Braiding the Healing Gifts of Photovoice for Social Change: The Means Are Ends in the Making.

Photovoice is an important participatory action method for motivating social change. The potential for this change within the processes of the method remains under-explored. We present the voice and perspectives of three health promotion practitioners who have important connections to photovoice: a grandmother and co-founder of the method, a nurse from Wales, and an early adopter seeking change. Through braided storytelling, the voices describe their history with photovoice and how their relationship to the method has changed over time, arguing ultimately that in photovoice the means are as important as the ends for advancing relations with others, understanding and working with power, and realizing the gifts the processes bring.

Climate Justice Is Environmental Justice: System Change for Promoting Planetary Health and a Just Transition From Extractive to Regenerative Action.

Our climate emergency is changing health promotion practice, and we need to increase our efforts. In the 20 years since our journal was published, we have witnessed the pressing challenges incurred by human-caused threats to planetary health. These threats are most profound in communities that are already unjustly under threat from structural factors such as poverty, toxic exposures, and inequitable allocation of resources for promoting their health. Those least responsible for contributing to this emergency, including all living environments in harm's way, will unjustly experience the greatest burdens. This commentary calls for health promotion practice to engage in system change and action in the struggle for climate justice by adopting a planetary health perspective. There must be a just transition from extractive to regenerative economies and actions. We describe our own journey as researchers and health practitioners toward this call for action. We propose a series of system change actions in social, environmental, political, health systems, and health profession education within the scope and responsibility of health promotion practice.

Emancipatory Photovoice Research: A Primer.

Photovoice can be more than a research method for communities to identify and mitigate social oppressions. Photovoice has the potential for emancipatory outcomes and the transformation of power relations. This article serves as a primer for beginning researchers who are new to the emancipatory power of the photovoice method or for advanced researchers who would like to re-imagine their current use of the photovoice method to an emancipatory approach that elevates and empowers. Our purpose is to provide a framework for deciding structures, processes, and outcomes of emancipatory photovoice. We specifically prescribe steps with respect to power relations among partners, design prompts or heuristics, and the anticipated and unanticipated outcomes. We base our perspectives on over a decade of photovoice research experiences. Emancipatory photovoice research, if implemented thoughtfully, can facilitate power sharing, collective learning, healing, and growth.

"Is It Good or Bad for the Air?" Latino and Asian Pacific Islander Youth-Led Messaging and Action for Environmental Justice Through Photovoice.

Photovoice is a powerful way to generate youth reflection and social action for health promotion. While the literature offers numerous examples of photovoice studies involving youth, they are most often engaged in taking, dialoguing, and developing phototexts, but not always in the critical next stages of planning what to do with this data, in terms of analyzing and then planning change-related strategic actions. This article describes the ways in which an intergenerational environmental justice project, as part of a larger community-based participatory research program, engaged youth through all stages of a photovoice project. Latino and Asia Pacific Islander adults recruited their own and other youth to conduct a photovoice and air sample data collection, analysis, exhibition, and evaluation activity focused on addressing indoor environmental justice threats from volatile organic chemicals. We offer lessons learned and reflect on the role of intergenerational collaboration to support youth in applying a critical lens for analyzing photovoice data and advocacy for health in their communities. We conclude with implications for photovoice practice and research.

Institutional procedural discrimination, institutional racism, and other institutional discrimination: A nursing research example.

Institutional discrimination matters. The purpose of this longitudinal community-based participatory research study was to examine institutional procedural discrimination, institutional racism, and other institutional discrimination, and their relationships with participants' health during a maternal and child health program in a municipal initiative. Twenty participants from nine multilingual, multicultural community-based organizations were included. Overall reported incidences of institutional procedural discrimination decreased from April 2019 (18.6%) to November 2019 (11.8%) although changes were not statistically significant and participants reporting incidences remained high (n = 15 in April and n = 14 in November). Participants reported experiencing significantly less "[when] different cultural ways of doing things were shared, the project did not support my way" from April 2019 (23.5%, n = 4) to November 2019 (0%, n = 0), Wilcoxon signed-rank test Z = -2.00, p < 0.05. Some participants reported experiencing institutional racism (29.4%, n = 5) and other institutional discrimination (5.9%, n = 1). Participants experiencing institutional racism, compared to those who did not, reported a higher impact of the Initiative's program on their quality of life (t = 3.62, p < 0.01). Participatory survey designs enable nurse researchers to identify hidden pathways of institutional procedural discrimination, describe the impacts experienced, and examine types of institutional discrimination in health systems.

Development and Pilot Testing of a Bilingual Environmental Health Assessment Tool to Promote Asthma-friendly Childcares.

BACKGROUND: Childhood marks the highest risk for allergic sensitization to asthma triggers. Hispanic/Latino children are at higher risk for hospitalization for asthma than non-Hispanic White children. Childcare providers lack knowledge about reducing asthma triggers. OBJECTIVES: The purpose of this paper is to describe a community-based participatory research (CBPR) initiative aimed at developing and pilot testing a bilingual walk-through assessment tool for asthma-friendly childcare environments. METHODS: Ten Latina mothers of children with asthma living in the Pacific Northwest collaborated with research partners to develop and pilot test a Childcare Environmental Health (CEH) assessment walk-through survey.Results and Lessons Learned: The women innovated the survey with photography and structural examinations of stress and provision of basic needs. The survey tool identified environmental threats to asthma in all three childcares surveyed. CONCLUSIONS: Parents are well-positioned to build trust with childcare providers, assess asthma triggers, and recommend practical mitigation strategies.

