Issue 8 Stories

Speaking Through Pictures

Photovoice Project Brings Attention to Health Disparities in the Community

Sometimes, community change can start with young people. Despite their young ages, teens and tweens are often able to articulate creative ideas and surprising and powerful insights about how to resolve community challenges.

That’s the conclusion of Jackie Martin, director of community benefit at Sentara Martha Jefferson Hospital, who has been working on tapping into the promise of youth. One issue Martin has been addressing is that of health equity, which means “giving everyone a fair chance” to be healthy.

“Two areas, among others, that we’ve been working to address are infant mortality rates among African Americans and diabetes mortality rates for people of color,” says Martin.

Since minority groups are among those most likely to experience health disparities, Martin and leaders from community organizations like City of Promise and Jefferson CHiP (Children’s Health Insurance Program) and many others are collaborating to develop solutions that address these inequalities.

For the past several years, Sentara Martha Jefferson has hosted a spring break camp for a group of African American girls between the ages of 11 and 15 who are part of Sisters of Nia, an organization that provides empowerment opportunities for girls. During these camps, they explore topics such as nutrition, physical activity, and how education and jobs can be connected to health.

“We talk to them about what makes them comfortable, what makes them happy and what encourages good health,” Martin says.

This April, the girls taking part in the camp tried something different: They participated in Photovoice, a qualitative research tool that “gives voice, through photography, to people who often aren’t included in research,” Martin says. The project was sponsored by Move2Health, a coalition of local organizations, including Sentara Martha Jefferson, that work together to build healthy communities.

“Our priority is improving health disparities and access to care—it’s all about giving people a fair chance to be healthy,” Martin says. “It’s important to listen to these girls, and I’ve been so impressed with their insights. To begin improving health disparities, you really have to listen to the people living with these inequalities, learn what kinds of programming they’d like and determine how best to communicate with them regarding health issues.”

Throughout the spring break week, the girls participated in a variety of activities, from yoga and mindfulness exercises to a private showing of “Black Panther” and a road trip to the newly opened National Museum of African-American History and Culture in Washington, D.C. By documenting their adventures through photography, they had a chance to explore their heritage, develop an understanding of and appreciation for their culture, and brainstorm about ways to overcome inequalities—such as lack of access to health care and healthy foods—in their communities.

The Move2Health Coalition asked the girls to take photos identifying cultural and community assets that could contribute to improving health equity. They spent the week learning about assets (things of value), resilience (surviving and thriving) and well-being (comfort, good health and happiness).

The girls took hundreds of pictures representing these concepts: their neighborhoods in the Charlottesville community, African Americans involved in the Civil Rights Movement, and happy moments with family and friends. A few weeks later, the girls met with Martin and other project leaders to participate in focus groups, during which they sifted through the photos and selected 16 images that best represented cultural and community assets.

“We were able to do this project in part due to Sentara Martha Jefferson’s strong connections with community partners,” Martin says. “Community gatekeepers like the facilitators at Sisters of Nia give people like me access to the young people they have been working with for many years. And because we have been doing the spring break camps for several years, we have an established relationship and sense of trust with these girls. I think that helped them to be open and honest with us.”

The photos and input from the girls were used to identify several cultural and community assets that organizations in Charlottesville and surrounding areas could build on to improve health equity:

•    Strong families. Expand opportunities for stable housing, jobs and education.

•    Rich history.Make sure that all kids are exposed to an inclusive history that includes and values the African American experience.

•    Community programs.Provide more programs for kids that build and encourage friendship and community.

•    Safe spaces.Provide gathering places for kids that are free from bullying, drugs, violence and racism.

•    Community leaders.Develop more role models and mentors in schools and in the community.

•    Willingness to try new things.Encourage kids to develop healthy lifestyles by offering them opportunities to try new things such as different types of healthy foods and exercises.

The Photovoice project ties into the community health needs assessment (CHNA), which is due to be completed in 2019. “The CHNA helps us understand a community’s healthcare strengths and opportunities for improvement,” explains Martin. “Sentara Martha Jefferson Hospital participates in the CHNA every three years and adopts an implementation strategy to address the priorities identified.”

The CHNA core group—consisting of Sentara Martha Jefferson Hospital, the University of Virginia Health System, the Thomas Jefferson Health District and the University of Virginia’s Department of Public Health Sciences—has decided to use an asset-based approach to gathering community input for the assessment. The group plans to partner with the Move2Health Coalition to conduct Photovoice projects throughout the health district and gather data on how to improve health equity.

Throughout the Photovoice project, Martin and her colleagues were particularly intent on making the project as relevant to these girls’ lives as they could.

“As we worked on the project with the girls, I was constantly asking myself if we were presenting the terms and concepts in a way they could easily follow,” Martin says. “Would the sessions from community leaders define the terms in ways that could be seen in the pictures the girls took?”

But as the project came to fruition, the project leaders were delighted with the outcome. “When we started listening to them talk about their pictures in the focus groups, they were echoing themes others in our community are talking about—and that’s amazing to me,” says Martin. “But they were telling the story in their own unique way.”

Data from the Photovoice initiative will be used to help community organizations determine where to focus time and resources to improve health equity, including addressing social determinants of health like jobs and education, finding ways to improve access to fresh fruits and vegetables, and improving access to fitness opportunities.

Martin has enjoyed seeing the girls from Sisters of Nia mature over the years and was especially impressed with their work on the Photovoice project.

“Everyone has a voice worth listening to, and Photovoice is a great way to give a platform to those who often do not feel empowered to share their insights,” says Martin. “I believe all of us who have had the privilege to work with these girls have seen their self-confidence growing. Their contributions can lead to better opportunities for others and hopefully, one day, to a community in which everyone has a fair chance at being healthy.”

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