Using Photovoice to Examine and Initiate Youth Empowerment in Community-Based Programs : A Picture of Process and Lessons Learned

Photovoice is a creative, participatory action research method that puts cameras in the hands of people whose voice is often hushed by the power elite, such as youth, to document issues and concerns as perceived by that group. Adult society provides youth few opportunities to positively influence the laws and regulations that govern their lives or the policies of programs in which they participate. Communitybased programs are one channel for youth to gain skills and opportunities for changing the community context in which they live. Mechanisms to facilitate youth empowerment in these programs, however, are currently vague and imprecise. Photovoice was implemented in two community-based youth programs in South Carolina to examine and initiate youth empowerment in those communities. This article details the process and lessons learned from conducting Photovoice with youth in out-of-school, community-based youth program settings. While roadblocks appeared for both the youth researchers and the universitybased investigative team, the Photovoice method was embraced by the youth who participated in the research process. Some challenges the investigative team experienced for implementation included geographic distance between the Photovoice project facilitator and the youth, challenges of working with youth and their competing commitments, an uncertainty of youth expectations, and underestimation of time and other resources. © 2006 Californian Journal of Health Promotion. All rights reserved.


Introduction
Youth today have few occasions to positively influence the laws and regulations that govern their lives or the policies of programs in which they participate (Bales, 2001;Youniss, McLellan, & Yates, 1997;Youniss & Yates, 1997).Society therefore provides youth with very little legitimate power.Community-based programs are one channel for youth to gain skills and opportunities for changing the community in which they live (Barton, Watkins, & Jarjoura, 1997;Larner, Zippiroli, & Behrman, 1999;Zeldin & Price, 1995).Mechanisms to facilitate youth empowerment, however, are currently vague and imprecise (Roth, Brooks-Gunn, Murray, & Foster, 1998).
This article details the process and lessons learned from conducting evaluation research that implemented Photovoice, a creative method to facilitate youth empowerment through community based programs.Photovoice is a participatory community assessment method developed by Wang and Burris (1994;1997) to identify community problems and resources.Therefore, this method was chosen by the SCALE research team to not only acquire youth perspectives about youth empowerment and tobacco prevention (identifying the community issue) but to also assist these youth with gaining their voices and articulating them to audiences usually less receptive to youth ideas (facilitating youth empowerment).Additionally, the participatory assessment process would ignite youth in shaping community ethos and public discourse.

Background and Significance
To gain a better understanding of youth empowerment from the perspectives of those most affected by the outcomes of the research, an exploratory and participatory project involving youth was undertaken.A statewide, community-based research project called the South Carolina American Legacy Empowerment (SCALE) Evaluation Project was initiated in the Arnold School of Public Health at the University of South Carolina to examine youth empowerment processes for tobacco prevention and was funded by the American Legacy Foundation with support from the Centers for Disease Control Foundation.
Photovoice, a participatory action research process, provided an opportunity to engage youth in a research process that facilitated a collective consciousness of their situation (George, Daniel, & Green, 1999;Minkler & Wallerstein, 2003;Penuel & Freeman, 1997;Stringer, 1999) by utilizing the subject under scrutiny (the youth) as the researcher himself.By encouraging a participatory process, community members are better poised to determine relevant and effective solutions to the problems that affect their quality of life than are outside investigators (George et al., 1999;Minkler & Wallerstein, 2003;Stringer, 1999).
Youth participants therefore served as the eyes, ears and voice of the research and followed a "look, think, act" model (Stringer, 1999).The youth researchers examined the first component of the "look, think, act" model by looking at the programs and school activities in which they participate and the community where they live.In the second component, "think," youth researchers reflected on the data that they collected and constructed a description of how youth make a difference in their community.Youth reflection was guided through a systematic debriefing procedure that addressed antecedents as well as predisposing, enabling and reinforcing factors (Green & Kreuter, 1991).The third component, "act," was achieved when youth presented their findings to influential stakeholders and community leaders.Photovoice supported the "look, think, act" model.
