My blog post summarises a recently published systematic scoping review by Stephens and colleagues (2023), which explores the use of Photovoice within mental health research involving adolescents.
Background
Photovoice, a research method developed by Wang and Burris (1997), combines photography and narrative (Mooney & Bhui, 2023), as illustrated in Figure 1. Photovoice has emerged as a powerful tool for researching adolescent mental health (Kaushik et al., 2016). Photovoice enables participants to express themselves visually, providing unique emotional and metaphorical insights less accessible to other traditional research methods (Wass et al., 2020). An example of the data collected by adolescents involved in Photovoice studies is illustrated in picture one. Photovoice emphasises a democratic approach (Kimera & Vindevogel, 2022) by engaging adolescents in data collection and analysis (Golden, 2020). Through this process, Photovoice studies teach what participants perceive as significant regarding their concerns and priorities, creating change by shaping policy (Smith et al., 2023). Despite adolescents’ enthusiasm towards Photovoice (Wass & Safari, 2020), its use in adolescent mental health research remains underexplored (Butschi & Hedderich, 2021). Stephens and colleagues (2023) conducted a scoping review to remedy this lack of evidence, which explored the main themes across findings of Photovoice studies included in our review.
Figure 1 – Photovoice can produce insights that are less accessible compared to other research methods.
Quality Appraisal
Our scoping review appraised the quality of twelve studies that met our review’s eligibility criteria. None of the studies met the criteria for “good” quality, but we rated the majority as “moderate” reporting quality, with some falling into the “poor” category. These drawbacks relate to recruitment, data collection, and reflexivity. Despite these issues, most studies defined their aims, used suitable qualitative methods, employed relevant designs, and managed ethical concerns.
Common themes among findings of Photovoice studies exploring mental health among adolescents
Struggle can give strength and a sense of belonging
Key subthemes elicited across the study findings related to adolescent experiences of coping, resilience, and self-perception. For instance, an adolescent in Bashore and colleagues’ (2017) study used musical instruments to relieve stress, while an adolescent in Rose and colleagues (2018) recognised coping as a distraction.
Furthermore, adolescents in Orth and van Wyk’s study (2022) showcased resilience by visually expressing their acceptance using a rain photo, while an adolescent in Liegghi’s (2016) study highlighted their resilience using a photograph of a skull drawing.
Conversely, adolescents in Dempsey’s (2016) and Georgievski and colleagues’ (2018) study revealed negative beliefs’ impact on depression, influenced by loneliness and cancer experiences. Similarly, Woodgate and colleagues (2021) associated self-perception with anxiety and depression, using a stop sign photo to convey stagnation. However, adolescents in Northwest Michigan’s Behavioral Health Initiative (2021) stressed the importance of believing “you are not alone” in combating negative beliefs towards mental ill-health.
Overall, adolescents creatively represent coping mechanisms for depression, anxiety, loneliness, and cancer. Additionally, social support is highlighted as crucial for negating negative beliefs and fostering unity.
Family and friends provide hope and (mis)understanding
Our review found family and friends as essential subthemes across the study findings. For instance, Orth and van Wyk (2022) found that a participant’s sibling provided a sense of purpose and hope to an adolescent, illustrated through a photo and the sentiment, “When I look at her, there is a moment that I want to be myself.” (Page 1438). Similarly, Bowers and Wozniak’s (2020) project emphasised the support friends provided to adolescents, evidenced in an adolescent’s photograph’s caption: “Friends are always there to lend a hand or an ear when you need it.”
Notably, Velez-Grau’s (2019) study revealed differences in how adolescents and their families understand mental health, with one adolescent describing it as a ‘one-way road.’ Furthermore, Wainaina’s (2021) research showcased the complex dynamics of adolescent friendships, where friends may not fully comprehend a situation but can still provide hope, highlighting the potential strains or strengths in such relationships.
Feeling safe and the challenges of poverty
Our review revealed safety and socio-economic challenges as common subthemes across the study findings. For instance, an adolescent in Dempsey’s (2016) study attributed living near danger to an increased risk of depression, while adolescents in Woodgate and colleagues’ (2021) explored the difficulties of leaving perceived safe areas. Furthermore, an adolescent in Watson and Douglas’ (2012) study discussed anxiety around an ‘unsafe’ bridge. Similarly, adolescents in Wainaina and colleagues’ study (2021) described the stress of living in an informal settlement via a photo of a precarious building. Conversely, Northwest Michigan’s Behavioral Health Initiative (2021) participant highlighted community safety through empathy, support, and respect.
