The Integrated Use of Audio Diaries,Photography,and Interviews in Research with Disabled Young Men

Conceptual Framework

The study was grounded in a critical approach that drew on the work of Pierre Bourdieu (Bourdieu, 1990, 1997; Bourdieu & Wacquant, 1992). Critical approaches focus on individuals' experiences and behaviours within the context of the larger socio-political themes that shape people's experiences and world views (Kincheloe & McLaren, 2005). In the study, we focused on an examination of shared social assumptions regarding masculinities, adulthood (and adult male roles), and disability and how they intersect. Intersectionality is a concept used to theorize the relationship between different identity categories, such as gender, race, sexuality, and ability, and how they are constituted in people's everyday lives (Valentine, 2007). For example, it can be used to explore how particular identities are given importance by individuals in specific contexts, and it looks at the circumstances under which categories such as disability might override other categories such as gender. Critical intersectionality research recognizes that identities are usually understood in relation to their alternatives (i.e., masculine to feminine, disabled to nondisabled, and child to adult). Identities are constituted through relations of power such that certain identities are valued more so than others in particular times and places (Rose, 1993, pp. 4–6).

Bourdieu's “sociology of practice” provided specific conceptual tools for examining these interrelationships. His central concept of habitus, which can be described as a set of dispositions that incline persons toward particular practices in given contexts, provided an explanatory lens for analyzing the interplay between individual attitudes and behaviours and internalized social norms and patterns of behavior (Bourdieu, 1990, pp. 7–10). Habitus operates in relation to fields which can be described as relatively autonomous social microcosms, such as the family, health care, or education. In the study, we examined the relationships between hierarchical field positions (dominant, subordinate, marginalized, complicit) and participants' everyday strategic practices in accomplishing their gendered identities (Coles, 2009; Connell, 1995). Identity work was thus linked with practices of claiming or rejecting membership in particular social groups (men/boys, teen/adult, disabled/nondisabled), in particular times and places, and with the strategies participants engaged in to improve their positioning within these groups (Bourdieu, 1997; Gibson, Young, Upshur, & McKeever, 2007).

In this article, disabled young men/youth refers to male teens and young adults who have one or more physical impairments. We use the term disabled people rather than persons with disabilities in keeping with current usage in disability studies. Disability is not considered a condition of individuals as is implied by the phrase “with disabilities” but rather something experienced as a result of social discrimination and exclusion (Morris, 2001).Generation is drawn from Priestley's (2003, pp. 19–25) work to denote an age-related life stage and social category with associated expected roles (i.e., childhood, adulthood, and old age). In the study, we considered how one “transitions” between generations, when each begins and ends, and who is included or excluded. Similarly, masculinity was viewed as both a relational identity category and as a set of “situated doings” that emerge in relation to time and place and the interacting social positions of individuals (Connell, 1995; West & Zimmerman, 1987).

Study Team

The study builds on our previous international research exploring the identities, masculinities, and transitions with this population and other disabled youth and men (Abbott, 2012; Gibson, 2005; Gibson et al., 2007). The seven member team consisted of transdisciplinary rehabilitation clinicians and researchers with expertise in qualitative methods, disability studies, sociology, and policy analysis. Two individuals with Duchenne muscular dystrophy (DMD) also acted as advisors and provided input on study procedures, interview questions, and emerging analyses.

Photo/Diary/Interview Methods

The study methods included participant-generated photographs, solicited narrative diaries, and a final semi-structured interview. We speculated that the combination of methods would provide a potentially powerful approach for capturing and analyzing identity practices. Latham (2003) has similarly used what he calls the “diary-photograph, diary interview” method in human geography research as a way to investigate “social practices in the making” (p. 2005). Like Bourdieu, Latham suggested that much of what individuals know they come by through intuitive knowledge which, although not exactly unconscious, obeys an internalized logic not ordered through the discursive. Investigating this logic is thus aided by non-discursive methods. Individuals perform and reveal their identities in their actions and talk, the places they go, the objects they treasure, the décor of their rooms, their dress and comportment, and their hopes and desires (Sweetman, 2009). The mixture of methods in our study was meant to capture identity practices without necessarily expecting participants to be able to fully articulate or explain these practices.

