School of Medicine & Dentistry

University of Aberdeen

Can Photovoice help us 'see' and understand the perspectives of disadvantaged young people about the determinants of their mental wellbeing?: A

pilot study 

Flora Douglas & Megan Pettie

2011

Photovoice and health research

Photovoice and health research

• Community-based participatory research method (CBRM) popularised by Carol Wang - based on feminist and empowerment social theory 1, 2.

• Uses photography – a contemporary means of researching health issues affecting young people 3,4, 5.

• Qualitative research methodology that enables participants, not researchers, to select, capture and discuss images that represent the issues of research interest or concern, and generate ideas for change.

• Has engaged young, marginalised people in research when other methods have failed.

Young people and well-being

• Estimated one in ten children between the ages of 1 and 16 has a mental disorder in the UK6.

• Children who have a mental disorder are more likely to:– Live in single parent families;– have parents who are out of work, and have low

formal educational attainment;– have access to friends;– participate in clubs; – perceive their local communities to be unsafe..

• Stressful neighbourhoods have also been linked to mental health problems5.

Objectives

1. Investigate:– participants’ views about aspects of

their local area of residence that positively and/or negatively affected their well-being,

– participants’ ideas about how to remedy negative issues or concerns.

2. Explore the usefulness of Photovoice methodology for engaging young people in research about their health and well-being.

Participant and Area Characteristics

• Ages ranged from 12-19 years with the average age of 14.5 years.• The average years of residence in The Area was 10years, min three

years, max 17.• Seven of the participants were Aberdonian, one Lativian and one

Lithuanian.• Only one participant lived with both their parents, seven lived with

one parent and one lived with a family member other than a parent.

• The Area is one of Aberdeen’s six regeneration areas, - ranked by employment and health is Aberdeen’s second most deprived area.

• The Area ranks 320 most deprived datazone according to its SIMD score (1 being most deprived 6505 being the least deprived)

Methods

Stage One• Participants were given

disposable cameras and asked to spend one week taking photographs of things in their lives and neighbourhoods that made them feel (1) happy and healthy, and (2) those that made them feel sad or unhealthy.

• Camera returned to researcher for developing

Stage Two• Participants were asked

to pick 10 images that were most important to them reflecting on the photographs taken.

• A topic guide (based on the ‘SHOWED’ process) was used to guide individual discussions with participants.

SHOWeD

S – What do you See here?H – What is really Happening here?O - How does this relate to Our lives?W – Why does this problem/situation

exist?E – How can we become Empowered?D – What can we Do about it?

(Flicker et al 2008)

Findings

1. Perceived level of investment in the local area.

2. Individual and collective access to (various forms of) capital.

3. Fears about personal safety

4. Notions of remedial actions

Perceived level of investment in the local

area.• Visible investment• Lack of investment• Disinvestment

1a. Visible investment• All photographed scenarios of tangible

examples of symbols or actions in process to improve or make a difference in the community. 1. Perceived investments in housing a

dominant theme.2. Efforts to keep the area clean and tidy.

• Clear investments in the local area were perceived to affect participants positively - but surprisingly in a negative way too.

1a. Visible investment – Housing

“they’re actually taking into consideration that more people want to stay in the Area, n they want, they need to build new houses for people to move into the Area...it shows that people care about the Area n that it’s not that bad a place...when the houses are fully done then like there’ll be more people staying in the Area and then we’ll be able to make more friends and stuff...so we don’t look so poor and boring l!” P2

1b. Lack of investment

• Pictures of neglect or lack of investment were common.

• Beliefs that other areas were having money spent on them.

• Perceived lack of investment in young people.

I know that down near the shops they are like making new building and everything, OK it’s nice, but why they are doing that I actually don’t even know...ok they are making flats and everything but if they are thinking that the Area is one of the worst parts in Aberdeen – why then they are making flats, new flats in there”P1

““

1c. Disinvestment

“it’s actually just inappropriate and it’s making us look disgusting n like a minky place...and it makes me feel like a mink...it makes me feel depressed because it’s actually bang out of order and people shouldn’t be doing it.” P2

•Vandalism•Littering•Appearance of place to others.