The premise of Photovoice is "empowering communities through documentary photography."Photovoice is a specific method that puts cameras in the hands of people whose voice is often hushed by the power elite.These people often do not have an audience for their voice because they have little power themselves, or little access to those who have power over their lives.The camera therefore becomes their tool, their voice.Photovoice can be seen as a grassroots approach to social action.That is, it is a process that can reach, inform and organize community members for social change (Wang & Burris, 1997).

Participatory Action Research Method
Study Population/Youth Researchers Purposeful sampling determined the selection of the SCALE study population/participatory youth researchers.The particular programs in this evaluation study were selected based on a strict criteria of being an out-of-school, communitybased program, as well as one which considers itself a youth development and empowerment organization and/or having a tobacco use prevention mission.It was important to have project participants representing geographic, racial, gender and socioeconomic diversity.The two youth programs selected to participate in the research included Action Against Tobacco and Youth Service.
Action Against Tobacco is a youth tobacco prevention advocacy organization located in largest metropolitan area in South Carolina.The mission of Action Against Tobacco is to advocate against teen tobacco use by developing strategies similar to those which the nationally recognized anti-tobacco campaign, the truth®, promotes which also champions the use of empowerment as its approach to addressing issues.
Youth Service is a county-wide youth volunteer service organization located in a rural part of South Carolina with a participant roster of more than 500 youth.Youth Service is premised on youth development and youth empowerment principles and seeks to provide youth with tools necessary for success: access to a caring adult, a safe place, health education, marketable skills and opportunities to serve.The Youth Service mission is to instill an ethic of service among the rural county youth through cooperative community volunteer activities.
Twenty youth ranging in age from 13-20 years completed all phases of this evaluation research.These adolescents represented twelve schools (six middle schools and six high schools) in two distinct regions of South Carolina; one in a rural community located on the coast and the other in a large urban city on the other side of the state.Thirty percent of the participants were male (n=6) and seventy percent were female (n=14).Forty percent (n=8) self identified as Caucasian, fifty-five percent (n=11) African American, and five percent (n=1) Asian.

SCALE Photovoice Structure
A member of the SCALE investigative team was designated as the Photovoice project facilitator.The role of the facilitator was to initiate the project at the sites, train the youth, serve as technical assistance to the youth and the community programs, and lead the youth in group discussions and about their photographic findings.
Most meetings with the youth occurred during meeting times that were regularly scheduled for each community program (usually monthly meetings).The purpose was to limit scheduling complications with the youth.Therefore, program commitment to the project was essential.Some special meetings were called, however, for the sole purpose of the project.
The SCALE Photovoice project commenced with Action Against Tobacco and lasted for a period of five months.Twelve Action Against Tobacco youth were trained yet only five youth completed the project.Feedback about the method from those completing the pilot project was incorporated into the Photovoice protocol.Youth Service began its project once the amended protocol was approved by the SCALE steering committee.
The stages of the SCALE Photovoice project closely follow the Photovoice process developed by Wang and Burris (1997) and include: 1) defining the research issue, 2) training the participants, 3) devising initial themes for taking photos, 4) taking pictures, 5) facilitating group discussion, 6) documenting the stories and 7) reaching the audience.
Getting Started with Photovoice 1. Defining the research issue.The SCALE investigative team and funding agency defined the research issue, youth empowerment, prior to selecting the study population.While this was a participatory action research project, the problem was defined from the outset and from the top down (SCALE investigative team) rather than in a true participatory fashion that would include the community and the youth researchers (the study population).However, it was up to the youth researchers to conceptualize the problem (youth empowerment) in their own ways.

2.
Training the youth researchers.The youth researchers participated in a mini-workshop where they were trained in the Photovoice process by the project facilitator.Each youth was given a workbook that the SCALE investigative team had created to help organize and guide their research.
The workbooks provided background information about Photovoice including instructions of how to plan and carry out the activity.The SCALE facilitator reviewed thoroughly each section of the workbook.Each section was a step for completing the SCALE Photovoice project and provided detailed information for the following seven tasks: 1) taking photos that addressed the research issue, 2) documenting the photographs taken, 3) keeping a journal of the Photovoice activities, 4) having the photos developed, 5) creating a photo essay that displays the photos, 6) meeting with the SCALE team for debriefings, 7) having a public exhibit of the photo essays.
