Through their eyes: a Photovoice study of environmental stressors and mental health among young women in Kampala’s urban slums

Abstract

Environmental stressors such as poor sanitation and overcrowding affect the mental health of women living in urban slums, yet their lived experiences remain understudied. Photovoice was selected to engage participants as co-researchers to document and discuss how their environments influence their daily lives and mental health. In 2022, 15 women aged 18–24 from three Kampala slums participated in a 5-week Photovoice project involving training, photography, small group discussions, and a final thematic validation session. Ethical approval and informed consent were obtained. Three overarching themes emerged: (1) Entrepreneurship and Trade, which provided income, agency, and coping mechanisms against poverty; (2) Health, Wellness, Education, and Security, emphasizing the role of access to clinics, schools, and places of worship as protective and restorative influences on mental health; and (3) Urban Infrastructure, highlighting inadequate sanitation, drainage, and water systems as major sources of stress and vulnerability. The Photovoice process amplified participants’ voices, revealing how they interpret and respond to the physical and social environments that define their well-being. These insights can guide contextually grounded interventions and policies aimed at improving mental health, resilience, and living conditions among women in urban poverty.

Photovoice is a participatory visual research method extensively employed for empowering vulnerable populations for several decades (Wang and Burris 1994, Wang 1999, Dassah et al. 2017), and which has proven effective in fostering individual and community change (Shaffer 1985). This approach enables participants to utilize photography as a tool for self-expression and shedding light on community issues (Dassah et al. 2017). Through capturing their experiences and perspectives in photographs, participants can increase awareness, advocate for change, and advance social justice goals (Budig et al. 2018). However, Photovoice is also critically important as a tool for formative research, contextualizing complex topics and providing a deeper understanding of social issues that influence the health of community environments (Freedman et al. 2014).

One of the primary advantages of Photovoice lies in its capacity to empower participants. Through the act of capturing and discussing photographs, participants not only gain a sense of agency but also take control of their narratives (Budig et al. 2018). This visual and impactful sharing of stories and experiences can result in heightened self-confidence and self-esteem for the participants (Teti et al. 2013). Additionally, Photovoice promotes critical consciousness, prompting participants to reflect on their experiences and the societal structures influencing them (Kimera and Vindevogel 2022). This reflective process contributes to a deeper understanding of the social determinants of health and the structural barriers contributing to health disparities (Evans-Agnew and Rosemberg 2016), which is a key focus of our mental health research among young women in the slums of Kampala, Uganda (Swahn et al. 2022, Culbreth et al. 2024).

While the Photovoice methodology has been widely used to engage marginalized groups, there remains limited research examining how environmental conditions in urban informal settlements shape mental health, particularly among young women. Young women living in poverty face multiple intersecting stressors, including unemployment, food insecurity, overcrowding, exposure to violence, and inadequate access to water, sanitation, and health services. In this study, environmental stressors refer to physical, social, and infrastructural conditions in urban slum environments, such as overcrowding, poor sanitation, unsafe water, and community insecurity, that directly or indirectly influence women’s mental health and wellbeing. These social and environmental stressors often co-occur, reinforcing cycles of psychological distress and poor well-being. Despite growing recognition of these challenges, few studies have examined the pathways through which neighborhood and environmental stressors contribute to women’s mental health risks in low-resource urban contexts. Even fewer studies have engaged women directly in identifying and interpreting these determinants through participatory approaches.

The choice of the Photovoice methodology in this study aimed to foster active participation and reflection among women who often experience marginalization and exclusion from discussions about health and development. As previously outlined (Swahn et al. 2022), a growing body of the literature explores the connection between ‘place’ and ‘health’ (Centers for Disease Control and Prevention 2022, Lyons et al. 2025, Swahn et al. 2025), a key goal of this project. However, challenges arise due to the inherent complexity of establishing empirical links between health and specific environmental factors. This complexity has led to renewed interest in approaches that can elucidate these relationships through community-led, contextually grounded inquiry. Photovoice, as a participatory method, has been used to engage participants in critical dialogue and to reflect on social conditions that shape community health (Freedman et al. 2014), including in research examining health risks and needs in the urban slums of Kampala (Ssemugabo et al. 2020) and Nairobi (Kingery et al. 2016).

