Developing Action Plans in Youth Photovoice to Address Community-Level HIV Risk in Rural Malawi

"PrEP a double-edged sword": Integrating implementation science methodology with Photovoice to guide culturally-tailored pre-exposure prophylaxis (PrEP) programs for Latino/a and non-Latino/a men who have sex with men in South Florida

BACKGROUND

DiversiPrEP is a culturally-tailored PrEP program for LMSM offered in South Florida. DiversiPrEP navigates LMSM through their PrEP journey, including education, deciding if PrEP is relevant for them, payment, and accessing/maintaining PrEP use. DiversiPrEP includes five ERIC strategies (Increase Demand, Promote Adaptability, Alter Client Fees, Intervene with Clients to Enhance Uptake and Adherence, and Tailor Strategies).

DESCRIPTION

Photovoice was used to conduct five two-part focus groups with LMSM (n = 12) and Non-LMSM (n = 12). In the first session, trainers provided guidance on selecting and contextualizing photos to generate CFIR themes. Then, participants captured photos that embodied their lived experiences accessing PrEP. In the second session, using SHOWeD, participants discussed photos, identifiedhow photos relate to culturally relevant issues. Triangulation approaches compared/contrasted themes between LMSM and Non-LMSM.

RESULTS

Five central themes emerged around barriers and facilitators to PrEP services: 1) the need for normalizing PrEP messages within the MSM community, 2) the need for normalizing PrEP messages outside the MSM community, 3) the need for expanding PrEP knowledge, 4) different motivations for using PrEP, and 5) the presence of structural barriers that limit PrEP access. This study compared similarities and differences of barriers and facilitators to PrEP use between Latino/a and non-Latino/a MSM. Similarities included the built environment (outer setting) as a barrier, the need for normalizing PrEP messaging within and outside of the MSM community, and the need to expand PrEP knowledge. Differences between Latino/a and non-Latino/a MSM were found in assessing the motivation and personal drivers (inner setting) for initiating PrEP associated with how participants viewed their responsibilities to self or others.

CONCLUSIONS

Photovoice with focus groups identified CFIR constructs that can guide the large-scale implementation of a client-centered PrEP service model with telehealth for both Latino/a and non-Latino/a MSM. Implementing client-centered accessible PrEP programs is an essential step to promoting sexual-health equity.

Ethical Issues in Photovoice Studies involving Key Populations: A Scoping Review

Photovoice, a community-based participatory research method, employs images and words to convey participants' needs, concerns, and desires. It proves particularly valuable in researching marginalized communities who face elevated health risks, disease transmission, and social and health disparities. This paper seeks to investigate the ethical considerations inherent in photovoice research projects. We conducted an extensive literature review spanning four databases to identify pertinent photovoice studies. Ethical issues from the selected articles were identified, categorized, and summarized. Our analysis of twenty-five photovoice studies uncovered various ethical concerns, which had been grouped into informed consent, participant safety and disclosure, privacy and confidentiality, misrepresentation, power dynamics, and compensation. In essence, our findings underscore the importance of addressing these ethical concerns to uphold the rights and autonomy of participants, even as photovoice research strives for authenticity, inclusivity, and empowerment.

Using Photographs to Understand the Context of Health: A Novel Two-Step Systematic Process for Coding Visual Data

In qualitative research, photographs and other visual data have been used with oral narratives in ethnography, interviews, and focus groups to convey and understand the perceptions, attitudes, and lived experiences of participants. Visual methodologies that incorporate photographic data include photo elicitation, which has varied approaches with the inclusion of photographs generated by researchers or participants, and Photovoice, which is a form of photo elicitation focused on participatory action research. Current literature provides insufficient guidance on a systematic coding process of visual data elements that could maximize capturing of visual data for qualitative analysis. We describe our rationale and process for developing a two-step systematic process for coding visual data, specifically photographs. The two-step systematic process for coding photographs involves coding the foreground (focal point) and then the background of the photograph, using separate codebooks. Application of this two-step coding approach resulted in surfacing additional rich data on the health-related contexts and environments in which participants lived. Incorporation of this methodology could enhance understanding of the context of health and generate ideas and new directions of inquiry.

Social ecological resources for youths living with HIV in western Uganda

Introduction

The adversities faced by youths living with HIV (YLWH) are manifold, resulting not only from the health impact but also from society's response to HIV and the people living with it. This study sought to explore these youths' perceptions and representations of what promotes resilience.

