photovoice villaverde project: a participatory action research project to study and improve the food...

Manuel Franco MD, PhDAssociate Professor

School of Medicine, University of Alcala, SpainAdjunct Associate ProfessorDepartment of Epidemiology

Johns Hopkins Bloomberg School of Public Health

A Participatory Action Research project to

study and improve the food environment

in Madrid

PHOTOVOICE VILLAVERDE PROJECT

http://hhhproject.eu

Food environment research

Food environment and residents dietary patterns• PhD project MESA study 2005 (AJPM, AJCN)

• Baltimore City Health Department meeting 2007

Baltimore Food Policy Timeline. JAFSCD 2014

Social and Physical Urban Environment and CV Health:

The Much Needed Population Approach

PI: Manuel Franco MD, PhD


To study the impact of the

social and physical environment in terms of

tobacco, alcohol, food and physical activity

on residents cardiovascular health

Heart Healthy Hoods Overall Objectives


Food environment research

Food environment in Madrid, Heart Healthy Hoods• Structural changes to improve population´s diet (JECH 2014)

• Madrid-Baltimore study on Healthy Food Stores (PM 2016)

• The HHH exploratory study in Madrid (BMC Methods 2016)

Understanding food environment in whole cities• Baltimore City Food Environment 2010, 2015

• Philadelphia?


• Understanding food environment and residents diet• Need for participatory research in order to obtain “real” data

of use and meaning of food environment

• Necessary information to design culturally appropriate and

effective interventions

Food environment researchParticipatory Project in Madrid

Manuel Franco MD, PhD



in Madrid

PHOTOVOICE VILLAVERDE PROJECT


What is Photovoice? • Photovoice is a participatory-action research method. Caroline

C. Wang and Mary Ann Burris (1994, 2000)

• Enables people to identify, capture, and reflect their

community´s strengths and concerns through photography

• Informs policy makers to promote health related public policies


Main objective

To conduct a photovoice project with

residents of a low-income Madrid area to

understand the local food environment and

its influence on individuals’ diets


Specific Objectives

1. To describe photovoice participants’ main themes

relating local food environment to residents’ diets

2. To translate phtovoice findings into urban food policy

recommendations

3. To communicate and disseminate Photovoice results


Methods: Study setting

• Two administrative

low-income

neighborhoods

(Los Rosales and

San Cristobal)

• Collaboration with

Villaverde Health

Promotion Centre


Methods: Participants

• We used a purposive sampling

strategy to engage participants.

• Participants completed informed

consents and image release forms.

• Villaverde Health Promotion Center

facilitated participants’ recruitment

and retention.

• 24 residents enrolled in the project.


Methods: Photovoice procedure

• Four Photovoice groups by gender/neighborhood

• During five group discussion sessions, participants:

• attended a Photography workshop

• critically discussed their photographs

• analyzed their photographs


• Participants took 163 photographs, and identified 30

categories emerging from the photographs and discussions

• Final categories were then organized around five themes

of the food environment related to dietary behaviors :

1. Eating in moderation2. Cultural diversity3. Food stores4. Social relationships5. Economic crisis and poverty

Methods: Participatory data analysis

Diez. J. Under Review, Health and Place

Theme 1: Eating in Moderation

Theme 2: Cultural Diversity

Theme 3: Food Stores

Theme 4: Social Relationships

Theme 5: Economic crisis and poverty


Translation into food policy recommendations: Methods



Participants and co-facilitators met twice to translate photovoice results into policy recommendations


1. We conducted a “problems and objectives” analysis using an adapted logical framework approach.

2. We identified root and causes of both: a) positive environment features to be encouraged b) negative environment characteristics to be addressed/changed

Problem:

Roots: Shortage of food retailers

Insufficient access to variety of food with suitable quality and price

Low competition between businesses higher prices Low quality food supply



3. Participants turned identified problems into policy recommendations

Promoting small food retailersInsufficient access to variety of food with suitable quality and

price

4. Recommendations were prioritized according to: a) Time (score: 1-5)b) Impact (score: 1-5)c) Feasibility (score: 1-5)d) Cost (score: 1-5)



Food policy recommendations (ranked)

1. Offering local leisure time activities to avoid unhealthy behaviors (e.g. snacking, alcohol, sodas)

2. Improving food banks management 3. Reactivating traditional markets and small retailers4. Improving food hygiene conditions5. Promoting the availability of organic foods and for patients

(e.g. diabetes and celiac disease)6. Reducing food waste7. Improving nutrition labeling8. Offering healthier alternatives to workplace vending machines 9. Teaching food education at schools

10. Promoting healthy social networks for older people 11. Giving street vendors legal status


Dissemination and communication Photovoice results

• Residents participated in dissemination and communication strategies to promote social action:

• Photobook

• Exhibition

• Video

• Citizen Science meetings

• Interactive Cartography

• Media collaboration



• Free- downloadable Photobook: hhhproject.eu/photovoice



• Photography exhibition in three different venues in Madrid

• 6 months at the third most visited cultural center un Madrid



• Two citizen science meetings. Participants presented

results and policy recommendations to local policymakers



• Interactive cartographical application: http://www.geogra.uah.es/PHHHotovoiceMap/photovoice.html

http://www.geogra.uah.es/PHHHotovoiceMap/photovoice.html


Ongoing and future research

The mismatch between observational measures and residents’ conceptualization of food access: a mixed methods study


Photovoice and empowerment? Kirsten Budig, MPH Erasmus

Empowerment dimensions: Knowledge gain, Self-perception change and Access to local resources.

Methods: 10 semi-structured interviews

Results: Participants acquired new knowledge and developed a critical awareness of their food environment.

The social recognition they received transformed their self- perception.

Participation expanded their social networks in the area.

Photovoice empowered participants to take different actions.


Ongoing and future researchPedro Gullón MD, MPH, PhD Candidate

Studying the urban environment and its influence on physical activity using

Photovoice in two different SES neighborhoods in Madrid


Successful method to engage residents in a participatory action research project collecting, analyzing, and communicating

Participants identified five themes relating their local food environment to residents’ diets

Results were translated into community generation food policy recommendations may inform policies improving population diet

Project communication included a photobook, a public exhibit, a video and an interactive cartography

Photovoice conclusions


Video

https://www.youtube.com/watch?v=VIiFggKzVas


Acknowledgements

http://hhhproject.euhttp://hhhproject.eu/research/photovoice/


• Collaboration Madrid Public Health Institute Hall and

• Funding:

• European Research Council

• Fundación Mapfre

• Ayuntamiento de Madrid

• Drexel University Urban Health Collaborative

Acknowledgements



in Madrid

¡ GRACIAS !