Photographs are increasingly used as tools of elicitation in qualitative studies, particularly as the technology becomes cheaper and easier to manage digitally (Harrison, 2002). They can ease rapport between researcher and participant, lessen potential awkwardness of interviews by providing a point of focus, and introduce relevant topics potentially unknown to the researcher (Booth & Booth, 2003; Capello, 2005; Clark-Ibáñez, 2004; Croghan, Griffin, Hunter, & Phoenix, 2008; Radley & Taylor, 2003; Strack, Magill, & McDonagh, 2004; Wang & Burris, 1994). In research with men, photo elicitation has been used to facilitate discussion about potentially sensitive topics and to illuminate the complexities of how and in what circumstances gender norms are followed or rejected (Bottorff, 1994; Oliffe & Bottorff, 2007).

Research with children and youth suggest that photographs can increase children's engagement in research, encourage expression of their ideas, reduce self-consciousness, and alter power dynamics (Adams, Theodore, Goldenberg, McLaren, & McKeever, 2010; Capello, 2005; Clark, 1999; Clark-Ibáñez, 2004; Einarsdottir, 2005; Morrow, 2001; Worth, 2009). Others have cautioned against overly simplified claims that photographs reduce power inequalities between researchers and participants (Lomax, Fink, Singh, & High, 2011). Although this might be the case, power dynamics within a study are multidimensional, shifting, and dependent on a number of factors. Visual methods may alter these dynamics in multiple ways that can and should be assessed rather than assumed.

Photography provides a method for investigating strategic identity practices that might be excluded from verbal accounts (Aitken & Wingate, 1993; Böck, 2004; Clark-Ibáñez, 2004; Sweetman, 2009). Because identities are largely performed pre-reflectively, individuals might struggle to explain their behaviours, values, or identities that obey the deeply internalized logic of the habitus (Gibson, 2005; Sweetman, 2009). Photographs can thus provide a visual illumination of the unthought or unstated that, when combined with other methods, reveals how identities are produced and reproduced in the everyday. Images are not “true” or “more valid” representations than talk but provide a partial account-in-the making (Latham, 2003) that is co-created by producers and viewers in the same way as other texts (Chaplin, 1994, p. 196; Harrison, 2002; Lomax et al., 2011).

Solicited narrative diaries are reflections that participants are asked to create for a research study. This method has been shown to facilitate the capturing of participants' priorities and understandings about what are often taken for granted issues in their accounts (Elliott, 1997; Milligan, Bingley, & Gatrell, 2005; Worth, 2009). Elliott (1997) suggested that an advantage of the diary-interview method is its flexibility. Participants, she noted, come to the diary task with different notions of what they want to reveal and how to structure their entries, for example as factual information or more abstract reflections. These choices reveal aspects of the self as much as diary content and can be probed further within an interview. Audio-recorded diaries have the advantage of capturing the subtleties of tone not possible in a written account (Monrouxe, 2009). On a practical level, the ease of operation of the recorder can make audio diaries well suited for individuals with physical functional limitations (Worth, 2009). The audio dairy approach we used in the study was adapted from the work of Worth (2009), who combined audio diaries and interviews to explore visually impaired young people's transitions to adulthood.

Like interviews, the photos and diaries were viewed as reality-constructing, meaning-making occasions (Jarvinen, 2000) that provided examples of “doing identity work” where participants positioned themselves in a given way for a perceived audience. The data could thus be analyzed not only for participants' intentional choices but for the invisible structures that organize them (Bourdieu, 1996). Participants created data as members of a category of persons defined by the research (young men with DMD transitioning to adulthood) and produced accounts of themselves that embraced or resisted this categorization. As in any narrative study, participants impose their own definitions of the situation (consciously or not) and turn it to their advantage to present an image that they want to give both to others and to themselves (Bourdieu, 1996; Holliday, 2000).

