Visual storytelling: a beneficial but challenging method for health research with young people

Navigating Both Roles: A Photovoice Exploration of the Young Adult Balancing Daughterhood and Caregiving for a Mother With Young-Onset Dementia

Young adults thrust into the role of caregiving for parents with young-onset dementia (YOD) face unique challenges during their formative years. While existing research acknowledges the crucial role of young adult caregivers, a gap persists in understanding how this group experiences and redefines their identity amidst these circumstances, along with the psychological and societal challenges encountered. This knowledge deficit hinders the identification of suitable social support, adversely affecting the personal growth and well-being of these young adult caregivers. In this single-case study, we used a combination of a semi-structured interview and photovoice to explore the journey of a 19-year-old caregiver, Alice, whose mother had been diagnosed with dementia in the preceding 3 years. Through this unique perspective, we aimed to illuminate how caregiving for a mother with YOD may profoundly redefine familial roles and relationships. Over 3 months, Alice captured significant life moments through photography, selecting meaningful images for bi-weekly meetings. These images served as pivotal themes, triggering in-depth conversations during subsequent interviews to provide nuanced insights into her life experiences. Findings reveal four major themes faced by a young caregiver: (1) challenges adapting to an unexpected role, (2) navigating the complex emotional terrain of losing a loved one to YOD, (3) prioritizing the well-being of the healthy parent, and (4) expressing a profound desire for both informal and formal support. These results underscore the intricate identity and emotional challenges faced by young adult caregivers, emphasizing the urgency of addressing their unique needs through family-centered systemic support services.

"Pictures helped me understand it in a way words couldn't": Youth reflections participating in a youth-led photovoice study

INTRODUCTION

People with lived experience of a health issue can be engaged in research to address issues related to social justice, informing change through partnerships and an understanding of community perspectives and needs. Although photovoice has been applied to various disciplines and topics across the health sciences, the concrete design of the photovoice process and participants' experience of engaging in photovoice is not always well documented or understood.

OBJECTIVE

This paper describes youth participants' experiences and perspectives with a youth-led photovoice design process on a study regarding COVID-19 vaccine confidence.

METHOD

The sample consisted of 27 youth aged 14-24 who reported experiencing mental health and/or substance use challenges [MHSU] during the COVID-19 pandemic and some degree of COVID-19 vaccine confidence. Youth participated in a series of photography workshops, then each attended one of the six focus groups about both the topic and experience of the photovoice project.

RESULTS

Four themes were constructed from the data: 1) Participating in a photovoice project was an enjoyable experience that had a positive effect on participants; 2) Shared group experiences contributed to building a safe space for participants; 3) Photography and the photovoice process served as a catalyst for reflection; 4) Photovoice shifted participants' perspectives on both the COVID-19 vaccine and photography.

CONCLUSIONS

This project, a youth-engaged and youth-led photovoice study, describes how the photovoice methodology can be applied in a public health context to meaningfully involve young people and impact their lives. By involving youth in the co-construction of the study design and implementation, photovoice research can represent positive and empowering experiences for participants. Bringing together a diverse and multifaceted lived experience engagement research team structure strengthened the design, delivery, analysis, and interpretation of the project.

The adult in the room: The push and pull of parental involvement in research with children

Parental involvement in research where children are the primary study participants is frequent but under-analyzed. To understand such dynamics in research with children, we examined children's (ages 8-14) interactions with parents who came in and out of view during our virtual interviews in our study, Photographing Health by Rural Adolescents in the MidwEst (PHRAME). We identified the pull and push of this adult involvement-a choreography in which children were active participants. Our analysis demonstrates that such interactions provide important data about how children navigated power dynamics, and also offer integral insights on how they were doing health and care.

The use of arts-based methodologies and methods with young people with complex psychosocial needs: A systematic narrative review

BACKGROUND

Arts-based methodologies and methods (ABM) can elicit rich and meaningful data with seldom-heard groups and empower participants in research. Young people with complex psychosocial needs could be better engaged in research using arts-based approaches to overcome communication and literacy issues as well as distrust of those with power, including researchers. A critical review of the use and impact of ABM among this population is timely. The purpose of this review is to synthesize and examine the experience and use of ABM with young people with complex psychosocial needs.

METHODS

A systematic narrative literature review was conducted with a search of the literature from 2009 to 2021. All abstracts were reviewed independently by two authors and full papers were screened for eligibility against inclusion and exclusion criteria. Data synthesis focused on a descriptive numerical summary and a thematic analysis focused on key patterns across papers relating to the review objectives.

RESULTS AND DISCUSSION

A total of 25 papers were included. The most common issues of focus were mental health (n = 10) and homelessness (n = 11) and methods using Photovoice (n = 12) and Body Mapping (n = 5). Individual interview data (n = 20) were the most commonly analysed, followed by created works (n = 19). Less than half the studies involved young people in the interpretation of the data collected. Knowledge translation was not described in almost half the studies, with public exhibits (n = 7) and forums with service providers (n = 4) being the most common activities. Key themes across the studies were valued over traditional methods in eliciting data, ABM as an approach to engage these young people in research and the impact of the use of ABM on participants and on key stakeholders through knowledge translation.

CONCLUSIONS

The growing field of ABM presents opportunities to enhance research with young people with complex psychosocial needs by promoting meaningful exploration of experiences, engaging participants in research and strengthening knowledge translation. The involvement of young people in the interpretation of data and ensuring that knowledge translation occurs are key areas for future attention.

PATIENT OR PUBLIC CONTRIBUTION

The findings of this review will inform future research to improve the engagement of young people with complex psychosocial needs in research and promote power sharing between researchers and research participants.