Photovoice has also been applied across diverse vulnerable populations, such as individuals with physical disabilities (Dassah et al. 2017), marginalized youth living with HIV/AIDS (Kimera and Vindevogel 2022), and impoverished and racial/ethnic minority women with HIV (Teti et al. 2013). Its effectiveness extends to actively involving these populations in research and encouraging their participation in decision-making processes (Koren and Mottola 2023). By providing a platform for these populations to express themselves, Photovoice has the potential to challenge stereotypes, diminish stigma, and foster social inclusion (Kimera and Vindevogel 2022). This becomes particularly crucial in understanding the health and living conditions in urban slums (Ssemugabo et al. 2020), an aspect often overlooked in the previous mental health research.

In fact, relatively few Photovoice projects to date have examined health and socioenvironmental contexts specifically in urban slums (Kingery et al. 2016, Ssemugabo et al. 2020, Karuga et al. 2022, Nuwematsiko et al. 2022, Kulkarni et al. 2023), but the approach has been well received and yielded important insights. For context, urban slums are growing rapidly, primarily fueled by population growth and rural migration. Data from the UN-Habitat indicate that the bulk of urbanization is anticipated in low-income countries (United Nations 2019, 2022). This surge is particularly worrisome in sub-Saharan Africa, where over 60% of the urban population resides in slums (Thelwell 2020).

Uganda, identified as a country experiencing significant population growth (World Bank 2019, The World Bank 2021), stands out with half of its urban population residing in slums (World Bank 2014). Within this context, it is critically important to focus on the unique needs of women residing in these settings and to explore how environmental and social stressors shape their mental health and well-being. Guided by the social determinants of health and resilience frameworks, this study conceptualizes empowerment and mental health as interconnected outcomes shaped by women’s interactions with their physical and social environments. This framing aligns with TOPOWA’s broader emphasis on understanding how environmental and socioeconomic stressors intersect to influence mental well-being in low-resource urban settings (Natuhamya et al. 2025, Swahn et al. 2025a).

This Photovoice project is a component of a broader initiative encompassing multiple embedded research studies – including focus groups, community mapping, and a prospective cohort study – collectively known as ‘The Onward Project on Well-being and Adversity’ (TOPOWA). The term ‘TOPOWA’ translates to empowerment and perseverance in Luganda, a local language spoken in Kampala. The overarching project goal is to examine how Socioeconomic Strengthening Targeted Training moderates the pathways between the adverse effects of poverty (proximal social and environmental stressors) and mental illness among urban youth in Kampala (Swahn et al. 2022). In this article, we focus exclusively on the Photovoice component of TOPOWA, which explored how young women conceptualize and visualize the factors that exacerbate or mitigate the environmental stressors and hardships they experience in their communities. Specifically, this paper analyzes findings from the thematic validation discussions, identifying and operationalizing common themes across the three study sites. The Photovoice approach facilitated critical conversations around ‘environmental stressors’ and ‘mental health’ – abstract concepts that are seldom discussed openly in these communities. By amplifying participants’ voices and lived experiences, this study seeks to identify key environmental determinants that influence mental health and resilience among young women living in poverty and to inform future research and intervention strategies in similar settings.

Methods

Study design and setting

This study employed a Photovoice design as part of a participatory research approach to explore environmental stressors and their perceived influence on mental health among young women living in Kampala’s informal settlements. Photovoice was selected over other qualitative methods such as focus groups or interviews because it enables participants to visually capture, reflect on, and discuss aspects of their lived environments that shape daily experiences and well-being. This approach fosters agency, critical reflection, and dialogue – important dimensions when engaging marginalized populations whose perspectives are often excluded from traditional research.

The study was conducted in three urban slum communities, Banda, Bwaise, and Makindye, characterized by high population density, inadequate housing, limited sanitation, and persistent unemployment. These sites were purposively selected to represent the social and environmental diversity of Kampala’s informal settlements and because the Uganda Youth Development Link (UYDEL) operates youth support centers in each area. UYDEL provides psychosocial and vocational training to vulnerable youth and was a key community partner supporting this study.

Participant selection and recruitment

The Photovoice project was implemented in August–September 2022 with 15 young women aged 18-24 years (Swahn et al. 2022, 2025). Participants were recruited from the three UYDEL Youth Support Centers in Banda, Bwaise, and Makindye. UYDEL works with youth aged 10-24 to provide psychosocial services, rehabilitation, and vocational training to those at risk of exploitation and poverty.

