An Exploration of Social Justice Intent in Photovoice Research Studies: From 2008 to 2013

Abstract

In an age where digital images are omnipresent, the use of participant photography in qualitative research has become accessible and commonplace. Yet, scant attention is paid to the social justice impact of photovoice among studies that have used this innovative method as a way to promote social justice. There is a need to review this method to understand its contributions and possibilities. This literature review of photovoice research studies 1) explores whether authors implicitly or explicitly related the methodologies to their aims of promoting social justice (methodology-method fit), and 2) outlines the social justice research impact of photovoice findings using the framework of social justice awareness, amelioration, and transformation. PubMed, Scopus, PsycINFO, and Web of Science databases were searched from the years 2008–2013 using the keywords: photovoice; photonovella; photovoice and social justice; and photovoice and participatory action research. Of the 30 research studies reviewed, only thirteen identified an underlying methodology guiding the photovoice method. The social justice impacts emphasized were more related to social justice awareness (n= 30) than amelioration (n= 11) or transformation (n=3). Future researchers using photovoice as a way to promote social justice are encouraged to assess and plan for the social justice impact desired.

The last two decades witnessed an explosion in the use of participant – photography, or photovoice, by qualitative health researchers. Developed by Wang and Burris (Wang & Burris, 1994, 1997), photovoice was first used with the theoretical underpinnings of Freire’s critical consciousness and feminism (Freire 1973; Weiler 1987). Wang proposed photovoice as a method for those marginalized to document their experiences, and comment on the social and political forces that influenced those experiences.

There were three original reasons proposed for the use of photovoice. First, it could record and document the strengths and weaknesses of a community. Second, it could empower individuals by providing a platform for group and community discussions. Third, critical dialogues from photovoice - geared toward community improvement - could be used to influence policy making to promote systemic change (Wang, 1999).

However, since its introduction, several researchers have critiqued the photovoice method. Critiques of photovoice have focused on either ethical dilemmas (Allen, 2012; Evans-Agnew, Sanon & Boutain, 2013; Prins, 2010; Wang & Redwood-Jones, 2001) or on methodological and technical challenges (Evans-Agnew, Sanon, and Boutain 2013; Novek and Morris-Oswald 2012; Royce, Parra-Medina, and Messias 2006). Despite these concerns, these critiques reaffirm Wang’s (Wang, Morrel-Samuels, Hutchison, Bell, & Pestronk, 2004; Wang & Pies, 2004) contention that the principal goal of this method is to influence policy change and promote social justice. However, the extent to which these impacts occur as a result of research using photovoice requires further study.

This article aims to advance the use of the photovoice method by conducting a historical review of its use related to social justice. There are two specific purposes for this article. This article explores how the authors implicitly or explicitly related the methodologies to the historical photovoice aims of social justice. In this paper, we define this as methodology-method fit. This article also maps the research impacts using a framework of social justice awareness, amelioration, and transformation. Impact in this article refers to how the research findings were used to promote change either at the individual level or in the systems, environment or policy realms.

This article is organized in four major sections. First, we provide a view of prior critiques of photovoice as a method. Second, we describe the framework we use to critique the literature, focused on methodology-method fit and social justice approaches. Third, we outline the literature review method used to retrieve studies reviewed in this article. Fourth, we analyze whether the authors implicitly or explicitly reported how their methodologies were driven by to goal or promoting social justice (methodology-method fit). Fifth, we explore the social justice impact of the research studies relating to awareness, amelioration, and transformative action. Last, we summarize the implications for future research.

Prior Critiques of the Photovoice Method

Extensive reviews of photovoice were completed in 2009 (Hergenrather, Rhodes, Cowan, Bardhoshi, & Pula, 2009) and 2010 (Catalani and Minkler 2010; Hergenrather et al. 2009). However, neither review focused on the extent to which the photovoice findings promoted social justice impact. Instead, the use and possibilities of the photovoice method was the primary focus.

Hergenrather and colleagues (2009) reviewed 31 articles to determine how photovoice promoted individual and community change. Individual and community change referred to increased individual awareness and participation as change agents; and physical improvements within the community, respectively. They reported inconsistencies in the photovoice process among the studies. They recommended the need for researchers to identify both researchers’ and participants’ role in all aspects of the project.