2. Access to capital

• Social capital• Economic capital• Natural capital• Opportunities to develop

personal human capital

2a. Social Capital

• Friends

•The Project

“Cause it makes me feel at home and special...I feel I fit in when I come here and if I go anywhere else I don’t feel like I fit in” P2

2b. Economic capital• Personal money worries• Being aware of others struggling

financially.• Gambling The sad thing is people

have to live on the streets, they don’t have enough money to buy a house...And the sad thing is people don’t, doesn’t have money to buy anything” P4

2c. Natural capital

em like overgrown trees eh and the council won’t do anything about them, they’re just too much. I mean, Don Bank Street I think it is, there’s loads there and they don’t do anything about them, they hit buses...it’s pretty common, it’s basically everywhere now...it looks disgusting to be honest...it just makes it look really untidy” P6

“Em actually the water and the rivers calms down...if

somebody’s really stressed if and he will sit beside the river

it will just help an calm down...actually because city is a city, there is lots of people, lots of cars and everything, but like

these kind of places – nature where nothing has been

touched – they are the best ones.” P1

2d. Opportunities to develop personal capital

“Cause it shows that I like to play drums and it shows the way I am” P8

3. Perceptions of personal safety

• Fear for personal safety prevalent theme.

• Fears centered on people, places and animals, and the presence and impact of drugs and excessive alcohol consumption.

Reassuring presence of the police

4. Notions of remedial actions

• Solutions volunteered ranged from the high tech - resource intensive to low tech - low cost solutions. – Cameras and more police– Grafitti (black) boards and brightly

coloured bins.– Recycling furniture and fabric from

other areas of the larger council estate that might be being refurbished.

Strengths and Limitations• Strengths

– Prompted deeper reflection on issues amongst participants -

– Generates rich contextualized data.– Participants enjoyed engaging with the research and

reported feeling empowered by it.– Provided a window into a world unknown to many

health professionals and policy makers.• Limitations

– Time and resource intensive– Getting the ‘right’ person to engage with the young

people of concern is crucial.

Conclusions

• YP’s notions of the determinants of their mental health and well being were closely aligned with their beliefs and experiences of individual and/or collective access to various forms of capital and perceptions of neighbourhood safety.

• They held and were able to articulate plausible solutions aimed at improving their local circumstances.

• Data showed contradiction

Conclusions• Young people were politically aware

– Believed there to be iniquitous spending of resources in different parts of the city.

– Sensitive about the social status and the appearance of poverty within their neighbourhood!

• The youth project was important to these young people – key component of their social capital!

Engaging communities of concern in devising health improvement

interventions• Adolescents should be viewed as active,

capable agents within a community, who should be involved in the development of interventions intended to improve their mental health6

• Direct engagement in development of local communities can itself have a positive effect on adolescent mental well-being7

• Asset-based health improvement?

Acknowledgements

• Young people who took part in the study

• The TillyYouth Project staff.

References1. Wang, C. (1994) Empowerment through photo novella: Portraits of participation.

Health Education Quarterly, 21: 171-186.2. Wang, C. & Burris, 1997’ Photovoice: Concept, Methodology and Use for Participatory

Needs Assessment’ Health Education and Behaviour, 24(3): 369-387. 3. Flicker, S., Maley, O., Ridgley, A., Biscope, S., Lombardo, C. and Skinner, H.A. (2008)

e-Par Using technology and participatory action research to engage youth in health promotion. Action Research, 6:285-302.

4. Wilson, N., Dasho, S., Martin, A., Wallerstein, N., Wang, C. & Minkler, M. (2007) Engaging young adolescents in social action through photovoice; The Youth Empowerment Strategies (YES) Project’, The Journal of Early Adolescents, 27(2):241-261.

5. Catalani, C , & Minkler, M. (2010) Photovoice: A review of the literature in health and public health Health Education and Behaviour 3(73): 424 -451.

6. Meltzer, H., Gatward, R., Goodman, R, & Ford, T. (2000) The mental health of children and adolescents in Great Britain. Office of National Statistics: London.

7. Patel, V., Fisher, A.J., Hetrick, S. & McGarry, P. (2007) Mental health of young people: A global health challenge. The Lancet 369: 1302-1310.

8. Sustainable Development Commission (2010) Improving young people’s lives: The role of the environment in building resilience, responsibility and employment chances. http://www.sd-commission.org.uk/publications/downloads/SDC_IYPL_report.pdf. Accessed 11th Nov 2010.