During the session, youth were trained on basic camera use and photography techniques.Photography tips were included in the workbooks.Youth were encouraged to complete photo-documentation forms that provided a record of the photographs taken.While there was no specific number of photographs the youth researchers were required to take, dozens of images would be captured during the process.The photo-documentation form could assist the youth researcher to remember why the photo was taken in the first place.The form requested the frame number of the photo, who took the photo, whether or not a photo release form was needed, a description of the picture, why the picture was taken (any personal thoughts), and a potential caption for the photo.These forms were also included in the workbooks.
To minimize risk to the youth researcher, it was important for the youth to understand basic research etiquette and protocol to protect privacy and eliminate any potential for physical harm.Therefore, the SCALE facilitator emphasized during the training session that no picture is worth taking if it put the photographer at harm or caused ill will.The youth researchers received instruction in basic research standards, such as practicing common safety rules while in public, acting responsibly towards the public, and respecting the rights and privacy of others.Youth were trained in obtaining permission from their human photographic subjects to take their photograph.
Project supplies were distributed to the youth programs during this training session.These included disposable cameras, film processing instructions and gift cards for the film processing, and provisions for creating their photo essays and photography exhibit such as scrapbooks, makers, pens, scissors, glue, photo corners, paper, etc.The supplies became the property of the youth programs and were distributed to the youth as needed.
The youth worked in self-selected teams of two or three.Each individual youth had a workbook with the necessary forms to complete the project.Additionally, a journal was provided in each workbook so youth could capture their thoughts and feelings about the Photovoice project as well as thoughts about the overall issue of empowerment as desired.
Since each program had sizeable numbers of youth participating in the project, small teams of youth were used to manage the amount of potential data.Rather than having each youth create a photoessay, each small team of two to three created one.Additionally, the small team approach provided opportunities to youth for camaraderie and validation of ideas with their peers.

Devising the initial themes for taking photos.
During the Photovoice training session, the youth participants were led in creative and critical thinking exercises to help inspire their imagination and resourcefulness and to explore the overarching research issue, youth empowerment.To better understand the utility of the Photovoice project, the youth were asked to describe what photography means to them in their daily lives.They were also shown examples of photographs and asked to describe the emotions the pictures elicited as well as their interpretation of the content of the photographs.
Youth were given a worksheet for developing a problem statement which guided their initial reflection on youth empowerment.They were also given a photo worksheet to complete which served as a planning tool for devising initial themes for their photos and to begin organizing where, when and of what and whom to take photos.The youth spent time during the training session creating a "plan of action" for their projects.
Youth in the Community: "Look" 4. Taking Photos.Youth were asked to consider, "With your photographs, what information can you convey to others about youth empowerment?"Therefore, the goal was to document on film the people, places, and things that represent the role of youth making a difference in the community.Equipped with cameras, the youth had the freedom to be creative and document their activities in youth programs, the realities of youth in the community, youth concerns, or other issues of interest.
Prior to taking pictures of other persons, however, the youth researcher asked permission of the photographic subject and obtained their signed consent.In such instances as crowd shots or where the person(s) could not be identified, consents to be photographed were not obtained.The photo release forms were provided as part of the workbooks.Those agreeing to be photographed were not considered part of the research study.
Youth Reflection: "Think" 5. Documenting the stories.The youth met with their team members periodically to review their photos.The meetings were intended as an opportunity for the youth to show their pictures and tell their stories to their teammates.The youth selected photos for reflection and discussion and determined their next steps for taking more pictures as needed.Once the youth were satisfied with their photos, the small teams convened to create their photo essays to tell their story about youth empowerment.These were self-initiated and self-directed meetings without the Photovoice project facilitator.
The purpose of any type of documentary is to record and demonstrate what is important about the people, place or event.The finished product therefore contained selected excerpts from the entire observational experiences.Captions or explanations were given to each photo selected in the essay.There was no limit to what the youth could do with their essays to represent their interpretations of empowerment.
