Research and commentary

Researchers explore factors influencing mental and emotional health in at-risk young people

  At-risk young people in a US middle school took part in an innovative qualitative research project.

Bashore L, Alexander GK, Jackson DL et al (2017) Improving health in at-risk youth through Photovoice. Journal of Child Health Care. 21, 4, 463-475.

Picture: iStock


To explore factors that influence the health of at-risk young people attending an after-school programme.


This qualitative research project was conducted through an interprofessional collaboration between nursing and social work in a predominantly Hispanic middle school in the US. Photovoice and the SHOWeD (see, happening, our, why, do) methods were used to elicit perceptions of adolescents’ environment in line with the school’s new health curriculum.

Photovoice is a method where participants photograph scenes in their community that represent their points of views. Each participant worked with a researcher who provided support in handling the cameras, reflection on the selected photographs, and ensured privacy was honoured and protected, for example by not showing faces on the photographs.

The SHOWeD method was used to facilitate discussion of the photographs and is a way to include learning through problem solving. It stands for:

S) what do you see here?

H) What is really happening?

O) How does this relate to our lives

W) Why does this problem or strength exist?

D) What can we do about it?

Data in the form of photographs and a reflective journal were analysed using content analysis methods.


Eight of the ten participants enrolled completed the study, all were Hispanic and taking part in the after-school health programme. Themes emerged from the data represented students’ perceptions of: staying healthy, stress, dealing with anger and frustration, maintaining friendships and communication, recognising bullying, and planning for the future.


Using the Photovoice method facilitated adolescents’ views of their health and how the school environment influences it. Recommendations included support for this population in how to communicate with peers, teachers and parents, lessons on coping strategies for stress induced by school work and a re-focus on bullying and healthy eating.

Involving young people from the outset in this process will reap benefits

Photovoice requires training for participants in the use of a camera, perhaps made easier by advances in single use cameras or cameras on mobile phones, basic concepts of photography and ethical related issues such as taking pictures of people. Photographs are then used as a focus or prompt for discussion. In Bashore et al’s study (2017) they used SHOWeD to structure this process.

The discussion is recorded verbally or in writing and common themes across the data are identified based on qualitative analysis. Participatory methods, such as Photovoice, are more in line with young people’s interests and activities and, therefore, more likely to increase engagement with research. 

In a literature review evaluating the use of Photovoice (Catalani and Minkler 2010) only seven of the 46 papers reviewed represented the adolescent population highlighting the important contribution Bashore et al’s paper makes to the use of participatory methods in this population.

A limitation, acknowledged by Bashore et al, was that groups of participants moved around together and therefore took photographs of the same situations. This limited the collection of data based on individual perspectives, but highlighted the need to consider usual behaviour patterns and participant preference when designing research methods.

In addition, ethical principles applied to protect the privacy of other students restricted a ‘true’ depiction of participants’ views of their environment. Involving young people throughout the participatory process from the development of the idea, designing the research proposal and dissemination might go some way to addressing associated limitations. 



  • Catalani C, Minkler M (2010) Photovoice: a review of the literature in health and public health. Health Education & Behavior. 37, 3, 424-451.

Compiled by Linda Milnes, associate professor in children and young people’s nursing, University of Leeds, on behalf of the RCN’s Research in Child Health community

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