutenhoofd(1998)in which photography was used successfully in interviews with deaf people who documented their visual life with the aid of a camera.

7. Photography in narrative inquiry (cont’d.) • “Photographs are an important site for the embodiment of memory, as traces of working through a place for self in the past and the present. They are also a means by which people in everyday life can narrate experience, and in this way can come to an understanding of what those experiences mean” (Harrison, 2002, p. 109).

8. A variety of methods that utilize photography in research • Photo Essay: A series of photographs made with the intention of telling a story about someone or some situation. These photographs may reveal more about the participant than meets the eye (Casey & Dollinger, 2007). The photos may have narrative text placed on or with the photograph (Harper,2002). Photo essays, once made, may be used for photo elicitation. • Photo Elicitation: Inserting photographic images into your research interviews for your participants or subjects to comment on (Lorenz & Kolb, 2009). Collier(1957) wrote that more information was elicited from interviews with study subjects when photographs were used to elicit responses during interviews. In addition, the subjects were less easily fatigued by the interview process when the act of looking at photographs was included in the interview process. • Photo-Voice: A participatory action research method in which a participant in a marginalized community takes photographs in order to tell his or her own story and their community point of view through photographic images of their community and lives(Poudrier & Mac-Lean, 2009). Photographic images made through Photo-Voice may later be used to generate comments during interviews or focus groups through the use of photo elicitation.

9. Examples of the use of “photo essay” • Macarow (2010) writes about the photo essays of a variety of photographers as the photographers explored the lives, roles, resilience, migration, and opportunities for victims of the holocaust in the Jewish Diaspora. Researchers view the photographs to gain an understanding of the phenomenon. • As a photographer and writer, Allen (2007) studied the Transgender Community in the united States for over 30 years through the use of photo essay.

10. “photo essay” (cont’d.) • Casey and Dollinger (2007) used photo essay and regression analysis in a quantitative study to provide insight into patterns of alcohol consumption among college students. The students (N=135)took a series of photos of their lives in regards to alcohol consumption in order to determine their “alcohol identity” and predicted risk for alcohol related problem behaviors. • Killion(2001) researched the use of photo essay in a successful attempt to promote cultural awareness in nursing students, and to identify multicultural themes in their photographs. The students in the class were each assigned to produce a photo essay depicting cultural aspects of health.

11. Examples of the use of “photo elicitation” • In a paper on photo elicitation, Harper(2002) writes that the methodology has been used by researchers to investigate the social identify of kids, ethnically diverse immigrants, drug addicts, and work worlds. • Longoria and Marini (2006) used photo elicitation in a descriptive mixed methods study using a survey tool and open ended questions in order to explore the perceptions of children's attitudes towards peers with a severe physical disability. The children were shown photographs of severely handicapped children and asked to comment on them.

12. “photo elicitation” (cont’d.) • Brand and McMurray (2009) used photo elicitation in an explorative, qualitative descriptive pilot study exploring first year nursing students perceptions of older adults. In individual interviews, the student was shown pre-existing photographs of older adult patients receiving nursing care. The student was asked to comment on the photographs. • In an effort to improve quality of life for older people, Newton, Ormerod, Burton, Mitchell, and Ward-Thompson (2010) used photo elicitation in a qualitative descriptive study to determine the preferred neighborhood street design by older people. Older people were individually interviewed and asked to view and discuss environmentally contextualized photographs of various street features.

13. Examples of the use of “photo- voice” • Wang and Pies (2004) used photo-voice, a participatory action research methodology, in an ethnically diverse California community in order to augment previously collected quantitative data. Residents of the community were provided with disposable cameras and asked to take photographs reflecting their views on family, maternal, and child health assets, and concerns in their community. They later participated in group discussions reflecting on the photographs through the use of photo elicitation. • Andonian (2010) used photo-voice as an action research methodology in order to research the community participation of mentally ill individuals within an urban setting. The mentally ill participants were given cameras and asked to photograph people, places, and things, that showed their experience of community participation.

14. “photo-voice” (Cont’d.) • Poudrier and Mac-Lean (2009) used photo-voice, as a qualitative, participatory, visual methodology to record Canadian, Aboriginal Women’s experience with breast cancer. The participants were loaned cameras and asked to take 12-15 photographs of what the experience of breast cancer meant to them. The images were later discussed individually and in a sharing circle using the photo elicitation method. • Gallagher et al. (2010) used focus groups and photo-voice in an exploratory, qualitative study in which adult African American community members were given disposable cameras and were instructed to take pictures in the community of anything that encouraged or discouraged walking. • Oliffe, Bottorff, Kelly and Halpin (2008) used participant produced photographs and narrative interviews in an ethnographic study exploring fatherhood and smoking.

