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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.

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Presentation on theme: "Photovoice: Understanding the perspectives of HIV+ lower income women through participatory action research Pamela Valera, PhD, MSW Grand Rounds 25 June."— Presentation transcript:

1 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

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

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

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

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

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

7 Focus Group Protocol (2 nd meeting) Objective of taking pictures: What did you observe? Objective of taking pictures: What did you observe? Reflective questions were asked to enable the group to discuss how they felt about their photos. 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? 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? 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. 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? 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. 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 ideas of possible solutions do you have to address food insecurity? What needs to be changed? and Who should be involved in changing policy? 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. 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. 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) 9 HIV+ women (3 Afro-Caribbean, 4 African American, 1 Asian, 1 Caucasian) Mothers (20-45 years old) Mothers (20-45 years old) Residents of Central Harlem Residents of Central Harlem Family shelters and lower income apartments Family shelters and lower income apartments

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

12 NYCDOHMH, May 2007 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

13 NYCDOHMH, May 2007 Social Environment of Harlem: Limited Access to Healthy Food Bodegas/corner stores are more common in Harlem compared to the Upper East Side 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 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 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. One in six restaurants (16%) in East and Central Harlem is a fast-food restaurant compared to 4% on the Upper East Side.

14 Photovoice Study Objective #1:To document the experiences of HIV+ womens access to healthy food in Harlem Objective #1:To document the experiences of HIV+ womens access to healthy food in Harlem Objective #2: To bring public awareness on access to healthy food by HIV+ women 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? 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 Rashida Diabetes on Sale Diabetes on Sale I was taking pictures of some of the things that were healthy and some of the things that Ive 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)

18 Shelly 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! Thats a lot of money. I just look at [it] and leave it alone. I need them, but I cant buy them. (Afro- Caribbean woman with one child)

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

20 Photovoice Study Results into Action Photovoice Study Results into Action Report reviewed by State Legislators (2008) Report reviewed by State Legislators (2008) Women presented paper at Columbia University Teachers College 2 nd Annual Health Disparities Conference, 2008 Women presented paper at Columbia University Teachers College 2 nd Annual Health Disparities Conference, 2008 Paper is in press, Affilia (2009) Paper is in press, Affilia (2009) Community Mobilization – agency is currently applying for funding to work with bodegas (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) Ethical considerations (taking photographs of people) Discuss safety issues Discuss safety issues Understanding womens realities with HIV and other health problems Understanding womens realities with HIV and other health problems

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

23 Future Work with Photovoice Develop Photovoice study with early released inmates Develop Photovoice study with early released inmates Develop Photovoice methods/guidelines for working 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) 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 Partners in this study - Joyce Moon Howard, Sister Link and Participants Mentors – Rogério M. Pinto, Nabila El Bassel, and Theo Sandfort Mentors – Rogério M. Pinto, Nabila El Bassel, and Theo Sandfort Others – Anke Ehrhardt Fellows ( ), 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 Others – Anke Ehrhardt Fellows ( ), 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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