This photovoice experience provided students with the opportunity to collect and interpret qualitative data on what they felt was influencing their health through the lens of a camera. The pictures were explored both at an individual and group level in a process that engaged the participants in health advocacy endeavors.
The poster products reflect the youths’ focus on advocating for reducing stress in relationships and in schools, and addressing the ways in which community food choices influence weight gain. Local obesity (body mass index ≥ 95th percentile) prevalence data for youth 12 to 19 years old from the Los Angeles County area are 19.0%21
compared with 17.4% nationally.22
To this end, youth created posters using social marketing strategies that were intended to foster change among their peers.
Social marketing applies commercial marketing principals to influence social behaviors that benefit the individual and general population, not the marketer. These include audience segmentation, message targeting, and product branding, placement, pricing, promotion, and positioning.20,23
Social marketing for health promotion strategies incorporates behavior change theories like social cognitive theory,24
the theory of reasoned action,25
and the theory of planned behavior25
to identify modifiable behavioral determinants that will likely respond to persuasive appeals. These strategies also incorporate communication theories such as the elaboration likelihood model26
to increase the persuasive impact of messages and the likelihood that messages will affect specified behavioral determinants. In addition, it acknowledges that the tactics and strategies used to augment health behaviors must reflect and adapt to the constantly changing marketplace. Youth using photovoice are well positioned to capture their unique perspective on their community’s changing marketplace.
In addition, project participants focused on social marketing elements that they considered important (e.g., audience segmentation, message targeting, and product placement). They applied these strategies by using visual images, and phrases that they considered compelling to their peers, teachers, school staff, policymakers, and others. These products represent the participants’ use of social marketing strategies to advocate for improvement on the health issues they selected. The application of digital images, and compelling text, and the use of a poster format to mobilize public opinion, is a form of media advocacy.
Although we saw a significant activation of the youth and engagement in the issues addressed, we did not have a control group. Although our sample size was similar to those in projects using video narratives with children with chronic illness, it was nonetheless a small convenience sample, so making broader generalizations from the findings should be done with caution. Nonetheless, this pilot can serve as an example for others who would to adopt or modify it for their particular communities.
For the year before coming up with the project idea, we developed relationships with the youth and their parents by participating in YAB, CAB, and community partner activities. This step was important for establishing trust between the research staff and participants, and developing the project structure and dissemination. The participatory approach also produced important benefits. The participants selected the issues they wanted to address and made a major contribution to understanding their data. In addition, this work inspired the participants to continue voicing their concerns about youth obesity to the Center, which responded by successfully competing for an NIH CBPR grant to advance work on this issue.
This project supports anecdotal reports from previous studies about participants’ enthusiasm for the photovoice experience.5,13,14
Photovoice can actively engage students in a process of identifying community-level health influences and creating advocacy approaches to promoting health. The project was successful in voicing its findings to a larger audience through the exhibition, media coverage, community presentations, continued presence of the posters in participants’ schools and community centers, and its influence on the center’s pursuit of CBPR funding. The project helped researchers to understand community-level factors that contribute to health through the eyes of youth in a process that inspired and motivated the participants.
After the Teen Photovoice Project, several participants have continued to develop their community advocacy interest through center-organized advocacy-related skill building activities, involvement in community organizations, and college classes that address this topic. The project gave participants an opportunity to consider social and environmental factors that influence their health. It gave them the chance to express their thoughts through images they photographed, discussions about their photographs, and, in a modification of traditional photovoice projects, through the products they produced from the photographs. Similar project adaptations could be studied to determine the full effect of such programs on participant-driven, community-based health promotion.