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Photovoice : Understanding the perspectives of HIV+ lower income women through participatory action research Pamela Valera, PhD, MSW Grand Rounds 25 June 2009 HIV Center for Clinical and Behavioral Studies. Outline of Presentation. What is Photovoice ? A Study Example with HIV+ Women

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Outline of Presentation

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  1. Photovoice: Understanding the perspectives of HIV+ lower income women through participatory action researchPamela Valera, PhD, MSWGrand Rounds 25 June 2009HIV Center for Clinical and Behavioral Studies

  2. Outline of Presentation • What is Photovoice? • A Study Example with HIV+ Women • Photovoice Study Results into Action • Issues and Concerns of Photovoice • Community Empowerment • Ideas for Future Work

  3. What is PhotoVoice? • An applied approach based on the principles of critical consciousness1 and feminist2 theory, and used in the first stage of participatory action research • The use of photographs as a vehicle for participants to identify pressing issues and determine solutions for collective action 1Freire, 1970; 2Wang & Burris, 1997

  4. Rationale of Photovoice • Health disparities and social problems are complex • Increasing interest in engaging consumers and community participants • Increasing demands to hear from marginalized and indigenous populations • Increasing funder interest in building capacity and community-driven responses

  5. Photovoice Approach • Participants participate in focus group discussions • Examine issues/social problems • Determine research question to study, • Reflect on meaning behind photos, and • Create an action plan. • Involves long term commitment to social change

  6. Three Focus Group Discussions • 1st meeting – discuss social problem, develop research question, address ethical issues, distribute disposable cameras • 2nd meeting – discuss process and reflect on meaning behind the photographs • 3rd meeting – discuss how to disseminate findings, determine collective action activities

  7. Focus Group Protocol (2nd meeting) • Objective of taking pictures: “What did you observe?” • Reflective questions were asked to enable the group to discuss how they felt about their photos. • “How did you feel when you took that picture?” • “What was the most challenging part of taking pictures about access to healthy foods?” and “How did you decide to take this picture?” • Interpretive questions were asked to enable the group to describe the meaning of their photographs. • “What would you say about this picture to someone who is not from your neighborhood?” • Decisional questions were asked to enable the group to respond to the problems of food insecurity and limited access to healthy foods and fresh fruits and vegetables. • “What ideas of possible solutions do you have to address food insecurity?” • “What needs to be changed?” and “Who should be involved in changing policy?”

  8. A Photovoice study example with HIV+ women in Central Harlem

  9. Agency Partner: Sisterlink • A Community Action for Prenatal Care (CAPC) program funded by the New York State Department of Health AIDS Institute. • Designed to reduce adverse birth outcomes such as mother-to-child HIV transmission and low birth weight.

  10. Participants • 9 HIV+ women (3 Afro-Caribbean, 4 African American, 1 Asian, 1 Caucasian) • Mothers (20-45 years old) • Residents of Central Harlem • Family shelters and lower income apartments

  11. Community Health Concerns • Unavailable men (ie., incarcerated) • Community violence • Illicit drugs • Access to healthy food Women decided after a lengthy discussion to focus on access to healthy food

  12. Health Effects: Limited Access to Healthy Food • 3 times more likely to be obese and four times as likely to have diabetes compared to Upper East Side Residents NYCDOHMH, May 2007

  13. Social Environment of Harlem: Limited Access to Healthy Food • Bodegas/corner stores are more common in Harlem compared to the Upper East Side • Supermarkets are much more common on the Upper East Side than Harlem • Bodegas/corner stores are not likely to carry low-fat dairy products and are less likely to carry common fruits and vegetables compared to the Upper East Side • One in six restaurants (16%) in East and Central Harlem is a fast-food restaurant compared to 4% on the Upper East Side. NYCDOHMH, May 2007

  14. Photovoice Study • Objective #1:To document the experiences of HIV+ women’s access to healthy food in Harlem • Objective #2: To bring public awareness on access to healthy food by HIV+ women • Research Question: Can we afford to eat healthy in New York City?

  15. STUDY FINDINGS

  16. Our Options to Eat: “24 Hours to Eat Fat”

  17. “ “Diabetes on Sale” I was taking pictures of some of the things that were healthy and some of the things that I’ve noticed that they were [practically] giving away. When you go to the supermarket and when you see a can of soda for 25 cents and a bottle of water for $2, sometimes your income will force you to buy the unhealthy food. (African American woman with two children) Rashida

  18. “Sky High Prices! For What?” Bad. Angry sometimes? This stuff. I have to cook with it, just to get the nutrients stuff that I need to better me. But, oh man! That’s a lot of money. I just look at [it] and leave it alone. I need them, but I can’t buy them. (Afro-Caribbean woman with one child) Shelly

  19. “Beat Up Torkey” People buy this stuff? (all) Yeah, they can’t afford not to. No, that’s not the local store, that’s between Broadway and Amsterdam. You see how beat up the turkey is; that’s why it’s so cheap, but people buy it. So many scary turkey parts. . . . Scary, but it looks like food, and you don’t feel hungry [afterward], but for fruits, you know, you pay like $10 and still make you feel hungry. (Asian woman with one child) Patricia

  20. Photovoice Study Results into Action • Report reviewed by State Legislators (2008) • Women presented paper at Columbia University Teachers College 2nd Annual Health Disparities Conference, 2008 • Paper is in press, Affilia (2009) • Community Mobilization – agency is currently applying for funding to work with bodegas (2009)

  21. Issues and Concerns of Photovoice • Ethical considerations (taking photographs of people) • Discuss safety issues • Understanding women’s realities with HIV and other health problems

  22. Community Empowerment • Community members are involved in the stages of research • Foster collaboration and strong partnership • Shared data and shared authorship

  23. Future Work with Photovoice • Develop Photovoice study with early released inmates • Develop Photovoice methods/guidelines for working with early released inmates • Examine space/place, HIV risk and chronic health diseases (diabetes and cancer)

  24. Thank You! • Partners in this study - Joyce Moon Howard, Sister Link and Participants • Mentors – Rogério M. Pinto, Nabila El Bassel, and Theo Sandfort • Others – AnkeEhrhardt Fellows (2006-2009), Patrick Wilson, Miguel Muñoz-Laboy, Bob Fullilove, Susie Hoffman, Alex Carballo-Dieguez, Patricia Warne, Heino Meyer-Bahlburg, Bob Remien, Milton Wainberg, Joyce Hunter, Adrienne Braithwaite, Jimmy Liranzo, Shari Dworkin, and Nicholas Freudenberg

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