Photovoice and informed decision making: Helping people talk about their health choices

A picture is worth a 1000 words.  Pictures can convey emotions and situations in an instant.  Pictures help people learn; but, they can also help people convey how they make decisions about their health.

SurroundHealth, a free online community for health professionals, is always on the lookout for projects about informed decision making and behavior change.  Shaun Owens, MPH, and Tracey Thomas,  MA, MS, doctoral students of Health Promotion, Education and Behavior at the University of South Carolina, recently completed a research project using photovoice to enhance participants’ communication with researchers about the factors influencing their health decisions. Funded by the University of South Carolina’s Science and Health Communication Research Group, their research showed the power of photovoice as a tool for learning, collaboration and communication.

About the photovoice methodology.  The photovoice project was associated with the parent study, Promoting the role of cancer research within an African American faith-based community, which included 4 educational sessions about prostate screening and clinical trial participation. Participants included African American men (n=7) and women (n=7) ages 38 to 64 years old.  Among the group, 57% had a high school diploma or no diploma; 14% had attended some college; and 29% were college graduates. Each person got a digital camera and was told to take pictures of things (not people) that influence their health decisions. Among the photos taken, participants chose their 3 best photos that they wanted to write and talk about.  Participants provided written and oral answers to this question: How does this image affect how you make decisions about your health?

Photos became the springboard for deeper, richer conversations about health.  “When we compared the written and oral responses to the question, ‘How does this image affect your health decision,’ we discovered the participants gave us substantially more information orally,” Tracey explained. Below is an example Shaun and Tracey shared from one participant: 

What this picture says about the choice to exercise.

Written response: “With the constraints that we have on our life with kids, school, and work, trying to find time for exercise is one of the most difficult things to do” [29 words]

Oral response “Basically with the constraints that we have on our life with kids, school and work…trying to find time for exercise is one of the most difficult things to do. So, basically, if you have anything at home that you can utilize, I think it makes the best possible situation.  You can work out in your spare time or when you are watching TV.” [63 words]

Photos can give people a very personal way to show what influences the choices they make about their health. The photovoice project revealed 4 themes, or sets of factors, that influenced people’s decisions about their health: food/eating, physical activity, access to health-related services, and spirituality/nature.  By using pictures, each person could easily show how a factor was a motivator or hindrance to making a positive health decision.

What this pictures says about the barriers to exercise

 Oral response: “This picture relates to how I make decisions about my health because I like to exercise…and as you can see…we can’t exercise on our softball field no more. And, I like to keep healthy and exercise a lot.”

What this picture says about the connection between family and health.

Oral Response: Each letter on this bird house represents the first letter of my family [member’s first names].  We have always been a tight knit family who cares about each other and we always ask a question about each other’s health and how we are doing.”

Shaun remembered how this photo of the birdhouse helped the participant reflect on the connection among nature, his cohesive family, and taking care of his health.

The photovoice methodology has the potential to extend well beyond its use as a research tool.  Tracey observed, “Photovoice helped people gain clarity about what they were learning. It was clear they were applying the information from the educational sessions into their own lives.” Shaun agreed and added, “For me, photovoice served as a moderator to make people recognize and think about the barriers that are keeping them from taking actionbarriers that could be personal, such as fear of talking about cancer, or societal, such as lack of health insurance. Photovoice also empowered participants to find more health information and healthcare resources that can be shared with the greater community. Having access to these informational and health-related resources, the community will be more capable of making informed decisions about their health. In addition, photovoice can serve as a means for the community to fight for access to resources when they are not available.Therefore, I think photovoice is both a research method and advocacy tool that can lead towards communities making healthier and more informed decisions.”

How about extending photovoice into Motivational Interviewing or ongoing education for chronic disease self-management? Once you see the power of photovoice as a research tool in community-based public health, it’s easy to imagine using the same approach to help people explain what factors motivate them or to help explain what aspects of managing a chronic disease are most challenging. “I could see this being used in the medical community.  I’ve known doctors to get frustrated that people are not making recommended changes for their health. Photovoice could be a good way for patients to communicate the barriers they encounter to treatment. If a person took a picture of their regimen and wrote ‘so much to read’ this could point to the need for a health navigator or coach to help simplify the information in a culturally appropriate way.”

 Want to learn more about Photo Voice methodology?  Check out PhotoVoice.

This research study has now been published.  See the abstract/access the article.

SurroundHealth  is an interdisciplinary community for health professionals.  We are committed to helping professionals learn how to enhance their skills in behavior change strategies, health communication, and adult learning principles.  As we continue to grow and evolve, join us! Membership is always free.


About Susan Collins, MS, CHES, RD, SurroundHealth Blogger

I am Community Leader for SurroundHealth (, a social network where health professionals from different backgrounds come together to learn from one another's expertise and to share knowledge and resources. We share a passion for improving the health and well-being of communities and individuals. I am also a registered dietitian and certified health education specialist.
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