The Good, the Bad, and the Vision: Exploring the Mental Health Care Experiences of Transitional-Aged Youth Using the Photovoice Method

Transitional-aged youth (TAY) between the ages of 16 and 24 experience higher rates of mental distress than any other age group. It has long been recognized that stability, consistency, and continuity in mental health care delivery are of paramount importance; however, the disjointed progression from paediatric to adult psychiatric services leaves many TAY vulnerable to deleterious health outcomes. In Spring 2019, eight TAY living with mental health challenges participated in a Photovoice study designed to: (1) illuminate their individual transition experiences; and, (2) support a collective vision for optimal mental health care at this nexus. Participants took photographs that reflected three weekly topics-the good, the bad, and the vision-and engaged in a series of three corresponding photo-elicitation focus group sessions. Twenty-four images with accompanying titles and captions were sorted into nine participant-selected themes. Findings contribute to an enhanced awareness of psychiatric service delivery gaps experienced by TAY, and advocate for seamless and supportive transitions that more effectively meet the mental health care needs of this population.

Photovoice and Instagram as Strategies for Youth Engagement in Disaster Risk Reduction

Community involvement is essential for an all-of-society approach to disaster risk reduction. This requires innovative consultation methods, particularly with youth and during pandemic restrictions. This article outlines methods used for a Photovoice project where we brought together student co-researchers from multiple levels (high school, undergraduate, and graduate health sciences) to explore the topic of youth engagement in disaster risk reduction. Over a two-year period, our team used Photovoice as an arts-based participatory method to collaborate with members of our EnRiCH Youth Research Team. We adapted the protocol to continue our project during the COVID-19 pandemic and presented our work in a Photovoice exhibition using Instagram. This article was written from the perspectives of high school and university students on the project. Our hybrid Photovoice protocol facilitated participation through the pandemic, including a virtual presentation at an international conference and online consultation with the Canadian Red Cross.

Generating youth dialogue through the literary arts: A citywide youth health collaboration in the U.S

A process and outcomes evaluation was conducted of a citywide literary-arts initiative designed to reduce stigma, amplify underrepresented narratives, and generate dialogue about violence. Over 4 months, students in 85 middle schools read a novel addressing mental health and violence-related themes. As a collaboration between a public school district and public library system, the program's classroom activities emphasized dialogue, while coordinated library events supported community engagement. Students completed pre/postsurveys (total n = 1487); school program leaders (n = 39) and public librarians (n = 14) completed postsurveys. Half of student respondents reported personal encounters with violence. Most said the novel influenced their thinking; students with personal experiences of violence reported greater influence than those without. Highest rates of dialogue were seen among students who read the novel in full, and over half of postsurvey respondents wanted more dialogue opportunities. Leaders and librarians indicated that the program was smoothly integrated with existing curricula, but also offered recommendations for improved processes. Findings suggest that this intervention was effective at stimulating dialogue while providing assets-based opportunities for youth to share experiences and concerns. Current program processes indicate promise for further engagement and impact, with some modifications. To this end, authors draw upon evaluation findings and youth development literature to offer recommendations for program development and replication in other regions.

Understanding factors that promote uptake of HIV self-testing among young people in Nigeria: Framing youth narratives using the PEN-3 cultural model

It is important to understand how to frame the formats for promoting HIV self-testing to increase uptake among young people. In this study, we used a culture-centered model to understand the narratives of HIV self-testing preferences among young people in Nigeria. We conducted a crowdsourcing contest to solicit ideas surrounding HIV self-testing promotion among young people (10–24 years) in Nigeria from October to November 2018 as part of the 2018 World AIDS Day event. We received 903 submissions and employed thematic content analysis to evaluate 769 eligible youth narratives. Thematic content analysis of the statements from the youth narratives was guided by the PEN-3 cultural model to examine the positive, existential, and negative perceptions (beliefs and values), enablers (resources), and nurturers (roles of friends and family) of HIV self-testing promotion among young people in Nigeria. Several themes emerged as factors that influence the uptake of HIV self-testing among young people in Nigeria. Specifically, seven themes emerged as perceptions: HIV testing accessibility, stigma reduction, and autonomy (positive); HIV self-testing kit packaging and advertisements (existential); lack of knowledge and increased stigma (negative). Seven themes emerged as enablers: social media, school, and government promotion (positive); gamification and animation (existential); high cost and access to linkage to care services (negative); And seven themes emerged as nurturers: peer, families, and faith-based communities (positive); parents and family-centered approach (existential); and partners and family (negative). Our data suggests that increased awareness around HIV self-testing on current youth-friendly platforms, de-stigmatization of HIV and HIV self-testing, decreased prices for HIV self-testing kits, reliability of testing kits, increased linkage to care services, and promotion of self-testing among family members and the community will be beneficial for HIV self-testing scale-up measures among young people in Nigeria.

Dialoguing With Images: An Expressive Arts Method for Health Research

Despite the increasing integration of arts-based methods within qualitative research, few expressive arts methods have been studied to understand their process, rationale and impact on the inquiry process. We conducted a grounded theory study on family experiences of paediatric HSCT where we simultaneously adapted and studied a 'dialoguing with images' (DI) expressive arts process as method. Fifteen family members participated in two interviews, drew an image and were guided through the DI method. We articulate the social process shared by researchers, participants and the images as they co-constructed knowledge through the DI method. The four distinct phases of the method include: 1) containing the imaginative space within an outer and inner frame, 2) creating an embodied image: image work is an expressive, generative process, 3) a shared, participatory aesthetic interpretation and 4) crystallizing stories of illness. The findings are grounded in expressive arts theory and philosophy, hermeneutics and analytical art psychotherapy theory.

What about Using Photovoice for Health and Safety?

