At the recent HSR2018 Symposium delegates explored how to challenge embedded power dynamics in health systems research through participatory methodologies. In moving towards ‘health for all’, there was a recognition that the forty-year anniversary of the Alma Alta declaration, provided a clarion call for a re-emphasis on the participation of marginalized people in health systems research. Clearly, while transformative change is challenging, chances of success are improved by including a wider range of ‘voices’ through co-produced research activities.
One of the innovations that the Local Organising Committee (LOC) introduced for HSR2018 was the inclusion in the programme of a multi-project Photovoice exhibition. Photovoice is a participatory action research methodology that involves the taking of images by individuals, the discussion and analysis of these images and the use of the images to communicate the lived experiences, strengths and challenges of the photographers. Colleagues commented that this was the largest health based Photovoice exhibition to date but more significant was the scope of the material displayed. Most Photovoice exhibitions are about one study or have a specific focus, for example, a disease. In this case applications were welcomed from any international researchers using Photovoice as a methodology for health research and this resulted in the receipt of a wonderfully varied set of images and research foci.
This provided a challenge and an opportunity for the Liverpool School of Tropical Medicine (LSTM) team selecting images for the exhibition but after some consideration it was decided to take an inclusive approach that recognised the theoretical roots of Photovoice in critical consciousness and documentary photography. A total of 31 research studies were included from 30 researchers and images showed health challenges in 9 African countries, 4 Indian states, Nepal, Mexico, Canada, Greece and Jordan, United States and the UK. The wide range of health issues included mental health, palliative care, maternal health, child disability, lung health, alcohol and drug abuse and water borne diseases. The positive role of community health workers in low resource settings was highlighted by several studies including the group project that won first prize in the Photovoice competition.
The Photovoice exhibition content was a collaborative endeavour, between researchers, photographers and those depicted, and this approach was reflected in the organisation of the exhibition and associated activities:
- The physical exhibition at HSR2018 was curated by Elaine McNeill from Liverpool John Moores University (LJMU) School of Art and Design. LJMU technical staff were involved in the design and construction of the innovative exhibition framework that allowed display against a backdrop of the River Mersey.
- To reach the local community, a digital film exhibition was produced by LSTM in conjunction with the Museum of Liverpool (MOL) and a local media organisation. This was designed to link with the museum themes and in particular the role of Liverpool and LSTM in promoting innovation in public health. The aim was to introduce Photovoice as a methodology and to emphasise the role of photography as a health communication tool. Photovoice researcher exhibitors whose work included in the film, visited the MOL and interacted with visitors, reaching out from the conference venue into the city.
- A team of three international volunteers from LSTM’s Masters in International Public Health programme were available to assist visitors at both venues during the week and reported that this role enhanced their understanding and appreciation of participatory methodologies and the power of images to move and inform exhibition visitors.
- Feedback from Photovoice exhibition visitors was also gained by using a ‘feedback tree’, labels were available for attaching comments and some of these are shown below:
- ‘I love this method, it is a great way to make results of research visual. it is very confronting sometimes. It really stays with you!’
- ‘Photovoice gives a voice to the voiceless. So, it’s a powerful representation of the challenges often marginalised people face.’
- ‘Photovoice is such a powerful tool in research for informing stakeholders about the realities. More sessions required.’
These Photovoice exhibition activities are a great representation of the strength and challenges of using this visual participatory methodology. Using photos to promote the voice of the less powerful seems such a laudable and simple aim but it is important not to overlook the underlying power shifting aims of the methodology
Care was taken throughout the process not just to meet ethical ‘rules’ but to think carefully about issues of representation and equity. It is hoped that the Photovoice exhibition at the symposium venue encourages attendees to consider this and related methodologies in their work. In linking with the public through the film, the ‘health for all’ message was key. The approach taken was to link public health in Liverpool with global efforts to tackle health inequity.
Photovoice can be used to build bridges between researchers, research participants and policymakers but can also link disparate ‘communities’ as shown through these activities. Conferences and symposiums can sometimes seem remote from the people who live in the area in which such events are located. Visual methodologies such as Photovoice and film provide a way of expanding the reach of research activities beyond exclusive research environments. Plans are now in progress to hold further exhibitions of the HSR2018 Photovoice ‘collection’ in Liverpool.
That is not to say that sharing experience with other researchers and practitioners through symposia is not valuable. It is hoped that the collective experience of Photovoice displayed through the physical exhibition and digital film will be a useful resource and will lead to collaborative opportunities in the future. The role of these Photovoice exhibition activities in engaging communities in policy, practice and research was highlighted in the Liverpool Statement.
The HSR2018 website now includes an online gallery of all HSR2018 Photovoice accepted submissions. If you saw the exhibition and did not have time to contribute to the ‘feedback tree’ or have comments having seen the on-line gallery, please add them to the comment section below.