15. Ethical and legal issues • The main ethical concern is usually what will happen after the photograph is taken (Close, 2007). • Depending on the review board, at times, photographs may be taken of objects and places but not of people (Close, 2007). • Informed consents must be obtained, the person (or child) or the child’s representative, must be competent to provide consent. • Are the photographs to be published or disseminated? The informed consents must include the exact use of the photograph. • Who will own the photograph if it was taken by a community participant? In a study by Miller and Happell (2006), the photographs were on loan to the researchers, but could be withdrawn at any time.

16. Ethical and legal issues (cont’d.) • Andonian (2010) instructed her photo-voice participants to only photograph non-family members in public spaces to address issues of consent. Only pictures of people in public spaces were used as data in the study. Legally one may take photographs in public places outside, however, what is legal is not always ethical. Check with your IRB ethics committee. • Martin, Garcia, and Leipert (2010) suggest that careful training of photo-voice participants in the ethical issues related to taking pictures of people is necessary. They recommend that every person who is photographed sign an informed consent. • Originally, Poudrier and Mac-Lean (2008)received IRB ethics approval to de-identify their study participants in the photographs, because their study participants later wished to be identified, the researchers re-applied for ethics approval out of respect for their participant’s wishes. • Check with your Institutional Review Board

17. References Allen, M.P. (2007). Momentum: A photo essay of the transgender community in The United States over 30 years, 1978-2007. Sexuality Research & Social Policy, 4 (4) 92- 104. Andonian, L. (2010). Community participation of people with mental health issues within an urban environment. Occupational Therapy in Mental Health, 26, 401-417. Brand, G., & McMurray, A. (2009). Reflections on photographs: Exploring first-year student’s perceptions of older adults. Journal of Gerontological Nursing, 35(11) 30- 35. Casey, P. F., & Dollinger, S. J. (2007). College students’ alcohol-related problems: An autophotographic approach. Journal of Alcohol and Drug Education, 51 (2) 8. Close, H. (2007). The use of photography as a qualitative research tool. Nurse Researcher, 15(1) 27-36. Collier, J. (1957). Photography in anthropology: A report on two experiments. American Anthropologist, 59, 843-859. Gallagher, N., Gretebeck, K., Robinson, J. C., Torres, E. R., Murphy, S. L., & Martyn, K. K. (2010). Neighborhood factors relevant for walking in older, urban, African American adults. Journal of Aging and Physical Activity, 18, 99-115. Hansen-Ketchum, P., & Myrick, F. (2008). Photo methods for qualitative research in nursing: An ontological and epistemological perspective. Nursing Philosophy, 9, 205-213.

18. References (cont’d.) Harper, D. (2002). Talking about pictures: a case for photo elicitation. Visual Studies, 17 1,13-26. Harrison, B. (2002). Photographic visions and narrative inquiry. Narrative Inquiry, 12 (1), 7-111. Hodges, H. F., Keeley, A. C., & Grier, E. C. (2000). Masterworks of art and chronic illness experiences in the elderly. Issues and Innovations in Nursing Practice, 36(3), 389- 398. Killion, C. M. (2001). Understanding cultural aspects of health through photography. Nursing Outlook, 49 (1) 50-54. Longoria, L., & Marini, I. (2006). Perceptions of children’s attitudes towards peers with a severe physical disability. Journal of Rehabilitation,72,(3) 19-25. Lorenz, S., & Kolb, B. (2009). Involving the public through participatory visual research methods. Health Expectations, 12, 262-274. Macarow, K. (2010). Where language may falter: photography and the Jewish Diaspora. Social Alternatives, 29(1), 52. Martin, N., Garcia, A. C., & Leipert (2010). Photovoice and its potential use in nutrition and dietetic research. Canadian Journal of Dietetic Practice and Research, 71 (2) 93-97. Miller, G., & Happell, B.(2006). Talking about hope: The use of participant photography. Issues in Mental Health Nursing, 27, 1051-1065.

19. References (cont’d.) Oliffe, J. L., Bottorff, J. L., Kelly, M., & Halpin, M. (2008). Analyzing participant produced photographs from an ethnographic study of fatherhood and smoking. Research in Nursing & Health, 31, 529-539. Poudrier. J., & Mac-Lean, R. T. (2009). We’ve fallen through the cracks: Aboriginal women’s experiences wit breast cancer through photovoice. Nursing Inquiry, 16 (4), 306-317. Wang, C. C., & Pies, C. A. (2004). Family, maternal, and child health through photovoice. Maternal and Child Health Journal, 8(2) 2004.