The positive reception of Wang and Burris' photovoice method, published in 1997, has led to a proliferation of ways in which professionals deploy photovoice in a widening range of application fields, e.g., public health, social development and phenomenological research of human experiences. A scoping review method is used to obtain an overview of current photovoice designs and of application examples in the health and safety domain. The results show a variety of method designs. Our findings indicate that all of the photovoice designs are composed from different combinations of eleven process steps. Five generic objectives cover the range of application examples found in our literature study. We therefore condensed the variety into five generic photovoice designs for: (a) communication, (b) education, (c) exploration, (d) awareness, and (e) empowerment purposes. We propose this for use in a classification system. The potential for application of these photovoice designs in safety management is illustrated by the existence of various safety related application examples. We argue that the five generic designs will facilitate the implementation and usage of photovoice as a tool. We recommend that both a theoretical framework and guidance are further developed. We conclude that photovoice holds potential for application in health and safety management.

Digital Storytelling as a Patient Engagement and Research Approach With First Nations Women: How the Medicine Wheel Guided Our Debwewin Journey

When research is conducted from a Western paradigm alone, the findings and resultant policies often ignore Indigenous peoples' health practices and fail to align with their health care priorities. There is a need for decolonized approaches within qualitative health research to collaboratively identify intersecting reasons behind troubling health inequities and to integrate Indigenous knowledge into current health care services. We engaged with First Nations women to explore to what extent digital storytelling could be a feasible, acceptable, and meaningful research method to inform culturally safe health care services. This novel approach created a culturally safe and ethical space for authentic patient engagement. Our conversations were profound and provided deep insights into First Nations women's experiences with breast cancer and guidance for our future qualitative study. We found that the digital storytelling workshop facilitated a Debwewin journey, which is an ancient Anishinabe way of knowing that connects one's heart knowledge and mind knowledge.

Sexual and reproductive health of Syrian refugee adolescent girls: a qualitative study using focus group discussions in an urban setting in Lebanon

Background

The war in Syria caused the forced displacement of millions of Syrians to neighboring countries. Lebanon is the host country with the largest overall number of Syrian refugees per capita. Adolescent refugee girls experience a unique level of vulnerability during human emergencies and are at increased risk of suffering from poor sexual and reproductive health (SRH) outcomes. We conducted an exploratory qualitative study to learn about the SRH perceptions and experiences of refugee adolescent girls living in Bourj Hammoud, an urban setting in Lebanon.

Methods

We employed a qualitative design with eight focus group discussions (FGDs) conducted with 40 Syrian Arab and Syrian Kurdish adolescent girls between January and March 2020. Every FGD consisted of five participants aged 13 to 17 years. A semi-structured guide was used covering multiple themes: menstruation, puberty, SRH awareness, and sexual harassment. FGDs were transcribed and analyzed using thematic analysis.

Findings

The participants discussed adolescent girls’ health and named six elements of good health, such as healthy activities and self-protection. The majority of the FGD participants reported a lack of awareness about menstruation when they experienced it for the first time and the social stigma associated with menstruation. When defining puberty, they indicated its social link to a girl’s readiness for marriage and her need to become cautious about sexual harassment. Most FGD participants had very poor knowledge of the female reproductive system. Mothers were the most approached persons to receive information on SRH issues; however, the girls indicated a wish to receive advice from specialists in a comfortable and private atmosphere. All the girls reported that either they themselves, or an acquaintance, had experienced some type of sexual harassment. The girls rarely reported those incidents due to fear of being blamed or subjected to mobility restrictions, or forced to drop out of school.

Conclusions

The findings show the refugee girls need for satisfactory knowledge on SRH issues and interventions to prevent sexual and gender-based violence that take into consideration the complexity of urban settings.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12978-021-01178-9.

After almost 10 years of war, Syria’s neighboring countries are hosting millions of Syrians who were forcibly displaced. Most prominent among these countries is Lebanon. Adolescent refugee girls are exposed to precarious conditions, which make them more prone to sexual and reproductive health (SRH) problems. This qualitative study was performed in Bourj Hammoud, an urban setting in Lebanon, in order to explore Syrian refugee adolescent girls’ SRH perceptions and experiences. The agenda of the International Conference on Population and Development (ICPD) in addition to the Inter-Agency Field Manual on Reproductive Health in Humanitarian Settings (IAFM) and its Adolescent Sexual and Reproductive Health Toolkit for Humanitarian Settings issued by the Inter-Agency Working Group on Reproductive Health in Crises (IAWG) formed the framework of this study. Focus group discussions were performed with 40 Syrian Arab and Syrian Kurdish adolescent girls, each group consisting of five participants aged 13 to 17 years. Different themes were discussed within the groups including menstruation, puberty, and sexual harassment. The participants talked about the social stigma related to menstruation and the social link between puberty, a girl’s readiness for marriage, and her need to be careful about sexual harassment. Most of the girls had insufficient information about the female reproductive system. The girls consulted their mothers to learn about SRH issues; however, they expressed a wish to receive well-informed advice from specialists in a safe atmosphere. All the girls reported incidents of sexual harassment, which happened either to them or to other girls they know; however, they were discouraged to report them because they feared other consequences, such as being blamed or not being allowed to go to school anymore. The outcomes of the study show the girls’ urgent need to have adequate information about SRH issues and appropriate interventions to prevent sexual and gender-based violence within complex urban settings.