6. Facilitating group discussion.It was not enough to simply present the pictures youth had taken to each other.The pictures served as a starting point for discussion of what occurred, why it occurred, what the scene accomplished, and what could be done (Labonte, Feather, & Hills, 1999).Therefore, each team of youth spent about one and a half to two hours debriefing the Photovoice project facilitator.This included interpreting the photographs and relating them to their problem statement.Additionally, comments and feedback about the process was solicited at this time.
During the debriefings, the Photovoice project facilitator asked "grand tour" questions about the photographs to have the participants describe the situation in their own terms.Additionally, an adapted version of the "SHOWeD" model of questioning was used (Wallerstein, 1994;Wang, 1999), to prompt youth to reflect upon the relationship of the photograph to their personal realities.The SHOWeD acronym stands for: What do you See here?What is really Happening here?How does this relate to Our lives?Why does this situation, concern, or strength exist?What can we Do about it?The investigator also probed deeper on empowerment, civic identity, and other themes as they emerged."A good theme is one that identifies tensions or strained relations that exist within and between the people who are a part of it" (Labonte et al., 1999, p. 44).The very nature of youth empowerment suggests tensions or strained relations due to an inequitable structure of power imposed on youth.
Youth Voice: "Act" 7. Reaching the audience.The last phase of the Photovoice project was to have youth present the findings to people that they believed could be mobilized to create change.During the debriefing sessions with the youth, the youth determined to whom they would like to present their findings in the community.They were encouraged to choose an audience for the purpose of changing something, starting a movement to bring attention to an issue or getting people involved in a movement.Some very excited youth wanted the Governor of the State of South Carolina to hear what they had to say about youth empowerment and the paucity of opportunities that exist to foster this.Other youth identified city and county council members as well as members of the boards of directors for their programs and other youth programs.South Carolina youth were also identified as an important audience to hear their concerns.
To select the audience after debriefing the participants is contrary to the sequencing of events that Wang proposes.She suggests selecting and recruiting a target audience of policy makers or leaders from the outset and having them serve as an ad hoc advisory board to the project (Wang, 1999).This ad hoc group is seen as one with political will who could put the recommendations and ideas of the participants into effect.
Wang's approach was not feasible for this particular research.In this case, the purpose of the SCALE Photovoice activity was for the youth to reflect upon their community context and understand how the members and structures of their community affect their civic identity and voice rather than assessing community needs.It was not until they had the reflection process that they were able to identify those who could help resolve their issue.In fact, it was discussed that the youth may wish to present the photographs to other youth to gain momentum for a youth empowerment movement.SCALE capitalized on the youths' enthusiasm and ideas and arranged an "empowerment summit" for the youth programs participating in the Photovoice project.The empowerment summit served as an opportunity for the youth to meet other youth from across the state, share ideas about youth empowerment, prepare their public presentations and present their ideas and issues to key youth empowerment stakeholders in South Carolina.For their presentations, the audience included a group of their peers, program directors of other community-based youth programs, leaders from the state tobacco control program, leaders from the state health department, community coalition representatives, the SCALE advisory committee and other key influencers in the youth development and empowerment movement.Additionally, the summit was an opportunity for the Photovoice project facilitator to probe further on the issues, themes and theories that emerged from the individual team debriefings and prompt further discussions among the entire group.

Discussion
Impact of Research The initial purpose of the empowerment summit was to serve as an opportunity for the youth to have their voices heard by key stakeholders in youth programming and an opportunity for the youth to network with other youth and learn about social action projects happening in other parts of the state.This was also a time the youth could be publicly recognized and rewarded for their efforts and contributions to the SCALE project and for sharing their perspectives that forward youth empowerment theory.In addition, the summit served as an opportunity for the Photovoice project facilitator and other SCALE investigators to "member check" (validate) the empowerment data the youth researchers yielded through focused questioning and discussion sessions.
