As I read Sarah Pink’s groundbreaking text, Doing Visual Ethnography (3rd ed., 2013), I’ve been starting to think about a key question: If I have participants do visual ethnography (i.e. some kind of participant-elicited photography)…what am I going to do with the photographs? Also important: how will I make them meaningful/illuminate their meaning and be ethical in this process? (Luckily, I’m trained in the humanities, so the idea treating research participants like humans and respecting them as such comes very naturally to me. According to Pink, this is not always the case…especially when people try to do creepy shit like film or photograph people without their awareness or consent). I was looking through various starts/stops (i.e. “drafts”) of my prospectus (notes) and saw that I had noted at some point that I thought that having participants create digital stories based on their images would be a contentious, aesthetically pleasing, and possibly useful way to compile and display their images. From what I’ve read so far of Pink’s book, visual ethnography can and SHOULD vary greatly based on the sites and historical moments in which research takes place. Apparently, what counts as “visual ethnography” is rather broad (or at least much more expansive than what I was expecting). It can range from compiling photographs and film that participants have already taken and doing an analysis, researcher as photographer, participant as photographer (I think this is called participant-elicited?), and everything in between. Pink place the most emphasis, however, on having reflexivity be part of the research method, since no research method is ever completely “objective” anyway. This claim assuages my fears about claiming some of the same identity groups as some of my potential participants and the pressure for “objectivity” that often remains present in the social science research I’ve read thus far….
Okay, back to digital storytelling. In short: what if I had my participants “do” visual ethnography with me (I’m thinking that, like any good workshop leader, I’ll also do the study?) as a means of putting together a digital story that might reveal unspoken, invisible, and/or un- or under-recognized experiences (and visuals?) of illness. I met with Dan yesterday, and he suggested that I put together a very specific (workshop-style, now that I think about it) project trajectory. This might look like:
I ask interview participants, ask them to capture the following images, and then put together a workshop where everyone talks/things/composes their images into a digital story.
- Week 1: Take 7 photographs of your environment to document how it affects your illness/condition, and do 5 minutes of free-writing about the images and the situation (so that you can remember it).
- Week 2: Take 7 photographs of your own body (“selfies”?) to document how it affects your illness/condition, and do 5 minutes of free-writing about the images and the situation (so that you can remember it).
- Week 3: Take 7 photographs of the other people who are part of your illness experience to document how they affect your illness/condition, and do 5 minutes of free-writing about the images and the situation (so that you can remember it).
- Week 4: Workshop.
- Week 5: Workshop.
- Week 6: Workshop.
Now, there’s still a lot of thinking to do about these “tasks.” For instance, what are the ethics of asking my participants to photograph other people as part of their story? Do I need to consent ALL of these people? This makes me think about Jen’s forthcoming book chapter in which she talks about how, for rhetorical research methods in situ, vulnerable subjects are relative based on the specific situation and environment.
What’s on my side, I think, is that (according to my google scholar investigations), there have been many successful (i.e. IRB approved) studies that have used visual ethnography to study health and medicine. (Barbara Harrison’s 2002 review article, “Seeing health and illness worlds – using visual methodologies in a sociology of health and illness: a methodological review” has given me a lot of confidence). The two paragraphs below, drawn from the introduction to “Visualizing harm reduction: Methodological and ethical considerations,” a 2015 article by Switzer et al. from Social Science and Medicine, have also proved to be exceptionally helpful. I think this is one of the key *conversations* that I’d like to join!
The use of visual methods is becoming increasingly common and accepted in health research (Fraser and al Sayah, 2011 and Mitchell, 2011). Photography has emerged as a particularly popular visual medium wherein researchers use images to elicit conversation with/or amongst participants; as data artefacts ripe for analysis; as a way of documenting the research process; and/or as a dissemination tool (Weber, 2008). Photography has been used in health intervention research (Shinebourne and Smith, 2011), clinical nursing research (Riley and Manias, 2004); epidemiological research (Cannuscio et al., 2009); and community-based participatory research (CBPR) (Catalani and Minkler, 2010). However, how and why health researchers use photography varies significantly depending on the study, context, and disciplinary frames of the researchers. While there are a number of source books documenting different ways of selecting a visual method (Knowles and Cole, 2008, Margolis and Pauwels, 2011 and Rose, 2012), literature merging both theoretical and applied approaches to visual methods in community-based health research is limited (for a notable exception see Castleden et al. (2008) and Drew and Guillemin (2014)), especially when it comes to CBPR in clinical spaces. Systematic reviews on arts-based methods in health research (Boydell et al., 2012, Catalani and Minkler, 2010 and Fraser and al Sayah, 2011) have noted that researchers employing visual or arts-based methods often fail to describe how they arrived at methodological decisions, leading to a field that Fraser and al Sayah describe as lacking “theoretical clarity.” Similarly, as Mitchell (2011) explains in a chapter onlooking at looking, studies using visual methods most often report on the “products” of research or the stories embedded in the art work (e.g., this is what the photos show us) however, community-based visual researchers should be encouraged to examine the way participants engage with photographs, or the act of photography itself, especially in the context of HIV CBPR where the principles of meaningful community engagement are paramount ( Flicker et al., 2008 and Israel et al., 1998).
This paper explores the opportunities and constraints of using photo-based methods in the context of a CBPR study on how to engage people living with HIV (PLHIV) in conversations about a hospital’s recently introduced harm reduction policy. We discuss our team’s process of selecting, implementing and modifying photovoice – a method in which participants are given cameras and asked to identify and represent issues and solutions in their community – with photo-elicited interviews. In particular, we reflect on key methodological insights from the study to think through the process of doing photo-based work on a stigmatized topic in a small hospital setting. We begin with a description of the research study and setting, a sub-acute HIV hospital in Toronto, Canada; our initial rationale for selecting photovoice as a methodology; and our subsequent adaptations to meet both study- and importantly, community-needs. We foreground the opportunities and constraints of engaging with photo-based methods in our study by highlighting the following: 1) how the act of taking photos assisted participants in visualizing connections between space, harm reduction, and substance use; 2) expectations of participation and navigating daily health realities; 3) issues of confidentiality, anonymity and stigma in clinical settings. Together, these methodological insights allow us to re-think issues of context when applying photography in health research. Rather than viewing context as a neutral backdrop to apply a method (are arts-based methods appropriate?), context should be viewed as an active force in shaping what can or cannot be done or produced within the space (Duff, 2007). These reflections respond to a call by Castleden et al. (2008) for researchers to thoroughly explain how and why visual methods were selected and implemented so that visual methods can be assessed for rigor.