Ten2Twenty-Ghana: Study Design and Methods for an Innovative Randomized Controlled Trial with Multiple-Micronutrient-Fortified Biscuits among Adolescent Girls in Northeastern Ghana

Investing in adolescent girls' nutrition is vital for health and for breaking the intergenerational cycle of malnutrition and deprivation, but limited knowledge on the type, timing, and efficacy of interventions delays progress. We describe the design of a 26-wk randomized placebo-controlled trial with multiple-micronutrient-fortified biscuits (MMBs) among adolescent girls in northeastern Ghana. Apparently healthy, premenarche (n = 312) and postmenarche (n = 309) girls (10-17 y) were randomly assigned to receive the following for 5 d/wk: 1) MMBs (fortified with 11 vitamins and 7 minerals) or 2) unfortified biscuits. Data included plasma micronutrient status, anthropometry, body composition, cognitive function, psychosocial health, fertility, dietary intake, and sociodemographic and socioeconomic covariates, complemented with in-depth interviews (n = 30) and 4 focus group discussions. We hypothesized an increase in plasma ferritin and retinol-binding protein with a resultant increase in hemoglobin, cognition, vertical height, and psychosocial health. Our study seeks to investigate the efficacy and optimal timing of a multiple-micronutrient food intervention program for adolescent girls. The RCT was registered prospectively with the Netherlands Clinical Trials Register (NL7487).

"To Be a Guy Is to Be Human": Outcomes of the WiseGuyz Program Through Photo-Based Evaluation

Gender-transformative approaches (i.e., approaches that support male-identified individuals to critique and resist stereotypical male gender role norms that negatively affect health and well-being) are increasingly recognized as a key health promotion strategy. However, there is limited evidence to date on gender-transformative interventions for male-identified adolescents. In addition, given the dynamic and socially constructed nature of gender, methods beyond quantitative data collection are needed to gain a holistic understanding of promising gender-transformative health promotion approaches. One newer method to capture lived experiences with adolescents is photo-based evaluation, where youth program participants take pictures to represent their knowledge, attitudes, and/or behaviors before and after a program. The present study presents findings from the photo-based evaluation of a gender-transformative health promotion program called WiseGuyz. WiseGuyz is offered to mid-adolescent, male-identified youth in school and community settings, and is designed to promote mental and sexual health and prevent violence. Six youth photographers from a rural Canadian setting took part in this evaluation, taking photos to represent what being a guy in their world meant before and after WiseGuyz. Youth then participated in an individual visual storytelling interview and a group-based photovoice process. Key themes in relation to masculinities that emerged from these data were around changes to (1) social norms and (2) emotionality following program participation, and the need for a safe program space to support these changes. This study adds to literature demonstrating the promise of gender-transformative approaches with adolescents, with implications for future health promotion research and practice with male-identified youth.

Exploring the after-hours social experiences of youth with disabilities in residential immersive life skills programs: a photo elicitation study

PURPOSE

This study explored the meaning of the after-hours social experiences of youth with disabilities in a residential life skills program. After-hours experiences occur outside of formal program hours, primarily in the evenings.

METHOD

Five youth with cerebral palsy (three females) participated in an exploratory photo elicitation study while attending one of two residential immersive life skills programs. Following an auto-driven photo elicitation method, youth took photos of their choosing and then were interviewed about photos they elected to share. Interview data were analyzed thematically.

RESULTS

Themes illustrated meaningful social experiences and their benefits. Two themes described the after-hours social experiences of most importance to youth: learning about strengths from working together, and having meaningful individual and group conversations. Three themes reflected benefits reported by youth: learning about differences among people, gaining new perspectives and new knowledge about oneself, and developing friendships and a sense of "family."

CONCLUSIONS

The findings illuminate the benefits of after-hours social experiences for youth who may have had little opportunity previously to informally interact with other youth with disabilities. The findings highlight the importance of the immersive, group nature of a residential, away-from-home youth transition program, particularly the value added by the after-hours program component.IMPLICATIONS FOR REHABILITATIONThe findings support the value of an over-night residential aspect for life skills programs for youth with disabilities.Residential immersive life skills programs provide opportunities for youth to discuss common experiences and shared challenges, leading to the formation of social bonds.Residential immersive life skills programs provide opportunities for youth to interact with peers in the absence of adults, and to make choices about how to use their personal time.It is important to intentionally design transition programs to provide opportunities for after-hours social experiences, including working together and socializing.

Effects of colour narrative in community-dwelling older adults: A mixed methods study

BACKGROUND

Based on occupational storytelling/story-making, this study developed Colour Narrative, a program to promote the health and well-being of community-dwelling older adults.

OBJECTIVES

To conduct a pilot study to implement Colour Narrative in a heavy snowfall area of Japan and verify the participants' experiences in the program and its effectiveness.

MATERIAL AND METHODS

An advanced mixed methods design was used. The participants were 22 members of a community-based social group for older adults. Quantitative measurements of life functions and health-related quality of life (HRQOL) were conducted before and after the intervention. Qualitative data were collected from focus group interviews regarding the participants' experiences during the intervention process. Lastly, both datasets were integrated.

RESULTS

The harsh living conditions due to heavy snowfall reduced the participants' overall activity. In this environment, Colour Narrative encouraged them to control their lives more in their own ways and enhanced their HRQOL. The core of their experiences was 'negating occupations'. This negotiation was a highly intellectual task that significantly improved their cognitive function.

CONCLUSIONS

The structure and content of Colour Narrative were found to be useful and feasible for community-dwelling older adults.

SIGNIFICANCE

Colour Narrative offers a new occupation-based intervention strategy for preventive occupational therapy.

Factors Affecting the Participation of Physically Disabled Children and Young People in Out-of-School Activities in the United Kingdom: A Qualitative Study

Physically disabled children and young people (PDC&YP) face many challenges when participating in out-of-school activities. PDC&YP should have the same choices and opportunities as other C&YP: to forge friendships locally and to access out-of-school activities. However, PDC&YP have fewer opportunities than their non-disabled peers due to challenges such as access, support, and suitable provision. This multi-method qualitative study examined the factors affecting participation of PDC&YP in out-of-school activities. The perspectives of PDC&YP and parents were sought using a range of data collection tools. These included interviews, focus groups, and creative focus groups with 13 PDC&YP and 19 parents. Play-based creative focus groups were specifically designed for PDC&YP aged 7 to 17 years. The study demonstrated that PDC&YP enjoy specialist disabled activities to meet others 'like them' but want more local opportunities to do this. Some PDC&YP and parents felt they were not disabled enough for 'disabled' activities but not able enough for mainstream. PDC&YP requiring personal care were a 'hidden' group who are at risk of missing out on experiences that they are entitled to. The study concludes by presenting the need to improve provision through disability awareness training and a co-ordinated partnership approach to be employed by the local authority to raise the profile of disability and 'bridge the gap' between service users and service providers. The social needs of children require the same focus and attention to aid their wellbeing and to enhance out-of-school lives.