Catalani and Minkler (2010) used Wang’s photovoice approach to explicate the positive relationship among community involvement, individual empowerment, community asset recognition, and action towards policy change. Community involvement activities were defined as those including interactive activities such as training, discussion, and documentation. Their critique of photovoice studies preceded the year of 2008. The critique focused on how the photovoice process was undertaken (e.g. recruitment, sample size, sample characteristics, and training), including a particular focus on the elements of participant engagement (e.g. “participant involvement”, and “empowerment”). Inconsistencies in rigor and fit between the method and the particular health concern of interest were noted. Although most of the studies (60%) used the word impact, impact referred to community member involvement and their experiences of individual empowerment and awareness. No observations were made about social justice impact as a result of using the photovoice method. We extend Catalani and Minkler’s (2010) analysis to review and describe the social justice impact of photovoice research and also by extending the discussion on methodology and method fit for articles published since 2008.

In the next section, we will begin with discussions about methodology-method fit, and the social justice framework. These two discussions will anchor our analysis of the research studies retrieved. The discussion provides more information about the theories used to analyze the studies.

Analyzing Methodology- Method Fit

The identification of methodologies guiding research methods is of upmost importance (Chenail 2009; Crotty 1998; Mack 2010). Methods that are intended for justice promotion, must be guided by justice oriented methodologies and philosophical underpinnings (Evans-Agnew, Sanon, and Boutain 2013). Researchers have been called upon to be transparent about their epistemological underpinnings, research approach (methodology) and their chosen tools to execute the research process (methods) (Chenail 2009; Crotty 1998). Hansen-Ketchum and Myrick (2008) support this notion with respect to photovoice as they argued that peoples’ existence/reality (ontology), belief about how knowledge is acquired (epistemology) and their approach to developing knowledge (methodology) most notably shape their decision about research methods. Thus when aiming to use a methodology that attends to social justice, it is important to have clarity about the social justice intentions.

To this end, there continues to be a lack of consistency among photovoice studies in identifying a guiding methodology. Many photovoice studies used community based participatory action research and participatory action approaches as a way of describing their social justice intent. However, there has been no concrete description of how participatory study designs using photovoice have addressed social justice. This lack of explicit detail possibly resulted from research and publishing expectations (Castleden, Garvin, and First Nation 2008) because of the pressure on the researchers to confirm to publication requirements and academic standards of rigor.

Analyzing Social Justice Impact

Definitions of social justice have focused on the equal distribution of benefits and burdens in society (Boutain 2011; Redman and Clark 2002) and promoting change in society focusing on social relationships and institutions (Drevdahl et al. 2001). Buettner-Schmidts and Lobo (2012) synthesized the definition of social justice as the “full participation in society and the balancing of benefits and burdens by all citizens, resulting in equitable living and a just ordering of society” (954). Researchers that use a social justice framework emphasize moral obligation and citizens’ rights (Boutain 2011) and a focused agenda of direct change to minimize subordination and vulnerability (Kirkham and Anderson, 2002).

A social justice framework could benefit researchers in photovoice design given the original goals for photovoice use. Despite the extent of photovoice studies, an evaluation of the social justice impact of research using the photovoice method has not been completed. In this review we employ the social justice insights described by Boutain (2011) that includes three major ways of focusing on social justice impact. Namely, we will focus on social justice awareness impacts, social justice ameliorative impacts, and social justice transformative impacts related to photovoice use in research studies. This framework is selected as it describes a variety of ways to delineate social justice impacts. Each framework component is described in more detail below.

Social Justice Awareness

Social justice awareness focuses on making burdens and benefits more apparent with attention to relationships of power. Awareness impacts inspire cognitive, emotional or intellectual insights on the part of individuals or groups. It can promote constant questioning of the influence of systems of oppression in creating privilege, marginalization, and health. It calls for contextual consideration on the part of the researcher to begin to grasp different aspects of a phenomenon. Social justice awareness is ongoing and is never fully met as it “temporal and [is] dependent on [one’s] frame of reference” (Boutain, 2011, 51).

