Using Photovoice to Understand Barriers to and Facilitators of Cardiovascular Health Among African American Adults and Adolescents, North Carolina, 2011–2012

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The figure depicts 6 ovals in a line from top to bottom. Each oval contains a question that has a word in all capital letters. Each of these words starts with one of the letters in the acronym SHOWED. The first oval contains the question “S: What do you SEE here?” The second oval contains the question “H: What is really HAPPENING here?” The third oval contains the question “O: How does this relate to OUR lives?” The fourth oval contains the question “W: WHY does this problem exist?” The fifth oval contains the question “E: How can we be EMPOWERED by this?” The sixth oval contains the question “D: What can we DO about it?”

Figure 1. The SHOWED mnemonic.

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The figure depicts a series of boxes. The first box is centered at the top of the figure and lists the title, “Timeline of Topics Discussed by Adults and Adolescents.” The second box, which falls below the first box, is connected by an arrow, and is also centered in the middle of the figure. This box contains the description, “1st meeting: orientation, description on project and SHOWED method, informed consent, selection of first photographic topic (separate for adults and adolescents).” Below these 2 boxes are 2 columns of additional boxes. There is an arrow from the box that is centered above to these columns of boxes. In the left column, there are 6 rows of boxes, which describe the adult photovoice sessions. The boxes are titled “2nd Adult session: local food options,” “3rd Adult session: ways to educate about health — what’s here and what’s not,” “4th Adult session: unhealthy practices,” “5th Adult session: barriers to health promotion and overcoming barriers,” “Members (adults) checking of themes,” and “Forum planning.” There are arrows connecting each of the 6 boxes (going from top to bottom). In the right column, there are 6 rows of boxes, which describe the adolescent photovoice sessions. The boxes are titled, “2nd Adolescent session: health education,” “3rd Adolescent session: how our surroundings influence what we eat,” “4th Adolescent session: barriers to and facilitators of healthy eating,” “5th Adolescent session: how advertising and school influence what we eat,” “Member (adolescents) checking of themes,” and “Forum planning.” There are arrows connecting each of the 6 boxes (going from top to bottom). Below these 2 columns of boxes, there is another box that is centered at the bottom of the figure, connected by arrows to the boxes above. This box lists the title, “Final meeting: community forum (disseminating findings to the community). At the very bottom of the figure, the left-hand side contains the caption “Facilitators: coinvestigator, postdoctoral scholar, undergraduate nutrition student” to indicate who facilitated the adult sessions. The right-hand side includes the caption, “Facilitators: PhD student in nutrition, undergraduate nutrition student” to indicate who facilitated the adolescent sessions.

Figure 2. Timeline of topics discussed. The adolescent sessions occurred after the adult sessions (represented by an arrow) and resulted because of adults’ beliefs that any type of community health promotion should include adolescents.

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