Visual Elicitation: Methods for Enhancing the Quality and Depth of Interview Data in Applied Qualitative Health Research

Generating rich data from interviews for a qualitative study can be difficult to operationalize; especially when difficulties establishing rapport, power imbalances, and participant factors threaten the interview process and quality of data. The aim of this methods article is to (a) discuss the value of incorporating visual elicitation tools or tasks within semistructured or in-depth qualitative interviews to enhance the depth of data generated and (b) provide a specific example of how this is planned and executed within the context of an applied qualitative health research study.

Learning to live with a hand nerve disorder: A constructed grounded theory

STUDY DESIGN

Grounded theory.

INTRODUCTION

The broader perspective of health offered by the World Health Organization's International Classification of Functioning, Disability and Health has had a significant bearing on how we view the measurement of health outcomes after surgical or therapy interventions for peripheral nerve disorders affecting the hand. The value of the patient's perspective is now recognized and outcomes which reflect this are being advocated in the clinical management and support of this population.

PURPOSE OF THE STUDY

This qualitative study sought to explore the lived experience of a hand nerve disorder and in particular the impact on body structure/function, activities, and participation.

METHODS

In depth, one-to-one interviews with 14 people with a range of hand nerve disorders were conducted. Constructivist grounded theory methods were used to collect and analyze the data. Patients were also given the option of taking photographs to visually represent what it is like to live with a nerve disorder, to bring with them for discussion during the interview.

RESULTS

The impact of hand nerve disorders forms part of a wider narrative on adaptation. A process of "struggling" and then "overcoming" was experienced. This was followed by an interior aspect of adaptation described as "accepting." This gave rise to participants "transforming," being changed as a result of the journey that they had been on.

CONCLUSIONS

This study provides an explanatory theory on the adaptive process following a hand nerve disorder which may inform future patient-therapist interactions.

Using a Mixed-Methods Approach to Analyze Traumatic Experiences and Factors of Vulnerability Among Adolescent Victims of Bullying

A number of studies have analyzed the bullying phenomenon among adolescent victims. Relatively few studies, however, have specifically addressed the associated post-traumatic stress disorder (PTSD). Our clinical practice and therapeutic encounters with adolescents reveal that the majority of bullied adolescents suffer from high levels of PTSD. The objective of this study is to further explore bullied adolescents' traumatic experiences. In an attempt to analyze these experiences, this article presents a mixed-methods approach. Such an approach will allow to analyze the PTSD that results from bullying as well as subjects' psychic and family-relevant vulnerabilities. First, bullying will be defined in the context of adolescence. Then the main studies on bullying will be presented. The objectives, tools and methods of analysis will be presented. The interviews will be analyzed according to the Interpretative Phenomenological Analysis (IPA) method. Projective tools, family drawings, Rorschach and Thematic Apperception Test (TAT), will be analyzed using a psychoanalytic interpretation method. Each qualitative tool will be used alongside a validated quantitative tool. The Clinical Administered PTSD Scale (CAPS-CA-5 questionnaire) and the interviews conducted will thus allow to analyze PTSD and traumatic experiences. The Family Assessment Device (FAD) and the family drawing test will enable to assess family functioning; lastly, the Symptom Check List (SCL-90) that will be used alongside Rorschach and TAT tests will allow to analyze individual psychological vulnerabilities. This approach will increase data validity. The originality of this research study is based on a mixed-methods approach, our methodology which is based on clinical psychology, and the choice of certain research tools which have received little attention to date. Ultimately, this study may help improve how bullying is identified and could contribute toward the reinforcement or revision of the criteria that characterize bullying. Lastly, it may help us explore various unexamined dimensions of bullying. A possible limitation is the complexity associated with such a protocol.

Is Film as a Research Tool the Future of Public Health? A Review of Study Designs, Opportunities, and Challenges

Among public health researchers, there is growing interest in film methods due to their ability to highlight subtleties in practices, capture emotions, engage hard-to-reach populations, and advocate for social change. Still, little is known about strengths and challenges associated with using film methods in public health. This review synthesizes peer-reviewed, public health research studies that apply film methods, and describes opportunities and challenges. Of the 3,431 identified articles, 20 met the inclusion criteria. Fifteen different film methods were found that offer numerous methodological strengths, including the ability to provide rich descriptions, capture emic perspectives, increase comfort in participation, empower participants, and be used for advocacy. Future studies may explore engaging participants throughout the entire research process and using visuals created in the study to communicate findings. Keeping in mind their challenges, film methods are long overdue in public health and provide unique opportunities to capture sensory data.

