Using Photovoice to Assess Midlife Women and Health-Related Quality of Life

Photovoice, a community-based participatory process, is an effective assessment method for gaining insight, as participants use photographs to reflect community strengths and concerns. It offers health educators an opportunity to "promote critical dialogue and knowledge about important issues through large and small group discussion of photographs" (Wang & Burris, 1997, para. 1). Photovoice may be used in conjunction with other assessment strategies to further refine results in the given community setting. Using photovoice for an assessment of health-related quality of life in midlife women would be particularly effective in identifying contextual information to develop programs that support physical, mental, and spiritual health of midlife women. This paper will identify the rationale and assessment process of using photovoice as a method for gathering qualitative data.

An Appropriate Strategy

Photovoice offers an opportunity to identify and engage a specific group of women to capture community attitudes and behaviors that support or create barriers to improved health-related quality of life. The use of photographs to expand dialog among a community of women will provide health educators with a greater understanding of the qualitative information needed to identify specific programs that support midlife strengths and concerns. Photovoice provides contextual data, as the results from the natural setting include images that reflect the challenges of physical changes, ecological and social concerns, and the shifting role within the community.

Sarah Lawrence-Lightfoot, in her book The Third Chapter (2009), explores life after fifty, and the adaptation, exploration, and personal growth potential as individuals look for new purpose. As women, the transition often comes with self-doubt, fear, and confusion, as home and work life changes begin, affecting health-related quality of life. Additionally, Dennerstein, Dudley, & Guthrie (2002), identify the health factors associated with the societal expectations when children leave home, and the affects on women’s health. Photovoice will provide contextual visual images of empty nesting, menopause, retirement concerns, and other life changing markers.

Advantages and Disadvantages

The use of photovoice for assessing strengths and concerns of midlife women provides many advantages over other assessment strategies. Health educators may assess the community in a natural setting, with participants providing visual images of important community aspects. The images capture the perceived needs and assets from community members, further validating the concerns (Gilmore, 2012). A broad section of the population may be represented, as the method is fairly simple, with training on camera use within the assessment parameters. Participants may also remain involved in the planning process, as programming is developed based on results.

There are disadvantages to using photovoice as the primary assessment method. There is a limited amount of information that may be gathered through the technique, requiring additional assessments to further refine the data. In this study, the photovoice assessment results will be used as a foundation for focus groups and surveys to further identify specific community program elements. The potential for personal judgement on what images to use, what issues may confidently be shared, and what settings are used, is another potential limitation on sound data results. Creating a community with parameters that reflect a large enough sampling of women, may result in some population segments being under-represented. Finally, the complexities of summarizing and analyzing the data may create validity issues if the process is not professionally managed. Careful consideration must be given to ensure the photographs are appropriately analyzed (Gilmore, 2012).

Assessment Preparation

In this assessment, the participants will be St. Louis County females over the age of fifty, with a household income of $70,000, college-educated, with no significant health issues. This is necessary to support the program development, as individuals that are unable to meet their basic economic and health needs will have a different health support network. Twelve females will be identified from the four sub-counties for the first assessment, with training for camera use and guidelines to assist in the development of photographs that represent the physical and ecological aspects of their community segment.

The cameras will be digital point and shoots, as participants will have the greatest familiarity with the operational features. The written assessment goals will be shared and a practice session will occur after the first training session. Encouragement will be offered to increase confidence as participants understand the potential outcome of additional community programming and services to improve health-related quality of life for their population.

Conducting the Assessment

The timeline for the assessment will be four months, to provide adequate time to take the photographs, and choose the appropriate representations. The women will be given significant freedom in the types of photos taken, with guidelines for permission-based photos, respecting privacy, and the ethical sensitivities when using photovoice (Gilmore, 2012). A small group of facilitators will remain in contact with the participants during the four months, with three planned meetings before the final presentation.

Using the Results

The photovoice assessment is designed to engage and empower the participants, as they analyze their own situations and potentially recognize opportunities for improvement (Gilmore, 2012). The goal is the identification of key themes and community strengths and voids, finding common areas for program development within each sub-county. An example of a new concept in St. Louis county for mothers of young children, is The Nest, a privately funded, member-based educational and community center that offers kid-friendly dining, healthy fare, and drop in childcare, along with self-care classes that strive to support busy and often isolated young mothers (The Nest, 2014). That same concept of support for midlife female community members may be met with unique meeting spaces, educational opportunities, and personal growth support to improve health-related quality of life as a result of the photovoice assessment.


Dennerstein, L., Dudley, E., & Guthrie, J. D. A. A. (2002). Empty nest or revolving door? Aprospective study of women's quality of life in midlife during the phase of childrenleaving and re-entering the home. Psychological Medicine, 32(3), 545-550.

Gilmore, G. D. (2012). Needs and capacity assessment strategies for health education and healthpromotion (4th ed.). Burlington, MO: Jones & Bartlett Learning.

Lawrence-Lightfoot, S. (2009). The Third Chapter: Passion, Risk, and Adventure in the 25 YearsAfter. Macmillan.

The Nest. (2014). Our Story. Retrieved from!our-story/c1gux

Wang, C., & Burris, M. A. (1997). Photovoice: Concept, methodology, and use for participatoryneeds assessment. Health education & behavior, 24(3), 369-387.