Some important messages about negative youth images, empowerment, unity and diversity were provided by the youth.While the youth researchers were able to have their voices heard at the planned empowerment summit, the Youth Service youth went on to later present their findings from the Photovoice project to their City Council and to the Board of Directors of Youth Service.They chose these bodies of decision-makers because they felt it was important that these people recognize that youth do good things in the community, provide a service to the community, and are resources for the community.They wanted to begin curbing the negative images many community members have of youth as liabilities, that youth should not be stereotyped, and that they can and do make a difference in the community.The youth researchers supported this with photographs of diverse youth participating in community service activities and being responsible and productive citizens.
Additionally, the empowerment summit became a networking opportunity for the youth.At the time of the summit, Action Against Tobacco was initiating a statewide youth movement against tobacco called Rage Against the Haze.Meeting the other Photovoice teams from around the state was an opportunity for them to build momentum and membership for their statewide movement.This was an unintended consequence of the research project but a natural result of community based participatory research.
Upon learning about the nation's tobacco problem and exploitation of youth by big tobacco companies at the empowerment summit, the Youth Service youth committed to joining Action Against Tobacco in the fight against tobacco in South Carolina.Therefore, meeting the Action Against Tobacco youth ignited a social action project for Youth Service that had never been previously considered.After the empowerment summit, the Youth Service youth made their voices heard at several educational presentations to targeted audiences such as the statewide Teen Institute alcohol and drug prevention camps and the Youth Service summer recruitment workshops.As demonstrated by their involvement in the tobacco movement, the Youth Service youth continued the "look, think, act" cycle even while the Photovoice project was ending and beyond.

Lessons Learned -Positive Feedback
Photovoice proved to be a creative and empowering way to investigate and initiate youth empowerment.One youth explained, "…because there's a lot of things in papers and things about youth doing things that's really not too good.And so, this is a way to show people that all youth aren't doing bad things.There's some youth that are actually doing things that make a difference, that's trying to make our community better.And so, the Photovoice project allows us a way to show that." Taking pictures was fun for many of the youth including those who had little experience with a camera.Many youth took this as an opportunity to take unrelated pictures of friends and family which was expected by the investigator and deemed one way for youth to have ownership in the process.Putting together a photo essay of their findings was another creative outlet for them."I liked taking the pictures because I love taking pictures anyways.But, I thought it was neat how… I've never done anything like this before and I know it was a really good idea, you know, just to show things through pictures and then tell about them with captions versus just an essay.So, it was a neat project."Another youth added, "It's kind of like a yearbook.It was like, you know, you may have the pictures and then the captions that try to explain it and it tells a story like a yearbook." Lessons Learned -Room for Improvement While roadblocks appeared for both youth and the SCALE team and occasionally altered progress of the Photovoice research, the project was never-the-less embraced by the youth who engaged in the research.Some challenges included geographic distance between the Photovoice project facilitator and the youth, challenges of working with youth and their competing commitments, an uncertainty of youth expectations, and underestimation of time and other resources.
One of the greatest challenges affecting the research was conducting community based participatory research from a remote site.SCALE was a multi-site project where geographic racial, gender and SES diversity were important features of this research.As a result, the SCALE Evaluation community partners were geographically dispersed throughout the state and located in towns other than Columbia, SC where the SCALE project was housed at the University of South Carolina and where the Photovoice project facilitator lived.Programs in this study were at least two hours away from SCALE and about five hours from each other.Working with the youth longdistance became complicated and relying on the community program partners became paramount.
The SCALE Photovoice project relied on the generosity of its community partners to carry out the research.The partners served in a supportive role as access points for youth.The project was therefore adopted by the youth programs as one of their own activities and doing so provided the partners with a sense of ownership to the project.In the absence of the Photovoice project facilitator, the program leadership distributed the supplies, motivated youth, and generally attempted to keep the youth on task.
