Using photovoice to understand perceptions of cardiovascular health in multi-cultural settings

Purpose: In many settings, verbal language may not be the best means of communication, especially in non-English speaking communities. This project attempts to understand issues relating to cardiovascular disease, including barriers to and factors promoting healthy behaviors, in older Asian immigrants for whom language may present difficulties for initiating conversation. Method: Photovoice is a qualitative process by which visual representations, i.e. photographs, are used in more vulnerable populations to enable them to record and reflect on community or personal issues, and to promote critical dialogue in communicating concerns. We recruited 15 older Asian immigrants of three ethnicities, Chinese, Vietnamese and Korean, and provided them with cameras to photograph objects and settings representing issues of concern to them in terms of their cardiovascular health. Participants returned for group discussions in their native languages to contextualize the stories told in the photographs and help codify themes. Results: Photographs were an excellent means to stimulate conversations of knowledge and concerns regarding heart disease, stroke, diabetes, hypertension, and hyperlipidemia with participants. Issues surrounding smoking, food, physical activity, and stress were depicted leading to further discussion of individual and community needs within their homes and neighborhoods. Similarities and differences between cultures were identified. Information will be used to develop educational materials and interventions to promote cardiovascular health in non-English-speaking communities. Conclusions: Photovoice is an excellent qualitative tool for gathering information from older adults on complex health topics, including cardiovascular disease, to identify areas for health promotion, education, and further research needed in multi-cultural communities.