“Place-ing” Dementia Prevention and Care in NunatuKavut, Labrador

Le vieillissement de la population autochtone du Canada a mis en évidence l’importance du milieu de vie et de la culture sur la santé et la résilience dans le parcours de vie. La présente étude expose les résultats d’un projet Photovoix portant sur les expériences des Inuits du Sud lors de transitions associées au troisième âge et à la démence au NunatuKavut (Labrador). Dans cette région, la culture et l’environnement naturel occupent une place prépondérante dans les descriptions des activités de promotion de la santé et des trajectoires de soins. Ces facteurs peuvent contribuer au vieillissement en santé, offrir une protection contre le déclin cognitif et favoriser le maintien de l’identité des personnes atteintes de démence. Or, les modes de vie ancrés dans la terre ancestrale font l’objet de fortes pressions. Ces pressions affectent les perspectives des aînés Inuits du Sud de vieillir et d’être soignés « dans leur milieu ». Les résultats de cette recherche reflètent la nécessité d’élaborer des approches de soutien pour les aînés Inuits du Sud désirant vieillir dans leur milieu, en considérant les conceptions culturelles de la personne et les politiques et programmes qui promeuvent l’engagement envers la nature et la culture.

Family trouble: Heteronormativity, emotion work and queer youth mental health

Conflict with the family about sexual orientation and gender diversity is a key risk factor associated with poor mental health in youth populations. Findings presented here derive from a UK study that employed an interdisciplinary critical mental health approach that de-pathologised emotional distress and conceptualised families as social and affective units that are created through everyday practices. Our aim was to explore how family relationships foster, maintain or harm the mental health and well-being of LGBTQ+ youth. Data were generated through exploratory visual, creative and digital qualitative methods in two phases. Phase 1 involved digital/paper emotion maps and interviews with LGBTQ+ youth aged 16 to 25 (n = 12) and family member/mentor interviews (n = 7). Phase 2 employed diary methods and follow-up interviews (n = 9). The data analytic strategy involved three stages: individual case analysis, cross-sectional thematic analysis and meta-interpretation. We found that family relationships impacted queer youth mental health in complex ways that were related to the establishment of their autonomous queer selves, the desire to remain belonging to their family and the need to maintain a secure environment. The emotion work involved in navigating identity, belonging and security was made difficult because of family heteronormativity, youth autonomy and family expectations, and had a stark impact on queer youth mental health and well-being. Improving the mental health of LGBTQ+ youth requires a much deeper understanding of the emotionality of family relationships and the difficulties negotiating these as a young person.

Young internal migrants' major health issues and health seeking barriers in Shanghai, China: a qualitative study

Background

China is experiencing a sizeable rural-urban flow, which may influence the health of internal migrant youth deeply. Disadvantages in the city are highly likely to contribute to health issues among the young internal migrant population. The current qualitative study is to explore how internal migrant young people view the health issues they face, and the services and opportunities they could seek in their host community.

Methods

Data were collected from 90 internal migrant youth aged between 15 and 19 years old and 20 adult service providers who worked with them in a community of Shanghai, where the population of internal migrants was relatively large. Four types of qualitative research methods were used, including key informant interviews with adults, in-depth interviews with adolescents, a photovoice activity with adolescents and community mapping & focus group discussions with adolescents. Guided by the ecological systems framework and the acculturation theory, thematic analysis was conducted using ATLAS.Ti 7.0 software.

Results

While younger migrants had a limited understanding of health, elder migrant youths were more sensitive to societal and political factors related to their health. Mental health and health risk behaviors such as smoking, violence and premarital unsafe sex were thought as major health issues. Internal migrant youths rarely seek health information and services initiatively from formal sources. They believed their health concerns weren’t as pressing as the pressure coming from the high cost of living, the experience of being unfairly treated and the lack of opportunities. Participants also cited lack of family and social support, lack of awareness and supportive policies to get access to community and public services as impacting health factors.

Conclusions

The study’s findings provide the insight to the social contexts which influence the health experience, health seeking behaviors, and city adaptation of young internal migrants in their host community. This research stresses the importance of understanding social networks and structural barriers faced by migrant youth in vulnerable environments. A multidimensional social support is essential for internal migrant youth facing present and potential health risks.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-6661-0) contains supplementary material, which is available to authorized users.

Digital Storytelling With Heroin Users in Vancouver

As the opioid crisis escalates across North America, photographers are highlighting the gravity of the situation. However, many of their images of people who use drugs are problematic and stigmatizing. This study looks at how digital storytelling (DST) was used in order to assist long-term heroin users taking part in North America's first heroin-assisted treatment program in Vancouver, BC, in amplifying and sharing their personal experiences. DST is a participatory and collaborative process designed to help people share narrative accounts of life events. A total of 10 participants took part in a 3-day DST workshop and eight individuals completed 2 to 3-minute digital stories. Participants demonstrated increased agency in terms of how they represented themselves. Their digital stories disrupt hegemonic representations of heroin users and can help educate the public and decision makers about compassionate and science-based treatments for chronic addiction. Theory, methodology, practical applications, and ethics are discussed.

The Dominant Obesity Discourse Versus Children's Conceptualizations of Health: A Comparison Through Dialogue and Drawings

The emphasis on childhood obesity reduction has been attributed to the dominant obesity discourse. However, some researchers argue that this discourse may be ineffective and even harmful for children. From a post-structuralist perspective, the dominant obesity discourse has the power to shape children's subjectivities, though subjectivities may also be influenced by personal experiences and other knowledge about bodies and health. There is limited research which explores how children's conceptualizations of health are informed by the dominant obesity discourse. To address this knowledge gap, qualitative data were collected from 8- to 11-year-old children ( n = 29) regarding their conceptualizations of health, healthy bodies, and health practices. Results suggest that children's conceptualizations reflected arguments embedded within the dominant obesity discourse, but at times, also contradicted or deviated from it. Study findings can be applied toward children's health promotion programming to offer a more holistic and inclusive perspective on health and well-being.

Using photo-elicitation to understand reasons for repeated self-harm: a qualitative study

BACKGROUND

Reasons for self-harm are not well understood. One of the reasons for this is that first-hand accounts are usually elicited using traditional interview and questionnaire methods. This study aims to explore the acceptability of using an approach (photo-elicitation) that does not rely on solely verbal or written techniques, and to make a preliminary assessment of whether people can usefully employ images to support a discussion about the reasons why they self-harm.

