4 Dartmouth s Prevention Research Center, the Health Promotion - - PowerPoint PPT Presentation

USING PHOTOVOICE TO ENSURE A RIGHT TO HEALTH:

ELICITING RESIDENT PERSPECTIVES THROUGH THE LIFE COURSE TO SUPPORT HEALTHY EATING ACTIVE LIVING (HEAL) POLICIES

Semra Aytur,1 Alyssa Henry,1 Emily Dollar,2 Sara Rainer,5,1 Beth Wheeler,6 Emily Counts,1 Stephanie Kelly,2,4 Anna Adachi-Mejia2,3,4

1University of New Hampshire, 2The Geisel School of Medicine at Dartmouth, 3The Norris Cotton Cancer Center, 4Dartmouth’s Prevention Research Center, the Health Promotion Research Center at Dartmouth (HPRCD), 5Institute on Disability, 6Foundation for Healthy Communities

• The National Prevention Strategy (NPS) recognizes four

strategic directions for improving population health:

• Healthy and Safe Community Environments
• Clinical and Community Preventive Services
• Empowered People
• Elimination of Health Disparities
• State-level public health plans also emphasize chronic

disease and injury prevention

• Vertical integration of national, state, and local

policies/plans requires understanding the needs, values, and perceptions of community members

• Photovoice and photo-elicitation methods can facilitate this understanding

INTRODUCTION

http://www.surgeongeneral.gov/priorities/prevention/strategy/#The Strategic Directions

OBJECTIVE:

• To synthesize data across multiple photovoice/

photo-elicitation projects in order to amplify our collective voice and identify important contextual issues pertaining to policy development, implementation, and evaluation.

METHODS

• We synthesized data from 7 photovoice/photo-elicitation projects conducted over the past

6 years in New England pertaining to healthy eating/active living (HEAL), neighborhood safety, sleep, alcohol/substance use, and other public health priorities

• Photovoice participants ranged in age from pre-adolescent through older adult; included

rural residents, urban refugee/immigrant youth, and persons with disabilities

• A multi-disciplinary team consisting of academic researchers, practitioners, clinicians,

educators, community organization leaders, and students submitted content

• Two team members (a medical student and a health policy/nursing student) synthesized the

data from various photovoice projects and identified policy-relevant themes

• The team developed cross-cutting implications and summarized key lessons learned

YOUTH PHOTOVOICE PROJECT: “CREATING SAFE NEIGHBORHOODS” MANCHESTER, NH

Source: Aytur, A., Butcher, R., Carlson, C., & Schifferdecker, K. (2014). Creating safe neighborhoods for obesity prevention: Perceptions of urban youth. In: Brennan, V., Kumanyika, S., & Zambrana, R. (eds). Obesity Interventions in Underserved US Populations: Evidence and Directions. Johns Hopkins University. (November, 2014). ISBN 978-1-4214-1544-4 Funded by the Robert Wood Johnson Foundation’s Active Living Research program.

Project Description: Fourteen refugee/immigrant adolescents (ages 13-19)

participated in a Photovoice project for six weeks to explore youth perceptions of relationships between safety, active living, and healthy eating in the context of their daily lives.

Health Issues: Neighborhood safety and perceptions of opportunities for physical

activity and healthy eating in two urban neighborhoods in Manchester, NH

Lessons Learned & Themes:

• Project enhanced understanding of immigrant/refugee teens’ perceptions of

neighborhood safety, health, and active living.

• As Photovoice sessions progressed, participants began to discuss ways that they

could initiate change (e.g., serving on Youth Council; engaging school staff).

“I took this picture of cigarette signs on a gas station next to Pulaski Park. Smoking is bad for you, yet the advertising is big and eye-catching. It’s weird that these ads are so close to a place that is healthy and

• good. “ −S.R, 16

“Why can’t this vacant lot be used for a community garden or a sports field?” − S.R., 16 Trash in alleys where kids play. –W.P ., 15

Policy/Practice Implications:

• NH State Health Improvement Plan (SHIP): Obesity/diabetes, tobacco, injury prevention
• NH Healthy Eating Active Living (HEAL) Healthy People, Healthy Places Plan
• An Art Exhibit and a community-wide Photovoice training session was held at the end of the

study to enable community members to conduct future Photovoice projects.