In a photovoice project, findings may be used to help researchers, participants and audience members reach new understanding about systems of oppression. The photovoice findings may show connections between health and society anew. Findings can provide visuals of life realities. Thus, visual senses can be heightened to identify the vulnerable and privileged and the factors leading the disparities. Although awareness is needed as an initial process of consciousness raising to understand issues of power, privilege, and health compromise, this impact is most focused on increasing sensibilities for individuals or groups about issues using the photovoice approach.

Social Justice Amelioration

Social justice amelioration impacts would involves actions to mitigate the immediate factors leading to the unjust conditions. Social justice amelioration does not provide long term remediation of the health and social injustices. Instead the social justice impact is an immediate reaction to address acute and emergent issues that are symptoms of oppression or power imbalances which result in vulnerability and health compromise.

Photovoice findings may inspire remedial reactions by those who are present. Or the photographs may be presented in a way to anchor reactive discussions about actions needed. Reactions may be short-term or long-term but will center on addressing symptoms of oppression and not address systems of power which lead to oppression or health vulnerabilities. Often these reactions do not deeply consider how to change one’s power position in order to subvert participation in oppressive relationships. For example, the reactions may center on how to address the issues presented by those who have taken the photos. The discussion does not focus on the conditions which gave rise to the contexts or issues photographed.

Transformative Action

Unlike social justice amelioration which does not prevent the problem from recurring, an impact focused on social justice transformation aims to address the issue at its roots. The goal of transformative impact is to promote change in systems of oppression in ways of being, ways of interacting, and ways of governing. These changes can be explicitly shown at the systems, governance, or policy levels to eliminate or minimize the underlying factors leading to power imbalances and unjust conditions. Systems level change would show a difference in relationships between institutions or sectors. Policy change, an alteration in the governance of how systems are operated, may occur at the institutional or public regulatory levels.

Transformative impacts can involve new policy development or changes in existing policies. For example, photovoice findings may inspire changes in systems of care to address patterns of poor health outcomes. Additionally, photovoice findings which show unequal, unjust or uneven applications of regulations in addition might prompt a more extensive policy review. Thus research impacts using photovoice would most likely focus on system, policy or environmental changes.

Literature Review Methods

Two research questions guided our review of the literature. Those questions were: Did study authors use the photovoice method with the intent to promote social justice describe their methodology with a justice-based orientation (methodology-method fit)? How did the photovoice study findings promote a social justice awareness, amelioration, or transformation impact? We searched the PubMed, Scopus, PsycINFO, and Web of Science databases from the years 2008–2012, using the terms photonovella and photovoice, and the combination of photovoice and social justice; and photovoice and participatory action research.

The original searches from all the databases combined yielded 695 articles. After all the duplicates were removed, articles were excluded if they met several criteria. They were excluded if 1) not written in the English language, 2) not available in full text, 3) published outside of 2008–2012 (building upon Catalani and Minkler’s review which included articles that were published before 2008) (n = 28); 4) were multiple reports from one research study (n =3); 5) were exploratory studies that utilized the photovoice method and were more focused on individual experiences and cultural approaches (n= 13); 6) only discussed effectiveness/evaluation of the photovoice method with respect to the research study and did not provide a full study description (n= 16); and 7) did not report photovoice findings to an audience (n= 29). Articles with these aforementioned concerns used photovoice merely as an additional source of data collection. For example, photovoice was used to triangulate data or used as a way to show pictures to emphasis research points. Consequently, a total of 30 research studies were reviewed (see Table 1).

Table 1.

Addressing social justice through photovoice: Methodology-Method Fit and Social Justice Impacts

