Envisioning Our Future Selves: Black Women Navigating Diabetes through Photovoice

Background and Purpose: Black women are disproportionately impacted by type-2 diabetes and experience gross inequities in diabetes morbidity and mortality resulting from a complex set of interrelated social, economic, and environmental factors, driven by a legacy of racism and racialized policy. Successful management of type-2 diabetes requires individuals coping with the disease to adopt lifestyle changes including healthy eating, exercise and medication adherence while simultaneously navigating competing demands and stressors at home and in the community such as poverty, food insecurity, and community violence. The current qualitative study uses Photovoice methods to explore the collective experiences of one group of Black women managing type-2 diabetes and their ability to balance competing demands and stressors while maintaining a hopeful vision of their future selves.

Methods: African American women with type-2 diabetes were recruited from Boston area community agencies. Participants (N=11) between the ages of 36 and 85 engaged in three community-based Photovoice sessions facilitated by the researcher and an MSW student research assistant. Participants each took a series of photos related to their experiences with diabetes and then shared them with the group. Next, participants discussed the meaning of the photos using the SHOWed method (Wang, 1997). Participants related their experiences through a story and then selected a set of photographs to illustrate the story. The sessions were voice recorded and transcribed verbatim, and the data were analyzed using an inductive approach to thematic analysis to examine salient themes.

Results: The participants shared their own unique aspirational story of their collective experiences with type-2 diabetes through a series of five photos and accompanying text. Despite managing stressors and being at different stages of adopting self-management behaviors, the photos depicted the tools participants needed to overcome obstacles in their lives and improve their diabetes management. The photos represented the aspirational selves of these women and included heroes who had success managing diabetes, a bowl of fruit capturing healthy eating, an exercise bike representing importance of physical activity and an image of the cross reflecting the importance of God in their lives.

Conclusions and Implications: These findings reflect the power of visual storytelling for Black women managing type-2 diabetes. Aspiring to an idealized future self can help improve women’s coping leading to improved self-management of type-2 diabetes. Aspirational photos and narratives can help Black women cope with disease and improve their lives. This study has the potential to inform future interdisciplinary teaching models and social work research and practice with African American women and other marginalized groups experiencing racial health inequities.