• Manchester Neighborhood Health Improvement Strategy
• Building on strong community engagement and

cross-sector partnerships, the City of Manchester became a 2016 Robert Wood Johnson Foundation Culture of Health Prize Winner:

http://www.rwjf.org/en/library/collections/coh-prize-winners/2016

• winner-manchester-nh.html

Manchester Neighborhood Health Improvement Strategy: http://www.graniteuw.org/assets/pdf/compaign-toolkit/ Manchester_NHIS_2014.pdf

THROUGH THE LENS OF A CAMERA: EXPLORING THE MEANING OF PHYSICAL ACTIVITY PARTICIPATION AMONG YOUTH WITH DISABILITIES THROUGH PHOTOVOICE

Patti Craig, Ph.D., CTRS/L and Semra Aytur, PhD, MPH (University of New Hampshire), in partnership with Northeast Passage (nepassage.org/)

Project Description: This Photovoice study explores the meaning of physical

activity participation and competitive sport experiences among youth athletes with disabilities

• Members of the Northeast Passage Wildcats Sled Hockey team

Methods: Photovoice, semi-structured interviews, and focus groups were used to

explore the meaning of sports participation from the perspective of youth with physical disabilities (n=8; ages 9-18).

Health Issues: Physical activity, positive youth development

Northeast Passage: http://nepassage.org/about/

Policy/Practice Connections:

• Individuals with Disabilities Act
• Section 504 of the Rehabilitation Act of 1973 (ensuring equitable school

athletic opportunities for students with disabilities)

• NH HEAL Healthy People, Healthy Places Plan:
• Example: Goal: To active transportation and recreation
• Objective 1: Ensure equitable access to options for getting

around, and safe, high-quality places to play and be active.

• Objective 2: Ensure access to indoor and outdoor recreation

facilities within a reasonable distance.

“This is a picture of the baseball and soccer field at my school. Lots of times in the fall & spring P .E. classes are held up here

• r we get extra recess here. Even though there is a paved

walkway to the field, I can’t get through the gate in the fence because it is too small. There is no other entrance. This makes me mad because they make zero effort to include me, so I just stay inside and don’t want to be with them anyways.” (C.H.) “This photo represents the sacrifices me and my family make to get me to a Doctor’s appointment. I missed school & my parents had to drive 1 hour & 30 minutes to get me there.” (A.D.) “I love playing basketball. I tried out for my school team but didn’t make it. I have to travel to CT to play on a wheelchair basketball team.” (C.H.)

“This is a picture of my school’s playground. I have hardly been on this playground during the 8 years I have gone here because its really hard to push across the field to get there and then I can’t push in the bark mulch once I do get there. I feel like I missed out on a lot of fun.” (C.H.) “This is a picture of my new

• bathroom. I am independent

in my new bathroom because it is built for my needs. It builds self-confidence.” (P.M.) “I am at the skate park dropping into the bowl. I’m the only one in a wheelchair here. But it’s ok because when I’m here I am like everyone else. I watch the skateboarders and BMX’ers and try to make my chair do what they do. I can do the same things but I just do it in a different way.” (D.M.)

Lessons Learned & Themes: Intrapersonal Level

Qualitative analysis of text and photos revealed themes associated with empowerment and Positive Youth Development:

• Competence
• Social competence
• Cognitive competence
• Vocational competence
• Confidence
• Connection
• Character
• Caring and Compassion

“’Grab a piece of chair.’ My coach always says this at the end of basketball practice. We all grab onto each other’s chairs and do a little chant.” (D.M.)

Sources: Lerner R. M. (2004). Liberty: Thriving and civic engagement among American youth. Thousand Oaks, CA: Sage Roth, J. L. , & Brooks-Gunn, J. (2005). Positive Youth Development A View of the Issues. Journal of Early Adolescence; 25(1):10-16

Policy Implications: School Level

• Youth with disabilities face barriers to participation in

athletics, particularly in after-school settings

• Barriers exist despite policies such as Section 504 of

the Rehabilitation Act of 1973, which aims to ensure that K-12 schools provide youth with disabilities

• pportunities to participate in physical activity and

extracurricular athletics equal to those of their peers.

• As a result of limited sport opportunities for youth with

disabilities, community-based therapeutic recreation (TR) and adaptive sports organizations have emerged to fill the gaps by providing a cost-effective alternative for schools.

• Community Level: See APHA abstract 2024.0

https://apha.confex.com/apha/144am/meetingapp.cgi/ Paper/361962

Northeast Passage (NEP) in New Hampshire partners with school personnel/administrators, students, families, and community providers to ensure that youth with disabilities are provided equal opportunities to participate in athletics through their competitive youth sports program. Rainer S, Drum C. Community Engagement Initiative Knowledge Transfer Research Project. APHA abstract 2024.0 ; 2016.