#	Author (s) & Year	Purpose	Methodology	Participants	Exhibits & Audience	Direct Impacts	Aspects of Social justice addressed (Awareness, ameliorative, or transformative impacts)
1	(Andonian and MacRae 2011)	To explore social participation among older adults while living alone	Mentioned Action research when describing photovoice, but did not use participatory action approach	N = 7 urban older adults who live alone (age 55+). San Francisco CA, USA	Exhibit: City hall: Legislators, providers, educators and others	Not Reported	Awareness Impact
2	(Bharmal et al. 2012)	To identify and prioritize factors associated with the transition to manhood among African American Men	CBPR-to create partnerships	N = 12 African-American men (ages 16–26 years). Los Angeles, CA, USA	Exhibit: Community forums: secondary school members.	Designed and implemented a young men’s access support group	Awareness & Ameliorative Impacts
3	(Brazg et al. 2011)	To assess adolescent substance use and abuse.	CBPR – to create partnerships	N = 12 high school students (grades 10, 11, 12) WA, USA	Exhibit: Community forum: alcohol and drug intervention specialists, youth and family services director, city attorney, and local police	Not Reported	Awareness Impact
4	(Castleden, Garvin, and First Nation 2008)	To evaluate the use of photovoice	CBPR-Complete	N = 45 (ages 19- 75 years) First Nation in Western Canada	Exhibit: Newsletters and posters during potluck dinners at 4 community sites within the community and upon request.	Two community members trained in photovoice research and are using it to address other environmental and health issues	Awareness & Ameliorative Impacts
5	(Chilton et al. 2009)	To record single mothers’ stories on poverty and hunger to inform social welfare policy	Human rights framework. Participatory advocacy	N= 42 mothers of young children	Exhibit: 1) Interactive searchable and socially networked website, 2) United States Senate by 3 US senators, 3) Congressman Jim McGovern home district in Massachusetts, 4) senate democratic steering and outreach committee	Women shared stories and images through internet, and public forums and media.	Awareness Impact
6	(Davison, Ghali, and Hawe 2011)	To Determine interventions to foster social inclusion and improve student health	Mentioned participatory action research while describing photovoice but did not use that approach.	N= 10 young students	Exhibit: School display: Students and staff	As a result of the study, teachers consciously worked to prevent harassment of younger students, instituted new measures for ESL students and a formal orientation.	Awareness and Ameliorative Impacts
7	(Denov, Doucet, and Kamara 2012)	To Explore the post war & reintegration experiences of former child soldiers	CBPR-to create partnerships with the project.	N = 11 Youth (ages 18–23 years) Bedeluslum, Freetown, Sierra Leone	Exhibit: Community forums: government, local, and international NGOs, youths and local media. Exhibited at McGill University in Canada: study participants, faculty, students and the public.	Not Reported	Awareness Impact
8	(Downey, Ireson, and Scutchfield 2009)	To explore the empowerment education model and community health assessment	PAR	N = 18 (ages 15–18 years). rural citizens of one Appalachian county, USA	Exhibit: Community forum at local diner, community center, high school, and a church: community leaders and stakeholders	Not Reported	Awareness Impact
9	(Duffy 2010)	To record, reflect and act on community influences on health; to promote critical dialogue and to reach policy makers.	PAR	N = 7 (ages 18 +) single mothers in Moncton, New Brunswick, Canada	Exhibits: partner agency board; an open house; a three-day event: Mayor and media; Various public venues and conferences; radio, newspaper, and television (regional and national) coverage.	The women implemented: 1) an survey of public transit, 2) A white paper for accessible public transport presented to: a) the general manager Transit System, b) transit board, 3) other evaluations of transit	Awareness & Ameliorative Impacts
10	(Findholt, Michael, and Davis 2011)	To assess for obesity prevention and physical activity.	Mentioned CBPR as they were describing photovoice	N = 6 (ages 15–18 years)	Exhibit: high school auditorium: coalition members, parents, teachers, school administrators, city and county government employees, health care professionals, business leaders, and local media.	Not reported	Awareness
11	(Foster-Fishman et al. 2010)	To learn about young people involvement, support in neighborhoods, schools, and community	PAR-involved participants in all phases of the research.	N= 19 middle school students (representing four middle schools; ages 12 to 13)	Exhibit: Retreat for local organizations and residents	Published guide about youth concerns. As a result, youths’ concern was the focal point during two major community events	Awareness & Ameliorative Impacts
12	(Flum et al. 2010)	To Explore hazards for workplace injury	Mentioned PAR when describing photovoice	N= 16 University Custodians	Exhibit: Forum: custodians and occupational safety and health stakeholders	Improved waste removal; ergonomically safer equipment purchased; management disseminated exhibit via website. Established safety committee for custodians has been established; and custodian injuries had decreased from 39% in 2007 (year of the study) to 26% in 2008 and 20% in 2009	Awareness & Ameliorative Impacts,
13	(Grieb et al. 2013)	Housing residents perspectives on housing and health	Used CBPR when describing photovoice	N= 9 men in transition al housing, returning from incarceration, Baltimore	Exhibit: community based organizations, 2 libraries, and city hall	Community and academic partnership for community clean up projects and for development of a family intervention program	Awareness & ameliorative
14	(Green and Kloos 2009)	To document youths’ life in community	Mentioned PAR when describing photovoice	N = 12 migrant youths from Uganda (ages 12 to 16 years)	Exhibit: website; four small cafes in North Carolina and South Carolina (USA).	Fundraising for: laptop computers (n=2) and school fees for participants	Awareness & Ameliorative Impacts