Eligibility criteria included: (1) being a young woman aged 18–24 years; and (2) residence in one of the three selected study sites. No additional exclusion criteria were applied. Participants were invited through word of mouth at the youth centers and were enrolled on a first-come, first-served basis. More women expressed interest than could be accommodated, but only the first five from each site were selected. All participants provided written informed consent prior to participation. Ethical approvals were obtained from all relevant institutional review boards in Uganda and the United States.

Participants were not selected based on engagement with mental health services, and none were receiving services through UYDEL at the time of the study. As compensation for transportation and time, participants received USD 56 total upon completing all project sessions.

Ethical considerations

Ethical approvals were obtained from Kennesaw State University, the Makerere University School of Social Sciences Research Ethics Committee (MAKSSREC 06.22.566) and the Uganda National Council of Science and Technology (registration number SS1347ES). All participants completed informed consent and detailed training, which included detailed discussions of confidentiality, data use, and risks related to photographing public spaces. Participants selected pseudonyms to use in the group discussions to ensure their privacy and were explicitly guided not to take identifiable photos of individuals without verbal consent and were discouraged from photographing people whenever possible. Because all selected photographs were taken in public spaces, no additional community-level or property-owner consent was required, consistent with accepted practice for Photovoice research in public environments. Moreover, the facilitators (two Ugandan women from UYDEL) were fluent in English and Luganda and provided translation support as needed.

The Photovoice process and data collection

The Photovoice process comprised five sessions: one full-day group training, three weekly small-group sessions (one per site), and a final large-group validation session.

Training: The project began with a one-day training for all 15 participants, led by two African women facilitators trained and CITI-certified in participatory methods. One facilitator had specialized experience in participatory photography. Training topics included research ethics, safe photography, confidentiality, framing and captioning photos, and navigating community spaces. Participants practiced taking photos during a guided walk in their communities.

Photo-taking and Weekly Sessions: Each participant received a Samsung A03 smartphone with GPS capability enabled to capture geocoded images. Smartphones were used because they were discreet and familiar to participants. Over the following 3 weeks, participants took photos representing their perceptions of factors influencing well-being and mental health in their communities. During weekly meetings, the photos were shared and discussed using the adapted SHOWeD framework (Shaffer 1985, Wang and Burris 1994, 1997):

1. What do you see here?

2. What’s really happening in this photo?

3. How does this relate to our lives?

4. Why does this situation exist?

5. What can we do about it?

These structured prompts guided reflective dialogue and critical analysis. Participants also generated captions and titles for their photos during these discussions.

Final Validation Session: The project culminated in a one-day thematic validation workshop with all 15 participants. Using a ‘photo gallery’ approach, participants collaboratively sorted 54 selected photographs into thematic categories, discussed similarities and differences, and refined labels and meanings. This participatory validation process constituted the primary analytical step of the study.

Participant characteristics

Participants ranged in age from 18 to 24 years. None were married, but one was cohabiting with a partner. Nine had completed lower secondary education, five primary, and one upper secondary. Nine identified as Christian and six as Muslim. Two participants were mothers, each with one child. Eight were unemployed, four self-employed, two employed, and one unknown. Monthly income among employed participants ranged from UGX 15,000–320,000 (USD 4.30–91.42). The most common vocational skills were hairdressing/cosmetology (n = 8) and bakery (n = 3). Family size ranged from 1 to 10 members.

Given the small sample and the descriptive nature of these characteristics, we report them narratively to preserve readability rather than in tabular form, consistent with qualitative reporting conventions.

Analysis

The analysis was participant-led and inductive, aligning with community-based participatory research principles. During the final thematic validation session, participants collaboratively reviewed and categorized all 54 photographs, refined theme labels, and reached consensus on final groupings. Each theme reflected collective discussion and agreement, not researcher-imposed coding. Facilitators guided the process, ensured equitable participation, and recorded participants’ statements. Because participants completed the thematic validation, no separate researcher-led coding, software-based analysis (e.g. NVivo), or intercoder reliability testing was conducted. Translations from Luganda to English were crosschecked by bilingual facilitators to ensure meaningful consistency. This approach centers participants as coanalysts, ensuring that the thematic structure authentically reflects their lived experiences and perceptions of environmental stressors and mental health.

