Boosting Resilience: Photovoice as a Tool for Promoting Well-Being,Social Cohesion,and Empowerment Among the Older Adult During the COVID-19 Pandemic

Applications of study findings

• Expanding the use of art-based creative methods among older adults.

Introduction

Photovoice is a critical methodology under the principles of community-based participatory research (Wang & Burris, 1994, 1997). The principles of the methodology rely on critical theory such as Paulo Freire’s critical pedagogy (Freire, 2000); Feminism, as a social theory of human rights; and art-based documentary photography (e.g., Spence & Solomon, 1995). Photovoice adopts the idea of social art: it gives people from a variety of backgrounds, especially marginalized communities and vulnerable population groups, the opportunity to express their voice through photography. The act of photography allows people to document reality, interpret it, and participate in negotiations on various social interpretations of social phenomena. The photovoice method is implemented through the medium of group intervention under which members of the group share common experiences they have documented through photography and through a written narrative that is paired with the photography (Wang & Burris, 1997). During the group sessions, they participate in group dialogue, becoming part of a space that gives an echo and expression to their otherwise hollow experiences as part of a community, or collective with shared characteristics (Wang & Burris, 1997). This methodology also serves as a basis for social change processes, based on the knowledge produced by the participants, which may serve as an opportunity for a better understanding of their expressions, and the basis for formulating policy change to benefit the community in question (Wang & Burris, 1997).

Thus, the use of different implementation forms of the photovoice methodology among the older-adult is not new (Bryanton et al., 2019; Ferlatte et al., 2022; Fitzpatrick et al., 2012; Heinz et al., 2023; Miller et al., 2019; Mysyuk & Huisman, 2020; Novek et al., 2012; Salma et al., 2023). Considering the philosophical and theoretical principles of methodology as a critical research form (Wang & Burris, 1997), photovoice can be a valuable method to explore and understand the perspectives and experiences of the older-adult, who are often regarded as a vulnerable and/or marginal population. This approach allows the older-adults to share their voice and contribute to a broader understanding of their lives, both for themselves and for others.

For example, the technique has been used to investigate how the older-adults cope with chronic pain (Baker & Wang, 2006). Furthermore, photovoice has been employed to examine the health needs of rural older-adult women (Leipert & Smith, 2009), as well as their food consumption patterns (Neill et al., 2011). Additionally, studies have used photovoice to understand the attitudes of the older-adult in relation to accessible and age-friendly communities (Novek & Menec, 2014). It has also been employed to explore the perceptions of the older-adult regarding respect and social inclusion within cities (Ronzi et al., 2016). Other areas of research include the needs of recovering addicted older-adult individuals who use methadone (Rosen et al., 2011), older-adult cardiovascular awareness (Fitzpatrick et al., 2012), the older-adult perspectives on dependence and independence (Bellhe & Menec, 2015), and their coping strategies during the COVID-19 pandemic (Chen, 2023; Ferlatte et al., 2022). However, the therapeutic and psychosocial benefits of photovoice with the older-adults have been less explored.

Contrary to work with younger populations, the utilization of photovoice among older-adults in this comprehensive psychoeducational and empowerment context is less prevalent. Instead, it has predominantly been applied as a research tool to explore issues related to physical and mental health (Baker & Wang, 2006; Fitzpatrick et al., 2012; Yankeelov et al., 2015). While most studies investigating the use of the photovoice methodology among the older-adult relied heavily on meta-analyses of recommendations from previous research or the reflective insights of researchers, there is a scarcity of studies that directly explore the perspective of the older-adult regarding their firsthand experience with photovoice. Furthermore, these studies primarily focus on discussing the technical challenges associated with the photography task (Bell & Menec, 2015; Fitzpatrick et al., 2012) and the subjective interpretation that the older-adult attribute to their photography assignment remains relatively unexplored in the existing literature. Thus, the primary aim of this study was to conduct an examination of the phenomenological experience of a group comprising 13 older-adult participants who actively engaged in a photovoice-based group intervention program during the period of the coronavirus (COVID-19) pandemic.

Against this background, the study aims to answer three central questions: (1) what are the challenges and barriers that older-adults face, with reference to participation in a photovoice group intervention program; (2) what learning and growth process was possible for older-adults as a result of their participation in a photovoice group intervention program; (3) what meanings do older-adults give to their participation in a photovoice group intervention program and to the process they went through during and following their participation in the photovoice group intervention program.

Literature Survey

Materials and Methods

This study was conducted using the qualitative-phenomenological method, aimed at exploring two phenomena: first, the meaning of the lived experience of the participants, in this case, the way in which older-adult people experienced the use of photography to document their day-to-day experiences during the COVID-19 pandemic crisis (Van Manen, et al., 2016); second, the way in which they experienced the use of photography within the photovoice-based group meetings, during the COVID-19 crisis (Van Manen et al., 2016).

Results

The data yielded three themes which were divided into fifteen sub-themes upon analysis (Table 1).

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Table 1.

