Using Photovoice and Asset Mapping to Inform a Community-Based Diabetes Intervention, Boston, Massachusetts, 2015

Abstract

IntroductionDiabetes self-management takes place within a complex social and environmental context. This study’s objective was to examine the perceived and actual presence of community assets that may aid in diabetes control.MethodsWe conducted one 6-hour photovoice session with 11 adults with poorly controlled diabetes in Boston, Massachusetts. Participants were recruited from census tracts with high numbers of people with poorly controlled diabetes (diabetes “hot spots”). We coded the discussions and identified relevant themes. We further explored themes related to the built environment through community asset mapping. Through walking surveys, we evaluated 5 diabetes hot spots related to physical activity resources, walking environment, and availability of food choices in restaurants and food stores.ResultsCommunity themes from the photovoice session were access to healthy food, restaurants, and prepared foods; food assistance programs; exercise facilities; and church. Asset mapping identified 114 community assets including 22 food stores, 22 restaurants, and 5 exercise facilities. Each diabetes hot spot contained at least 1 food store with 5 to 9 varieties of fruits and vegetables. Only 1 of the exercise facilities had signage regarding hours or services. Memberships ranged from free to $9.95 per month. Overall, these findings were inconsistent with participants’ reports in the photovoice group.ConclusionWe identified a mismatch between perceptions of community assets and built environment and the objective reality of that environment. Incorporating photovoice and community asset mapping into a community-based diabetes intervention may bring awareness to underused neighborhood resources that can help people control their diabetes.

Dimensions of Community Assets for Health. A Systematised Review and Meta-Synthesis

“…As regards methodology, 10 of the 14 studies (71%) adopted Kurt Lewin’s participatory action research approach, most of which (79%) used the CBPR research model [ 27 , 30 , 31 , 35 , 37 ], while Aviñó [ 10 ], Greetham et al [ 36 ] and Matthiesen et al [ 34 ] employed the ABCD method proposed by Kretzmann and McKnight [ 3 ], and others used specific variants such as the CHAMP method for associations, which was employed by the Railton Foundation and the University of Stellenbosch in Lazarus et al [ 37 ].…”

“…In this type of research, where the study participants are the subject of analysis (e.g., their behaviours, their discourses), even if they sometimes take an active part in the research, it is important for the researcher to take ethical considerations into account. However, these were only explicitly mentioned in six of the 14 studies reviewed (43%) [ 29 , 30 , 31 , 34 , 35 , 37 ]. However, since the report by Greetham et al [ 36 ] was a pilot study funded by the National Health Service, it can be assumed that it observed ethical principles.…”

A community-based diabetes group pilot incorporating a community health worker and photovoice methodology in an urban primary care practice

“…Photovoice is a participatory research method where participants use photography and accompanying narrative to describe their lived experiences in relation to a certain topic, in this case, diabetes self-management. Our study showed that photovoice had the potential to help participants gain insight to their illness, motivate behavioral change (Florian et al, 2016), and could be a useful intervention to improve diabetes control.…”

“…To improve understanding of factors that prevent patients in these hotspots from achieving better diabetes control, and to inform future interventions, we previously conducted a study incorporating photovoice methodology (Florian et al, 2016). Photovoice is a participatory research method where participants use photography and accompanying narrative to describe their lived experiences in relation to a certain topic, in this case, diabetes self-management.…”

“…Given that multicomponent interventions have shown the most promise in reducing health disparities (Chin, Walters, Cook, & Huang, 2007), in the present study, we combined photovoice with a community health worker (CHW) to connect participants to existing resources. In previous work with the target population, themes that emerged from photovoice sessions included the importance of access to healthy food, restaurants, and prepared foods; food assistance programs; exercise facilities; and church (Florian et al, 2016). Incorporating photovoice into a communitybased diabetes intervention may bring awareness to underutilized neighborhood resources that can help people control their diabetes.…”