Advancing Health Equity and Justice for Rural Mothers through Photovoice Methods

Background and Purpose: Disparities research typically focuses on racial, ethnic, and socioeconomic injustices, omitting rurality. One in five Americans reside in rural areas. Rurality can widen existing disparities among racial minority and/or socioeconomically disadvantaged mothers. To address these disparities, approaches based lived experiences, cultures, and environments of rural mothers are needed. Yet most research has not partnered with rural mother and communities to co-create sustainable change. Using community-based participatory research (CBPR) and a critical feminist methodology, we asked the following questions rural mothers health and wellbeing: What strengths do rural mothers and communities bring? What do they need? What challenges do they face? How can we achieve and sustain health equity for rural mothers?

Methods: We recruited a purposive sample of mothers receiving services from three home visiting programs in a rural, majority-minority Southeastern Unites States County to participate in Photovoice. Photovoice, an exploratory qualitative CBPR method, draws on principles of constructivism, feminist theory, and documentary photography to enable participants to reflect strengths and concerns, (b) promote important dialogue, and (c) reach decision-makers through public forums. We developed photovoice assignments with seven participants on five prompts around challenges, stress, needs, issues, and support for mothers. Sessions used the SHOWeD technique and were audio-recorded and transcribed verbatim. Grounded theory guided data analysis. To ensure trustworthiness we used reflexive accounting, triangulation of data and researchers, member and transcript checking, and consensus of coders. Mean age of participants was 25 years, all identified as BIPOC, received WIC, had one to four children receiving Medicaid, and most were employed or in school.

Results: Photovoice sessions focused on maternal experiences, strengths, and facilitators and barriers impacting health and wellbeing. Five themes emerged: “We can’t hardly make it,” focused on desires for community cohesion and investment in families; “They do everything,” detailed the critical role of home visiting programs; “A mom community,” highlighted the need for peer support; “One-on-one,” identified an unmet need for confidential therapy, and “Family dynamics” detailed the support and stress families offered.

Conclusions and Implications: This study highlights the lived experience and challenges of BIPOC mothers in the rural southeast, including known disparities related to maternal mental health. Mothers desired safety and support to promote their and their families’ health. They need both formal and informal social support. They recognized strengths of home visiting programs while identifying the need to enhance mental health using peer support and resources sharing. Issues such as stress, depression, posttraumatic stress disorder, and violence required individual therapy beyond what existing services could provide. However, stigma around mental health remained a barrier to peer support and therapeutic services for many mothers. Future practice, research, and policy should incorporate rural mothers’ and communities’ strengths into program, policy, and research development and expansion by drawing on existing home visiting programs, peer-support, creating referral networks, and supporting confidential therapeutic services. Through continued community partnership, we can help change the narrative around rural mothers’ experiences of having and raising children and ultimately work towards achieving health equity with rural mothers.