During the final Photovoice session, 21 different themes were discussed and included; 1) poor disposal of rubbish/poor sanitation; 2) business/workplaces/employment; 3) health centres/clinics, security; 4) places of worship; 5) water drainage system (poor drainage system and constructed drainage system); 6) schools/education; 7) wells/water sources; 8) markets; 9) idleness games/activities such as drug and alcohol use, board games; 10) farming; 11) nature; 12) living and lifestyles; 13) house congestion; 14) bars/entertainment places; 15) construction; 16) sports; 17) community development (such as electricity, transport network); 18) people, children, women; 19) sign posts; 20) toilets/latrines; and 21) security.

By consensus, all the participants across the three groups were able to present and review their photo captions and how they represented the overall themes. The captions originally provided were discussed and the group and further revised the theme and captions. The participants engaged in the photo description activity during the gallery walk, articulating their experiences, opinions, and insightful findings, thereby contributing to the encapsulation of overarching themes and motivations behind their selection of specific images. Subsequently, participants were instructed to categorize the 21 provided themes according to priority, facilitating the emergence of a reduced set of key themes based on this classification. The collaborative nature of participant interaction and ensuing in-depth discussions guided the process of condensing the initially presented photos into a final selection of broader themes.

Of the 21 themes originally identified and discussed, the final validation session reduced the number of themes (i.e. business, markets, and urban farming; health centres/clinics, schools, security, places of worship; drainage system, sanitation/garbage disposal, water sources) (Table 1). We have organized these into three broader categories given the overlap and to facilitate the representation of the broader links to mental health and well-being as follows: 1) entrepreneurship, trade, and urban farming; 2) health, wellness, and security; and 3) urban infrastructure (Figures 1–9).

Table 1.

Final theme validation narratives with participants from three study sites to identify the key factors that exacerbate and mitigate environmental stressors (TOPOWA study).

Theme Validated	Individual Captions	The Group Validated Caption
THEME 1: Entrepreneurship, Markets and Urban farming
Entrepreneurship	Availability of small-scale business in our community helps us earn a living Availability of small-scale business improves standards of living because people can earn a living The more land one has the better the business Being job creators not job seekers Creating jobs	Availability of small-scale business improves standards of living because people can earn a living
Markets		Empowerment of women in small-scale business boosts their family’s wellbeing. Women empowerment in the agrobusiness and small-scale business which boosts on the well-being of their family and economic development in the community
Urban Farming	Proper use of plastics can help us to keep our environment clean Urban farming in the slum areas leading to food production. Urban farming while using reusable products Urban farming creates creativity in one’s mind Agricultural skills in urban slum communities Proper usage of wasted plastics Usage of small spaces to be able to get what we want.	Innovative agricultural skills in urban slum communities help to keep our environment clean through proper disposal of plastics. Innovative urban farming skills in the urban slums
THEME 2: Health, Wellness, Education and Security
Health Centres/Clinics	Easy access to free medication Access to free medical services and counselling in the community that improves our well-being. Provision of free medical services in the community Community medical services increase access to medical care Organised medical centre due to the cleanliness of hygiene of the place and services are located properly which they offer	Access to safe medical health services and counselling in the community improves our well-being/mental status.
Schools		Safe and secure formal education in schools for our children in slum community contributes to community development.
Security	Security in our community makes us secure and decrease crimes in our community Police station shows safety in our community Security in our community Various job opportunities in the community, if people are working, they will not engage in crime and other behaviours. When one has no money, they may not have a way to survive. Youth engaging in the transport sector for a living There are some areas that have security and at the same time facing high crime rates	Security in our community makes us secure, boosts job opportunities, and decreases crimes in our communities.
Places of Worship	Having a spiritual being Worshipping places are supporting recovery from depression or suicide tendencies in communities. It is a place of hope in our community and religious development in our community Existence of worship places in our communities provides counselling and gives hope to people in our communities Presence of worshiping places in our community helps people that are depressed and provides hope. Presence of worshipping places in our community can help people to know more about God Prayerful community When people are prayerful and have spiritual beliefs, they tend to avoid crime, immorality, drug abuse, and other risk behaviours Churches and mosques (worshiping places) contribute to a copying mechanism and resilience	Existence of worship places in our communities provides counselling and gives hope to people in our communities When people are prayerful and have spiritual beliefs, they tend to avoid crime, immorality, drug abuse, and other risk behaviours
THEME 3: Urban Infrastructure
Drainage system/sanitation/Garbage disposal	Poor hygiene and sanitation represent TOPOWA Poor personal hygiene Contagious environment/STI transmission Here is a clean environment Need to keep clean to avoid getting diseases and sick Community development due to constructed trenches Environmental protection verses environmental degradation. Keeping our environment clean to avoid getting diseases and sickness through construction of trenches to avoid environmental degradation. Keeping our environment clean for improved well-being and environment protection	Poor hygiene/sanitation in our communities creates health and mental risks Keeping our environment clean to avoid getting diseases and sickness through construction of trenches to avoid environmental degradation
Water sources	Easy access to safe and clean water in the community Sources of water people can access water freely with no cost Free water source which prevents people from having hard time in the community Natural water source which prevents people from attracting diseases and also conserving the environment Well-constructed clean natural water because the well is constructed properly with no impurities Free water source, basic need, and healthy environment Poor garbage disposal near water source point which causes water contamination leading to diseases such as Bilharzia	Easy access to safe and clean water in the community improves our wellbeing

