title: Using photography as a method to explore adolescent challenges and resilience in type 1 diabetes.
abstract: Patient-centered approaches to disease management are consistently recognized as valuable tools for improving health outcomes, yet studies are rarely designed to elicit adolescent perspectives. This study sought to better understand the perspectives of youths with type 1 diabetes according to key demographic variables. We conducted an exploratory study through which 40 youths were provided with disposable cameras and prompted to take five photographs each that captured what diabetes meant to them and to provide narratives to accompany their photo choices. Demographic variables examined included sex, age, disease duration, socioeconomic status (SES), race, and glycemic control (A1C). Content analysis was used for photos and open-ended responses to assign photo index scores, which were then analyzed by demographic variables using Mann-Whitney U tests for statistical significance. Analysis of photos/narratives (n = 202) revealed five main types of representations depicted by at least 50% of the young people. "Challenge" photos included diabetes supplies as tethering, food as a source of frustration, and the body as a territory for disease encroachment. "Resilience" photos included coping mechanisms and symbols of resistance. Overall, these representations were consistent across demographic categories with two exceptions. Males took more food depictions than females (P <0.005) and had fewer coping depictions (P <0.05). Youths from more affluent households were more likely to take photos of resistance (P <0.05). The use of photo index scores expands previous studies using photography by comparing demographic variation within a sample. Our findings provide insight into coping strategies and indicate that SES may provide an advantage for affluent youths in meeting diabetes-specific challenges.
authors.affiliation: Department of Health Outcomes and Policy and Institute for Child Health Policy, University of Florida College of Medicine, Gainesville, FL.
authors.forename: Ashby F
authors.initials: AF
authors.lastname: Walker
authors.affiliation: Department of Sociology and Laney Graduate School at Emory University, Atlanta, GA.
authors.forename: Cathryn
authors.initials: C
authors.lastname: Johnson
authors.affiliation: Department of Pediatrics, University of Florida College of Medicine, Gainesville, FL.
authors.forename: Desmond A
authors.initials: DA
authors.lastname: Schatz
authors.affiliation: Department of Pediatrics, University of Florida College of Medicine, Gainesville, FL.
authors.forename: Janet H
authors.initials: JH
authors.lastname: Silverstein
authors.affiliation: Department of Pediatrics, University of Florida College of Medicine, Gainesville, FL.
authors.forename: Shannon
authors.initials: S
authors.lastname: Lyles
authors.affiliation: Department of Pediatrics, University of Florida College of Medicine, Gainesville, FL.
authors.forename: Henry J
authors.initials: HJ
authors.lastname: Rohrs