Using photovoice to inform and support health systems to reach marginalised populations: experiences from six low- and middle-income countries

ABSTRACT

Photovoice methodology centralises the voices of marginalised populations within health systems using photography and critical dialogue to record, reflect and communicate community health issues. This paper presents findings from applying photovoice to explore and document the lived experiences of groups of marginalised populations in six low- and middle-income countries: Cambodia, Ghana, Nepal, Sierra Leone, Uganda and Zambia. The strengths of using photovoice included: creating safe spaces for communication; community solidarity and stakeholder engagement; community ownership of actions and advocacy; developing new soft skills and confidence; capturing hidden community challenges; and taking collective action. Suggestions for use in future photovoice studies include: providing space for the exploration of contextual factors before implementation; developing a capacity strengthening plan to ensure participants have the competencies required to effectively take part in research and dissemination; considering the use of non-visual methods alongside photovoice when needed; and having in place partnership structures between researchers and participants that facilitate power sharing, agency, empowerment and joint decision making. Lastly, we present recommendations that have the potential to strengthen the value and use of photovoice as more than a participatory method but also a vehicle for individual, relational and health systems improvements.

KEYWORDS:

• Photovoice
• lived experiences
• strengths
• challenges
• health systems

Acknowledgements

We thank all participants, research teams, collaborators and partners who supported the studies in the six countries. Our appreciation also goes to Health Systems Global for organising the 5th Global Symposium on Health Systems Research held in Liverpool (UK) in 2018 during which the authors met and presented the findings in a Visual Methods Workshop.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

Ghana’s case study was funded by the COUNTDOWN project [Grant ID – PO 6407] which was formed in 2014 and is funded by UKAID, part of the Department for International Development. The Sierra Leone case study was supported by the UK Department for International Development [grant number PO 5247]. One of the Uganda case studies was carried out as part of research for the Future Health Systems Research Consortium, which is funded by the UK Department for International Development, while the other study was supported by a subagreement from Johns Hopkins University Bloomberg School of Public Health with funds provided by contract no. PO 5683 from the UK Department for International Development. The funders played no role in the design of the studies and in collection, analysis and interpretation of data and in writing the manuscript.