‘We are the people whose opinions don’t matter’. A photovoice study exploring challenges faced by community health workers in Uganda

ABSTRACT

Understanding the experiences of community health workers (CHWs) through the use of participatory visual methods (PVMs) has been relatively underexplored. One such PVM is photovoice, which involves the capture of photographic images related to issues of social importance. In this study, we explore challenges faced by eight CHWs in Mukono District, Uganda through the use of photovoice. Over a six-week period, CHWs captured 62 relevant photographs. Subsequent individual interviews and group discussions were held with the CHWs regarding the content of the photographs. Using traditional content analysis, a range of themes related to perceived challenges faced by the CHWs were highlighted, including poor infrastructure, insufficient on-going training and supervision, relationships with other health professionals and equipment supplies. Suggestions were raised as to why such challenges existed and how they could be addressed; mainly through increased roles of the government and supporting NGOs. Overall, photovoice was generally a feasible method to highlight the challenges faced by CHWs, however community acceptability regarding image capture and consent taking may prove challenging, given past historical experiences. The use of photovoice in this study highlighted the need to address the multiple and complex challenges faced by CHWs in order to help them fulfil their roles.

KEYWORDS:

• Photovoice
• participatory visual methods
• Uganda
• community health worker
• village health team

Acknowledgements

We wish to thank Omni Med for their support in establishing the study and advocating for the research team during community meetings, as well as providing in kind support, such as accommodation. We wish to thank the CHWs for participating in this study and sharing their invaluable insights, and the community members for their willingness to take part. Conceptualisation: JOD, NW, DM, CS. Data Curation: JOD, RH, ASN. Formal Analysis: JOD, RH, ASN. Funding Acquisition: JOD and NW. Investigation: JOD, RH, ASN. Methodology: JOD, NW, DM. Project Administration: JOD. Resources: JOD, NW. Supervision: NW and DM. Writing – Original Draft Preparation: JOD, RH, ASN. Writing – Review and Editing: JOD, NW, DM, RH, ASN, CS.

Disclosure statement

This study was dually funded by an unrestricted grant from The British Medical Association and The Economic and Social Research Council secured by JOD. JOD receives a student stipend from the ESRC. Neither funding organisation played a role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript, and only provided financial support in the form of procurement of research materials.

Data availability statement

The data that support the findings of this study are available on request from the corresponding author, JOD. The data such as individual photographs are not publicly available due to information that could compromise the privacy of research participants or community members who took part in the study.

ORCID

James O’Donovan http://orcid.org/0000-0002-7248-5436

Niall Winters http://orcid.org/0000-0001-8597-2914

Additional information

Funding

The study was jointly funded by The British Medical Association Charitable Arm [grant number Charitable Arm Grant BMA2018/1]; The Economic and Social Research Council [grant number ES/P000649/1].