Reviewing diaries and photographs within an interview does more than elicit information from participants. It also creates a situation of co-analysis where the interviewer learns from the participant how the image was created, the motivation for including it, and what it represents for them (Aitken & Wingate, 1993). Through this process, participants actively negotiate the details of the photos and diaries, revealing their identities to themselves as well as to the interviewer (Latham, 2003). With both the photo and diary methods, we sought to provide participants with a degree of control over how to represent themselves, while recognizing that the context of the study and the absent-presence of the researchers significantly mediated their choices (Clark, 1999; Darbyshire, MacDougall, & Schiller, 2005; Gibson, 2005; Lomax et al., 2011; Worth, 2009).

Study Participants

The study was conducted in Toronto, Ontario, Canada. Eleven young men, aged 16 to 27 years, with Duchenne muscular dystrophy (DMD) participated in the study. The age range is based on our clinical and research observations that this group of young men generally become interested in and/or begin “typical” transition activities (e.g., postsecondary school, independent living, dating, and condition self-management) later than nondisabled peers. The age range allowed us to include participants who have a range of experiences with transitioning. All of the participants lived with parents/guardians, which is quite common for this group. We were not able to identify any potential participants in the study area who lived independently. Six participants were attending high school, one was at university, and the remaining four had completed community college or university.

DMD is a genetic condition that exclusively affects males and is characterized by progressive weakening of skeletal muscle. This population has been largely excluded from transitions research to date, likely because it is only in the last 15 to 20 years that their expected life span has extended past childhood. With new interventions, they can now live into their thirties or forties, and life expectancy continues to increase. In their teens, youth with DMD begin using power wheelchairs for mobility and require assistance with activities of daily living, including eating, dressing, and toileting. Because of progressive weakness of their respiratory muscles, youth in their late teens and twenties increasingly require mechanical ventilation, initially at night only and eventually for 24 hours a day.

Participants were recruited from a large regional children's rehabilitation centre in Ontario, Canada that provides life-long services and supports for individuals with DMD from across the province. Institutional ethics approval was obtained from the centre's Research Ethics Board. Potential participants were approached by clinical staff to ascertain their interest and then interested individuals were contacted by a research team member. All participants provided independent consent. Through the recruitment and consent processes, participants were informed that the study was oriented to exploring their perceptions of their experiences transitioning to adulthood as boys/men. They were not given the opportunity to self-identify their gender and those who did not strongly identify as male may have chosen not to participate. This was perhaps a limitation of the study, but we believe it may have been confusing to some participants to enter into a discussion of gender identification.

Study Procedures

The introductory interview was conducted by a research assistant (RA) either at home (n=8) or at the rehabilitation centre (n=3) according to the participant's preference. The interview focused on building rapport, reviewing the data collection procedures, and setting up adaptive equipment to facilitate data generation. We gave participants the option of having someone else present during the initial interview. The five oldest participants chose to be interviewed on their own, whereas the others were accompanied by a parent or guardian. Each participant was provided with a digital audio recorder (Sony ICDUX300) and a digital camera (Kodak ZI8 Pocket Video Camera). We provided camera mountings and adapted switches to facilitate independent photography and audio recording according to each participant's functional abilities.

The RA who was responsible for data generation with 10 of the 11 participants has a background in critical qualitative research and interviewing. The team acknowledged that as a nondisabled woman in her 30s, her positionality differed from participants, and this could affect the data in unpredictable and/or unknowable ways. We did not, however, see this as a weakness (or strength) of the design but rather as part of the multiple individual and structural factors that shape the co-creation of knowledge within the interview and research (Gibson, 2005; Manderson, Bennett, & Andajani-Sutjahjo, 2006; Pini, 2005; Schwalbe & Wolkomir, 2001). We discuss this further below.

Over the subsequent two weeks, participants were asked to audio record thoughts and take photos that reflected their daily lives (Gibson, 2005; Worth, 2009). For both activities, they were given a list of suggested topics (see Box 1 and Box 2) but encouraged to include anything they wished. Participants were invited to take a photo and/or make a diary entry as many times as they liked, but at least once a day over the two weeks. The digital photos and recordings were then collected from the participants. This second visit also provided an opportunity for unstructured discussion regarding the participants' experiences with the data generation processes. Audio entries were later transcribed and photos were catalogued in terms of number, setting, people, objects, and activities. The RA took detailed field notes at each of the first two visits and any intervening telephone contacts.

