Salerno Valdez, E., Korchmaros, J., Sabo, S., Garcia, D. O., Carvajal, S., & Stevens, S. (2019). How the U.S.-Mexico border influences adolescent substance use: Youth participatory action research using photovoice. The International journal on drug policy, 73, 146–155. https://doi.org/10.1016/j.drugpo.2019.07.011
The article can be accessed here
Glasgow Caledonian University (GCU) team
Online journal club discussion with 19 colleagues supported by Scottish Alcohol Research Network @SARNalcohol
In this study, researchers developed a Youth Participatory Action Research (YPAR) approach with a state-funded youth coalition group on the US/Mexico border to explore factors influencing adolescent substance use. Twenty three young people were trained as researchers, and carried out a “photovoice” study, using photographs they had taken to document what they perceived as environmental influences on their behaviour and that of their peers. Photos were used to generate discussion and develop recommendations to improve the environment in which the young people lived.
This paper is a superb example of co-production of research, Participatory Action Research (PAR), as of the photovoice approach. The research leads developed a relationship with the youth coalition, which already had a history of advocacy and health promotion activities, to empower youth researchers as experts. The photovoice approach enabled reflection on the community’s strengths and concerns, critical dialogue, and prompted discussions during analysis. The paper sets out clear and concise guidelines on how to carry out this method, and how to integrate community partners into every aspect of the research. Potentially the most difficult aspect of PAR, analysis, was described in detail. Strategies to ensure that youth researchers could participate included: training and practice of active listening; youth researchers sitting in a circle and taking it in turns to present photographs; and continuous emphasis that all youth researchers had valuable insight to contribute in order to provide a comprehensive understanding of risk and protective factors.
Youth researchers identified a range of factors where, risk and protection overlapped, including; normalisation of drug trafficking; normalisation of substance use; close knit communities; and strong family and social support systems.
Successful PAR requires that action and impact are integrated into the research, and again this project is a fantastic example of this. Members of the YPAR team set up an exhibition showcasing the photographs and discussions for the local community, and met with the city’s mayor to develop local and state policy recommendations including: stricter IDing in clubs and bars; increased collaborations with local organisations; increasing youth friendly spaces.
QMJC Paper Discussion
The discussion in the session was wide ranging, and we were impressed by the authors’ description of the methodological approach. Simple and clear language and step by step instructions meant this paper could be used as a blueprint for carrying out similar research in our own contexts, particularly in terms of the collaboration with the youth researchers. For example, the use of affinity diagrams to develop initial themes and theories was highlighted as interesting in discussions, an approach which it seemed made it easier to engage with the youth researchers for analysis without necessarily getting into large volumes of text, or requiring substantial theoretical understandings of qualitative research processes, particularly for large volumes of data.
Participants also appreciated the consideration of power dynamics throughout the study, emphasising the equality of the youth researchers and how valuable their insights were. This provided inspiration to researchers about how we might change our current work, or design future studies.
Discussions also focussed on whether or not the approach taken in the study would work in other contexts, and what would need to be in place. The group suggested the following were important:
- Clear statement that all youth researchers and other collaborators are experts in their own right. This “charter” of values was clear throughout the study. The youth researchers initiated the conversation (they brought in their own photos which were the starting point for the research), and had power in leading the discussion.
- Existing Close connections with an organisation that had some previous experience of advocacy. Building this relationship from scratch was potentially a significant barrier
- The extent to which a smaller population setting (town as supposed to large city) meaning more straightforward access policy makers/leaders to effect change. However, we also discussed that in larger settings such as Glasgow, with third sector help (who often have more direct access to policy makers than academia), this would still be possible.
- A clear, logical, plan and structured approach (particularly for data collection, analysis and write up) from the outset that allows everyone involved to know exactly what is going to happen and what their responsibilities will be.
- Clear guidelines to ensure representation and input from youth researchers from inception of the research questions to dissemination of findings.
- Expertise and experience in carrying out PAR and photovoice approaches
- Lead researchers and coordinators that are passionate about the approach and willing to put in the clearly large amount of work that is required to make a study like this successful.
- An objective to effect change and the will to follow through.
We discussed the extent to which these would be viable in our own contexts, with agreement that we would be able to adapt some of these approaches in improving the inclusivity of peer researcher and in patient and public involvement in their own studies.
We agreed that this approach would also require some change from our comfortable norms of relationships with participants and power dynamics, and perhaps extra training and support for researchers. There was a discussion about whether this type of research would be fundable in the UK, and it was agreed that large funding bodies are now prioritising patient and public involvement in research.
More broadly the use of “environments” as units of understanding, particularly around substance use, was a novel aspect for many of the discussion participants. Also, the idea that protective factors and risk factors can overlap was interesting, and something that many of us had not considered. In addition, the use of photographs, as with the exhibition, was discussed as being a powerful way to engage with policy makers and the public, and as being potentially more effective and compelling than reports alone.
Overall this was a great exemplar of PAR and inclusive research, as well as an impressive example of redressing power dynamics, effective communication, and a fascinating study.
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