Using Photovoice to Engage Minority Consumers with Serious Mental Illness In the Implementation of Health Interventions In Housing Agencies

Background: People with serious mental illness (SMI; e.g., schizophrenia), on average, die 25 years earlier than the general population largely due to preventable medical conditions (e.g., cardiovascular disease), poor health care, and modifiable risk factors (e.g., smoking). Racial and ethnic minorities with SMI appear to be at even higher risk for excess morbidity and mortality than non-Hispanic whites with SMI. Despite these health disparities, limited attention has been paid to the implementation of promising health interventions (e.g., lifestyle interventions) in order to benefit underserved minorities with SMI in community settings, such as housing agencies. Community-based participatory research has emerged as a useful translational strategy that can reduce the gap between research and practice by increasing community members' engagement in the planning, development, and implementation of health interventions to address health inequities. This study used photovoice in two housing agencies in New York City to engage Hispanics and African Americans with SMI to inform the implementation of health interventions in these agencies.

Methods: Photovoice is a participatory research method that empowers people with cameras to document their lives and inform social action. Sixteen consumers, eight at each agency, participated in six weekly sessions in which they took photographs about their physical health needs and then discussed the meaning of these photographs in individual interviews and group discussions. All interviews and groups discussions were audio taped and transcribed. Pile-sorting techniques and grounded theory were used to analyze narrative and visual data.

Findings: Consumers in this study were mostly male (56%) and either African American or Hispanic (87%). The majority (88%) had a diagnosis of schizophrenia, major depression or bipolar disorder, and more than half reported a history of substance abuse (56%). The most common health conditions among these consumers included hypertension, high cholesterol, and arthritis. Six implementation themes related to consumers' preferences for intervention format, content, and methods were identified. Peer-based approaches were preferred over professional led programs, as peers were considered a credible source of support and inspiration. Consumers wanted to move beyond knowledge of healthy eating and develop skills to change eating habits. Consumers also mentioned the benefits of teaching methods that provide concrete health information and enable them to learn by doing. There was a general interest for programs that empower consumers to overcome internalized stigma of living with SMI. Moreover, consumers stressed the important role that supportive relationships with friends, families, and providers play in their physical health and wellness. Lastly, consumers wanted to increase their motivation and opportunities to engage in regular physical activities.

Conclusions and Implications: Project findings illustrate through photographs and narratives that physical health is central to consumers' recovery, particularly as their housing situation stabilizes and they begin to focus on other aspects of their lives. This study supports the use of photovoice as a valuable participatory method to engage minority consumers with SMI in the planning, development, and implementation of health interventions in housing agencies. Implications for using community-based participatory research in implementation science to address racial/ethnic health disparities will be discussed.