Box 1.

Suggestions for audio diary recordings

What to say for the diary recordings:

Talk about anything: who you are, what you do, and what life is like for you. There is no right or wrong.

Suggestions:

People, places, activities important to you

Things you do on a typical day

Your future and becoming/being an adult

Relationships, dating, and sex

Ways you see yourself as a “man”

Box 2.

Suggestions for photographs

What photos to take:

Anything is welcome. You can put yourself in the photos! There is no right or wrong.

Suggestions:

Rooms and objects in your home

People, places, and things important to you

Things you do on a typical day

Photos that show you as a “man” or “adult”

The photos and recordings were reviewed by the research team to identify potential lines of inquiry that could be explored in the final interview. Interview guides were created that included a mix of topics common across all interviews as well as topics specific to each participant's data. Both sets of questions were oriented to the photos and diary entries, which were used to elicit discussion (see Box 3). We recognized that some of the issues participants included in their recordings or photos might be more difficult to discuss face-to-face. Participants were thus given the option of declining to comment on any photos or diary entries (Milligan et al., 2005). Because an aim of the study was to further develop and assess the methods, we asked all participants to comment on their experiences with generating the photos and diaries.

Box 3.

Sample interview questions

Based on audio recordings:

You said that wheelchair hockey “is one thing that keeps me going in life.” Can you tell me about this?

You talked about dating as a possibility. Can you say more about this?

Based on photographs:

You included a few photographs of your paintings. Can you talk about those?

I noticed that all of the pictures you took were inside of your home. Can you tell me about that choice?

You are in all of your pictures. Can you tell me about that decision?

Diary/Interview

The participants created between two and 20 audio entries each. Some participants quite closely followed the suggested topic list and tried to comment on each, including topics they were less comfortable discussing in the interviews. Some entries focused on more or less factual descriptions of a day's activities with little elaboration. For example, the entirety of Michael's recordings for two subsequent days was as follows:

Even these brief entries, particularly when combined with the photos, provided useful entry points for discussion in the interviews. Many of Michael's photos were taken during activities with the friend he mentioned in the first entry. In the interview, he described their relationship as a “bro-mance” and his account revealed how he positioned himself in relation to particular masculinities:

Michael thus performed his masculinities through presentation of a largely fact-based diary, but the diary also provided a point of departure for collecting a much more detailed and reflective narrative in the interview. His account also demonstrates how diaries generated in a research context differ significantly from other forms of expression with different purposes and audiences (Gibson, 2005; Harvey, 2011). Michael shared with us his online blog where he discusses the experiences and challenges of living with DMD. Many of his entries contained detailed personal reflections that stand in sharp contrast to the brevity of his audio recordings, even though they cover many of the same subjects. Nevertheless, Michael did not seem to want to hide this information. Rather, the audio diary method was either a less appealing form of expression for him and/or he created it according to his idiosyncratic interpretation of the aims of the research.

Other participants provided much lengthier and reflective audio recordings on a variety of topics. Shyam, for example, recorded this entry about his discomfort with the label of “disability”:

When this topic was raised in the interview, Shyam was at first somewhat reticent to discuss it further. He noted that the process of creating the diary prompted him to reflect on how he understood himself in relation to disability:

Shyam thus revealed that the act of creating the diary prompted his reflective thinking about disability and identity, a position he further articulated in the interview. He is hesitant to get into the discussion without some reminders about the content of his diary, which suggests that the recording and the interview together might help to stimulate a deeper discussion compared to either method alone. Other participants also suggested that the diaries helped them to learn about themselves, reflect on becoming an adult, and improve their confidence:

We had anticipated that participants would find speaking to be physically easier than writing, thus the choice of audio-recorded as opposed to written diaries. Participants were provided with adapted switches to facilitate independent recording. Three participants, however, complained that the recorder was difficult to operate on their own despite the switch, and they thus asked someone to assist them. Three others (Albert, Peter, and Shyam) typed out their entries and then read them into the recorder. Each stated that, not only would they have found it physically easier to submit written responses but writing also gave them an opportunity to reflect on the topics and organize their thoughts.

