Ottawa Public Health reaches out to youth
Jan 08, 2016, By :Darcie Taing, RN, MN, CCHN(C), Shari Kneen, RN
Because it allows the ideas and concerns of an individual or a group to be shared through their photos, Photovoice aligns well as a public health strategy to engage vulnerable populations; the intervention is focused on clients’ strengths and participation to improve their health (Community Health Nurses of Canada, 2011).
At Ottawa Public Health (OPH), our reviews of local, provincial and federal data showed that certain youth behaviours had serious public health implications for the youth themselves and the community at large. For example, in 2011, although more than a quarter of Ottawa students in grades 7 to 12 reported their mental health as excellent, more than a third reported high levels of psychological distress. In 2012, 15- to 29-year-olds accounted for 79 per cent of all chlamydia and gonorrhea cases in the city, and more than a quarter of sexually active 15- to 19-year-olds had not used a condom when they last had sex (Ottawa Public Health, 2013). A Health Equity Impact Assessment we conducted on our programming for youth identified the need for us to try innovative strategies to engage this group in improving their health.
In spring 2013, a project group at OPH collaborated with local school boards and community associations to engage 12- to 19-year-olds in a conversation about their health. We wanted to gain a better understanding of the issues and identify — from the youth perspective — potential areas for action. Members of the group were a public health nurse from the school health team along with youth facilitators working with that team and a project officer from the health information and coordination team. Because we had already had a positive experience with a Photovoice contest on smoking cessation for this age group, we selected this format again.
To encourage participation, we developed promotional materials with input from the youth facilitators to ensure the materials would be relevant. OPH in-house graphic designers were involved in preparing PowerPoint presentations, posters and content for social media sites and the OPH website.
OPH’s school health team was already working closely with the region’s four publicly funded school boards. The schools’ public health nurses reached out to guidance counsellors to assist in recruiting contest participants. PHNs and youth facilitators outlined the purpose and details of the contest to about 3,000 students in 30 schools, sharing images submitted for the smoking cessation contest.
We offered chances to win grand prizes of cash and a camera to be presented at a gala event. We also held weekly draws for cash awards and gift cards to encourage a steady flow of submissions. The OPH school health program provided funding for the prizes.
Among the ethical considerations in the implementation of a Photovoice contest, especially when engaging youth as a vulnerable population, are the consent process, inclusiveness, disclosure and the well-being of participants (Teti, Murray, Johnson, & Binson, 2012).
Knowledgeable consent is very important for vulnerable populations; we abided by school board policies requiring consent from the youth and their parents/guardians. Consent forms, in both official languages, were made available at the schools and online at OPH’s website. The contest rules followed ethical guidelines, ensuring the safety and anonymity of participants. They were asked not to take pictures of illegal activities and were made aware that submissions would be shared for public viewing through OPH’s Pinterest page. However, we also outlined what types of photos would not be displayed in public.
We took steps to ensure participants’ well-being and safety, including requesting that no one appearing in a photo be identifiable. We consulted legal counsel to ensure participants were treated fairly and that contact information was protected. To reduce barriers, such as lack of access to a camera, disposable cameras were provided upon request. The submissions would not be judged, and winners of prizes would be chosen randomly to eliminate any bias.
Two of the nearly 200 contest submissions
The contest ran for five weeks, and we were pleased we received close to 200 entries (our target number) during that short period. The top issues identified in the photos were mental health, drugs and tobacco, healthy eating habits and physical activity.
Because OPH wanted to showcase the photos and build momentum in youth engagement initiatives that would overcome any health inequities, it organized a special community board of health meeting at which the contest awards were presented. Participants and their families, city councillors, prominent community and health partners, and the public were invited to attend and to take part in the conversation.
In reviewing the photos and captions, we felt at times we needed to consult OPH staff with expertise in mental health, sexual health and prevention of substance misuse to ensure the submissions did not contradict healthy behaviours or promote negative behaviours. When photos and captions indicated suicidal ideation or self-injury (e.g., cutting), PHNs called the individuals directly to ensure they were well supported and aware of community resources. These types of submissions drew our awareness to the importance of clearly stating what you are asking for and of making sure you can provide support for anyone who might need it.
This contest was a successful means of engaging young people in identifying relevant health issues requiring action. As well, OPH was able to provide funding that allowed youth groups to create action plans to address these issues. For example, one group worked with students in grade 7 and 8 to organize an assembly on how to cope with stress and deal with bullying. Some of the region’s high schools promoted active transportation by planning bike club activities and pedometer challenges.
More recently, OPH has expanded its use of Photovoice to raise awareness of issues and engage with other populations. The lessons we learned have helped ensure proper safeguards are in place for the well-being of participants.
Community Health Nurses of Canada. (2011). Canadian community health nursing: Professional practice model and standards of practice.
Ottawa Public Health. (2013). Youth speak, let’s listen, then act: Engaging youth in Ottawa Public Health programming.
Teti, M., Murray, C., Johnson, L., & Binson, D. (2012). Photovoice as a community-based participatory research method among women living with HIV/AIDS: Ethical opportunities and challenges. Journal of Empirical Research on Human Research Ethics: An International Journal, 7(4), 34-43.
Darcie Taing, RN, MN, CCHN(C), is a family health specialist at Ottawa Public Health.
Shari Kneen, RN, works in the school health program at Ottawa Public Health. She was the project lead for the Photovoice contest.