15	(Halifax et al. 2008)	To document and make changes in the homelessness community.	CBPR	N= 12 homeless women and men (ages 20–60) Toronto, Canada	Exhibit: informal and formal meetings with politicians, community events, written reports and publications.	Increased involvement of homeless people in the community	Awareness Impact
16	(Hannay et al. 2013)	To identify barriers to physical activity and initiating policy change actions	Mentioned CBPR when describing photovoice	Six adults and 19 teens	Presentation of photos and reflections were made at the Connecticut’s 2nd Annual Physical Activity and Nutrition Symposium. The audience included health providers, educators, policymakers, and community members.		Awareness
17	(Haque and Eng 2011)	To Record neighborhood implications on residents’ health	Community-based research (CBR)	N = 27 (ages 18–68 years) St. Jamestown Canada	Exhibit: community forum (n= 300) and City Hall: city councilor, and 15 self-invited municipal representatives	Conducted an inventory/replacement/rep air of neighborhood bicycle racks	Awareness & Ameliorative Impacts
18	(Harper 2012)	To document environmental issues	PAR – actually had the community leaders involved in the research process	N = 6 Romani Adults (ages 18–24 years) Northern Hungary	Exhibit: Sajoszentpeter & Budapest: community members. The mayor, local council members, public administrators, doctors, nurses, teachers, environmental NGO’s, media, activists, and lawyers. UN committees (n=2)	Developed: 1) proposal for a nationwide project addressing social justice and environmental issues, 2) Policy recommendations on environmental justice.	Awareness & Ameliorative Impacts
19	(Kramer et al. 2010)	To enable policy makers to be actively involved in identifying community needs	CBPR	N= 44 (29 adults and 15 youth) from Kaiser Permanente Colorado, USA	Exhibit: invitation-only policy roundtable, an active living summit local festivals, business, community centers, churches and planning department meetings: Policymakers, State Governor, & media.	Voter initiative passed to renovate the City Park. Full service grocery store, watershed project and walkable trails built.	Awareness, Ameliorative, and Transformative Impacts,
20	(Lardeau, Healey, and Ford 2011)	To explore determinants of food insecurity among food program users	Mentioned CBPR when describing photovoice	N = 8 regular users of food programs	Exhibit: Museum. No reports of attendance.	Not Reported	Awareness Impact
21	(Lorenz and Kolb 2009)	To understand and raise awareness about brain injury	CBPR-Actually involved participants in the research process (e.g. recruitment)	N = 8 individuals from the brain injury survivor support group. MA, USA	Exhibit: Three libraries, two brain injury conferences, a neurology conference, the Massachusetts State house, and the Brain injury Association of Massachusetts	Social networking website. Public library to raise awareness about the problem	Awareness Impact
22	(Markus 2012)	To empower healthy relationships & prevention of HIV unintended pregnancy	Used PAR (discussed the social justice framework)	N = 6 (18–19 yrs.) American Indian Wind River, WY, USA	Exhibit: University symposium on social justice and an art reception: parents, grandparents, Tribal leaders, college counselors, teachers, youths, and community mental health providers.	Peer education plan	Awareness Impact
23	(Mohammed, Sajun, and Khan 2013)	To explore the experiences of people with Tuberculosis and to advocate for a supportive environment for them	Not reported	Individuals (15 years and older) who were directly (e.g. tuberculosis patients) and indirectly (e.g. family members) affected by tuberculosis.	A call for action was developed and presented a gallery event. The call for action included 6 steps to reduce the spread of tuberculosis and having a supporting environment. About 1000 people were saw the gallery which was a 3 day display. Also 7 news channels (32 minutes to 1 hour air time), newspapers and other online sources coveed the event.	Not reported	Awareness
24	(Newman 2010)	To record the environmental barriers and facilitators to community participation	CBPR – actually built relations hips with community members prior to the study	N= 10 adults with spinal cord injury Charleston, SC, USA	Exhibit: Written testimony: South Carolina Senate Transportation Committee. Newspaper published stories	Coalition developed. State law to strengthen accessible parking laws proposed.	Awareness, and Transformative Impacts
25	(Pritzker, LaChapelle, and Tatum 2012)	To empower participation in civic engagement	CBPR - but participants not involved in the process	N = 15 high school students	Exhibit: School campus: parents, university professors, teachers, city and state policymakers	Not reported	Awareness Impact
26	(Poudrier and Mac-Lean 2009)	To explore and make visible experiences with breast cancer	Decolonizing Methodologies (Feminist Epistemology)	N=12 (ages 42–75) Aboriginal women, Saskatchewan, Canada	Exhibit: Community forum: key stakeholders, advocacy groups	Not reported	Awareness Impact
27	(Seitz et al. 2012)	To empower students to advocate for change of a campus smoking policy	Mentioned CBPR when describing the photovoice method	N = 49 undergraduate college students STATE, USA	Exhibit: University’s student union building: faculty, staff, students, and community members	Ashtrays were relocated/removed by the university’s Grounds Crew Supervisor. Students planned to write a version of an ideal policy.	Awareness & Ameliorative Impacts
28	(Tanjasiri et al. 2011)	To identify and understand environmental characteristics associated with tobacco use	CBPR-Community leaders were involved in the process	N= 32 youths ages 14 to 18 years WA & CA, USA	Exhibit: meeting of tobacco control advocates, & City Council.	The proposal that the students supported was passed and enacted in 2008.	Awareness & Transformative Impacts
29	(Valera et al. 2009)	To document challenges accessing healthy food in	Mentioned PAR during photovoice description	N= 9 low income women (ages 20–45) New York City, NY, USA	Exhibit: College conference, & in Letters to policymakers	Not reported	Awareness Impact
30	(Vaughn, Forbes, and Howell 2009)	To evaluate home visitation program	PAR	N = 7 mothers Cincinnati, KY, USA	Exhibit: Community forum: mothers, home visitors, policy makers, and program service providers.	Not Reported	Awareness Impact

