This presentation offers insight on the uses of photovoice as an arts-based research approach. Nasim Haque, MD, DrPH Director of Community Health www.wellesleyinstitute.com Follow us on twitter @wellesleyWI

1. Lillian Wright Maternal-Child Institute
Faculty of Health, York University
September 23, 2011
Photovoice as an Arts-Based
Participatory Research Approach
Nasim Haque
Wellesley Institute
September-27-11 |
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2. Learning Objectives
1. Learn what Photovoice is and how it can be used
2. Discuss the Photovoice methodology and the
ethical issues inherent to the approach
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3. Background
Photovoice methodology was developed in 1992 by
Caroline C. Wang and her colleagues as a means for
women living in rural villages in China to communicate
important health messages to policy-makers.
“What experts think is important may not match what
people at the grassroots think is important.”
– Caroline Wang (1996)
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4. About St James Town Initiative
SJT Initiative is a 5 yr CBPR Initiative
Research Question:
What implications do neighbourhoods have on the health
& wellbeing of immigrants?
Results:
Inform policy & support social change at neighbourhood
level
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5. St. James Town
Population &
Neighbourhood
•14,666 Residents on 0.23 km2 of Land
•64,636 People / km2
•(Unofficial Estimate: 25,000)
•64% Immigrants
•18 Aging High-Rise Buildings
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•Over 50 languages spoken 9/2
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6. Strategies & Activities
Multi-pronged Approach
COMMUNITY ENGAGEMENT
Participatory skill enhancing student Work with SJT Initiative
Research opportunities internships multiple Website
stakeholders
Community Action SJT Residents Action Group
1) Adult Photo Voice 4) Youth Photo Voice
2) Community Mapping 5) Focus groups/interviews (CAC)
3) Concept Mapping 6) Sample Survey (CIHR funded)

7. What is Participatory Action
Research?
• Action research is “learning by doing” - a group of people
identify a problem, do something to resolve it, see how
successful their efforts were, and if needed, try again
• Photovoice is an arts-based qualitative research technique
and a good example of participatory action research
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8. What is Photovoice?
Photovoice asks you to take photographs
of things that are important to you - and
to tell the story of why these things are
important. The visual images &
accompanying stories are the tools used
to reach policy- and decision-makers.
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9. Why use Photovoice?
• Powerful way to approach empowerment and advocacy
• Rewards of taking photographs are immediate
• Photography is fun and creative
• Taking photographs can change participants’ perceptions
about their social and physical environment
• Basic photography is easy to learn and accessible to all
• “A picture is worth a thousand words”
• Images are understood regardless of language or culture
• Policy makers & program planners cannot deny reality
when images are staring them in the face
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10. Who should use Photovoice?
A few examples:
• Children and youth in difficult circumstances e.g. orphans, children
forced into job market, children and youth living under the threat of
violence because of war or crime
• Homeless adults and families
• People with disabilities or mental health issues
• People with chronic diseases/medical conditions e.g. HIV, TB etc.
• Members of racial, ethnic, linguistic, or cultural minorities
• People who are discriminated against because of class, caste, way of life
• The urban poor, whose concerns and strengths are often different from
those of the larger society
• Women and men, to highlight gendered social and health issues
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11. When might you use Photovoice?
• When Photovoice can change people’s opinions about themselves and
their environment
• When a disadvantaged group’s situation or problem needs to be
publicized
• When change is necessary, & PV can inform policy makers
• When a community assessment is needed or in progress
• When you need to document the process of or gather data for an
evaluation of an intervention or program
• When you need to document a site, an event, or a way of life that is
threatened or about to disappear
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12. How to put together a PV project?
The stages of Photovoice include:
1. Conceptualizing the problem
2. Defining broader goals and objectives
3. Securing resources for the project
4. Formulating the theme/s for taking pictures
5. Identifying community partners & establishing relationship
6. Recruiting PV participants & target audience members
7. Planning the project with community – include PV participants
8. Beginning the project: Training staff and participants
• Training has two components : (1) technical &
(2) ethical and safe photography
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13. contd.. Process
9. Distribution of cameras and taking pictures
10. Photovoice group meetings at regular intervals
11. Selecting photographs for discussion/storytelling
10. Documenting the stories
11. Formulation of captions by consensus
12. Data analysis to identify issues, themes, and theories
13. Dissemination: Preparing a PV exhibit
14. Encouraging Social Action and/or Policy Change
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14. SHOWED:
Guideline for story writing
One way of exploring photographs
• What do you See here?
• What’s really Happening here?
• How does this relate to Our lives?
• Why does this problem/condition/strength exist?
• How could this image Educate the community/policy makers/ etc?
• What can we Do to improve the situation, or two enhance these
strengths?
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15. Ethics of Photovoice
• Ensure activities are done in a fair, respectful & ethical way
• Participants must have the opportunity to consent to participate in the
project, based on full and complete information about both the
advantages and disadvantages of participating
• Participants must be made aware of expectations of participation. They
should also be informed about how they can withdraw from
participation
• Because Photovoice participants are co-researchers and co-creators of
data, they must conduct themselves in fair, ethical and appropriate ways
• Participants should be familiar with process of informed consent
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16. Ethics of Photovoice
Ask yourself before using your camera…
• When is it ethical to take photos of individuals?
• Should someone take pictures of other people without their
knowledge?
• How do you ask permission to take a photo?
• Should you ask subjects to sign a release form?
• Should you offer them a copy of the picture?
• How do you react if the subject refuses?
• How do you protect yourself in dangerous situations, where people may
be engaged in illegal activity or may be aggressive?
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17. Training Workshop-1
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18. Photo Journalist : Training Workshop-1
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19. Important Stakeholders: Training Workshop-2
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20. Community Forum & Expo: March 20, 2008

21. Community Forum & Expo: September 18, 2010
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22. Resident Group Presenting
at Counselor ’s Office
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23. Change & Action
Audit of Bicycle Parking
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24. Change & Action
© The Wellesley Institute
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25. A few examples of the range of
information that can be collected
using Photovoice technique
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26. SOCIAL ATTRIBUTES
Safety, Crime, Drugs, Fear
The picture shows a memorial of a residence of St. James Town whose life was robbed off him last
year due to gun violence. The person who murdered “Juice” is yet to be found. It just comes to
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that more security is needed in the area. A lot of undercover police are the area dressing up
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as drug dealers or buyers but they are usually easily spotted and pin pointed.

