Using Photovoice to Address Gender-Based Violence: A Qualitative Systematic Review

A Feasibility and Acceptability Assessment of Photo-experiencing and Reflective Listening (PEARL): An Intervention to Promote Recovery Engagement After Gender-Based Harm

Photo-experiencing and Reflective Listening (PEARL) is a trauma-informed intervention developed to promote recovery engagement in survivors of gender-based violence (GBV). This study aimed to understand the feasibility and acceptability of PEARL and identify potential healing elements. GBV survivors were recruited in Philadelphia through an online survey (n = 20). Participants completed the PEARL intervention, a postintervention survey, and a follow-up interview. Results revealed PEARL to be both feasible and acceptable, with thematic analysis revealing its ability to facilitate purposeful reflection, connection to the present, and progress toward healing goals. PEARL shows promise as an engaging strategy to promote healing for survivors of GBV.

Therapeutic Dance for the Healing of Sexual Trauma: A Systematic Review

Therapeutic dance has been increasingly used as a treatment modality for sexual trauma, yet its evidence-based efficacy has not yet been catalogued. We therefore conducted a systematic review to summarize the existing evidence for therapeutic dance as an intervention for healing after sexual trauma. We searched 5 major databases to identify intervention studies on the use of therapeutic dance for individuals with histories of sexual trauma. Studies were included based on the following criteria: 1) the study involves individuals who have been exposed to sexual trauma; 2) the study reports on any form of dance as a therapeutic intervention; and 3) the study reports on dance intervention outcomes. A total of 1,686 sources were identified. Of these, 11 articles met eligibility criteria and were assessed. Reported outcomes were extracted and organized into emergent domains. We found that therapeutic dance acts upon three broad domains-affect, self, and interpersonal relationships - and can be delivered in diverse settings. Across the studies, dance showed benefits on outcomes. However, a significant weakness of the current peer-reviewed literature is the lack of robust empirical intervention research on dance therapy. Overall, the emerging literature suggests that therapeutic dance is a potential intervention for those who have experienced sexual trauma. The review findings presented here can be used to inform practitioners and systems of care targeted for those who have been subject to sexual trauma.

Experiences of recovery among adults with a mental illness using visual art methods: A systematic review

WHAT IS KNOWN ON THE SUBJECT?: Arts-based research is an established and accepted research approach and systematic reviews have been published on this methodology. There are many possible data collection techniques and study designs within arts-based research, which have been implemented but not yet systematically reviewed. Rationales and challenges for arts-based research have covered participants' experiences of being in arts-based studies in health service research. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: The main results of this systematic review are that mental health recovery concepts are effectively communicated by visual arts-based research and participation in these studies is progressive and connecting for mental health consumers. This paper adds new knowledge about participants' experiences specifically in visual arts-based studies, where the participants are mental health consumers. The results are significant because they support visual arts-based research in its development and popularity, both as a research approach and as an empowerment intervention. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The results of this systematic review can enhance the fields of qualitative research methods and mental health nursing. Recommendations for professional development can be advanced from consumers' ideas and experiences of recovery reported in this review. Nurse scientists and consumer researchers can take into consideration visual arts-based data collection techniques for use as research and empowerment interventions with mental health consumer participants.

ABSTRACT

INTRODUCTION: Art creation has been found to be therapeutic to mental health consumers, making the prospect of art creation's conceivable benefits as a mental health research strategy worthy of consideration.

AIM

This systematic review aims to explore experiences of recovery among adults with a mental illness using visual art methods.

METHOD

Following a comprehensive database search, 14 suitable studies were identified. These involved adult participants with a formal mental health diagnosis, or who self-identify as having a mental illness. The studies employed arts-based methodologies with participant-created, visual art as their data. Articles underwent data extraction and quality appraisal with the JBI-QARI (Qualitative Assessment and Review Instrument).

RESULTS

Results were categorised and further aggregated into two synthesised findings according to Joanna Briggs Institute (JBI) guidelines. The synthesised findings are: (1) Creative artmaking enables the use of visual metaphors which can aid expression of feelings, externalisation of identity, and personal learning, and (2) Interpersonal and self-connectedness through inclusion in community, receiving support when needed, and progressing through loss, are beneficial for mental health recovery.

