"My life after stroke through a camera lens"- A photovoice study on participation in Sweden

Experiences of Living With the Nonmotor Symptoms of Parkinson's Disease: A Photovoice Study

BACKGROUND

Nonmotor symptoms (NMSs) are frequently experienced by people with Parkinson's disease (PD) and are often perceived as their most bothersome symptoms. However, these remain poorly understood with suboptimal clinical management. These unmet needs are an important determinant of health-related quality of life (QoL) in PD.

OBJECTIVE

The aim of this study was to gain insights into the experience of living with the NMS of PD in real-time using participatory action methodology.

METHOD

Using the photovoice method, 14 people with PD took photographs to document their experiences of living with the NMS of PD. They composed corresponding written narratives to capture the impact of NMS on their daily activities and QoL. In total, 152 photographs and corresponding narratives were analysed using thematic analysis with an inductive approach.

RESULTS

Four interrelated themes were identified. Emotional well-being and sense of self encompassed a process of adjustment to living with PD. Engaging in valued activities, adopting a positive mindset and utilising coping strategies were thought to enhance confidence and self-esteem. Social support and societal awareness highlighted the importance of supportive relationships and socialising to aid participation and avoid isolation. Barriers to social engagement included the unpredictability of NMS and nonvisible NMS being neglected or misunderstood.

CONCLUSION

Findings demonstrated the far-reaching impact of nonmotor aspects of PD on emotional, occupational and social dimensions. These needs could be addressed through person-centred and comprehensive approaches to care.

PATIENT OR PUBLIC CONTRIBUTION

This study utilised a participatory research approach allowing participants to choose the subjects that mattered to them and how to present their results. Additionally, a group workshop was held with people with PD, their family members and healthcare professionals to guide theme development.

Analysing multimodal data that have been collected using photovoice as a research method

BACKGROUND

Creative arts practice can enhance the depth and quality of mental health research by capturing and foregrounding participants' lived experience. Creative methods are emotionally activating and promote multiple perspectives, tolerating ambiguities and uncertainties, which are shared and even celebrated.

KEY ARGUMENTS

Methods such as photovoice use imagery to elucidate narratives that are not easily captured by more traditional interview-based research techniques. However, the use of creative methods and participatory research remains novel as there is little guidance of how to navigate conceptual, practical, and analytical challenges.

CONCLUSION

This paper considers these challenges, and puts forward practical and theory informed recommendations, using as study of photovoice methods for investigating ethnic inequalities in the use of the mental health act (Co-Pact) as a case study.

Investigating recovery from problem substance use using digital photovoice

This study investigates the complex process of recovery from problem substance use using a visual research method known as 'Photovoice'. Seven service users from a harm reduction drug service were given digital cameras and asked to photograph 'people, places, and things' meaningful to them in their recovery. These photographs were then used as a catalyst for discussion during two in-depth interviews. This study demonstrates the nuanced experiences of recovery as some participants expressed feeling isolated while others reflected upon their access to various forms of social capital. These findings recognise the link between social capital and recovery outcomes, while also reflecting upon how services might imbed the need for relationship quality within artificial recovery networks. The use of photographs is a novel way of providing voice to the lived experience of service users and adds to the discussion and debate concerning how recovery services may develop.

"Pandemic Fatigue! It's Been Going On since March 2020": A Photovoice Study of the Experiences of BIPOC Older Adults and Frontline Healthcare Workers during the Pandemic

The coronavirus disease 2019 (COVID-19) pandemic intensified the stressful and already difficult circumstances of communities of color. Yet, there is no current photovoice research highlighting the lived experiences of these communities from two perspectives-the older adults (OAs) and the frontline healthcare workers (FLHWs). This qualitative study used photovoice to visually portray the struggles of Black, Indigenous, and persons of color (BIPOC) OAs (n = 7) and younger FLHWs (n = 5) who worked with older adults during the pandemic and how they coped and recovered from the challenges of the pandemic. The investigators conducted a three-day training of ten research assistants (RAs) who were paired with either an OA or an FLHW for the photovoice sessions conducted in four stages. Upon examination of the narratives, focus group transcriptions, and photo stories, it became clear that participants faced different challenges during the pandemic, such as the fear of COVID-19 exposure, struggles to adopt COVID-19 mitigation strategies, workplace challenges, and social isolation. Amid this crisis of suffering, isolation, and sadness, participants employed two major strategies to deal with the challenges of the pandemic: positive reappraisal and self-care practices. The findings have implications for clinical social workers, mental health counselors, faith communities, nurse managers and administrators, and policymakers.