Partnering provided the Photovoice project facilitator access to regularly scheduled youth program meetings.These became times when the Photovoice project facilitator could meet with already assembled youth rather than schedule additional meetings and fret with logistics of over-committed youth schedules.The training and administrative meetings took place during regular program times as often as possible.However, the limited number of meetings that each program schedules for the youth during the year and other program commitments to fulfill during that time limited when and to what extent the project could be addressed during regularly scheduled program times.Occasionally, it was necessary to meet with the youth outside of normal program dates and times because some of the activities associated with the project took several hours and could not be accomplished during regularly scheduled program meetings.Scheduling nonprogram meetings was difficult due to geographic distance and over-committed youth schedules.
Geographic distance limited opportunities for the Photovoice project facilitator to interact with the youth more frequently and to provide guidance between regularly scheduled meetings for the project.It inhibited regular and iterative debriefing meetings about the youth empowerment themes, it inhibited spontaneous in-person contact with the youth, and it prolonged project duration beyond the youth's attention span.Email and phone contact was certainly established with the youth, but not used optimally.
The challenges of working with youth and maintaining youth involvement in the project due to their competing commitments was another lesson learned.Competing youth obligations include those to the community program versus those to the Photovoice research project, as well as other youth commitments to school and family.For example, youth program goals and objectives superceded the needs of the Photovoice research project, and youth obligations to school and family superceded program involvement.When all were considered, participation in the project was a lower priority and the many youth commitments such as homework, athletic events, service hours, family affairs, etc., limited time altogether for the Photovoice activity and attendance at some Photovoice gatherings.One youth bemoaned, "I think it (Photovoice) would be kinda like too much all on one person with school and everything.I mean, if we didn't have school then it wouldn't be that bad.But, you know, we have homework and all the other stuff we have to do, so…" Participation in the Photovoice project required that youth participants attend a training session, explore their community during their free time to assess the needs and assets, meet with SCALE staff during regular program meeting times and occasionally outside of regular meeting times to reflect and discuss their progress.Therefore, the Photovoice project required a full understanding and commitment by both youth and the adult leadership of the program to encourage participation; otherwise, youth retention was potentially challenged.Therefore the local presence of a Photovoice project facilitator was determined to be essential.
Perceptions of Photovoice as a school assignment and an uncertainty of youth's expectations were other challenges and lessons learned.Youth admitted to their procrastination to begin the project.According to one participant, "It was kinda hard to get started at first.I didn't know where to go or what ideas to use.But once we got started, it was a lot easier."The requested paperwork for the Photovoice project made the project itself become too much like a school assignment, and for some, limited efforts may have been applied towards the project.One participant remarked, "I just thought 'Oh my gosh, this is gonna take so long with all the other stuff I have to do.'I was like 'When am I ever gonna have time for this.This sounds like a lot of work.' But, it really wasn't." The record keeping aspect of the Photovoice project included creating photo action plans, completing photo-documentation forms that detailed each photograph, and having photo release forms signed by the photographic subjects.Additionally, the youth were asked to keep a reflection journal of their Photovoice experiences.Many youth did not complete their journals, nor did they understand the utility of the photo-documentation forms and found them to be burdensome.The photo action plans did serve to jump start the youth in the Photovoice activity, however, they were rarely referred to after that.As one team admitted, having a plan helped the youth get the pictures that they wanted."We made an outline.As soon as we had gotten our new idea … we talked about what pictures we wanted to take.And so it makes it easier because it would be hard just to see things and take pictures of it, you know." Additionally, the Photovoice assignment required conceptual thinking and introspection on behalf of the youth and some youth may not have been cognitively developed to fully comprehend the abstract assignment to photograph an intangible idea (youth empowerment).Due to the limited presence of the Photovoice project facilitator on-site, further explanations and clarification were not as readily available to the youth who may have had questions regarding the process and the research topic.Future projects should stick to the primary purpose of research of photographing participants' realities and using the pictures as 1) cues for participant reflection and discussion, and 2) tools for change.