DISCUSSION

These findings are comparable to those already existing in the literature, and suggest that visual arts-based research methods are as dependable as other qualitative research methods. Additionally, this systematic review reveals that when conducting research studies, there are benefits for mental health consumer participants when visual arts-based methods are used.

IMPLICATIONS FOR PRACTICE

A visual arts-based research intervention can be concluded to have the effect of an empowerment intervention, as well as being a credible research method.

The influence of family and culture on South Asian student dating violence survivors' college experiences

Objective: This paper discusses the influence of family and cultural backgrounds on South Asian student survivors' understandings of dating relationships and help-seeking after experiencing dating violence. Methods: Six South Asian undergraduate women dating violence survivors participated in two thé talks (similar to semi structured interviews) and a photo-elicitation activity to share their experiences of dating violence and how they make meaning of these experiences. Findings: Through analysis guided by the tenets of Bhattacharya's Par/Des(i) framework, this paper highlights two key findings: 1) the powerful role of cultural values in students' conceptualizations of healthy and unhealthy relationships; and 2) the effect of familial and intergenerational experiences on students' help-seeking behaviors. Conclusion: Findings highlight the need to incorporate considerations of family and culture in efforts to address and prevent dating violence in higher education.

Perspectives on delivering safe and equitable trauma-focused intimate partner violence interventions via virtual means: A qualitative study during COVID-19 pandemic

Background

The COVID-19 pandemic has been linked with increased rates of intimate partner violence (IPV) and associated experiences of compounded trauma. The emergence of this global pandemic and the public health measures introduced to limit its transmission necessitated the need for virtually delivered interventions to support continuity of care and access to interventions for individuals affected by IPV throughout the crisis. With the rapid shift to virtual delivery, understanding the barriers to accessing virtually delivering trauma-focused IPV interventions to these individuals was missed. This study aimed to qualitatively describe the challenges experienced by service providers with delivering virtually delivered IPV services that are safe, equitable, and accessible for their diverse clients during the COVID-19 pandemic.

Methods

The study involved semi-structured interviews with 24 service providers within the anti-violence sector in Alberta, Canada working with and serving individuals affected by IPV. The interviews focused on the perspectives and experiences of the providers as an indirect source of information about virtual delivery of IPV interventions for a diverse range of individuals affected by IPV. Interview transcripts were analyzed using inductive thematic analysis.

Results

Findings in our study show the concepts of equity and safety are more complex for individuals affected by IPV, especially those who are socially disadvantaged. Service providers acknowledged pre-existing systemic and institutional barriers faced by underserved individuals impact their access to IPV interventions more generally. The COVID-19 pandemic further compounded these pre-existing challenges and hindered virtual access to IPV interventions. Service providers also highlighted the pandemic exacerbated structural vulnerabilities already experienced by underserved populations, which intensified the barriers they face in seeking help, and reduced their ability to receive safe and equitable interventions virtually.

Conclusion

The findings from this qualitative research identified key determining factors for delivering safe, equitable, and accessible virtually delivered intervention for a diverse range of populations. To ensure virtual interventions are safe and equitable it is necessary for service providers to acknowledge and attend to underlying systemic and institutional barriers including discrimination and social exclusion. There is also a need for a collaborative commitment from multiple levels of the social, health, and political systems.

Using intergenerational photovoice to understand family strengths among Native American children and their caregivers

The purpose of the current study was to examine Native American children and caregivers' perspectives of family and cultural strengths using photovoice and to identify lessons learned from the first-ever implementation of intergenerational photovoice with Native Americans. Participants were Native American, low-income caregivers (n = 6) and their children (n = 12) between the ages of 10 and 15 who participated in six photovoice sessions. The themes that emerged from photos and group discussion included myriad challenges faced by Native American families including exposure to community violence, substance abuse, and criminal offending and incarceration. Themes also emerged that highlighted the strengths of Native families that were used to overcome identified challenges, including religion/spirituality, engagement in traditional cultural practices (e.g., prayer, song, dance), healthy activities (e.g., running, meditation). These data provided foundational information that is currently being used, along with other data, to develop a culturally grounded, strengths-focused, family-based program (Tiwahe Wicagwicayapi [Strengthening/Growing Families in Lakota]) to prevent adverse childhood experiences. We also discuss the challenges of intergenerational photovoice and lessons learned to inform future intergenerational photovoice projects.