METHOD

Interviews with eight participants using photo elicitation, a method in which photographs produced by the participant are used as a stimulus and guide within the interview.

RESULTS

Participants responded positively to using images to support a discussion about their self-harm and readily incorporated images in the interview. Four main themes were identified representing negative and positive or adaptive purposes of self-harm: self-harm as a response to distress, self-harm to achieve mastery, self-harm as protective and self-harm as a language or form of communication.

CONCLUSIONS

Employing this novel approach was useful in broadening our understanding of self-harm.

Digital storytelling as a method in health research: a systematic review protocol

BACKGROUND

Digital storytelling is an arts-based research method with potential to elucidate complex narratives in a compelling manner, increase participant engagement, and enhance the meaning of research findings. This method involves the creation of a 3- to 5-min video that integrates multimedia materials including photos, participant voices, drawings, and music. Given the significant potential of digital storytelling to meaningfully capture and share participants' lived experiences, a systematic review of its use in healthcare research is crucial to develop an in-depth understanding of how researchers have used this method, with an aim to refine and further inform future iterations of its use.

METHODS

We aim to identify and synthesize evidence on the use, impact, and ethical considerations of using digital storytelling in health research. The review questions are as follows: (1) What is known about the purpose, definition, use (processes), and contexts of digital storytelling as part of the research process in health research? (2) What impact does digital storytelling have upon the research process, knowledge development, and healthcare practice? (3) What are the key ethical considerations when using digital storytelling within qualitative, quantitative, and mixed method research studies? Key databases and the grey literature will be searched from 1990 to the present for qualitative, quantitative, and mixed methods studies that utilized digital storytelling as part of the research process. Two independent reviewers will screen and critically appraise relevant articles with established quality appraisal tools. We will extract narrative data from all studies with a standardized data extraction form and conduct a thematic analysis of the data. To facilitate innovative dissemination through social media, we will develop a visual infographic and three digital stories to illustrate the review findings, as well as methodological and ethical implications.

DISCUSSION

In collaboration with national and international experts in digital storytelling, we will synthesize key evidence about digital storytelling that is critical to the development of methodological and ethical expertise about arts-based research methods. We will also develop recommendations for incorporating digital storytelling in a meaningful and ethical manner into the research process.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registry number CRD42017068002 .

Reflections on the ethics of participatory visual methods to engage communities in global health research

There is a growing body of literature describing conceptual frameworks for working with participatory visual methods (PVM). Through a global health lens, this paper examines some key themes within these frameworks. We reflect on our experiences of working with with an array of PVM to engage community members in Vietnam, Kenya, the Philippines and South Africa in biomedical research and public health. The participants that we have engaged in these processes live in under-resourced areas with high prevalence of communicable and non-communicable diseases. Our paper describes some of the challenges that we have encountered while using PVM to foster knowledge exchange, build relationships and facilitate change among individuals and families, community members, health workers, biomedical scientists and researchers. We consider multiple ethical situations that have arisen through our work and discuss the ways in which we have navigated and negotiated them. We offer our reflections and learning from facilitating these processes and in doing so we add novel contributions to ethical framework concepts.

Information needs of adolescent and young adult cancer patients and their parent-carers

PURPOSE

This study aimed to explore health-related information needs of adolescent and young adults (AYAs) and their parent-carers and to examine demographic and clinical variables associated with unmet information needs, including patient activation.

METHODS

In a national cross-sectional study, 196 Australian AYAs diagnosed with cancer between 15 and 25 years and within 24 months of diagnosis and 204 parent-carers reported on total and unmet needs for cancer and health-related information. Fifty-one percent of AYAs were male, 81% had completed treatment and 86% were treated in adult hospitals.

RESULTS

AYAs and parents reported high levels of total need for information. The mean number of unmet needs was 5.63 and 6.82 for AYAs and parents, respectively. AYAs reported the highest unmet needs in relation to their cancer (e.g. late effects and cancer recurrence, and having children in the future). The highest unmet parent information needs were related to medical information about their child as well as information on financial issues for their children and themselves. Unmet information need was associated with psychological distress (posttraumatic stress symptoms) for AYAs and parents. Patient activation was negatively associated with unmet information needs for AYAs. Demographic and treatment variables were not significantly associated with information needs.

CONCLUSION

These findings indicate the importance of information needs for AYAs and their carers. The association between patient activation and information needs suggests that promoting young people's engagement with healthcare is a key opportunity within AYA care. Parent information needs and associated emotional distress additionally highlight the importance of family-centered care.

Assessing the effectiveness of Wise Guys: A mixed-methods approach

Previous research with teens raised questions on the validity of survey studies with this population. As one response, our team implemented a mixed-methods study to evaluate an evidence-based, interactive curriculum, Wise Guys, that is designed to promote healthy relationships and sexual behavior in young men 14-17 years of age. The current study included a Youth Advisory Group, focus groups, and a video-journaling project to delineate teens' thoughts on the most salient aspects of Wise Guys and we used these to develop a stakeholder-informed survey instrument. The survey was administered via REDCap, a computer-based medium via phones and mobile devices. Quantitative survey analyses revealed significant positive changes in study constructs. Qualitative interpretations provided rich data that validated the survey findings. Community engagement in the research process and mixed methods may provide the infrastructure for future research and evaluation efforts related to teens.

'Yarning up with Koori kids' - hearing the voices of Australian urban Indigenous children about their health and well-being

OBJECTIVE

Australian Indigenous children experience some of the most substantial health inequalities globally. In this context, research regarding their health and well-being has overemphasised physical illnesses with limited exploration of a diverse range of dimensions and determinants, particularly those based on Indigenous holistic understandings of health and well-being. This deficit-based approach has thus missed many strengths and assets of Indigenous children. This research aimed to gain insight into the perspectives of Indigenous children about their health and well-being in an urban setting in Australia. It joins a limited international literature examining views and experiences of non-majority children.

