“a forever something”: Utilizing photovoice and photo-elicitation to explore the meanings religion creates in the experience of chronic illness among black American women

Background: Although disproportionately high rates of chronic disease are consistently reported among African American women, there are few empirical investigations into how they navigate illness experiences. Women's strategies for coping have the potential to mitigate and/or exacerbate health risks. Purpose: This paper identifies common themes in religious Black women's experiences of chronic illness, explicates the meanings and strategies important in their responses to illness, and describes the effects of these strategies. Methods: Qualitative interviews were conducted with Protestant African American women diagnosed with at least one chronic illness in California's Bay Area. Data was collected through participant observation and Photovoice methodologies designed to facilitate participant-directed research. Interviews utilized photo-elicitation methodologies, in which participants' photographs served as illustrative prompts for descriptions of social and physical experience. Results: In narrative and visual analysis, several themes emerged regarding women's changing relationships to divinity, other people, and themselves. Religious and organizational communities establish structure for members to seek and provide one another with meaningful support, yet also frequently promote interpretations that encourage women to prioritize the needs of others over their own. Changing social expectations and physical abilities constituted an ongoing challenge to each woman's personal identity. Participants characterized faith as an orientation towards possibility in contexts of normalized uncertainty. Discussion: Although costly and ethically demanding, Photovoice and photo-elicitation provide a unique means of understanding the processes of interpretation that inform health behaviors. Insight into collective systems of meaning can facilitate the development of social supports that address the immediate concerns of underserved populations.