Methods

Photovoice methodology was chosen to elicit first-person accounts that are grounded in lived experience and experiential knowledge. Eleven young people, boys and girls aged 14-21 living in western Uganda, participated in seven group sessions aimed at imagining, producing and discussing visual stories about what fosters resilience in the face of HIV-related adversity. The visual stories were subjected to inductive content analysis by the participants, and then thematically analyzed and interpreted by the researchers using the theoretical framework of social-ecological resilience.

Results

We found that participants experience well-being amidst HIV-related adversity through managing tensions in material resources, sense of identity, power and control in their lives, cultural adherence, relationships, sense of cohesion and social justice.

Discussion

The findings add to the body of knowledge on youth resilience in Sub-Saharan Africa by documenting multisystemic resources for YLWH in Ugandan communities. The findings further show that resources are highly incidental and situational, neither widely available nor structurally embedded in society. The study therefore informs the global HIV/AIDS agenda to spur ecologies of resilience around YLWH.

Acceptability and Feasibility of Online, Asynchronous Photovoice with Key Populations and People Living with HIV

Photovoice is an action-oriented qualitative method involving photography and story-telling. Although photovoice yields a powerful form of data that can be leveraged for research, intervention, and advocacy, it has arguably been underutilized within HIV research. Online, asynchronous photovoice methods represent a promising alternative to traditional in-person methods, yet their acceptability and feasibility with key populations and people living with HIV (PLWH) have yet to be explored. The current study describes the methods and evaluation of an online, asynchronous photovoice project conducted with 34 members of key populations and PLWH in Malaysia in 2021. A HIPAA-compliant website incorporating a series of instructional videos was created to facilitate participant engagement and data collection. Quantitative and qualitative indicators suggest that participants found the project to be highly acceptable and feasible. Online, asynchronous photovoice methods hold potential for increasing the scale of this powerful and versatile qualitative research method with key populations and PLWH.

Participatory Action Research for Adolescent Sexual and Reproductive Health: A Scoping Review

Introduction: Youth-friendly sexual and reproductive health (SRH) interventions are essential for the health of adolescents (10–19 years). Co-designing is a participatory approach to research, allowing for collaboration with academic and non-academic stakeholders in intervention development. Participatory action research (PAR) involves stakeholders throughout the planning, action, observation, and reflection stages of research. Current knowledge indicates that co-producing SRH interventions with adolescents increases a feeling of ownership, setting the scene for intervention adoption in implementation settings. Objectives: This scoping review aims to understand the extent of adolescents’ participation in PAR steps for co-designed SRH interventions, including the barriers and facilitators in co-designing of SRH intervention, as well as its effectiveness on adolescents’ SRH outcomes. Methods: Database searching of PubMed, Medline, Embase, CINAHL, Scopus, Web of Science, Google Scholar, and organisational websites was performed, identifying 439 studies. Results: Upon screening, 30 studies (published between 2006–2021) met the inclusion criteria. The synthesis identified that adolescents were involved in the planning and action stages of the interventions, but not in the observation and reflection stages. Although the review identified the barriers and facilitators for co-designing SRF interventions, none of the included studies reported on the effectiveness of co-designing SRH interventions with adolescents; therefore, meta-analysis was not performed. Conclusions: While no specific outcome of the interventions was reported, all papers agreed that adolescent co-designing in ASRH interventions should occur at all stages to increase understanding of local perceptions and develop a successful intervention.

"Youth Photovoice": Promoting Youth-Driven Community Changes for HIV Prevention in Rural Malawi

ABSTRACT

To meet the Joint United Nations Programme on HIV/AIDS global goal of no new HIV infections by 2030, it is imperative to reduce new infections among youth. Youth Photovoice was a 10-month, participatory, community-action research project developed to engage rural Malawi youth in an HIV prevention project focused on community-level outcomes. In this study, we describe how participants in Youth Photovoice engaged adults and community leaders to implement action plans, as well as the community and individual changes that occurred as a result of these collaborative efforts. Youth Photovoice participants, their parents, and local leaders in the community participated in focus groups and individual interviews. Community-level changes, such as moving initiation ceremonies to churches and changes to local business practices, were observed, along with increased community and parental involvement in youth monitoring for local events and activities. This youth-led project led to changes in the community environment that reduced exposure to situations supporting unsafe sex, uncovered ways that youth can lead collaborations with adults, and informed the implementation of plans for community action.