Treatment and the clinical environment influence perceptions of personhood.
Our review noted treatment and the clinical environment as subthemes across the study findings.
For example, Orth and van Wyk (2022) depicted an adolescent’s experience of HIV medication, expressing that she was ‘beautiful’ and ‘strong’ through a photo of a flower. An adolescent in Liegghio’s study showcased a monitored door in a mental health facility, reflecting the prevalent observation practice.
Furthermore, adolescents in Velez-Grau’s (2019) study indicated frustrations around treatment compliance, with an adolescent stressing the importance of being directly involved in discussions about their mental health care rather than through their parents.
Key themes elicited across findings of Photovoice studies are rich, nuanced and complex.
Going forward
Our review’s findings have new insights exploring the findings produced by a novel method, Photovoice, which can advance the understanding of adolescent mental health among critical stakeholders, including parents, educators, therapists, and policymakers. Our findings are emotive and highlight the complexities of adolescent mental health using a method that emphasises adolescents’ perspectives. The relevancy of our findings has the potential to impact practice and should be used to inform better policies aimed at bolstering adolescents’ resiliency to mental illness.
Our research demonstrates the insightful and nuanced findings produced by adolescents engaging in Photovoice studies within the mental health field. Photovoice allows for ideas to be disseminated more effectively than traditional methods using words alone (Teti et al., 2021), potentially challenging the mental health research status quo with adolescents. Our review also emphasises the importance of involving adolescents in mental health research equitably and creatively. It is essential, given their underrepresentation in this field (Mawn et al., 2016).
Our findings provide new insights derived from a novel method that has the potential to deepen our understanding of adolescent mental health.
Strengths and limitations
Our groundbreaking review filled a significant gap in adolescent mental health research by scoping the application of Photovoice. Our comprehensive review involved diverse studies, experts, and a rigorous synthesis procedure. Despite thorough quality appraisal, our review has limitations, including limited generalisability, the use of pre-extracted data, which may hinder replication, the inclusion of published studies, which may promote publication bias, and the low quality of some studies, which affects the inferences made by our review.
Conclusion
Our review has shown that Photovoice is valuable in exploring key influences affecting adolescents’ mental health by promoting unique perspectives. Photovoice’s strength is representing and empowering participants and showcasing opposing views concurrently. Our review is a guiding example for future mental health research in a landscape with few adolescent Photovoice studies. Researchers embracing Photovoice can establish inclusive practices, amplifying participant perspectives and reshaping society’s understanding of adolescent mental health.
Our review is an example for future Photovoice research or projects emphasising adolescents’ inclusivity.
Conflict of interest
I am the primary author of this blog and led the systematic review alongside the co-author. I wrote it as part of my doctoral studies, for which I received a stipend from the London Interdisciplinary Social Science Doctoral Training Partnership.
References
Stephens, M., Keiller, E., Conneely, M., Heritage, P., Steffen, M., & Bird, V. J. (2023). A systematic scoping review of Photovoice within mental health research involving adolescents. International Journal of Adolescence and Youth, 28(1), 2244043. https://doi.org/10.1080/02673843.2023.2244043
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Bowers, A., & Wozniak, M. (2020). How to Reduce Stress. https://www.canr.msu.edu/washtenaw/uploads/Abby% 20Bowers%20and%20Margaret%20Wozniak%20-%20How%20to%20Reduce%20Teen%20Stress.pdf
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Watson, M., & Douglas, F. (2012). It’s making us look disgusting . . . and it makes me feel like a mink . . . it makes me feel depressed!: using photovoice to help ‘see’ and understand the perspectives of disadvantaged young people about the neighbourhood determinants of their mental well-being. International Journal of Health Promotion and Education, 50(6), 278–295. https://doi.org/10.1080/14635240.2012.723379
Woodgate, R. L., Tennent, P., & Legras, N. (2021). Understanding Youth’s Lived Experience of Anxiety through Metaphors: A Qualitative, Arts-Based Study. International Journal of Environmental Research and Public Health, 18(8), Article 8. https://doi.org/10.3390/ijerph18084315
NB this blog has been peer-reviewed