Opportunities in the integration of primary care and public health nursing: Two case exemplars on physical activity and nutrition.

OBJECTIVE: The integration of primary care and public health nursing may provide new opportunities for transforming nursing practice that addresses population health. Effective programs emphasize multilevel approaches that include both downstream (education) and upstream (policy change) actions. The purpose of this article is to identify downstream and upstream nursing actions that integrate public health and primary care practice through two case exemplars concerning disparities in physical activity and nutrition. METHODS: Describe two research case exemplars: (1) a secondary analysis of school physical activity policy for female adolescents in 36 public middle schools and (2) a focus group study of African American adults in a community kitchen program. RESULTS: In exemplar 1, school policies lacked population-based standards and presented structural disadvantages to African American girls who were already obese. In exemplar 2, participants found the community kitchen program to be more effective than the federally funded nutrition program. DISCUSSION: Integrating primary care and public health nursing could improve the tailoring of physical activity and nutrition programs to local populations by following core principles of community engagement, infrastructural sustainability, aligned leadership, and data sharing for population health improvement.

Educator Preparedness for Mental Health in Adolescents: Opportunities for School Nurse Leadership.

One in five adolescents will experience a mental health event in their lifetime. If left untreated, depression, anxiety, attention-deficit/hyperactivity, and anorexia/bulimia can elevate the risk of dropping out of high school. As a key principle of 21st-century nursing practice, school nurses must provide leadership in educating school staff in identifying and responding to mental health issues in high school settings. This article describes the results of an online survey assessing secondary educators' knowledge of and experience with mental health issues in one school district. Resources are suggested to assist nurses in educating school staff, providing them with ways to decrease stigma in the classroom, and partnering with the community to improve services.

Advancing Nursing Research in the Visual Era: Reenvisioning the Photovoice Process Across Phenomenological, Grounded Theory, and Critical Theory Methodologies.

Photovoice is a powerful research method that employs participant photography for advancing voice, knowledge, and transformative change among groups historically or currently marginalized. Paradoxically, this research method risks exploitation of participant voice because of weak methodology to method congruence. The purposes of this retrospective article are to revisit current interdisciplinary research using photovoice and to suggest how to advance photovoice by improving methodology-method congruence. Novel templates are provided for improving the photovoice process across phenomenological, grounded theory, and critical theory methodologies.

Applying Critical Discourse Analysis in Health Policy Research: Case Studies in Regional, Organizational, and Global Health.

Critical discourse analysis (CDA) is a promising methodology for policy research in nursing. As a critical theoretical methodology, researchers use CDA to analyze social practices and language use in policies to examine whether such policies may promote or impede social transformation. Despite the widespread use of CDA in other disciplines such as education and sociology, nursing policy research employing CDA methodology is sparse. To advance CDA use in nursing science, it is important to outline the overall research strategies and describe the steps of CDA in policy research. This article describes, using exemplar case studies, how nursing and health policy researchers can employ CDA as a methodology. Three case studies are provided to discuss the application of CDA research methodologies in nursing policy research: (a) implementation of preconception care policies in the Zhejiang province of China, (b) formation and enactment of statewide asthma policy in Washington state of the United States, and (c) organizational implementation of employee antibullying policies in hospital systems in the Pacific Northwest of the United States. Each exemplar details how CDA guided the examination of policy within specific contexts and social practices. The variations of the CDA approaches in the three exemplars demonstrated the flexibilities and potentials for conducting policy research grounded in CDA. CDA provides novel insights for nurse researchers examining health policy formation, enactment, and implementation.

Questioning Photovoice Research: Whose Voice?

Photovoice is an important participatory research tool for advancing health equity. Our purpose is to critically review how participant voice is promoted through the photovoice process of taking and discussing photos and adding text/captions. PubMed, Scopus, PsycINFO, and Web of Science databases were searched from the years 2008 to 2014 using the keywords photovoice, photonovella, photovoice and social justice, and photovoice and participatory action research. Research articles were reviewed for how participant voice was (a) analyzed, (b) exhibited in community forums, and (c) disseminated through published manuscripts. Of 21 studies, 13 described participant voice in the data analysis, 14 described participants' control over exhibiting photo-texts, seven manuscripts included a comprehensive set of photo-texts, and none described participant input on choice of manuscript photo-texts. Photovoice designs vary in the advancement of participant voice, with the least advancement occurring in manuscript publication. Future photovoice researchers should expand approaches to advancing participant voice.

Asthma Management in Educational Settings: Implementing Guideline-Based Care in Washington State Schools.

Managing asthma in the schools is complex and requires careful planning. This article highlights key steps in implementing guideline-based care for children with asthma in Washington State schools: assessing students, establishing acuity, communicating with parents, and training staff. Advance planning can improve outcomes for students, parents, and school staff in managing this complex and prevalent disease. NASN recently developed asthma management guidelines. Developing state-specific guidelines provides an opportunity to speak specifically to state laws and nurse practice acts while also reinforcing the importance of specialized practice to school nurses, school administrators and teachers, parents, and students.

An exploration of social justice intent in photovoice research studies from 2008 to 2013.

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 amongst 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 (i) explores whether authors implicitly or explicitly related the methodologies to their aims of promoting social justice (methodology-method fit) and (ii) 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 2008-13 using the following 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.