An increasing focus on health equity across a number of health disciplines is generating more consistent prioritizations of trauma-informed approaches, cultural responsiveness, and community engagement. These foci have heightened interest in photovoice as a participatory research method—particularly in research among vulnerable populations or related to sensitive topics. Photovoice’s ballooning popularity can be traced in part to the alignment of its aims and practices with broad health equity goals; at the same time, its singular status reveals a lack of similarly creative, adaptive methods for use in vulnerable or sensitive contexts. In addition, photovoice is not without its concerning limitations, and its increasing usage warrants not only caution, but responsive innovation. To that end, this article draws on the extensive photovoice literature, as well as on the author’s own work at the intersections of public health and the arts, to offer an overview of four photovoice limitations and related concerns. It then highlights the method’s untapped potential by identifying under-researched qualities in need of development—noting these as opportunities to learn from (and further adapt) the photovoice method. Finally, the article pulls limitations and benefits together to frame photovoice as a basis for the continued innovation, study, and development of more equitable approaches to health research and practice.

The field of public health has increasingly promoted a social ecological approach to health, shifting from an individual, biomedical paradigm to a recognition of social and structural determinants of health and health equity. Yet despite this shift, public health research and practice continue to privilege individual-and interpersonal-level measurements and interventions. Rather than adapting public health practice to social ecological theory, the field has layered new concepts ("root causes," "social determinants") onto a biomedical paradigm-attempting to answer questions presented by the social ecological schema with practices developed in response to biomedicine. This stymies health equity work before it begins-limiting the field's ability to broaden conceptions of well-being, redress histories of inequitable knowledge valuation, and advance systems-level change. To respond effectively to our knowledge of social determinants, public health must resolve the ongoing disconnect between social ecological theory and biomedically-driven practice. To that end, this article issues a clarion call to complete the shift from a biomedical to a social ecological paradigm, and provides a basis for moving theory into practice. It examines biomedicine's foundations and limitations, glosses existing critiques of the paradigm, and describes health equity challenges presented by over-reliance on conventional practices. It then offers theoretical and epistemological direction for developing innovative social ecological strategies that advance health equity.

Mental and substance use disorders have been identified as the leading cause of global disability, and the global burden of mental illness is concentrated among those experiencing disability due to serious mental illness (SMI). Music has been studied as a support for SMIs for decades, with promising results; however, a lack of synthesized evidence has precluded increased uptake of and access to music-based approaches. The purpose of this scoping review was to identify the types and quantity of research at intersections of music and SMIs, document evidentiary gaps and opportunities, and generate recommendations for improving research and practice. Studies were included if they reported on music's utilization in treating or mitigating symptoms related to five SMIs: schizophrenia, bipolar disorder, generalized anxiety disorder, major depressive disorder, or post-traumatic stress disorder. Eight databases were searched; screening resulted in 349 included studies for data extraction. Schizophrenia was the most studied SMI, with bipolar disorder studied the least. Demographics, settings, and activity details were found to be inconsistently and insufficiently reported; however, listening to recorded music emerged as the most common musical activity, and activity details appeared to have been affected by the conditions under study. RCTs were the predominant study design, and 271 unique measures were utilized across 289 primary studies. Over two-thirds of primary studies (68.5%) reported positive results, with 2.8% reporting worse results than the comparator, and 12% producing indeterminate results. A key finding is that evidence synthesis is precluded by insufficient reporting, widely varied outcomes and measures, and intervention complexity; as a result, widespread changes are necessary to reduce heterogeneity (as feasible), increase replicability and transferability, and improve understandings of mechanisms and causal pathways. To that end, five detailed recommendations are offered to support the sharing and development of information across disciplines.

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