title: Visualizing harm reduction: Methodological and ethical considerations.
abstract: The use of visual methods is becoming increasingly common and accepted in health research. This paper explores the opportunities and constraints of using photo-based methods in the context of a community-based participatory research study on how to engage people living with HIV in conversations about a hospital's recently introduced harm reduction policy. Using a blended approach of photovoice and photo-elicited interviews, we provided participants (n = 16) with cameras and asked them to take a series of photos that "show how you feel about or have experienced harm reduction as a Casey House client." We reflect on methodological insights from the study to think through the process of doing photo-based work on a stigmatized topic in a small hospital setting by foregrounding: 1) how the act of taking photos assisted participants in visualizing connections between space, harm reduction, and substance use; 2) expectations of participation and navigating daily health realities; and 3) issues of confidentiality, anonymity and stigma in clinical settings. These reflections provide a case study on the importance of critically examining the process of engaging with photo-based methods. We conclude the paper by re-thinking issues of context and photo-based methods. Rather than viewing context as a neutral backdrop to apply a method, context should be viewed as an active force in shaping what can or cannot be done or produced within the space. Photo-based methods may offer an effective community-engagement strategy but may require modification for use in a clinical setting when working on a stigmatized topic with individuals with complex health care needs. Given the potential of visual methods as a community engagement strategy, research teams are advised to understand the entire process as a data collection opportunity so that these methods can be further explored in a variety of contexts.
authors.affiliation: Faculty of Environmental Studies, York University, Toronto, Canada. Electronic address: switzers@yorku.ca.
authors.forename: S
authors.initials: S
authors.lastname: Switzer
authors.affiliation: Faculty of Arts & Social Sciences, Carleton University, Canada; Department of Gender, Sexuality, and Women's Studies, Simon Fraser University, Canada.
authors.forename: A
authors.initials: A
authors.lastname: Guta
authors.affiliation: Casey House Hospital, Toronto, Canada.
authors.forename: K
authors.initials: K
authors.lastname: de Prinse
authors.affiliation: Casey House Hospital, Toronto, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University, Canada.
authors.forename: S
authors.initials: S
authors.lastname: Chan Carusone
authors.affiliation: University of Toronto, Dalla Lana School of Public Health, Toronto, Canada.
authors.forename: C
authors.initials: C
authors.lastname: Strike
mesh_terms: D001296:Audiovisual Aids / Q000941:ethics; D002170:Canada; D055812:Community-Based Participatory Research / Q000941:ethics; D003219:Confidentiality; D005260:Female; D015658:HIV Infections / Q000523:psychology; D040261:Harm Reduction; D006801:Humans; D008297:Male; D010781:Photography / Q000941:ethics / Q000379:methods; D019966:Substance-Related Disorders
keywords: Canada; Community-based research; Engagement; Harm reduction; Hospitals; People living with HIV; Photo-elicitation; Photovoice