The acceptability of photovoice as a method for incorporating resilience-enhancing factors into pediatric pain research

Recurrent or chronic pain affects 11–38% of children and adolescents. Pediatric pain research typically focuses on risk factors, such as anxiety and parent functional disability, but resilience-building, protective factors also play an important role in the pain experience. New methods to incorporate resilience-enhancing factors into pain research are needed. Photovoice is a highly participatory research method, where participants take photos to address a common question, caption their photos, and discuss the meaning of the photos in a group. The main objective of this study was to determine whether photovoice is an acceptable method to young people living with chronic pain for identifying and sharing sources of joy. Another objective was to explore sources of joy. Sixteen adolescents and young adults participated, which involved meeting in a group to discuss the goal of the study, taking photographs of self-identified sources of joy over a two-week period, and meeting as a group again to discuss the photographs and participate in a focus group about the experience. Results suggest that photovoice is an acceptable method, as all participants took photographs and attended both meetings, and three themes from the focus group data suggested the participants considered photovoice to be appropriate: 1.) Relief associated with meeting peers, 2.) Potential to benefit young people living with pain, and 3.) Potential to raise awareness. Three themes emerged from the discussion of the photographs to describe sources of joy: 1.) Gratitude for everyday pleasures and accomplishments, 2.) Support from pets, and 3.) Journey of acceptance. Results add to the strengths-based literature on pediatric pain by identifying an acceptable method that could be further explored for use as an intervention to enhance protective factors such as positive affect, gratitude, and social support and to compare the experiences of different populations of youth living with pain.

"Back into Life-With a Power Wheelchair": Learning from People with Severe Stroke through a Participatory Photovoice Study in a Metropolitan Area in Germany

Severe stroke leads to permanent changes in everyday life. Many stroke survivors depend on support in community mobility (CM). This leads to restrictions and limited social participation. A power wheelchair (PWC) can enable independent CM and reduce such restrictions. This participatory study focused on how people with severe stroke experience their CM in a PWC in Berlin/Germany and what changes they want to initiate. A research team of five severe stroke survivors and two occupational therapists examined the question using photovoice. Stroke survivors took photos of their environment, presented, discussed, and analyzed them at group meetings to identify themes, and disseminated their findings at exhibitions and congresses. The photos emphasize the significance of and unique relationship to the PWC for the self-determined expression of personal freedom. As a complex, individualized construct, CM requires an accessible environment and diverse planning strategies by PWC users to arrive at their destination and overcome suddenly occurring obstacles. Desired changes stress CM independent of external help, increased social esteem, and active involvement in the provision of assistive devices. Voices of severe stroke survivors need to be heard more in healthcare and research to ensure the possibility of equal social participation.

Co-creating Digital Stories With UK-Based Stroke Survivors With the Aim of Synthesizing Collective Lessons From Individual Experiences of Interacting With Healthcare Professionals

Background

Stroke survivor narratives can provide valuable insight into experiences of healthcare and beyond. There is need to further understand collective lessons from stroke survivor narratives, yet prior studies utilizing digital storytelling tend to not synthesize lessons from individual experiences. This study aims to develop a novel method to co-create digital stories with stroke survivors that will aim to synthesize and portray important collective lessons from individual stroke survivors' experiences of interacting with healthcare professionals.

Methods

This study follows-up a qualitative study conducted with 30 stroke survivors exploring factors that help or hinder survivors to positively reconfigure their identity post-stroke. Five co-creation workshops were conducted with a subset of UK-based stroke survivors from this previous study. Participants were invited to join through: online workshops, an online bulletin board, and as an advisor. A four-stage workshop framework was developed through the integration of UK Design Council's Double Diamond method, digital storytelling strategies and the Behavior Change Wheel (BCW) framework for developing behavioral change interventions.

Findings

Six online workshop participants (three male, three female; aged 33–63; time since stroke 2–16 years) co-created digital stories that share six collective lessons aimed at increasing empathy and encouraging behavior change in healthcare professionals (HCPs) working with stroke survivors. Online bulletin board participants (n = 1) and advisors (n = 5) supported the co-creation process. Collective lessons identified were: (1) Stroke has a variety of symptoms that must all be considered; (2) Stroke can affect anyone of any age and not just the elderly; (3) Assumptions should not be made about a survivor's lifestyle or habits; (4) It is important to acknowledge the person behind the stroke and ensure that they are communicated with and listened to; (5) Stroke survivors can often feel unprepared for the reality of life after stroke; (6) Adapting to life after stroke is a long-term process requiring long-term support.

Conclusion

Stroke survivor stories highlighted preconceptions, attitudes and behaviors embedded within healthcare that negatively impacted their experiences and recovery. The novel methodology employed in this study enabled these stories to be synthesized into collective lessons to bring about improvements in these behaviors in future.

