Photovoice as a promising public engagement approach: capturing and communicating ethnic minority people's lived experiences of severe mental illness and its treatment

Images that speak: A Portuguese Photovoice study on the psychosocial experience of a migrant population from Cape Verde after a first episode of psychosis

Several migrant populations have been identified worldwide as high-risk groups for psychosis because of their experience of social adversity. Recent evidence suggests that the local contexts in which these populations live should be addressed in their complexity to take into account individual and larger societal environmental aspects. This study aimed to assess the lived experiences of a group of migrant Cape Verdean patients, who had been recently hospitalized for a first episode of psychosis in a mental health service on the outskirts of Lisbon, Portugal. The study used Photovoice, a qualitative participatory research method in which people's experiences are documented through photography. Six individuals were recruited, and five weekly sessions were conducted to collect data that were analyzed thematically. Emergent themes addressed two main categories of well-being and illness. Participant concepts of well-being were rooted in a definition of freedom encompassing cultural expression, conveyed by familiar environments and supporting communities. Cultural differences may be experienced as important obstacles for well-being and can be associated with feelings of oppression and guilt. Participants' accounts focused on positive aspects of life despite illness and on personal concepts of recovery. The study findings contribute to knowledge of the dynamics of migrants' social experience and underscore the importance of socially and culturally informed mental healthcare institutions.

Analysing multimodal data that have been collected using photovoice as a research method

BACKGROUND

Creative arts practice can enhance the depth and quality of mental health research by capturing and foregrounding participants' lived experience. Creative methods are emotionally activating and promote multiple perspectives, tolerating ambiguities and uncertainties, which are shared and even celebrated.

KEY ARGUMENTS

Methods such as photovoice use imagery to elucidate narratives that are not easily captured by more traditional interview-based research techniques. However, the use of creative methods and participatory research remains novel as there is little guidance of how to navigate conceptual, practical, and analytical challenges.

CONCLUSION

This paper considers these challenges, and puts forward practical and theory informed recommendations, using as study of photovoice methods for investigating ethnic inequalities in the use of the mental health act (Co-Pact) as a case study.

Using participatory action research methods to address epistemic injustice within mental health research and the mental health system

In this paper, we describe a model of research practise that addresses epistemic injustice as a central objective, by valuing lived experience and addressing structural disadvantages. We set out here the processes we undertook, and the experiences of those involved in an attempt to transform research practise within a study known as Co-pact. We do not discuss the findings of the research. Rather, we wish to build expertise on how to address epistemic injustice and offer examples of participatory research processes, central values, and practical procedures that we implemented.

Examining Hashtag Use of #blackboyjoy and #theblackmancan and Related Content on Instagram: Descriptive Content Analysis

BACKGROUND

Social media is widely accessible and increasingly utilized. Social media users develop hashtags and visual, text-based imagery to challenge misrepresentations, garner social support, and discuss a variety of mental health issues. Understanding how Black men are represented on social media and are using social media may be an avenue for promoting their engagement with and uptake of digital mental health interventions.

OBJECTIVE

The aim of this study was to conduct a content analysis of posts containing visual and text-based components related to representations of Black men's race, gender, and behaviors.

METHODS

An exploratory, descriptive content analysis was conducted for 500 Instagram posts to examine characteristics, content, and public engagement of posts containing the hashtags #theblackmancan and #blackboyjoy. Posts were selected randomly and extracted from Instagram using a social network mining tool during Fall 2018 and Spring 2019. A codebook was developed, and all posts were analyzed by 2 independent coders. Analyses included frequency counts and descriptive analysis to determine content and characteristics of posts. Mann-Whitney U tests and Kruskal-Wallis H tests were conducted to assess engagement associated with posts via likes, comments, and video views.

RESULTS

Of the 500 posts extracted, most were image based (368/500, 73.6%), 272/500 (54.4%) were posted by an individual and 135/500 (27.0%) by a community organization, 269/500 (53.8%) were posted by individuals from Black populations, and 177/500 (35.4%) posts contained images of only males. Posts depicted images of Black men as fathers (100/500, 20.0%), Black men being celebrated (101/500, 20.2%), and Black men expressing joy (217/500, 43.4%). Posts (127/500, 25.4%) also depicted Black men in relation to gender atypical behavior, such as caring for children or styling their children's hair. Variables related to education and restrictive affection did not show up often in posts. Engagement via likes (median 1671, P<.001), comments (P<.001), and views (P<.001) for posts containing #theblackmancan was significantly higher compared with posts containing #blackboyjoy (median 140). Posts containing elements of celebrating Black men (P=.02) and gender atypical behavior (P<.001) also had significantly higher engagement.

CONCLUSIONS

This is one of the first studies to look at hashtag use of #blackboyjoy and #theblackmancan. Posts containing #blackboyjoy and #theblackmancan promoted positive user-generated visual and text-based content on Instagram and promoted positive interactions among Black and diverse communities. With the popularity of social media and hashtag use increasing, researchers and future interventional research should investigate the potential for such imagery to serve as culturally relevant design components for digital mental health prevention efforts geared towards Black men and the communities they exist and engage with.

Experience-based investigation and codesign of approaches to prevent and reduce Mental Health Act use (CO-PACT): a protocol

INTRODUCTION

The Independent Review of the Mental Health Act (MHA) in England and Wales confirmed increasing levels of compulsory detentions, especially for racialised communities. This research aims to: (a) understand the causes of and propose preventive opportunities to reduce the disproportionate use of the MHA, (b) use an adapted form of experience-based codesign (EBCD) to facilitate system-wide changes and (c) foreground the voices of service users at risk of detention to radically reform policy and implement new legislation to ensure the principles of equity are retained.

