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Photography
as a research
tool
RhysWilliams
Photography as a research tool
by Rhys Williams
Presentation
 What is IDEAS?
 Charting progress in maternal and newborn health
 How photography can help improve and innovate
health systems by enhancing research
 Wider debates
 What next?
What is
IDEAS?
 IDEAS aims to improve the health and survival of
mothers and babies through generating evidence to
inform policy and practice
 Working in Ethiopia, northeastern Nigeria and India
 IDEAS uses measurement, learning and evaluation to
find out what works, why and how in maternal and
newborn health programmes
 Funded by the Bill & Melinda Gates Foundation
 Based at the London School of Hygiene & Tropical
Medicine
 Find out more ideas.lshtm.ac.uk
Progress*
• Births at health centres increased from 14% to 43%
• More women had the recommended four or more antenatal
care visits
• Births attended by skilled birth attendants like doctors,
nurses or midwives increased from 15% to 46%
• BUT not all health workers and families adopt the
behaviours that could be the most effective in saving lives
*Data from IDEAS survey
areas and not nationally
representative
How did
this
photographic
approach
come about?
 Four learning questions – mechanisms of change
 Field research in Ethiopia
 Explore the barriers and enablers to improving
behaviours during the first hours and days of the
newborn's life
 What role do community health workers play in this?
 Wanted to understand why change happens
Promoting
heathy
behaviours
 Active management of the third stage of labour
 Thermal care
 Clean cord care
 Weighing the newborn
 Immediate breastfeeding
Qualitative
Methods
 Background: Community health workers trained to
make early postnatal care visits. Community health
volunteers help identify deliveries
 Study sites: Two 'typical' Kebeles, with reasonably
functioning Community Health Workers
 Respondents: Recent mothers, grandmothers, fathers,
community health workers and volunteers
 Data collection methods: Narratives, in-depth
interviews, friendship pair interviews and focus group
discussions
 Content: Perceptions and experiences with postnatal
care visits
 Analysis: Deductive and inductive coding and
interpretation in Nvivo
Photostory
as an
innovation
“The picture round”
 Participants shown a picture of the - correct or
"incorrect" - execution of one of the life saving
behaviour
 In first instance the team used more generic
pictures not specifically from the area where
they were undertaking their research
“We had tried out some of
the picture rounds with
pictures from several big
multilateral organisations
and most of the comments
we received from the
participants were "this baby
is not from here, this mother
has a strange necklace" etc.
which was not very helpful in
the research.”
Dr Pauline Scheelbeek
London School of Hygiene &
Tropical Medicine
Image © Grantham Imperial
What
happened
to the
research?
 Produced culturally sensitive photographs for research
 Discussion became more focused on the behaviour
 Generated locally relevant evidence that directly that
informed health programming
 Evidence shared with government and implementers
for course correction
Lessons
learned
 Powerful research tool
 Essential to seek appropriate permission
 Strong partnerships
 Plan in detail all logistics
 Can be very expensive
 There is a strong case for using a local photographer
How
multimedia
can help to
improve and
innovate
health
services and
systems?
Photography can…
 Begin a conversation about a topic
 May prompt or catalyse action
 Be a different way to present data and context
 Build on an evidence base
 A powerful advocacy tool
Is
photography
reliable?
 Social desirability bias
 Behaviour
 Ethics
Appearance vs Reality
(Courtesy of Bored Panda)
Wider issues
 Global imbalance in knowledge production and
utilisation
 Explicit focus of the SDGs on production and use of
local knowledge and data
Behind the
curve?
Networks
vs
Institutions
The Gombe Girls for Maternal and Newborn Health
© DFID
© GPfE© GPfE
Key Message
 Photography can be a good tool to generate locally
relevant evidence
 This evidence can also be a powerful tool for advocacy
 Shortcomings – photography is susceptible to bias
 New approaches need to be harnessed to increase
impact
 Alone is not enough for change
Thank you
Rhys Williams
Communications Officer - IDEAS
ideas.lshtm.ac.uk
rhys.Williams@lshtm.ac.uk
@LSHTM_IDEAS
Photographs by
Paolo Patruno
www.paolopatrunophoto.org

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How can multimedia help improve health services and systems? Photography as a research tool