Finding "Zen" in Aphasia: The Benefits of Yoga as Described by Key Stakeholders

PURPOSE

Recently, the literature has witnessed a surging interest regarding the use of mind-body approaches with people who have aphasia, generating a plethora of possible outcome measures. During this same time, a core outcome set for aphasia has been recommended. The purpose of this clinical focus article is to give our survivor, co-survivor, and clinician stakeholder coauthors a platform to share their personal narrative regarding their yoga journey, with the goal of identifying primary outcome domains central to capturing the impact of yoga on the recovery process for people with poststroke aphasia. Ultimately, we hope this clinical focus article helps clinicians understand how yoga might benefit their patients and draws attention to potential outcome measures, while also highlighting the important fact that traditional aphasia assessments do not capture the improvements stakeholders pinpoint as crucial to the essence of mind-body interventions.

METHOD

This clinical focus article summarizes the case reports of Terri's and Chase's poststroke yoga journeys using the power of personal narrative and an adapted photovoice method. Additional stakeholders share in this storytelling process, using a variety of narrative tools. As this story is unveiled, several patient-identified outcome domains are highlighted as essential to document the impact of yoga on survivors.

RESULTS

Terri's and Chase's yoga journeys revealed the multifaceted impact of yoga on five domains: (a) feelings of wholeness and "zen," (b) increased attentional capacity for language tasks, (c) increased verbal fluency, (d) decreased pain, and (e) relationship mutuality.

CONCLUSION

Team Yoga realized that the practice of yoga-whether as a stand-alone practice or integrated into therapy sessions-fosters feelings of wholeness or "zen," which likely correlates with decreased pain with a simultaneous increase in resilience and flexibility of coping strategies to manage the host of chronic poststroke challenges. Supplemental Material https://doi.org/10.23641/asha.17003464.

Empowering Maasai women behind the camera: Photovoice as a tool for trachoma control

BACKGROUND

Photovoice is a method used to help engage community members to understand local realities and promote social change. Photovoice uses cameras in the hands of participants as a tool to visually document a specified topic. Photos taken by participants allow for reflection and stimulate dialog on an issue to ideally lead to social change. Trachoma, hyperendemic in Maasai communities in Northern Tanzania, is the commonest infectious cause of blindness worldwide, caused by chlamydia trachomatis. The bacterial infection commonly occurs in childhood and over many years repeated infections leads to inflammation and scarring of the eyelid. Often as adults this leads to the upper eyelid turning inward and eyelashes scratching the eye, resulting in pain and eventually blindness. We used photovoice as a tool for Maasai women to share their lived experiences of educating peers on trachoma and ultimately empowering women in this society.

METHODS

This public engagement intervention was conducted September thru October 2017. We held a workshop on trachoma control for 20 Maasai women including use of photovoice method. Women were asked to disseminate information from the trachoma control workshop to their community and to capture their experiences using disposable cameras. Five weeks post-workshop we facilitated a discussion and women displayed photos of the successes and challenges they encountered as advocates for trachoma control in their community.

INTERVENTION OUTCOMES

It was observed throughout the process and at the photo discussion meeting, that women articulated empowerment by this experience; as educators, agents of change and a source of valued information.

CONCLUSION

Photovoice should be considered for future interventions as a communication tool on health issues and to empower women to be ambassadors for health promotion.

Participation profiles among Chinese stroke survivors: A latent profile analysis

Objectives

To investigate the current status of participation and explore the characteristics of individuals with different levels of participation among stroke survivors in mainland China.

Design

Cross-sectional survey.

Setting

Participants were recruited by convenience sampling from the neurology department of the tertiary hospitals and communities.

Subjects

Stroke survivors (N = 517; mean (±SD) age, 69.97±11.51 y; 36.8% female).

Intervention

Not applicable.

Main outcome measures

Participation was measured using the Chinese version of the Impact on Participation and Autonomy Questionnaire (IPA). Rating of disability was assessed using the Modified Rankin Scale (mRS). The Perceived Social Support Scale (PSSS), the Medical Coping Modes Questionnaire (MCMQ), and the Herth Hope Scale (HHS) were also employed to measure social support, coping strategy, and hope of stroke survivors. The latent profiles analysis (LPA) was conducted using the Mplus version 8.3.

Results

The mean score of participation was 41.21±21.204. Participants were divided into three groups according to the participation using the LPA. The mean score on the sum of IPA for the high, medium, and low participation groups was 18.93±8.529, 42.50±8.302, and 69.44±9.516, respectively.

Conclusions

Stroke survivors have a low level of participation. Stroke survivors with low income, high mRS stage, bad health condition, and being dissatisfied for life tended to have low participation. Healthcare professionals should pay special attention to them and make targeted interventions based on their characteristics.