Critical discourse analysis and photovoice: The discourses of asthma management disparities in African American Adolescents

Background: Asthma management disparities (AMD) between African-American and White-American adolescents are an alarming and persistent threat to the health of the Americans. The way disadvantaged groups write and talk about these disparities, their discourses, reveals important public health knowledge for a social justice critique of statewide and national asthma policies. Purpose: A critical discourse analysis (CDA) of African American AMD discourses within a Washington State planning process for asthma. Aim: Describe the AMD discourses that are introduced, promoted, and/or minimized by African American adolescents with asthma. Methods: January - March 2011: Observe/record focus groups of African American adolescents with asthma using Photovoice. Measures: audio-transcripts, photo-texts, and observations. Analysis: This CDA used linguistic/contextual analysis of texts to identify how persons, events, and actions are introduced, promoted, or minimized amongst focus group members. Results: 20 African American adolescents identified and promoted 30 discourse topics in their discussions, including 14 discourse topics in their photo texts. Of these topics, three discourses of disparity have not previously been identified in the national discourses of asthma management policy and research: 1) residential mobility "moving", 2) school exposures (including "stairs", "sports", and "healthy meals"), and 3) a "permanent fix" for AMD. Conclusions: Public health nursing research in asthma management disparities should explore interventions addressing disparities in residential mobility and these novel school exposures. Asthma policy makers need to design ecological approaches to mitigate structural inequities in reducing AMD. CDA utilizing recorded texts and Photovoice is an innovative and appropriate technology for public health nursing research.