The youth did enjoy being valued for their insight and contributing to a research study, but at the same time it was important for them to have fun.Taking photos, putting together a photoessay, and gaining a better understanding of their community were creative and rewarding outlets for them.As one youth explained, "We had it (photoessay) at school today, and everybody really wanted to see it.They'd be like, 'Oh, what is that?'And I would say, "Oh, it's this project that I'm doing with Youth Service and USC.'And they'd say, 'Oh, can I look at it?'And the teachers looked at it, too, And they liked it.They thought it was really cool, too."Lastly, the underestimation of time and human resources to complete the project was another issue to overcome for SCALE.The Photovoice project took many more months to fully complete than anticipated due to scheduling conflicts, competing commitments and the distance between Photovoice facilitator and the youth programs.Therefore, the project delayed the initiation of broader SCALE research goals for which the project was designed to inform.

Conclusion
Unlike more traditional methods for collecting data (survey, focus group, observation), the Photovoice project was beneficial because it actively engaged the community in the research versus a more passive process.With Photovoice, the researcher leaves with rich data and the community takes something as well.The SCALE Photovoice research project proved to be a legitimate method for eliciting youth perceptions about youth empowerment while simultaneously facilitating empowerment among youth participating in community-based programs.
As a result of their participation in the project, the youth were given an opportunity to examine their community as they had never before ("look").Together the youth determined issues of concern ("think") and voiced those ideas to others ("act").Their initiative to boost the reach of their voices by speaking and educating in other venues after the project had ended is support of a successful experience.Photovoice provided to the investigative team perceptions about youth empowerment from an experiential and overlooked perspective -youth.
For researchers wishing to implement a Photovoice project with community-based programs and their youth participants, a commitment to the project by the community program leadership is essential.Flexibility in carrying out procedural rules and forgivingness by the research project staff is also necessary.Regarding the SCALE Photovoice project, several of the processes and procedural tasks (informed consents, photo documentation) required by SCALE and the university where the research was housed, were cumbersome and tedious to complete.These tasks had the potential to interfere with picture taking spontaneity, creative expression and overall Wang and colleagues have not employed the use of workbooks in their training sessions.The workbooks for this research proved to be valuable tools in the youth training sessions and served as helpful reminders afterwards for the youth to complete their projects.One youth commented, "The workbook was my key tool in really getting into the gist of everything, because it had information on everything that I needed, from tips on taking photography, to what type things I should be looking for.It had everything I really needed."Another youth explained, "The workbook was very self-explanatory.It was extremely helpful.To tell you the truth, I don't know what I would have done without it."completion of the project.As one youth reminded the Photovoice facilitator, "You just want to take a picture and don't really want to think about it that much …the documenting and signatures."However, permission from human photographic subjects is important.
An available, on-site Photovoice project leader is recommended for guidance and support, to answer the many questions the youth will have, to motivate youth in their implementation endeavors, and to facilitate their regular and iterative reflection debriefings after photo taking sessions.An older youth or young adult could ideally serve as a Photovoice project leader.This person could be trained in the protocol and could thereby serve as a peer-leader to train the youth researchers.While the youth seemed to respond to the SCALE facilitator, a peer leader could have greater impact on the youth and may also encourage more youth to participate.An on-site project coordinator could also encourage more expeditious participation and help youth resolve their many competing commitments that stall full participation.Distance and email conversations fall short of this in-person influence.
Future Photovoice projects with youth should be fun and creative expressions of youth voice.A youth made this recommendation for a future project, "I think it would be really cool if we could get more youth, like in the schools, if somehow, this could be like a class project or something.I mean, it wouldn't have to be for class, but get it in the schools somehow and then have a display of it, like at the library or, you know, someplace where people can go, and you know, all the parents would want to go and see what their kids have done.And just have it displayed for anyone to look at and have it up for several weeks."With any Photovoice project, a sense of humor by all is highly recommended for overcoming some of the barriers that will arise and for youth to ultimately achieve their Photovoice goals.Most of all, Photovoice is a creative community assessment tool that can be easily adapted to a variety of scenarios and study populations.
Future projects should include a well-thought out plan for implementation, concrete assignments, as well as, comprehensive and sufficient training for the youth.This would include multiple training sessions to brainstorm and define the topic, understand photographic and camera techniques including a photo practice session, develop ethical and safe research practices, and create implementation plans.