Art as evidence in public health
As it has been pointed out, my blog posts over the last couple of months have raised a lot of questions. I thought for this blog post, I should attempt to try my hand at an argument for something I believe in strongly – the ability of art to act as evidence in public health research. All right, so maybe one last question:
This summer I did a three-month practicum in Argentina that was largely focused on facilitating the use of Photovoice in an indigenous community as a way to enable nursing and communications students to share their views on health in their community, especially in relation to Chagas disease. I would need a whole other blog post to expand on that project, but my point here is just to say that my experience with Photovoice really convinced me of its value as a method of conducting health research and translating the findings (that is, engaging in knowledge translation) in an engaging, empowering, and fun way.
Photovoice is a participatory action research method where individuals are given cameras to take pictures of their everyday lives in order to reflect upon issues and concerns in their lives and communities (Foster-Fishman et al., 2005). These images then serve as evidence, often about a specific health problem, presented from the viewpoint of the photographer (Wang and Burris, 1997). In this class, and in many others I have taken, we often talk about the importance of context. I think one of the major strengths of Photovoice is that it inextricably captures context.
Another advantage of Photovoice is that photos tell a story. It is quite cliché to refer to the adage that “a picture is worth a thousand words” when talking about Photovoice, and yet it is true. There is something about a photograph that moves people more than just describing it in words. In his article “Towards a general theory of indifference to research-based evidence”, Steven Lewis (2007) refers to power of the narrative to persuade people and argues that art can have a “subversive and inspirational power” (p. 4). This also relates to Maryam’s presentation last week on Public Narrative and the way that technique relies on appealing to people’s values through eliciting an emotional response. I think a photo can do this too.
Yet in this class we have also had a lot of discussions of the hierarchy of evidence, especially in health research. In discussions of randomized controlled trials and prospective cohort studies, it can seem difficult to even broach the topic on including photographs, drawings, and theatre performances as evidence. At the same time though, people respond to art in ways that they might not respond to data or written reports. We just need to convince them take it seriously.
I am hopeful that this can happen. Boydell et al. (2012) recently conducted a scoping review looking at the way that art-based research is being used to both produce knowledge and disseminate findings. They argue that “[the] growing use of arts-based knowledge creation and dissemination strategies is driving an important shift in our understanding of what counts as evidence, as well as appreciation for the complexity and multidimensionality involved in creating new knowledge” (p. 2). Still they identify gaps in the literature in terms of how arts-based researchers report on the impact of their work and whether these methods should be judged differently than through traditional positivist ways of looking at reliability, validity, and trustworthiness. They also highlight the important ethical considerations that need to be taken into account with this type of research.
Clearly it is not as easy as just believing in the usefulness of art and its impact on people. We need to engage in more discussions of why and how art can have a place in the world of health research. This requires acknowledgement of the ways research has been traditionally conducted and evaluated and a willingness to have more conversations about the ways we think about, value, and critically assess different types of evidence.
Boydell, K.M. et al. (2012). The Production and Dissemination of Knowledge: A Scoping Review of Arts-Based Health Research. Forum: Qualitative Social Research, 13(1).
Lewis, S. (2007). Towards a general theory of indifference to research-based evidence. Journal of Health Services Research & Policy.
Foster-Fishman, P. et al. (2005). Using Methods That Matter: The Impact of Reflection, Dialogue, and Voice, American Journal of Community Psychology, 36(3/4).
Wang, C. and Burris, A.M. (1997). Photovoice: Concept, Methodology, and Use for Participatory Needs Assessment. Health Education & Behaviour, 24, 369.