Table 2.

Themes From Photovoice Group Discussion on Diabetes Self-Management, Social Support, and Emotional Health

Theme	Description of photograph	Participant’s comments about photoa	Classroom discussion of photograph
Participation in self-care behavior	Photo of a box full of bags of fried street food, such as chips or chicharron (fried pork rind)	•“Junk food is nothing but fats; it is venom for the body.” •“I shouldn’t eat junk food because it has a lot of salt and fats.”	•“Not only diabetes patients but everyone should take care of their health.”
	Photo of a woman sitting on a bed, holding a case with a glucometer inside	•“It is very important to have a blood exam in order to know our blood sugar level.” •“I have to check my blood sugar level twice daily. That way I know if my blood sugar level goes up.”	•“It is very important to know our blood sugar level.”
Preventing and living with complications	Photo of a pair of feet on a tile floor	•“The participant loves herself and takes care of her feet because she does not want anything to happen to them.” •“The picture reminds me that I need to take care of me.”	•“Diabetic people should never be barefoot.”
	Photo of a sign for a dental clinic as seen from the street	•“We need to take care of our teeth and go to the clinic for regular care because I already had a bad experience with a molar.” •“Little by little, I have been losing my teeth; I think it’s because of my diabetes.”	•“It is very important to have a regular exam to check our teeth, gums, and molars. Also, to watch for the way that we eat.”
Facilitators and motivators of diabetes self-care	Photo of a table with food and drinks. There are people partially in the photo	•“A family get-together. They ate sopes [traditional Mexican dish] and walked after eating them.” •“My family is very important for me.”	•“Family is always important.”
	Photo taken of a framed photo of his family of more than nine people	•“If we don’t take care of ourselves, we will not be in that picture anymore. I would like to have one in the future with everybody and no one missing.”	•“If we don’t take care of ourselves then there will be no picture with us in it in the future and we will not be able to achieve our goals.”
	Photo of many small flowers in an outdoor flowerbed	•“Mother nature in full development. We see how an insignificant seed can turn into a beautiful flower.” •“It’s important because it teaches me that if one sets a goal we can achieve it and shine and look beautiful like a flower.”	•“Green means life and this has different colors and reflects a diversity of all the colors. Each color has a different meaning and how we are part of nature and we can be beautiful as a flower” •“People have to see the change in our lives with these classes” •“When diagnosed with diabetes, everything turned grey but now my life is full of colors” •“If I don’t water these flowers they will die so if I don’t take care of myself and take my medication then I can also die.”
	Photo of a medium- sized brown dog lying next to a person on a couch	•“A pet. It helps me to exercise. It is important for my diabetes to keep my sugar down.” •“Exercise is very important for my health.”	•“It is very important to exercise. It is good if you can do it with your pet.”
	Photo of the exterior of a local church taken from the sidewalk	•“For me it represents life, faith, hope. When I come here I feel in peace and the best place to meditate because I feel in peace” •“It helps me to maintain my faith and that no matter how tough life is there is always hope and a light to follow.”	•“Thanks to God I found this place, I feel comfortable when I am in mass and receiving the invitations for this class” •“No matter the circumstances in life, God gives us things that we can always achieve and overcome” •“Any church independent of the religion we profess, helps us because God, our father, always helps us”
Successes in diabetes self-care	Photo of a bike leaning against many quadricycles	•“He was in a 40-mile bike race. He stopped at Navy Pier to drink water.” •“His passion is riding bicycles”	•“He does lots of exercise that keep him healthy and he is doing well.”
	Photo of a bowl of apples, peaches, and grapes	•“We should always have fruits at home. By eating fruits and vegetables we can improve our life style.” •“It is important because instead of eating junk food she eats fruit.”	•“Having fruit on the table promotes family unity. However, we also need to be careful when eating fruits because some fruits have a lot of sugar. Fruits must be on our diet because they have fiber.”
Barriers to diabetes self-care	Photo of a summer backyard party with many adults and children present	•“Picture of a party, since it’s summer, in which we all eat a lot. I try eating something healthy and have to avoid eating a lot at a party.” •“If I don’t take care of myself I can have other diseases and not enjoy life with our kids.”	•“We would be on dialysis” •“Our family will be with us and not enjoying with us” •“A lot of temptation due to so many parties that take place in the summer” •“Drink water instead of beer” •“To be more united with the family and avoid eating too much.”
	Photo of a slice of cake	•“It helps to remind myself that eating does not help at all. On the contrary, it damages my health even more” •“I have been able to overcome my problems without eating and confront them”	•“We have to eat in small quantities” •“It is our weakness and usually we look for sweets or cakes to make ourselves feel happy” •“Some of us can live without them.”
	Photo of bread	•“To remind her that she needs to eat one piece of bread and not two.”	•“How much they have [struggled] to stop eating bread especially if it’s Mexican sweet bread.”
Social support
Group advice	Photo of a woman drinking from a small water bottle	•“Drinking water.” •“It’s better to drink and choose water than [soda].”	•“Hydrate your body – water hydrates your body a lot better than any other liquid.”
Group empathy	Photo of several images of Virgin Mary on the wall and in an altar.	•“It is a photograph of his daughter who died three years ago. His mother gave him a virgin Mary.” •“I have the picture with me at all times and I just wanted to share it with you.”	•“Thanks for sharing your pain and your loss. [Participants] shared their own experiences of losing a loved one.”
Information sharing	Photo of a smiling woman standing next to a portable stereo and a large television	•“Yoga teacher. She has encouraged her and helped her for the past seven years.” •“She has been following her teacher to all places where she works because she likes to do yoga.”	•“That is great to have a teacher like her.”
Group motivation	Photo of three women in a class.	•“She receives motivation from her classmates. She feels that they all speak the same language with the class leader. She is very happy with her job.” •“Because she receives support and inspiration from everyone in this program.”	•“Being part of a group helps them to be stronger. Learning how to improve their life style. Together, they are fighting to have a better life.”
Importance of social support	Photo of the class leader and two other participants during class	•“The exchange of views among group members helps all of us to stay strong and healthy.” •“Being part of this group helps us to learn a lot about diabetes.”	•“It is very important that we support each other and the exchange of ideas is also very important.”
Sharing of goods	Photo of a couple sitting on a couch with a walker nearby	•“Her parents. Her dad lost his left leg and some toes. Both of them have diabetes. Both use a wheelchair but her dad uses it only when he goes out.” •“She brought a picture of her parents because God has allowed them to live a long life.”	•“They asked her if her dad uses a walker because some of the participants might have some.”
Mental and emotional health
Concern for family developing diabetes	Photo of an adolescent boy smiling and standing next to a refrigerator	•“The picture is of her son and how she is afraid that he will have diabetes in the future.” •“Her son is 13 years old, he is healthy but with some extra pounds.”	•“He looks older than he is and it is a good thing that he doesn’t have diabetes.”
Ways to cope with stress	Photo of trees in a forest with a deer nearby	•“I am in the forest where I am peaceful and quiet. There, I can exercise and relax from all the stress.” •“It is very relaxing being in the forest.”	•“That is a great picture and it is very relaxing to walk in the forest.”
Self-motivation	Photo of a statue holding a pack of cigarettes inside an empty storefront	•“At a job, I decided to smoke less.” •“To remember I decided to start smoking less because this would help my health.”	•“It is a good way to start smoking less by looking at the picture. It is good to stop smoking even though it is hard to quit.”

^aThe comments are in first person and third person depending on how the class leader noted the participant’s comments.