Visual Voices is an arts-based participatory research method that can be used to engage young community members and to facilitate equitable involvement in CBPR. This systematic method included distinct creative writing, drawing and painting activities designed to yield culturally relevant data generated and explored by young people. The method provides a unique opportunity for young people to inform, implement, and interpret and guide the application of research findings. It is an innovative process that generates rich and valuable data about topics of interest and the lived experiences of community members.
The method productively engaged a group of young people in a research project and was successful in identifying and illustrating specific positive and negative community characteristics associated with safety. The specific illustrations and related discussions were informed by the youth themselves with the only “prompting” from facilitators being a reminder to (a) have fun, (b) respectfully share the materials and space, and (c) focus on community-level features that they considered to be safe and not safe. The youth participants, as co-facilitators, identified a range of issues related to community factors, community safety and violence. Results from follow-up focus group discussions with participants in the Visual Voices process suggest that this method is well-received for a variety of reasons, including involvement and flexibility of the different creative painting and drawing activities, the feedback they received from structured reflection and feedback sessions, and that it was simply and maybe most importantly, fun.20
Researchers interested in partnering with young people to address complex public health issues should consider using this approach.
Results from the projects provide valuable information about the young community members’ lived experiences and provide unique insights into their perspectives. Although more traditional research methods such as surveys or focus group discussions could be used with youth, the information obtained through this arts-based approach is likely to have more depth given the multiple opportunities for exploration and discussion.9
Visual Voices shares more in common with the photovoice method where cameras are placed in the hands of the community members and through a rigorous process, enables them to reflect on community strengths and weakness in order to engage in a dialogue about important issues related to their locality.3,4,10
However, unlike photovoice, which requires a certain level of comfort with technology such as cameras, the Visual Voices method uses creative approaches (paint, markers), which are common, comfortable, and familiar to children of all ages.
The observation that an arts-based method appears appropriate for CBPR with young people is consistent with existing research on creative arts and community development.21,22
found participation in locally run community heritage festivals resulted in youth expressing positive feelings about their community, culture, and language. The study also found that 41% of participants interviewed stated they wanted to help in other local projects. Additionally and consistent with this method, community-based creative arts programs offer an opportunity for increased interaction and dialogue around unique and subtle community health and safety issues.9,14
These opportunities can be important for the individual as well as the community by providing group space for expression of personal beliefs, important community issues, and ethnic pride.9, 24, 25
Designed to include multiple sessions utilizing both written and painted mediums, Visual Voices permits both individual and group processing and expression. This use of multiple forms of expression is a strength of the method and allows the participants to share their thoughts and perspectives in the manner they feel most comfortable. For example, whereas participant A may feel most comfortable creating an abstract painting and then talking about it, participant B may feel most comfortable writing down her thoughts. Visual Voices is also unique in that it includes both individual and group oriented activities. Participants first are asked to individually develop their paintings and/or writings and are then asked to share them with the group. This process of group sharing can permit the other participants to reflect on their own similar thoughts and perspectives and contribute to a broader discussion. In addition to being a developmentally flexible and appropriate forum for engaging in participatory research, the Visual Voices method is fun, nontraditional, and provides multiple process and outcome opportunities for community, adult, youth, and academic partners to lead the project and process. The intimate process of working together over several sessions lays the groundwork for relationships to develop between the academic researchers and the community participants. In addition, the Visual Voices method fosters the development of trust and helps to build relationships between academic researchers and community members. The formation of partnerships is a core component of CBPR and something that needs to be nurtured.
Although the Visual Voices method was used in these two locations primarily as a research data collection tool, the approach can itself be viewed as an intervention. For example, throughout the process the facilitators can, given the appropriate backgrounds and experience, help the youth participants to explore specific issues and to address some of the public health problems that that they describe. The method has been used as just such an intervention tool to address the issue of dating violence among adolescent middle school children to facilitate discussions of violent experiences and to visualize and explore nonviolent solutions.26
For these two projects, the participatory data collection findings have led to a number of short-term yet developing prevention efforts. For example, in Pittsburgh findings have been presented and productively received by the local police department leadership to inform mutual understanding of young peoples’ perceptions of safety issues and as a potential opportunity to develop new and nontraditional communication. In Baltimore, as designed by the team, the project findings were adapted and used by the organizational leadership of EDEN Jobs.
There are some unique challenges associated with using the Visual Voices method. One limitation is that the process is time consuming and resource intensive.11
In addition, it requires adequate space and community time for the painting and writing sessions. Although previous creative-arts based experience is absolutely not required to facilitate this method, it is necessary that the community and academic research partners are comfortable working with the different media, facilitating discussions, and working with the different types of qualitative data and data analytic techniques. Finally, like other qualitative data collection techniques, the generalizabilty of findings are limited. Cultivating and integrating youth expertise in research through CBPR does come at a noted price.11
Participation costs included heavy demands of time, an added burden of work, frustration with the process, missing other opportunities, risking loss of anonymity, and loss of perceived control. Special considerations and actions need to be taken to ensure that clear benefits are realized for all project partners and that the burden is minimized.
Visual Voices is an arts-based participatory research method to facilitate young community member engagement, uncover and celebrate their expertise, inform future community-engaged research and guide intervention and prevention efforts. Our application of Visual Voices serves as an example for how this arts-based participatory method can be adapted and used in future CBPR work with youth.