Photovoice Essay – CHWs as Bridges between the Worldviews and Experiences

Refugees, immigrants, and asylum seekers often face unique health challenges including inadequate access to healthcare services and difficulty navigating the US healthcare system. Additionally, these disenfranchised populations rarely have a voice regarding their own health needs and challenges in the development of health promotion programs. Power dynamics between individuals and health professionals often impact the ability to gather unbiased information about these groups. Community based participatory research (CBPR) navigates power dynamics, thereby strengthening individuals’ and groups’ ability to be heard.

Photovoice is an innovative methodology grounded in CBPR principles which provides participants the opportunity to communicate information visually and create narratives to articulate their perspective to the researcher. The current study utilized Photovoice with ten French-African asylum-seekers living in Maine in order to document participants’ understanding of and experience with accessing healthcare and social services in a rural US state.

Findings elucidated the distinctions between participants’ African-based worldview from typical Western-based worldviews in the experience of health, disease and treatment. As is current practice, results from the Photovoice were shared with participants and contributed to the development of an intervention initiative. The critical role of the Community Health Worker in bridging and navigating the different worldviews will be discussed. We will discuss implications from the Photovoice including how such findings were used to inform the creation of a coordinated system of care model for uninsured persons post implementation of the Affordable Care Act.