Figure 1.

Theme: small business (photo by Hopebella, age 19, Makindye). Availability of small-scale business improves standards of living because people can earn a living.

Figure 9.

Theme: drainage System, sanitation/garbage disposal (photo by Shamie, age 24, Bwaise). Poor hygiene/sanitation in our communities creates health and mental risks.

Results

The final three themes: Entrepreneurship and Trade; Health and Wellness; and Urban Infrastructure, were not only reflective of participants’ physical and social environments but also of how these factors influenced their mental well-being. During the theme validation session, participants discussed how certain features of their communities contributed to feelings of hope, safety, or stress, illustrating both mitigating and exacerbating effects on mental health. These linkages were embedded in their photo captions and discussions, reflecting the empowering process of identifying the factors that shape well-being in their daily lives.

Entrepreneurship, trade, and farming

Participants emphasized small-scale business, market activity, and urban farming as pathways to resilience and improved living standards. Photos and captions illustrated how women leveraged entrepreneurship as a coping strategy to navigate economic precarity, describing small shops, vending stalls, and agri-businesses as sources of empowerment and family well-being (‘Availability of small-scale business improves standards of living because people can earn a living’). Urban farming photos highlighted creative reuse of plastics and micro-spaces for food production, signaling environmental awareness and innovation (‘Innovative agricultural skills in urban slum communities help to keep our environment clean’). These images collectively depicted entrepreneurship not only as a means of survival but also as a positive coping mechanism contributing to mental well-being through self-reliance and community contribution

Participants emphasized that engaging in small-scale business or vocational work provided a sense of purpose and reduced stress associated with unemployment and financial insecurity, thereby contributing positively to their mental well-being.

Health and wellness

Access to health facilities, places of worship, and social spaces were described as restorative and supportive of emotional resilience, while their absence or inaccessibility was linked to anxiety and hopelessness. Images depicting clinics, schools, and security posts reflected the importance of accessible services and safe environments for sustaining mental and physical well-being. Participants described local clinics as sources of both medical care and emotional support (‘Access to safe medical health services and counselling in the community improves our well-being/mental status’), while schools symbolized hope and social development (‘Safe and secure formal education in schools for our children contributes to community development’). Security images conveyed both reassurance and anxiety – police presence was linked to safety, but also to uneven protection and economic opportunity (‘Security in our community makes us secure, boosts job opportunities, and decreases crime’). Together, these photos portrayed intertwined structural and social factors that either reinforced safety and stability or intensified stress in contexts of insecurity

Urban infrastructure

Participants reflected that poor drainage, uncollected waste, and overcrowded housing were daily stressors that heightened frustration and fear, yet community-driven cleanup efforts fostered pride and collective efficacy, mitigating some negative feelings. Participants’ photos of drainage systems, waste disposal, and water sources underscored the everyday stressors of inadequate infrastructure and environmental degradation.

Poor sanitation was associated with illness, contamination, and mental distress (‘Poor hygiene/sanitation in our communities creates health and mental risks’), while photos of improved trenches and clean water taps were linked to pride, well-being, and a sense of collective responsibility (‘Keeping our environment clean to avoid getting diseases and sickness through construction of trenches to avoid environmental degradation’). These environmental conditions were thus experienced as both risk and relief – amplifying stress when neglected and fostering well-being when improved

Discussion

This formative qualitative study examined how environmental stressors in Kampala’s urban slums influence young women’s mental health and well-being, using Photovoice to capture and interpret their lived experiences. Through photographs, captions, and group discussions, participants identified factors that either exacerbated or mitigated these stressors. Three overarching themes emerged during the thematic validation: (1) entrepreneurship, trade, and urban farming; (2) health, wellness, education, and security; and (3) urban infrastructure. Below, each theme is contextualized in relation to previous research and its implications for women’s mental health and resilience.