Capturing lifestyle changes and emotional experiences while having a compromised immune system during the COVID-19 pandemic: A photo-elicitation study

This study aimed to describe lifestyle and emotional changes individuals with compromised immune systems experienced during the early months of the coronavirus disease 2019 pandemic. A survey was distributed to online support organizations for those with chronic illness and a national research volunteer registry from April to June 2020. Participants were asked to document their experiences via three photo-elicitation prompts, followed by reflection and Likert scale questions. Forty-seven individuals responded with 282 photos submitted. Lifestyle changes noted include shifts in wellness strategies, health management, routine, stressors, and time perception. Participants described significant distress stemming from deteriorating mental health, safety fears, isolation, health management, and longing. Wellness strategies documented included finding comfort, connection, and escape, managing uncertainty, maintaining physical health, and building resilience. These findings can increase a sense of community for immunocompromised individuals who are struggling in isolation and enhance knowledge of their day-to-day health needs during times of increased stress and health risk.

Opportunities and challenges in preventing violence against adolescent girls through gender transformative, whole-family support programming in Northeast Nigeria

Background

Household violence is one of the most prevalent forms of gender-based violence faced by adolescent girls in humanitarian settings. A growing evidence base demonstrates the extent to which multiple forms of familial violence, including intimate partner violence, violence against children, and sibling violence overlap in the same households. However, existing evidence of family support programming that effectively reduces violence against girls by addressing intersecting forms of household violence are limited, particularly in the Global South. Through a qualitative implementation evaluation informed by a grounded theoretical approach, we explored the perceived impact of a gender transformative, whole-family support intervention aimed at building adolescent girls’ protective assets against violence, among program participants in two communities of internally displaced people Maiduguri, Borno State, Northeast Nigeria.

Methods

We conducted six in-depth interviews and six focus group discussions with adult caregivers; six participatory activities and four paired interviews with adolescent girls and boys; and 12 key informant interviews with program staff. Criterion sampling was used to recruit 21 male caregivers, 21 female caregivers, 23 adolescent boys, and 21 adolescent girls; purposive sampling was used to recruit 12 program staff to participate in qualitative research activities. We audio recorded, translated, and transcribed all interviews. In a collaborative coding process, a multi-stakeholder team used applied thematic analysis in Dedoose to identify emergent themes in the data.

Results

Participants reported a decreased tolerance for and perpetration of violence against girls at the household level, and endorsed their right to protection from violence at the community level. However, alongside these self-reported changes in attitude and behavior, aspects of normative, patriarchal norms governing the treatment of adolescent girls were maintained by participants.

Conclusions

This study builds the evidence base for gender transformative, whole-family support programming and its impact on preventing violence against adolescent girls in humanitarian emergencies. Situating our findings in a feminist analysis of violence, this study calls attention to the complexity of gender norms change programming amongst families in conflict-affected settings, and highlights the need for programming which holistically addresses the relational, community, and structural drivers of violence against girls in emergencies.

Using Participatory and Creative Methods to Research Gender-Based Violence in the Global South and With Indigenous Communities: Findings From a Scoping Review

This review provides a synthesis of existing research on best practice recommendations for the use of participatory and creative methods to research gender-based violence in the Global South. Following a five-stage scoping review process, 44 papers, which each related to at least two of the three parts of the topic, were selected for inclusion. A frequency table was compiled to identify the elements of best practice, which were most common across the literature. Qualitative content analysis was then used to group these elements into inductive themes. An overarching theme of safety was identified, along with four broad and intersecting domains underpinning ethical research approaches in this area: contextual, reflexive, relational, and transformative. The validity of these themes was confirmed through consultation with partners, who also emphasized the importance of a survivor-centered approach. The aims, methods, barriers, evidence for practice, and research recommendations (AMBER) framework was developed for this project as an innovative tool for analyzing the data collected and drawing out the relevance for research practice. The framework draws out the aims, methods, and barriers involved in participatory research in this context and sets out best practice recommendations and directions for future research in the following areas: (1) ensuring safety of participants and researchers, (2) redressing power inequalities within the research process, (3) embedding locally responsive ethical frameworks, and (4) understanding cultural context and respecting cultural norms.

