Using Photovoice to Develop a Self-Care Program through the Lens of Frontline HIV Providers and Their Supervisors

Background and Purpose:  There is growing evidence that human service providers are at a greater risk of burnout, due to the emotive nature of their work. There is limited research on burnout and coping within community-based HIV providers. To address this gap, we sought to understand burnout, and methods of coping with burnout, in four HIV providers and four managers using photovoice. Photovoice, a community-based participatory research (CBPR) approach, allows participants to visually capture their reality and express their ideas through photographs, in order to promote social change. In this study, the photovoice study was used as a vehicle to develop a self-care program within the agency.

Methods:  The study took place in a non-profit organization in New York City that provides comprehensive, community-based health and housing services to persons living with HIV/AIDS, and was coordinated by two academic researchers. Three focus groups were held separately with HIV community-based providers and managers (six groups in total). Each group was recorded and transcribed. In the first group session, academic researchers oriented particpants to the project and asked participants about their definitions of burnout. Participants were asked to take and share photographs on causes of burnout and on coping with burnout. In the second session, participants shared 6-8 of the photos they had taken with the group. In the third session, participants were presented with corresponding quotations to their photographs, extracted from transcriptions. Participants then chose photos that best represented themes identified.

Findings:  Participants defined burnout as unexplained anger in the workplace, emotionally withdrawing from work, and reduced productivity in the workplace. Themes identified fell under three general categories of burnout and coping - organizational, personal, social factors. Organizational factors impacting burnout included lack of training for managers to deal with staff conflict; high workloads; lack of role clarity; low recognition of staff efforts; poor coordination among departments; dearth of organizational resources; and poor interpersonal relationships in the workplace. Personal factors included physical health, family issues, and financial pressures. Social factors included balance between work and personal life, and perfectionism at work. Organizational factors supporting coping included opportunities for recognition, love of the work, and importance of co-worker support. Personal factors that helped with coping included physical activity, being in nature, and taking a moment away from work/drawing boundaries. Spirituality and religious beliefs were important to many participants. Social factors supporting coping primarily focused on support from family and friends; many brought in pictures that represented time with family, or photos of children or partners. Findings are being used to inform organizational changes to encourage self-care practices within the workplace.

Conclusion and Implications: To our knowledge, our study is the first to use photovoice to understand burnout and coping in HIV service providers. Findings contribute to the limited research evidence on HIV provider burnout, potentially informing the development of self-care programs, and improvements in management and supervisory practices within HIV services agencies.