Analysis was done using several steps. We recorded the study purpose, and research study methodology. Participants’ characteristics were also noted to describe the study sample of the photovoice studies. We also documented the mode of dissemination of the photovoice findings. For example, the photo-exhibits (whether via, schools, forums, etc.), and the type of audience that attended those exhibitions were recorded. This enabled us to determine whether the researcher and participants targeted key stakeholders and policy makers in power to make change based on the research findings. We also documented any reported direct research impacts (e.g. whether a policy was developed and/or revised as a result of the study). Based upon all the documentation, we matched the reported social justice impacts with the social justice analysis framework we described earlier. For example, we asked if the impact was more related to awareness, amelioration or transformation.

Results

Methodology-Method Fit To Promote Social Justice

Of the 30 studies reviewed, seven authors wrote about social justice and/or inequity. (Chilton et al. 2009; Duffy 2010; Foster-Fishman et al. 2010; Halifax et al. 2008; Harper 2012; Markus 2012; Tanjasiri et al. 2011) For example, throughout their study report, Halifax and colleagues (2008) referenced to their underlying goal of promoting social justice. Their goal was to explore the social factors influencing the experiences of homeless individuals in Toronto. Markus (2012) used storytelling for social justice model-with the theoretical underpinnings in the critical race theory (CRT) - for data analysis.

Authors from 23 studies described their participants as vulnerable populations. When describing the photovoice method, they also discussed that the underlying intent of the method was to foster empowerment and promote change among those researched. However they did not clearly discuss or identify the structural conditions (social oppressions and political conditions) constraining participant vulnerability.