Using photovoice to understand and amplify youth voices to prevent sexual and relationship violence

AIMS

Efforts to improve prevention of sexual and relationship violence (SRV) among adolescents call for more centering of youth voices, experiences, and skills to design prevention programs that incorporate youth engagement rather than those that are designed by adults for youth. Amplifying the voices of historically marginalized youth are especially needed. Photovoice (PV) is a participatory action method that can empower youth and generate prevention knowledge.

METHODS

The current project used PV to engage youth in late middle and early high school to discuss how they could work to prevent SRV in their community. A convenience sample of nine youth (predominately Native American) participated over seven sessions.

RESULTS

A key theme they generated is that SRV prevention needs to be viewed as relational. Participants described the complexity of prevention, including how youth need social support to thrive and prevent SRV and that asking for help can be challenging. Results also highlighted that youth can provide help and support, but it is not always welcome in addition to underscoring that youth are resilient and can be prevention leaders.

CONCLUSION

Innovations in SRV prevention, especially for older adolescents, should work to engage youth as prevention partners. Participatory research methods like photovoice can be an important part of that process.

Experience of dating violence’s victims in Indonesia: A photovoice study

Dating violence is one of the major violence issues that is continuously threatening female youth in Indonesia. Dating violence can cause significant negative consequences to its victims, which are often underestimated in areas with strong patriarchal cultures. This study aims to identify the experience faced by dating violence victims, which could help expand the literature and provide insights for better violence prevention programs. Photovoice design was used and data were gathered through interviews and a focus group. Participants involved in this study are nine female youth victims of dating violence in Kupang, Indonesia. Analysis of interviews and focus group identified five main themes: 1) types of dating violence, 2) risk factors, 3) protective factors, 4) impacts of dating violence, and 5) withstanding and withdrawing from the relationship. Dating violence risk factors were patriarchal attitude, social and economic condition, lack of knowledge about dating violence, and exposure to violence. Factors that protect female youth from dating violence were positive self-concept, knowledge about dating violence, the role of parents, educational institutions, and health institutions. Reasons for victims to withstand their dating relationships were varied. Types and impacts of dating violence were also varied based on unique experiences. This study provides a deeper understanding of the experience of dating violence victims through photovoice methodology. These experiences were affected by religious and cultural beliefs distinctive to the Indonesian context, highlighting the need for more culture-fit interventions.

Photovoice and dramatisation in the classroom with nursing students: An exploratory study to raise awareness of the cultural and social dimensions of violence against women

BACKGROUND

Active teaching methodologies that incorporate students' feelings and beliefs and encourage them to reflect upon and critically think about certain variables, are extremely useful to teachers.

OBJECTIVE

To explore the potential of dramatisation and photovoice technologies as instruments to stimulate nursing students to reflect upon violence against women in society, thereby encouraging critical thinking and debate in a participatory way.

DESIGN

This was a qualitative, descriptive-exploratory study which used the participatory action research approach.

PARTICIPANTS

Forty fourth-year students enrolled in the Nursing undergraduate degree at the University of Alicante in Spain.

METHODS

The photovoice technique was used to record images from a dramatisation which served as the basis to represent scenes from the everyday life of people who are subjected to physical and psychological violence. These photographs were then debated and analysed by the students. We used MAXQDA® software and the guidelines published by Giorgi to aid our data analysis.

RESULTS

Four main categories emerged; the 'violence against women'. The 'victim' and 'abuser' categories considered 'emotions', 'feelings', 'attitudes', and 'behaviours'. The fourth category that emerged was 'social viewpoints'.

CONCLUSIONS

Photovoice-dramatisation raised awareness among the students and allowed them to reflect upon these behaviours and to critically think about the cultural and social dimensions of violence against women. The use of both of these techniques in practical and theoretical contexts to train students can help to nurture social commitment when faced with this problem.