  • 1. Photography as a research tool RhysWilliams Photography as a research tool by Rhys Williams
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  • 15. Presentation  What is IDEAS?  Charting progress in maternal and newborn health  How photography can help improve and innovate health systems by enhancing research  Wider debates  What next?
  • 16. What is IDEAS?  IDEAS aims to improve the health and survival of mothers and babies through generating evidence to inform policy and practice  Working in Ethiopia, northeastern Nigeria and India  IDEAS uses measurement, learning and evaluation to find out what works, why and how in maternal and newborn health programmes  Funded by the Bill & Melinda Gates Foundation  Based at the London School of Hygiene & Tropical Medicine  Find out more ideas.lshtm.ac.uk
  • 17. Progress* • Births at health centres increased from 14% to 43% • More women had the recommended four or more antenatal care visits • Births attended by skilled birth attendants like doctors, nurses or midwives increased from 15% to 46% • BUT not all health workers and families adopt the behaviours that could be the most effective in saving lives *Data from IDEAS survey areas and not nationally representative
  • 18. How did this photographic approach come about?  Four learning questions – mechanisms of change  Field research in Ethiopia  Explore the barriers and enablers to improving behaviours during the first hours and days of the newborn's life  What role do community health workers play in this?  Wanted to understand why change happens
  • 19. Promoting heathy behaviours  Active management of the third stage of labour  Thermal care  Clean cord care  Weighing the newborn  Immediate breastfeeding
  • 20. Qualitative Methods  Background: Community health workers trained to make early postnatal care visits. Community health volunteers help identify deliveries  Study sites: Two 'typical' Kebeles, with reasonably functioning Community Health Workers  Respondents: Recent mothers, grandmothers, fathers, community health workers and volunteers  Data collection methods: Narratives, in-depth interviews, friendship pair interviews and focus group discussions  Content: Perceptions and experiences with postnatal care visits  Analysis: Deductive and inductive coding and interpretation in Nvivo
  • 21. Photostory as an innovation “The picture round”  Participants shown a picture of the - correct or "incorrect" - execution of one of the life saving behaviour  In first instance the team used more generic pictures not specifically from the area where they were undertaking their research
  • 22. “We had tried out some of the picture rounds with pictures from several big multilateral organisations and most of the comments we received from the participants were "this baby is not from here, this mother has a strange necklace" etc. which was not very helpful in the research.” Dr Pauline Scheelbeek London School of Hygiene & Tropical Medicine Image © Grantham Imperial
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  • 25. What happened to the research?  Produced culturally sensitive photographs for research  Discussion became more focused on the behaviour  Generated locally relevant evidence that directly that informed health programming  Evidence shared with government and implementers for course correction
  • 26. Lessons learned  Powerful research tool  Essential to seek appropriate permission  Strong partnerships  Plan in detail all logistics  Can be very expensive  There is a strong case for using a local photographer
  • 27. How multimedia can help to improve and innovate health services and systems? Photography can…  Begin a conversation about a topic  May prompt or catalyse action  Be a different way to present data and context  Build on an evidence base  A powerful advocacy tool
  • 28. Is photography reliable?  Social desirability bias  Behaviour  Ethics
  • 30. Wider issues  Global imbalance in knowledge production and utilisation  Explicit focus of the SDGs on production and use of local knowledge and data
  • 32. The Gombe Girls for Maternal and Newborn Health © DFID © GPfE© GPfE
  • 33. Key Message  Photography can be a good tool to generate locally relevant evidence  This evidence can also be a powerful tool for advocacy  Shortcomings – photography is susceptible to bias  New approaches need to be harnessed to increase impact  Alone is not enough for change
  • 34. Thank you Rhys Williams Communications Officer - IDEAS ideas.lshtm.ac.uk rhys.Williams@lshtm.ac.uk @LSHTM_IDEAS

Editor's Notes

  1. What is a photostory? What do we show?
  2. So, the team asked Paolo if he could capture some specific behaviours in the local area, documenting local women’s experiences of giving birth. It was these pictures the team used to ask the questions in their research surveys. With Paolo's new local pictures, the discussion became - in most of the cases - much more focused on the behaviour itself, and proved a major help in understanding the drivers of local maternal and newborn behaviours. Also, all digital images have a timestamp. So for each of the stories, this allowed the team to trace the time it took for all the interventions to take place. So the images capture both quantitative and qualitative data. One of the reasons we picked Paolo was for his energy and enthusiasm. He worked hard to gain the trust of the women in the photos and the health workers to get right in the middle of events. Paolo also gave small, but valuable gift to the mothers – a polaroid picture of them and their newborn child. A small token of appreciation that probably meant a lot to many of the women who lived in rural parts of Ethiopia. It is Paolo's striking images that make up this IDEAS story….