Entrepreneurship and small trade were described as vital for survival and empowerment. In a context where formal employment is scarce, women emphasized self-employment as a key strategy to reduce poverty and improve well-being. Uganda ranks among the countries with the highest share of entrepreneurs (28%) (Patton 2016), though most operate micro or small businesses. As participants stated, ‘small-scale businesses improve standards of living’ and contribute to ‘economic development in the community.’ This aligns with evidence showing that women entrepreneurs contribute significantly to sustainable development (Shiralashetti and Poojari 2022), economic growth (Henry et al. 2016), and financial inclusion (Azman and Kassim 2019). However, women face persistent barriers – limited capital, gender discrimination, and lack of work-life balance (Pareek and Bagrecha 2017, Pathak and Varshney 2017, Yasin et al. 2020). In this study, entrepreneurship represented both an income source and a symbol of agency and hope for better living conditions, reinforcing women’s self-confidence and perceived control over their circumstances (Tlaiss 2014).

The social and cultural context also shapes women’s ability to accumulate and manage resources (Khayesi and George 2011). Financial literacy plays a critical role in women’s entrepreneurial success (Yasin et al. 2020), yet many participants in this study had limited formal education, making market participation partly aspirational. Nonetheless, their emphasis on entrepreneurship as a pathway to empowerment underscores its relevance as a mental health resource, a way to regain control, structure, and purpose in challenging urban environments (Sajjad et al. 2020).

Urban farming emerged as another key livelihood strategy. Participants linked it to food security, income generation, and environmental stewardship. Prior research confirms that urban farming empowers women, enhances household nutrition, and supports economic resilience (Pottier 2015, Safitri et al. 2021). It has proven particularly valuable during economic hardships, such as the COVID-19 pandemic (Lusianingrum and Pertiwi 2022). Beyond its economic role, urban farming fosters a sense of purpose and connection to community, contributing to psychosocial well-being (Abdullah et al. 2017, Omondi et al. 2017, Kusumawati et al. 2022, Nugroho et al. 2023).

Participants also highlighted access to health care, education, and safety as central to their well-being. For women living in Kampala’s informal settlements, health challenges are multifaceted: high rates of HIV and sexually transmitted infections (Swahn et al. 2019, Lyons et al. 2025), reproductive health barriers (Akinyemi and Ibrahim 2024), poor mental health outcomes (Kinyanda et al. 2012, Swahn et al. 2012, Culbreth et al. 2018, Perry et al. 2020), growing non-communicable disease burdens (Guwatudde et al. 2015), and widespread gender-based violence (Swahn et al. 2012a, 2015, Amegbor and Pascoe 2021, Culbreth et al. 2021, Self-Brown et al. 2021), including transactional sex for survival (Swahn et al. 2016). Against this backdrop, access to ‘safe medical and counseling services’ was described as a crucial protective factor. This aligns with prior studies emphasizing the need for integrated health, HIV, and reproductive care for women in urban slums (Logie et al. 2019, 2021, Magunda et al. 2023, Fongar et al. 2023, Lyons et al. 2025).

Education was also viewed as essential for stability, empowerment, and community development. With most participants having only primary or lower secondary schooling, schools were seen not just as learning environments but as safe spaces that support personal growth and protect against early pregnancy and substance use (Swahn et al. 2013, Moore 2016, Parmar et al. 2016, Masuda and Yamauchi 2020).

Security was another recurrent theme. Women emphasized fear of violence as a constant source of psychological distress, echoing prior findings on the high risk of victimization among women engaged in informal labor or transactional sex (Tusiime et al. 2015). The presence of community policing and visible security structures was perceived as both protective and empowering, fostering a greater sense of safety and stability (Swahn et al. 2015, Logie et al. 2019).

Places of worship were identified as vital psychosocial resources. Participants described them as sources of ‘hope,’ ‘counseling,’ and ‘recovery from depression or suicide tendencies.’ These institutions provide emotional support, social belonging, and a sense of purpose (Mazumdar and Mazumdar 2004), though access and influence may differ across religious groups due to gendered cultural norms (Swahn et al. 2022). Collectively, these findings illustrate that faith-based and communal institutions play a central role in promoting mental health and resilience among young women in Kampala’s slums.

