Photovoice is a participatory-action method developed by Caroline Wang and Mary Ann Burris in 1994.1 It is a process in which people capture their everyday experiences from their own perspectives using photography. Participants discuss their photos in a group, thereby highlighting issues that are of greatest importance to them, individually and collectively. Finally, participants communicate those important issues to people in power to create change or awareness. Photovoice is a type of participatory-action research because it involves the effected group in the research process including data collection and dissemination of results.2 In this way, participants are empowered to take action to improve their own health or experience.
We were drawn to Photovoice because it places the power in the hands of the individual, not the researcher.3,4 Photovoice, as a method, takes the stance that the person with lived experience in the phenomenon under study is the expert.5
Photovoice has theoretical underpinnings in Paulo Freire’s education for critical consciousness, feminist theory, and community-based documentary photography. Freire’s critical consciousness emphasizes the importance of people speaking from their own experience, critically analyzing current situations to develop deeper understanding, and formulating solutions to their problems.6 Feminist theory argues that power accrues to those who have a voice, make history, and participate in decisions.7 Community-based documentary photography approaches emphasize a grassroots approach to representation of present realities and the use of photography as a personal voice.8,9 Photovoice combines these theoretical perspectives to empower individuals and groups who traditionally do not have a voice by placing a camera in their hands and asking them to share their reality on their terms while giving them a platform to share this perspective. In our case, the person who has been prescribed mental illness medication is the expert on medication experience with psychotropics. As such, use of Photovoice in this context creates the potential to explore aspects of a phenomenon unknown to the researcher.
Photovoice can remove some of the biased lens that a researcher would bring to a topic of study. For example, if you wanted to study medication experience using a survey, you might gather input from a focus group of individuals taking medications, but ultimately, you as the researcher would choose the main themes about which to gather information and would design and choose the questions you thought best fit what you wanted to know. Conversely, when employing Photovoice, the researcher hands over control to the participants who choose the aspects of the topic that will be focused on and further explored as they highlight them with their photographs and reflections. This lends itself to an authentic discovery of the topic and its nuances and a collective voice from those who know it best.
With Photovoice, the person with the lived experience is empowered to make it visible to others by using photographs and reflection. Photovoice was designed to give a voice to groups that traditionally do not have a voice—those who are marginalized, underserved, ignored, or do not have the capacity or power to speak up for themselves. Individuals living with a mental illness may fit this description. We also believed that the perspective of the individual with mental illness on this topic had not previously been sought in a way that empowered them to share freely. Hence, we decided to study the experience of living with mental illness medication using Photovoice method.
When using the Photovoice method participants capture photos that reflect their lived experience and then reflect on those photos. Participants reflected on each photograph using the SHOWED technique10 (see table) to guide reflection about each photo.