Many participants were more articulate and more forthcoming in their diaries as compared to their interviews, and overall the diaries provided some of the richest data in the study. They might have felt more comfortable expressing their thoughts this way as opposed to a face-to-face encounter. Although participants were aware that the recordings would be discussed in the interview, some participants became self-conscious when the content of their entries were probed, and they reacted by deflecting further questions. The following exchange provides an example of how Peter expressed clear views on what makes him “feel like a man” in his diary, but struggled when asked to elaborate:

Peter Diary: Hi, today is Friday April 22. Um, I feel like a man when I can make my own decisions about going to school and jobs and stuff like that. Yeah, hopefully I'll be more of a man, uh, one day [laughs]. Uh, I think, I think also, moving out would be a man, would be what I think about being a man, uh, living on my own. So yeah.

After several additional probes, Peter was able to talk about the importance of sports to his sense of masculinity. We thus concluded that it was not that Peter had nothing more to say but rather that he found these topics more difficult to articulate within the spontaneous demands of an interview situation. As someone who wrote out his answers prior to recording them, Peter might have preferred to have time to reflect privately on his answers. For participants that struggled with the immediacy or intimacy of the interview situation, the audio diaries provided a mechanism for participants to prepare their thoughts in private and at their own pace.

Photographs/Interview

In general, the participants were very enthusiastic about this aspect of the study. They took between seven and 113 photos each (Average = 39). Three participants took all of their photos independently, two had others take all of their photos, and five used a combination. This was expected as we had left these choices to the participant's discretion and viewed these choices as a source of data. For example, Chris refused to have his parents assist him and viewed the study task as an opportunity to assert his independence:

This exchange illuminated some of Chris' struggles to assert his independence within his family. Chris independently consented to the study without his parents' signature, which would likely differ from most of his treatment and research decisions in the past, and this consent helped establish the study as “his.” The study context provided Chris with a framework for independently crafting his own story in his own way. In contrast, other participants, particularly those under age 17, were welcoming of collaborations with parents and other family members.

The primary subjects of the photos were families (siblings and parents), participants themselves, pets, friends, and personal objects—action figures, posters, school awards, medical and assistive devices, and computers (see, for example, Figure 1 and Figure 2). Viewing the images was particularly beneficial to members of the research team who were not directly involved in data generation. The photos helped immerse us in the contexts of the participants' lives. This included all the subtle reflections of the habitus reflected in, for example, clothing, décor, neighborhood scenes, and the biographical objects in participants' personal spaces (Böck, 2004). Nevertheless, we remained cognizant that the photos were not direct representations of their lives, and like any data source, they provided only a partial, transient, and particular view of the participants' lives and experiences.

OPEN IN VIEWER

Figure 1.

Example of participant photo.

OPEN IN VIEWER

Figure 2.

Example of participant photo.

As with the diaries, some participants followed quite closely the suggestions provided, whereas others had their own ideas about how to best represent themselves, including what they believed would be beneficial to the research:

Shyam's comments reflected his assumptions about what would be most valuable for the study and how the research team would analyze the data. These comments provided an analytical resource for interpreting Shyam's photos as portraying particular aspects of identity that he assumes are useful for an imagined audience. All of Shyam's photos were images of the physical accessibility features of his home. No people appeared in any of the photos, nor did he speak about relationships in his audio recordings. This did not mean that relationships were not important to Shyam or that his disability was somehow the focus of his life. Rather, it suggested that he had a message about his life and experiences with DMD that he felt would help others, which he wanted to share through the research. Furthermore, the choices of recordings and photos, in conjunction with the interviews, provided analyzable instances of adult and masculine practices. Throughout his account, we saw numerous instances of Shyam (and others) positioning himself as an expert in the experience of living with DMD. The photos are an instance of this, whereby he takes up the position of key informant in a study about living with DMD, provides information to assist an uninformed audience, and presents his home set-up as a superlative example of accessibility.