STORIES OF HEALTH

ReThink Health Upper Connecticut River Valley (UCRV) & United Valley Interfaith Project (UVIP)

http://rethinkhealthucrv.org/project/project-2/

Photo by David Hearne

STORIES PROJECT DESCRIPTION

The data and vibrant stories collected from the Stories Project will impact change in

• rganizations and systems that give shape to our local healthcare, social, and economic
• systems. Key topical areas: Aging with dignity; life in Claremont
• Trained more than 40 volunteer “Listeners,” who are paired with individuals who

want to share their stories.

STORY GATHERING PROCESS

Health Issues: Aging in place, social determinants of health, community capacity building Lessons Learned & Themes:

• Uses the power of storytelling to create community-level change
• Created a multi-media exhibit, Take Another Look, to bring elders’ experiences to a wider

audience

• High-school documentary filmmakers created videos:
• https://vimeo.com/album/3883699

Policy/Practice Implications: Stories and data are being disseminated to leverage positive change in the organizations and systems that shape local healthcare, social, and economic systems.

FOR MORE INFORMATION…

ReThink Health: UCRV

• http://rethinkhealthucrv.org/project/project-2/

United Valley Interfaith Project

• http://www.unitedvalleyinterfaithproject.org/new-index-1/

#storiesproject

Take Another Look Videos

• https://vimeo.com/album/3883699

Photo by David Hearne

APPROACHES TO HEALTHY LIVING: BARRIERS AND FACILITATORS FOR EATING FRUITS AND VEGETABLES, BEING PHYSICALLY ACTIVE, AND HEALTHY SLEEP PRACTICES

Investigator: Anna M. Adachi-Mejia

Funding: Institutional Research Grant from American Cancer Society

• Project Description: A series of exploratory photovoice studies across

multiple years with several groups of middle school students, high school students, and older adults in rural New Hampshire

• Health Issues: Cancer prevention, obesity, healthy eating, active living, and

healthy sleep practices.

• Lessons Learned/Themes:
• Photovoice enables youth and adults who are not accustomed to being asked

their opinion to share their views

• Photovoice community events are an effective tool to build trust, rapport

between institution and community to facilitate effective research

• The intended goal was to elicit themes from community members, however

the experiential process of engaging in the steps of photography and group discussion led to the unintended positive consequences of desire for individual behavior change in participants!

IMAGES

IMAGES

IMAGES

Policy/Practice Implications:

• Led to student discussion of replacing unhealthy food choices at

school lunch with increased opportunities for offering fruits and vegetables

• Middle school students publicly spoke about what they learned

and what was important to them at community events

• Community events an opportunity for multi-generational sharing
• f ideas and ways to inspire healthy living
• Community event tied to a ”Weight of the Nation” Screening and

discussion in one of the communities

• Community event elicited press releases about Healthy Eating /

Active Living

• Community events a way to trigger new conversations with family

members, educators, policy makers, and community leaders

• Created opportunities for traveling road show of posters, including

displaying them at a local Healthy Eating Active Living conference and at the Foundation for Healthy Communities in Concord, NH

MORE INFORMATION

Movie with interviews https://www.youtube.com/watch?v=B-ufXSXY0_E Press release: http://www.dartmouth-hitchcock.org/news/newsdetail/64874/ Press release: http://jop.stparchive.com/Archive/JOP/JOP01042012p01.php See our other photovoice work at: www.hprcd.org

FRANKLIN PIERCE UNIVERSITY: SUBSTANCE MISUSE

IDENTITY AND RACE

Lead: Anne Goodrich-Bazan (Franklin Pierce University) Photovoice Mentor: Anna Adachi-Mejia (Dartmouth) https://www.flickr.com/photos/ 130665800@N07/16582551191/in/photostream/

Project Description:

• Staff initially invited college students to engage in a photovoice project to promote being substance

free and avoiding binge drinking on a rural college campus

• 12 students took photos, designed posters, and created slogans
• Posters and lamppost banners displayed photovoice photos and slogans throughout campus
• The success of the project led a different group, the ALANA Student Group, a student discussion

group comprised of students of color, to develop a photovoice movie about racial identity on a rural college campus. Health Issues:

• Promoting healthy living, avoiding binge drinking and substance misuse on a college campus
• Racial identity on a rural college campus

Lessons Learned & Themes:

• Students really liked the process
• Students focused on positive messages to promote to their classmates
• The success of the project led to the spinoff project that was then shared at a Martin Luther King

Leadership Award Banquet community event on the college campus

Policy/Practice Implications :