Thirteen out of the 30 studies (43%) clearly identified their research methodology. Three were explicit about their methodological framework, and 10 studies used principles of participatory action research (PAR). One study (Poudrier and Mac-Lean 2009) was guided by the decolonizing methodology and the feminist epistemology. Another study (Markus 2012) described using a social determinants of health and social ecological model. Chilton et al. (2009) used a human rights framework to guide their study.

Ten studies (Bharmal et al. 2012; Brazg et al. 2011; Castleden, Garvin, and First Nation 2008; Denov, Doucet, and Kamara 2012; Foster-Fishman et al. 2010; Grieb et al. 2013; Harper 2012; Lorenz and Kolb 2009; Newman 2010; Tanjasiri et al. 2011; Vaughn, Forbes, and Howell 2009) used core principles of PAR involving participants in all aspects of the research process. For example, Foster-Fishman and colleagues (2012) utilized the ReACT method to involve their youth participants in data analysis leading to theme emergence.

The remaining 16 studies only mentioned participatory research in terms of acknowledging the community-based participatory research (CBPR) origins of the photovoice method. Photovoice was used to promote participants’ involvement in data gathering. However, the researchers enlisted support of community members with a pre-determined research question, and pre-identified problem to be explored. It was not clear whether community members assisted in identifying community needs, formulated the research question, or explored ways to proceed with the research process. In these studies, following the photovoice sessions, participants were also not involved in the data analysis process.

Social Justice Impact: Awareness, Amelioration and Transformation

Researchers from all 30 studies reported that they raised awareness among the participants, community members, and targeted stakeholders. For example some have stated:

Through their own discussions and by sharing similar stories with each other, the participants voiced frustration and anger about coming to terms with this awareness of their circumstances within the context of their community (Valera et al. 2009).

Others have also noted:

The method was very useful for increasing public awareness of the conditions in Union County that affect children’s physical activity and diets (Findholt, Michael, and Davis 2011)

These statements are exemplars of how the researchers reported awareness raising. The former statement showed awareness-raising at the individual level. While the latter indicates awareness-raising at the community level. Two studies used direct quotes from participants to demonstrate increased awareness (Findholt, Michael, and Davis 2011; Hannay et al. 2013)

Eleven of the studies resulted in some form of immediate action to ameliorate the issue at hand. For example Duffy (2010) reported that the participants were invited to review and evaluate the transit improvements. Based on participants’ suggestions, changes regarding safety and scheduling were undertaken.

Only three of the studies prompted changes at the policy level for transformative impact. For example, the impact of Newman’s et al.’s study (2010) was the passage of a state law to strengthen accessible parking for handicaps. Kramer et al’s (2010) study spurred a successful voter initiative to renovate the city park and build a full service grocery store, a watershed project and walkable trails. Finally, Tanjasiri and others (2011) described the passing and enactment of a proposal that required licensing among tobacco vendors. These studies evidenced that photovoice research studies can lead to a social justice impact.

Discussion

The purposes of this article were to explore 1) whether authors implicitly or explicitly related the methodologies to their aims of promoting social justice (methodology-method fit), and 2) outline the social justice research impact of photovoice findings using the framework of social justice awareness, amelioration, and transformation.. Our present review supports the assertion made by Catalano and Minkler (2010) that research designs involving photovoice continue to under-deliver their supposed action potential.

Furthermore, this is the first review article that examined how researchers using the photovoice method describe methodology-method fit, and social justice impact. This is important because the original concerns of photovoice were towards community-level justice actions. This review documented that few studies are designed for this goal and instead accomplish change only at the individual level.

Awareness-raising as a result of using the photovoice method have been described elsewhere (Carlson, Engebretson, & Chamberlain, 2006; Foster-Fishman, Nowell, Deacon, Nievar, & McCann, 2005). These critiques have also acknowledged the need to go beyond the individual impact to focus on system level impact. Only three of the studies reviewed described transformative change in material or political circumstances for participants and communities involved (Kramer et al. 2010; Newman 2010; Tanjasiri et al. 2011). While clearly reporting awareness impacts in participants, researchers, and other audiences; the reviewed studies were limited in their identification of ameliorative or transformative social justice impacts.