DESIGN

Participatory and qualitative child-friendly research methods were utilised. The project was developed in partnership with Indigenous community organisations and members. Photo-elicitation activities and focus groups were conducted with 31 Indigenous children aged 8-12 years. Qualitative data were analysed thematically, combining focus group and interview data.

RESULTS

It was evident an urban Indigenous child perspective of health and well-being includes rich understandings of the interconnectedness of physical, social-emotional and cultural dimensions of holism, as well as the integral importance of family and community relationships. The study also found that specific worries regarding loss of loved ones and racism were highly salient in Indigenous children's lives.

CONCLUSION

The overwhelming conclusion to be drawn from this research is that Indigenous children in urban areas need ongoing recognition of both their agency and resilience in the face of adversity, within a wider context of historical and contemporary racialisation and racism.

Photo-elicitation with adolescents in qualitative research: an example of its use in exploring family interactions in adolescent psychiatry

BACKGROUND

Photo-elicitation is a method used increasingly often in qualitative health research, and its positive effect on the research process is well established today. Photo-elicitation appears to facilitate verbalization and insight and to improve relationships between the researcher and participants, thereby enriching the quality of the data collected. Nonetheless, it is barely used at all in the field of adolescent psychiatry. With the aim of exploring the potential of these methods for research with adolescents receiving psychiatric care, we conducted a qualitative photo-elicitation data collection study with this population, asking them about family interactions around food.

METHODS

The data were collected from 15 adolescents and 17 parents during semi-structured interviews in which a photo taken by the adolescent served as the focus of discussion. Data were explored through inductive thematic analysis.

RESULTS

Photo-elicitation played a threefold role in this study: (1) it induced the teens' interest, thought, and pleasure, (2) it played a mediating function during the interviews, and (3) it enabled family interactions to be viewed from the adolescent's perspective. Three themes concerning family interactions were found: (1) parent-child relationship patterns, (2) the functioning of the family group, and (3) the adolescent's individual relation with food, that is, the issue of the adolescent's autonomy.

CONCLUSIONS

Photo-elicitation proved to be an innovative technique in qualitative research in the area of adolescent psychiatry, one that enriched the data and enabled the emergence of new themes in this field, related in particular to the process by which adolescents develop autonomy.

"You've Gotta Be That Tough Crust Exterior Man": Depression and Suicide in Rural-Based Men

Suicide rates in Canada are highest among rural men. Drawing on photovoice interviews with 13 women and two men living in a small rural Canadian town who lost a man to suicide, we inductively derived three themes to describe how contextual factors influence rural men's experiences of depression and responses to suicidal thoughts: (a) hiding depression and its cause, (b) manly self-medicating, and (c) mobilizing prevention. Further discussed is how gender relations and ideals of masculinity within rural milieu can inhibit men's acknowledgment of and help seeking for mental illness issues. Participants strongly endorsed a multifaceted approach to the destabilization of dominant ideals of masculinity that likely contribute to depression and suicide in rural men.

Picturing Masculinities: Using Photoelicitation in Men's Health Research

This article explores the use of photo-elicitation methods in two men's health studies. Discussed are the ways that photo-elicitation can facilitate conversation about health issues that might be otherwise challenging to access. In the first study, researchers explored 35 young men's experiences of grief following the accidental death of a male peer. In the second study, researchers describe 64 fathers' perceptions about their roles and identity with respect to child safety and risk. Photographs and accompanying narratives were analyzed and results were theorized using a masculinities framework. Discussed are the benefits of photo-elicitation, which include facilitating conversation about emotions, garnering insight into the structures and identities of masculinity in the context of men's health. Considered also are some methodological challenges amid recommendations for ensuring reflexive practices. Based on the findings it is concluded that photo-elicitation can innovatively advance qualitative research in men's health.

Visual methods in health dialogues: A qualitative study of public health nurse practice in schools

AIMS

We aimed to explore how using visual methods might improve or complicate the dynamics of the health dialogue between public health nurses (PHNs) and school pupils. This was done from the perspective of PHNs, specifically examining how they understood their role and practice as a PHN and the application of visual methods in this practice.

BACKGROUND

The health dialogue is a method used by PHNs in school nursing in Norway. In this practice, there can be communicative barriers between pupils and PHNs. Investigating how PHNs understand their professional practice can lead to ways of addressing these communicative barriers, which can affect pupil satisfaction and achievement of health-related behaviours in the school context. Specifically, the use of visual methods by PHNs may address these communicative barriers.

DESIGN

The research design was qualitative, using focus groups combined with visual methods.

METHODS

We conducted focus group interviews using a semi-structured discussion guide and visual methods with five groups of PHNs (n = 31) working in northern Norwegian school health services. The data were collected during January and February 2016. Discussions were audio recorded, transcribed and coded into themes and sub-themes using systematic text condensation and drawings were analysed using interpretive engagement, a method of visual analysis.

FINDINGS

Drawings and focus group discussions showed that PHNs perceived their professional practice as primarily a relational praxis. The PHNs used a variety of visual methods as part of the health dialogue with school pupils. This active use of visualization worked to build and strengthen relations when words were inadequate and served to enhance the flexible and relational practice employed by the PHNs.

CONCLUSIONS

PHNs used different kinds of visualization methods to establish relations with school pupils, especially when verbalization by the pupils was difficult. PHNs were aware of both the benefits and challenges of using visualization with school pupils in health education. We recommend the use of visual methods in schools because they are useful for PHNs, other health professionals and teachers working with children and young people in developing relations, particularly where verbal communication may be a challenge.