27. SOCIAL ATTRIBUTES
This is related to our lives because every day we are witness to some type of harmful
carcinogens produced by these cigarettes. Whether second hand, or first hand smoke, living in
St. James Town means a high chance of encountering cigarettes. Because of this more people
are exposed to harmful chemicals.

28. PHYSICAL ATTRIBUTES
As a child, one way I kept myself occupied with my time was through playing basketball. It not only
kept me off the streets, but also wasted the majority of my time, keeping me active. If more
community programs ran such activities, it would bring the community closer and keep children off
the streets away from any type of violence. These activities are strengths in our community as
children are kept away from trouble. (Youth,SJT. 2010)

29. PHYSICAL ATTRIBUTES
Overcrowding
... In a neighbourhood such as St. James
Town where most people live in high rise
buildings and come from low income
families it may not seem like the best
idea to build more buildings when we
don’t already have that much green
space around. This issue relates to your
lives because we need more things than
buildings around our community, such as
more parks, centres for youth but
instead we invest in building and more
buildings.
(Youth,SJT. 2010)
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30. SOCIAL ATTRIBUTES
“The Tsismis Tree” Tsismis is a word in Tagalog that means gossip. This
tree is treasured by many immigrants because we meet here to share
experiences and support each other. Common spaces are important to
the wellbeing of both individuals and the community.
These different flowers represent people from different places and the vase represents this
country. If we arrange the flowers properly, they turn into a beautiful flower arrangement. If
people of different backgrounds are given equal opportunities and are accepted, everyone
benefits.
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31. ECONOMIC ATTRIBUTES
This tiny tunnel connects one of the poorest neighbourhoods in Canada, St. James Town, to one
of the most affluent, Rosedale. The short journey of crossing the bridge is actually painful,
arduous, and for the most part, impossible for the most, if not all, of the individuals living in SJT.
Despite being highly educated, newcomers have difficulty gaining recognition, and
consequently, employment.
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32. ECONOMIC ATTRIBUTES
Food Quality
How much can we trust our food supply? We don’t only care
about the price of goods, we also pay attention to our health.
We want to get good service when we go to the supermarket.
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33. “Anyone out there?” Our plea for help went unheeded and we were
buried in an overwhelming wave of ‘that’s not our problem’.
Anyone out there? Are you listening?

34. Advantages of using Photovoice Technique
• Non threatening method
• Usually not conceived as “research”
• Engage disadvantaged population
• Builds trust & empowers disadvantaged population
• Transfer ownership of the project to participants
• Help common voices heard by decision makers
• Understand participants perspectives on health and other issues
through their lenses
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35. Limitations of using Photovoice Technique
• The time commitment necessary may be daunting for participants and
researchers
• Participants may have difficulty in presenting complex or abstract ideas
through photographs
• Risk of losing or damaging cameras
• Participants choose what to photograph – these choices can influence
research findings
• Limitations of cross sectional design and qualitative design applies to
PV study design
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36. Can I use Photovoice in MCH?
MCH professionals can apply Photovoice as an
innovative participatory research methodology:
1. To engage community members in needs assessment
2. Community asset mapping
3. Program planning
4. In reaching planners and policy makers to advocate for strategies
promoting family, maternal, and child health as informed from a
grassroots perspective
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37. USEFUL REFERENCES
1) Wang, C. and Y. Redwood-Jones. 2001. “Photovoice ethics: Perspectives from Flint
photovoice.” Health Education and Behaviour, 28(5): 560-572.
2) Wang, C. and C. Pies. 2004. “Family, Maternal, and Child Health Through Photovoice.”
Maternal and Child Health Journal, 8 (2): 95-102.
3) Wang, C., J. Cash and L. Powers. 2000. “Who Knows the Streets as Well as the Homeless?
Promoting Personal and Community Action Through Photovoice.” Health Promotion
Practice, 1(1): 81-89.
4) Wang, C. 2003. “Using Photovoice as a participatory assessment and issue selection tool:
A case study with the homeless in Ann Arbor.” In M. Minkler and H. Wallerstein.
Eds.Community-based participatory action research for health.San Francisco:Jossey-ass.
5) Community Tool Box: http://ctb.ku.edu/
6) Haque, N., & Eng, B. Tackling inequity through a Photovoice project on the social
determinants of health: translating Photovoice evidence to community action. Glob
Health Promot, 18(1), 16-19.
7) Haque, N., Moriarty, E., & Anderson, E. (2008). Community Voices: Tackling Inequity
through a Community Based Initiative on the Social Determinants of Health. Toronto:
Wellesley Institute. www.sjtinitiative.com.
8) Haque, N., & Sun, E. (2011). Voices of Multicultural Youth: Impact of urban neighbourhood
on health and wellbeing Toronto: Wellesley Institute. www.sjtinitiative.com.
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38. ST. JAMES TOWN INITIATIVE
THANK YOU
For more info, visit www.SJTinitiative.com or www.wellesleyinstitute.com
9/27/2011
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