Participants’ photographs and discussions about water, sanitation, and drainage reflected deep concerns over inadequate urban infrastructure and its impact on daily stress and health. Limited access to clean water and sanitation contributes not only to disease but also to psychosocial distress, time burden, and gendered vulnerability (Essendi et al. 2011, Sahoo et al. 2015, Mukherjee et al. 2020). Women often described the stress of walking long distances to fetch water, which limits opportunities for work and childcare (Mukherjee et al. 2020). Poor sanitation also heightens exposure to violence and health risks, including reproductive complications (Beguy et al. 2014, Kwiringira et al. 2014, Mageswari 2020, Hailu et al. 2022).

The lack of drainage and waste management further compounds these challenges. Flooding, garbage accumulation, and open defecation create unsafe environments and reinforce cycles of stress and illness (Kwiringira et al. 2014, Corburn and Hildebrand 2015, Hirve et al. 2015, Hulland et al. 2015, Sommer et al. 2015, Bauza and Clasen 2019, Hyun et al. 2019, Nuradinda et al. 2021, Panchang et al. 2022, Alice et al. 2023, Alum et al. 2024, Lyons et al. 2025). Participants’ reflections highlight that environmental hazards are inseparable from mental well-being – each structural deficit, from blocked drains to uncollected waste, translates into a daily source of anxiety and insecurity.

This qualitative, participatory assessment involved 15 young women from three Kampala slums. While not representative of all women in informal settlements, the study provides valuable insights into lived experiences seldom captured in quantitative surveys. Its small, self-selected sample limits generalizability, and group dynamics may have shaped discussions. Ethical restrictions constrained which photos could be taken, and social desirability may have influenced narratives. Nonetheless, the Photovoice process, especially participant-led theme validation, ensured that the findings reflect authentic local perspectives.

As with most participatory methods, power dynamics and interpretation are inherent challenges. The research team minimized bias through community-based facilitation, collaborative analysis, and careful attention to ethical considerations regarding privacy and consent (Swahn et al. 2025). The use of Photovoice enabled participants to identify what ‘environmental stressors’ and ‘mental health’ meant to them, rather than imposing external definitions.

The findings highlight pathways linking environment, economic activity, and mental health, with implications for multi-sectoral interventions. Future stages of the TOPOWA cohort study will build on these themes to quantify relationships between environmental stressors, resilience, and mental health, ensuring that community-defined priorities inform study measures.

For NGOs and community organizations, the findings underscore the importance of integrating psychosocial support and mental health promotion into vocational and livelihood initiatives. For government agencies, they point to the need for gender-responsive urban planning that ensures safe water, sanitation, and secure public spaces. For funders and development partners, the study reinforces the value of participatory approaches that amplify women’s voices and prioritize mental health within broader urban development and poverty reduction agendas. Finally, this study uplifts the voices of young women whose insights reveal the complex interplay between environment and mental health in Kampala’s urban slums – reminding us that through their eyes, we gain a deeper understanding of resilience, agency, and the urgent need for inclusive urban transformation.

Figure 2.

Theme: market (photo by Rophie, age 19, Bwaise). Empowerment of women in small scale business boosts their family’s wellbeing. Women empowerment in the agrobusiness and small-scale business which boosts on the well-being of their family and economic development in the community.

Figure 3.

Theme: Urban farming (photo by Sharifa, age 22, Banda). Innovative agricultural skills in urban slum communities help to keep our environment clean through proper disposal of plastics.

Figure 4.

Theme: health centre/clinic (photo by Shamie, age 24, Bwaise). Access to safe medical health services and counselling in the community improves our well-being/mental status.

Figure 5.

Theme: schools (photo by Esther, age 21, Makindye). Safe and secure formal education in schools for our children in slum community contributes to community development.

Figure 6.

Theme: security (photo by Gamisha, age 18, Bwaise). Security in our community makes us secure, boosts job opportunities and decrease crimes in our communities.

Figure 7.

Theme: places of worship (photo by Jane age 24, Bwaise). Existence of worship places in our communities provide counselling and give hope to people in our communities when people are prayerful and have spiritual beliefs, they tend to avoid crime, immorality, drug abuse, and other risk behaviours.

Figure 8.

Theme: water sources. (photo by, Tracy, age 21, Banda). Easy access to safe and clean water in the community improves our wellbeing. Keeping our environment clean to avoid getting diseases and sickness through construction of trenches to avoid environmental degradation.