METHODS AND ANALYSIS

This is a qualitative study, using a comparative case study design. This study is composed of five work packages; photovoice workshops will be conducted in eight local systems with service users and healthcare professionals separately (WP1); a series of three EBCD workshops in each local system to develop approaches that reduce detentions and improve the experience of people from racialised communities. This will inform a comparative analysis and national knowledge exchange workshop (WP2); an evaluation led by the patient and public involvement group to better understand what it is like for people to participate in photovoice, codesign and participatory research (WP3); an economic evaluation (WP4) and dissemination strategy (WP5). The impact of the involvement of patients and public will be independently evaluated.

ETHICS AND DISSEMINATION

This study is sponsored by the University of Oxford and granted ethical approval from the NHS Research Ethics Committee and Health Research Authority (21/SC/0204). The outputs from this study will be shared through several local and national channels.

"The Road We Travel": Developing a co-produced narrative for a photovoice project

WHAT IS KNOWN ON THE SUBJECT?: PhotoVoice as a participatory methodology has been used within mental health to support marginalized communities in addressing the challenges they encounter. The PhotoVoice methodology aims to encourage and foster collaborative and equal partnerships. However, reports of previous projects highlight that not every stage of the process remains participant-centric. There is limited reporting on participant involvement in the latter stages of projects, such as exhibition design. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: It provides a detailed description of the phases involved in planning and executing a mental health PhotoVoice project. It provides an illustration of how collaborative partnerships can extend into the design and construction of a photography exhibition and its narrative. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: PhotoVoice is an ideal methodology for use within the field of mental health nursing as it promotes service user inclusion in research, places value on lived experiences and provides a creative medium through which service users and family members can advocate for themselves and others. PhotoVoice is an effective and creative methodology for disseminating and communicating both the individual and collective outcomes to the general public. When implementing this methodology, clinicians and researchers need to be cognisant of the necessity to include participants as equal partners at every stage, including in the design of photography exhibitions and disseminating the findings to academic and public audiences. ABSTRACT: Introduction PhotoVoice is a participatory methodology in which marginalized communities represent their lived experiences through photography. While the methodology aims to foster partnerships throughout all phases, the literature suggests that in the field of mental health, some phases are often completed without participant involvement. Aims This paper elaborates on how the PhotoVoice method was used to engage service users and family members around their experience of involvement in a co-produced and co-facilitated mental health education intervention, in order to enhance public and policymakers knowledge of the project. Methods Ten participants were recruited and trained in the PhotoVoice method. Participants documented, through photography, their experiences of involvement in the education intervention. Following this, participants came together to co-produce and disseminate the photography exhibition to the public. Results PhotoVoice proved to be a flexible and creative method by which to include marginalized groups. By adhering to the collaborative principles of the methodology, service users and family members can retain decision-making power from the project's inception to its conclusion. Implications for Practice PhotoVoice is ideal for use within mental health nursing as it coincides with the recovery principle of promoting collaborative partnership between service users, family members and clinicians. Mental health nurses work directly with service users and family members throughout their recovery journey. The PhotoVoice methodology is coherent with the recovery principles of empowerment, collaboration and prioritizing the lived experiences of the individual. As such, this methodology has the potential to enhance greatly what mental health nurses can know and understand about the lived experiences of service users and family members. In turn, engaging with the PhotoVoice methodology can provide a platform from which further collaborative engagement between service users, family members and clinicians can take place.

Community involvement and awareness raising for better development, access and use of medicines: The transformative potential of photovoice

Photovoice is a qualitative research method where people, through images (photography, drawings or paintings), capture, represent, and communicate their experiences and perspectives about issues that are important to them with the final goal of raising awareness and triggering social change. Photovoice is informed by participatory action research approaches, feminist theory, Paulo Freire's critical pedagogy, and the theory of photography. Developed with the explicit purpose of gathering voices to advocate for structural social change in the early 1990s, the application of Photovoice in projects related to social pharmacy research started approximately 15 year later. The first Photovoice studies within social pharmacy aimed at understanding patients' experiences with their medications. Photovoice has also been integrated in interventions mainly focused on enhancing adherence to pharmacological treatments. There is still, however, room to fully unfold the empowering and emancipatory potential of Photovoice within social pharmacy research. This article briefly presents the theories underlying Photovoice, a guide for its appropriate methodological and ethical implementation, and with the aim to serve as inspiration for future social pharmacy research projects, it also includes three previously published studies that used Photovoice to understand, raise awareness and trigger social change to facilitate better lives when in need of pharmacological treatments.

Identifying evidence of the effectiveness of photovoice: a systematic review and meta-analysis of the international healthcare literature

Background

Photovoice (PV) was conceptualized in the early 1990s to engage community members in capturing/communicating their lived experience narratives through photography. However, no meta-analyses in health research have assessed whether PV achieves its purported effects.

Methods

We carried forward any relevant references from a previous review identifying PV studies before 2008 and searched MEDLINE, Embase, PsycINFO and Cochrane Central Register of Controlled Trials from 2008 up until October 2019. We included both published and grey literature, in any population or context. We assessed quality with the Effective Public Health Practice Project’s (EPHPP) tool and pooled studies using the standardized mean difference (SMD) and 95% confidence intervals (CIs).

Results

Twenty-eight studies were included, showing significant post-treatment effects only for health knowledge (SMD, 95% CIs = 0.41, 0.09 to 0.73, n = 16) and community functions (SMD, 95% CIs = 0.22, 0.03 to 0.40, n = 4). Strong heterogeneity was indicated for health knowledge, potentially explained by a larger effect in ethnic minority populations. There was insufficient follow-up data for health knowledge, while in follow-up for community functions the post-treatment effect was lost.

Conclusions

PV’s post-treatment effect on health knowledge did not translate into positive health behaviours or physical and mental health outcomes, longer-term community functions, or health service outcomes.