Few researchers were explicit about their social justice intentions (Halifax et al. 2008; Harper 2012; Markus 2012; Tanjasiri et al. 2011) (Markus 2012). This is consistent with observations elsewhere (Kirkham & Anderson, 2010; Olshansky et al., 2005; Rogers & Kelly, 2011). Researchers working with issues relating to health inequities infrequently attend to ethical considerations pertaining to social justice issues in research design or reporting.

The photovoice method lends itself to implicit assumptions about awareness raising. The act of seeing and discussing photos is assumed to inspire awareness of new ways of thinking about inequity and health through the images produced by those disadvantaged. Limitations of these assumptions were not discussed by the researchers in the studies reviewed. Indeed, few researchers took the opportunity to adequately describe the importance of the awareness for themselves, on the research enterprise or on reducing health inequity. None discussed the indirect impact of this awareness on the potential audiences for the published research for community-based dissemination.

The lack of evidence for significant ameliorative or transformative social justice impacts in these photovoice studies diminishes the social justice promise of this methodological tool. Photovoice use may indirectly further marginalize participants through attributional bias. Attributional bias may occur, for example, when images and text are used to locate social justice problems within disadvantaged communities, and not in advantaged communities (Lin and Harris 2008). There is a need for a deeper discussion of research ethics concerning such bias in future reviews of photovoice studies.

Despite the notion of the underlying CBPR approach in many of the studies reviewed, researchers did not make transparent the community-based aspect of their study. As emphasized by O’Toole and colleagues (O’Toole et al. 2003), it is important to distinguish between community-based and community-placed research, as the latter often constitute an imbalance between the research process and targeted outcomes. Pioneers of CBPR have cautioned researchers to clearly provide evidence of the appropriate use of CBPR in their methodologies (Burhansstipanov, Christopher, and Schumacher 2005; Strickland 2006).

In an age where digital images are omnipresent, the use of participant photography in qualitative research has become accessible and commonplace. This review has shown that as the use of this method expands, important methodological concerns persist for researchers whose critical theoretical research designs are committed to the significant advancement of social justice. In particular, researchers must consider the extent of participation in all aspects of the study, and the extent to which social justice awareness, amelioration, or transformation may be achieved.

When evaluating the photovoice method researches must also ask themselves: Are both participants and researchers becoming aware of the oppressive situations and outcomes in the research process? Are both participants and researchers taking actions to ameliorate and/or transforming the status quo? Is the research method in itself empowering and not caught between the politics involved in the rigidity of research designs and reports? (Evans-Agnew, Sanon, and Boutain 2013). Based on Wang’s and Friere’s ontological and epistemological stance on conscientization and empowerment, addressing the researcher/advocate dichotomy must not be the only ultimate outcome. Addressing these questions re-engineers action from an individual to a multilevel ecological scale.

Limitations

This review only critiqued photovoice research studies published between 2008 and 2012. This excluded articles prior to 2008. However our goal was to build upon Catalani et al. (2010)’s review of photovoice with a new direction to describe the social justice intent of photovoice methods in research.

This review depended on data and contexts reported in the research reports. Word-limits of journals may have constrained the reporting details. Thus, particular aspects of social justice action may have been omitted in the interests of space. We also did not make an attempt to contact the researchers themselves to discover more contexts and outcomes.

Participatory studies are often by necessity small, thus transformative impact at the policy/system level may be harder to achieve during the course of the research study. Similarly small changes made in the contexts of ameliorative impact may not be recorded or observed. Thus, changes may not have been noted in the research articles.

Conclusion

The original intent for the use of photovoice was to facilitate change. Given its original intent and theoretical underpinnings, the photovoice method aligns well with the social justice framework which emphasizes the facilitation of just conditions for individual and community well- being. However, as suggested by this review, researchers have yet to embrace the full potential of the method and only few of the reviewed studies resulted in system level change. If researchers identify a clear underlying methodology-method fit (guided by the goal of promoting social justice) and the social justice impact of their research studies using photovoice, the original promise of this method to address social justice and inequality would be met.