• Collaborated with Cheshire County, Keene State College, NH Bureau of

Drugs and Alcohol Services

• Used images to promote positive behavior and share information about

policies

• Shared with AOD project students in Campus wide Academic Showcase

NH State Health Improvement Plan-

• Alcohol and substance misuse
• Injury prevention

IMAGES

PHOTO VOICE

At Franklin Pierce University

OUR MISSION

MADE POSSIBLE WITH SUPPORT FROM:

Photo Voice is a program whose mission is to raise awareness about social issues through the medium of

• Photography. Members express their

unique view points through creating statement works of art. Funding provided by NH Bureau of Drug and Alcohol Services. For more information contact Ann Goodrich-Bazan at (603) 899-1160 or goodricha@franklinpierce.edu.

For the campus community

IMAGES

IMAGES FROM ALANA PHOTOVOICE MOVIE

IMAGES FROM ALANA PHOTOVOICE MOVIE

IMAGES FROM ALANA PHOTOVOICE MOVIE

CROSS-CUTTING THEMES

• Synthesizing data across photovoice projects highlights the

importance of honoring and celebrating 'difference‘

• Participants voiced the importance of feeling included while

simultaneously honoring their unique identities

• Gives voice to people who may not feel comfortable expressing

themselves in other settings

• Importance of considering spiritual and emotional attributes of

healthy communities

CROSS-CUTTING THEMES

• Synthesizing data/themes across photovoice projects can raise awareness of

contextual issues that may affect policy development and implementation.

• Underscores the importance of involving community stakeholders in planning

and policy development

• Reinforces linkages between local and state plans/policies to more effectively

implement national public health strategies for chronic disease prevention Next steps:

• To engage the clinical community in future photovoice projects; promote
• pportunities for clinical-community partnerships

ACKNOWLEDGEMENTS

• We thank the following individuals for generously

sharing their photovoice/photo-elicitation projects and community engagement insights for this synthesis:

Funding support: American Cancer Society Research Grant #IRG-82-003-25 and #IRG-82-003-27 (PI: Adachi-Mejia). Support was also provided by the Dartmouth Health Promotion and Disease Prevention Research Center supported by Cooperative Agreement Number U48DP005018 from the Centers for Disease Control and Prevention. The findings and conclusions in this journal article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Ann Goodrich-Bazan Rebecca Van Dolah Laleh Talebian Steve Voigt Alice Stewart Trinity Dix Sophie Bodnar Patricia Craig Cynthia Carlson Charles Drum Photovoice participants

ADDITIONAL PROJECTS

MOBILIZING YOUTH FOR HEALTHY COMMUNITIES - LALEH TALEBIAN

• Participants:

Youth (ages 16-19) who were enrolled in a dual enrollment program at the Hartford Area Career & Technology Center.

• Goal: To create a replicable and sustainable model for educating, empowering and

motivating teens to influence policies aimed at reducing tobacco use and obesity in their local communities. Teens taught elementary school children about healthy eating and playing while learning about physical activity and other health related topics.

IMPROVING STUDENT ACCESS TO FREE, QUALITY WATER - REBECCA VAN DOLAH Participants: Students from 10 grade schools and 4 high schools The project raised awareness about promoting a healthier lifestyle for children by encouraging consumption of free, quality water during the school day.

Source: Van Dolah, R. Improving student access to free, quality water. (2012). Community service project, report available from the author.

REFERENCES

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• University. (November, 2014). ISBN 978-1-4214-1544-4

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Murray KE, Mohamed AS, Dawson DB, Syme M, Abdi S, Barnack-Taviaris J. Somali Perspectives on Physical Activity: PhotoVoice to Address Barriers and Resources in San Diego. Prog Community Health Partnersh. 2015;9(1):83-90. doi: 10.1353/cpr.2015.0011 [doi]. Saimon R, Choo WY, Bulgiba A. "Feeling unsafe": a photovoice analysis of factors influencing physical activity behavior among Malaysian adolescents. Asia Pac J Public Health. 2015;27(2):2092. doi: 10.1177/1010539513480229. Seavey, J., Aytur, S., & McGrath, R. Health Policy Analysis: Framework and Tools for Success. Springer: May, 2014. ISBN-13:9780826119230 Sebastiao E, Ibe-Lamberts K, Bobitt J, Schwingel A, Chodzko-Zajko W. Employing a Participatory Research Approach to Explore Physical Activity among Older African American Women. J Aging Res. 2014;2014:941019. doi: 10.1155/2014/941019 [doi]. Sylvester, C. (2011).Therapeutic Recreation, the International Classification of Functioning, Disability, and Health, and the Capability

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