Engaging photovoice to complement on sexual assault climate research: A literature review, case study, and recommendations

Through the implementation of three photovoice projects, we discovered how photovoice method complements sexual assault climate survey research. Scholars have recently asserted that qualitative and participatory research methods are necessary to conduct a holistic sexual assault climate evaluation. Nevertheless, an in-depth analysis of how photovoice complements sexual assault climate research is missing. To fill this gap, we examine photovoice studies focused on sexual assault climates, describe methods one author used to implement three photovoice projects, and demonstrate how the analysis of photovoice data generates findings distinctive from survey research. Our findings show how photovoice contextualizes and personalizes the problem, illustrates subjective and diverse standpoints, and highlight community values and norms. Specific to sexual climates the results demonstrate how society perpetuates a culture of victim-blaming, creates barriers to help-seeking, and how communities can support assault survivors by affirming their recovery process. We conclude the article with implications for practice and research.

Comparison of Standard and Transepithelial Corneal Cross-Linking for the Treatment of Keratoconus: A Meta-analysis

Purpose

To compare the clinical results of standard corneal cross-linking (SCXL) with transepithelial corneal cross-linking (TECXL) in progressive keratoconus using a meta-analysis.

Methods

PubMed, EMBASE, and Cochrane Central Register of Controlled Trials were searched up to June 2020 to identify relevant studies. The PRISMA guidelines were followed. Primary outcomes were change in uncorrected distance visual acuity and maximum keratometry (K_max) after CXL. Secondary outcomes were change in corrected distance visual acuity, mean refractive spherical equivalent (MRSE), spherical and cylindrical error, endothelial cells density (ECD), and central corneal thickness (CCT).

Results

Sixteen studies with a total of 690 eyes (SCXL: 332 eyes; TECXL: 358 eyes) were included. At the last follow-up, SCXL provided a greater decrease in maximum keratometry (K_max) than TECXL (weighted mean difference (WMD) −1.12; 95% confidence interval (CI) −1.96, −0.29). For the other outcomes, there were no statistically significant differences.

Conclusions

Except for a greater decrease in Kmax with SCXL group, both groups have a comparable effect on visual, pachymetric, and endothelial parameters at 24 months after surgery. Larger studies with a longer follow-up time are necessary to determine whether these techniques are comparable in the long term.

Violence at the Intersections of Women's Lives in an Urban Context: Indigenous Women's Experiences of Leaving and/or Staying With an Abusive Partner

This article is based on an ethnographic study exploring Indigenous women's experiences of leaving intimate partner violence. Analysis draws attention to the contextual features of Indigenous women's lives that differentially shaped women's experiences of "leaving and/or staying" with an abusive partner. Our findings are identified and described across four intersecting thematic areas: (a) the context of state-Indigenous relations; (b) complex trauma, stigma, and discrimination; (c) kinship and ties to communities and the land; and (d) health, healing, and resistance. These findings offer valuable insights into what constitutes appropriate, safe services, and support for the Indigenous women whose lives are shaped by multiple forms of violence.

Healing is not linear: Using photography to describe the day-to-day healing journeys of undergraduate women survivors of sexual violence

The purpose of this study was to describe the day-to-day healing processes of women who experienced undergraduate sexual violence. We engaged 19 women in a photo-elicitation experience with follow-up individual interviews to identify themes of both healing and darker moments in survivors' everyday lives. Healing was found to function on a continuum influenced by darker moments (i.e., moments that elicited fear, anxiety, loneliness, guilt, anger, and worthlessness) and healing moments (i.e., rebuilding moments of self-care, self-love, connection, hope, peace, and freedom). Responses to darker moments included feeling overwhelmed, disconnected, and intentional vulnerability. Healing moments were influenced by self-reflection, authentic interactions, and resource utilization. The photographs taken in this study shed light on the impact of sexual violence in women's daily lives long after these traumatic and unjust experiences. This knowledge can be used to foster a sense of universality in survivors who are currently struggling and growing after their experiences as well as give service providers greater insight into what survivors' day-to-day needs may be.