We also had instances of the participants creatively augmenting the methods. Four participants used the added functionality of the camera to include videos in their data without any instruction to do so. In addition, our sixth participant, Albert, submitted photos that he had taken prior to the study, including images of vacations and professional sporting events. From that point forward, we invited the remaining participants to do the same. Through these additional images, we were able to get a more diverse and longitudinal picture of the participants' lives and identities (Böck, 2004). Because the images were not taken for the research study but as personal mementos, they also provided additional points of reference to probe in the interviews.

Interviews

The interviews ranged from 45 to 120 minutes, with an average length of 80 minutes. As noted above, it was at times challenging to draw participants into conversation, particularly the younger group, and particularly around sensitive topics. There are a number of possible explanations for this, which likely intersect. The participants could be seen performing “typical” adolescent communication patterns as part of maintaining and promoting particular masculinities/youth identities (Schwalbe & Wolkomir, 2001). They limited their responses to just a few words and/or deflected questions. As discussed above, there were also gender, age, and ability differences between the interviewer and participants, which might (or might not) have led to decreased participant engagement (as discussed below). Finally, it is likely that many participants lacked experience reflecting on and discussing these topics.

This latter explanation emerged from the data. The accounts suggested that participants had learned to avoid thinking or talking about their impairments, the progressive nature of their condition, and their uncertain life expectancies. We identified a common disposition toward “staying positive” and focusing on the present. The study context, however, required participants to think and talk about their adult futures and processes of transitioning into adult men—topics that were challenging to discuss while staying positive. This was most apparent when participants were directly asked about how DMD affected their thinking about the future.

We also wondered if the reticence shown by participants in discussing some of these issues was partly related to the social position(s) of the interviewer. We asked a study advisor, who was also a young man in his twenties with DMD, if he felt it would have been easier for participants to engage with a male and/or disabled interviewer. He said “no” on both counts, that “it doesn't make a difference.” However, in relation to sensitive questions regarding sexuality, he offered, “you could get someone with experience in to talk about that topic, that specific topic, so maybe someone, like you said, someone in a wheelchair.”

A member of our research team (DA) had significant experience with interviewing boys/youth with DMD in a large qualitative study in the United Kingdom (Abbott, 2012). He reflected that his gender might have prompted some of the boys to be more forthright in some situations, but in others it might have been a deterrent. As someone more likely to be socially identified as a “successful man” (i.e., physically fit, nondisabled, educated, and with a career), participants might have been reticent to share their doubts, fears, and struggles regarding their masculinities and adult transitions. These insights are consistent with other work identifying complex gender dynamics within interview situations (Manderson et al., 2006; Pini, 2005; Schwalbe & Wolkomir, 2001).

We approached these issues as both problems and resources. Schwalbe and Wolkomir (2001) emphasized that because gender, sexuality, race, class (and we would add dis/ability and age) are each internally diverse identity categories, the best approach to interviewing is to avoid using them to presume affinities and to rely instead on analysis of the interactions to understand the individual qua individual. Positionalities of both researcher and researched are multidimensional and the effects on the data are not always predictable. For example, female interviewers might be perceived as unthreatening by males (e.g., see Horn, 1997) or class and age similarities can be just as important to rapport as ethnicity or gender, which are often foregrounded in positionality discussions (Manderson et al., 2006; Pini, 2005). Furthermore, the subject of the research and the context in which it is implemented are also important mediators of data generation (Böck, 2004).

In the study, we were thus cautious in making assumptions regarding how identity categories affected the data while acknowledging that they unavoidably exert effects. Having multiple sources of data, some of which were produced independently, helped to deepen the data by introducing different kinds of mediators into data generation. This helps to reveal the dispositions and habitus of participants by illuminating the various strategies they employ to position themselves with various identity categories. As others have noted, individuals perform their identities regardless of the gender of the interviewer but might employ different strategies by telling different stories or telling them in different ways (Pini, 2005; Schwalbe & Wolkomir, 2001). Because we were not searching for facts so much as understanding processes of intersection, we view this as a resource rather than a problem. We could reflectively analyze what masculinities were being performed in response to the interacting contextual mediators that together produce a text.