Themes & Sub-themes

Main themes	1. Challenges	2. Growth: New knowledge and skills	3. Meanings
Sub-themes	1.1. Challenges of technicalities of photography	2.1. Photography as gaining new knowledge and skills	3.1. Photography as a reflective tool
	1.2. Difficulty in finding subjects	2.2. Photography as a skill that remains beyond the group assignment	3.2. Photography as a projective tool
	1.3. Photography as time consuming and demanding patience	2.3. Photography perceived as a skill that is not age-related	3.3. Photography as a meeting and re-engagement with the external world
	1.4. Putting the experience into a frame of photography	2.4. Photography as a process of empowerment	3.4. Photography as mindfulness
			3.5. Photography as a space of choice
			3.6. Photography as a tool for creative expression across mediums
			3.7. Photography as developing a critical social awareness

Discussion

While the literature has described the importance of combating loneliness of the older-adult through social engagement and combating cognitive decline through new skills (Fernández et al., 2023; Krueger et al., 2009), the usefulness of photovoice for these aims, rather than for gathering data, has not been explored in the literature. The findings of the current study, which specifically dealt with the photography task, have facilitated the dissection of the distinct impacts made by photography and photovoice groups on the well-being of the older-adult. On the level of cognitive stimulation, the themes show that the participants encountered various challenges and, concurrently, developed new proficiencies that extended beyond the confines of the group environment. This learning encompassed the cultivation of an outward and inward perspective, enabling them to make informed decisions pertaining to aesthetics, content, and psychological dimensions.

On the level of sense of mastery and psychological well-being, it could be argued that the concurrent interplay of projective-reflective attributes, encompassing both internal and external social awareness, within the medium of photography, constitutes a vital factor responsible for fostering a sense of empowerment and creative involvement, both internally, in relation to self, and externally, concerning the world at large (Chui et al., 2020). In conjunction with the technical and creative challenges, the process fostered the development of creative flexibility. Participants were compelled to make compositional decisions that generated novel representations of the familiar. Such cognitive engagement has the potential to stimulate brain plasticity and cultivate adaptable, innovative perspectives, which are frequently compromised by constraints associated with advanced age (Galassi et al., 2022; Safar & Press, 2011; Yan et al., 2021). The orientation towards an external locus facilitated a profound interlinkage with creativity, coping mechanisms, and a sense of trust in the world, even under the extraordinary circumstances of stringent COVID-19 lockdowns. This convergence epitomizes the amalgamation of scholarly work pertaining to photovoice as a potent instrument of personal development and voice, as well as social critique. It connects to the body of literature exploring the utilization of creativity in the domain of arts in health to enhance subjective and imaginative spheres (Biglin, 2022; Huss, 2018; Malka, 2022; Pera et al., 2020).

In the context of old age, it becomes evident that both introspection, characterized by self-reflection, and extrospection, manifested through re-engagement with the external world, assume paramount significance as formidable facets. Likewise, the amalgamation of fresh proficiencies, encompassing technical elements akin to those found in an art class, along with creative autonomy and latitude, confined within the framework of art therapy, facilitated a comprehensive and all-encompassing encounter of challenges and expressions, entailing a journey of introspection and an outreach to the external realm (Huss and Havs teen-Franklin, 2023; Vaartio-Rajalin et al., 2021). This heightened focus translated into a state of mindfulness and profound attentiveness. Furthermore, it created a reflective milieu, wherein internal emotions found expression in external symbols, thereby fostering an immersive space for profound self-encounter (Chen, 2023). These benefits can extend beyond crises times, encompassing all older individuals grappling with reduced brain plasticity, limited social interactions, and a narrowing scope of their worlds. We can redefine solitude and physical constraints as opportunities to explore the world and self in a gratifying and empowering manner.

On the level of social contact, photography afforded the opportunity both to reflect inwards and also to share that reflection with others. This helps to transcend self-absorption and re-engage with the world, the self, and others, all encapsulated within the confines of aesthetic embodied involvement. The emphasis lies not on illness but on well-being, while simultaneously offering a means to address loneliness and suffering through impactful verbal expressions with others in a shared reality group, who can identify with the content (Huss, 2018; Segal-Engelchin et al., 2020).

This study highlights the valuable lessons we can glean from the liminal framework that bridges the realms of a support group and a skills group, as well as the convergence of photography as an art form and a means of communication with others. This fusion strikingly achieved the ideal equilibrium between providing challenges and ensuring a sense of safety for the participants—space to reflect, and space to meet others, mediated through art. Thus, photography catered to the reflective and social requirements that are essential for older individuals, as described earlier (Medroso & Ramos, 2022). As stated, interventions that address the challenges of social isolation, health concerns, limited mobility, and feelings of purposelessness hold immense relevance in enhancing quality of life for older adults (Heinz et al., 2023).

Photovoice does not demand complicated equipment, expensive training, or group leadership and is thus an accessible cost-effective way to reach these goals. Amidst the current climate of uncertainty characterized by political upheaval, climate change, and health crises such as the COVID-19 pandemic, these interventions become even more significant. The elements of this model for older people, as evidenced by this research, highlight the importance of providing ample support with technical photography matters, offering directives that structure the photography process and encourage engagement with the physical world. Additionally, a non-critical facilitated group environment is emphasized, where focus is placed on both technique and self-expression, fostering a sense of efficacy and mastery. Strong relational support and encouragement are also crucial components of this model.