Search

This special collection of Health Promotion Practice introduces critical narrative intervention (CNI) as a key theoretical framing for an asset-based, narrative, and participatory approach to promoting health and addressing social inequality. Innovative digital and visual methodologies highlighted in this special collection—comics and graphic novels, cellphilms and other participatory film, story booths, digital storytelling, and photovoice—are changing the way critical public health researchers and practitioners forge new knowledge, creating new possibilities for interdisciplinary and activist-based inquiry. Public health research and engagement efforts that critically contend with historically repressive structures and intervene through narrative and participatory processes to enact change with and for disenfranchised communities are long overdue. This special collection showcases six CNI projects that promote equity and justice in the context of LGBTQ, nonbinary, and other gender-diverse young people; people who inject drugs living with hepatitis C virus; young women who trade sex; undocumented and formerly undocumented immigrants; and people living with HIV/AIDS. It is our intent that this collection of exemplars can serve as a guidepost for practitioners and researchers interested in expanding the scope of critical public health praxis. Individually and collectively, the special collection illustrates how CNI can create space for the increased representation of historically silenced populations, redress stigma, and provoke important questions to guide a new era of health equity research.

Lifestyle interventions regularly rely on study staff to implement the intervention and collect outcomes data directly from study participants. This study describes the experiences of project staff in two randomized controlled trials of a postpartum lifestyle intervention to reduce risk factors for type 2 diabetes in Latinas. Latinas are the fastest growing minority group in the U.S. and have the highest rates of type 2 diabetes after a diagnosis of gestational diabetes mellitus. The challenges of implementing lifestyle interventions for postpartum women have been poorly documented. A qualitative focus group was conducted with eight staff members (five health educators and three health interviewers) involved in Proyecto Mama and Estudio Parto. The discussion was audio recorded, transcribed, and coded in NVivo. Focus group topics included: 1) participant recruitment, 2) participant retention, 3) implementation of the lifestyle intervention, 4) assessment of behavior change, 5) overall challenges and rewarding aspects of the trial, and 6) recommended changes for future trials. Key themes emerged regarding enabling factors and barriers to implementing a lifestyle intervention in postpartum Latinas. Enabling factors included: a) the staff’s belief in the importance of the intervention, b) opportunities associated with the longitudinal nature of the trial, c) belief that the staff could empower participants to make behavior change, d) benefits of flexible intervention sessions, and e) connection with participants due to shared cultural backgrounds. Barriers included: a) participant stressors: home, food, and financial insecurity, b) low health literacy, c) issues related to recent immigration to the continental U.S., d) handling participant resistance to behavior change, e) involvement of family members in assessment visits, f) limitations of the assessment tools, and g) time limitations. Findings highlight the challenging contexts that many study participants face, and shed light on the potentially influential role of health educators and interviewers in intervention implementation and data collection. Specific recommendations are made for strategies to improve adherence to diabetes prevention programs in postpartum underserved and minority populations in this challenging, transitional period of life. NCT01679210 . Registered 5 September 2012; NCT01868230 . Registered 4 June 2013.

Low/no-income, African American men are disproportionally burdened by chronic disease resulting from a complex interplay of systemic, sociocultural, and individual factors. These disparities are related to poverty, racism, gender role strain, high levels of stress, low levels of physical activity, and malnutritious diet. Men of Color Health Awareness (MOCHA) is a community-driven movement to address the physical, mental, social, and spiritual needs of men of color. As part of ongoing programming, the MOCHA Standard intervention consists of a 10-week program including: (1) small group discussions of issues particularly relevant to men of color, (2) classes on health topics focusing on chronic disease control, such as nutrition, obesity, high blood pressure, fitness, and the social determinants of health; and (3) 60-min of moderately intensive aerobic exercise twice a week. While the MOCHA Standard intervention has yielded positive results, feedback from previous participants warranted an in-depth sociocultural tailoring of the curriculum to improve community receptiveness, in particular, revising the sessions to "narrativize" the materials to strengthen their potential effectiveness. This manuscript describes the novel recruitment strategies; the development of an enhanced MOCHA+ Stories Matter program that uses narrative communication strategies; and the methodology used to assess the comparative effectiveness of the MOCHA Standard relative to MOCHA+ Stories Matter program in lowering stress and risk of chronic diseases in a randomized controlled trial. The results of this research will contribute to the identification of effective interventions to address health disparities in low-income African-American men and the dissemination of effective chronic disease prevention programming.

Drug scares have historically been created for a range of purposes and with a variety of effects in the United States. Moral panics evoked by these drug scares either support or challenge dominant American ideas about race, economics, and society. In the present study, we examined newspaper accounts of methamphetamine use in the Inland Pacific Northwest of the United States in an effort to understand how the "reality" of the "meth epidemic" is socially constructed in a "meth hotspot," and reflect upon the ways that the discourse of Whiteness intersects with this construction. For our analysis, we are cognizant of the "slipperiness" of the logic of Whiteness as a concept, and the ways that an alternative logic is articulated - one that strategically embraces or distances White drug users to support notions of White dominance. We focus on the possibility that individual meth users could then be portrayed pseudo-racially as "White trash," and thus rendered outside the logic of White racial order. Our findings center on two main themes: (1) the use of fear in the construction of the meth drug scare through the sensationalization of meth, its anthropomorphization, and the depiction of the threat of the White drug user; and (2) how the logic of Whiteness is discursively reconciled within this construction. Given current mediated discourses about drug use and health in the United States that center on the emergence of the White drug user as the face of the opioid crisis, we are well served to carefully consider the recent historical precedence of the "meth epidemic" in which the public was faced with reconciling their views about drug use and the intersection of race, class, and mainstream American identity.

This article focuses on findings of a two-year pilot research study focused on addressing sexual and reproductive health inequities faced by adolescent women of Puerto Rican descent living on the mainland United States. Working with three groups of young women, in the pilot study we gathered ethnographic data in and around a group-based digital storytelling process to inform the development of a larger intervention. Digital stories are short (1–3 minute), participant produced videos that synthesize still and moving image, a voiceover recording of the participant telling her story, and background music and text to document personal experiences. Based on narrative analysis of digital stories and field notes written in and around the digital storytelling workshop process, as well as follow-up individual interviews with workshop participants, our findings center on the ways that trauma has specifically shaped participants’ sexual and reproductive health experiences. We argue that digital storytelling serves as a critical narrative intervention, whereby participants’ engagement in the storytelling process enables them to collaboratively interrogate and potentially address prior trauma, bolster a sense of social support and solidarity, and potentially recalibrate stigmatizing conversations about them. We introduce our project methodology, and then present key findings on trauma as it informs sexual and reproductive health practices, with digital storytelling showcased as a modality for critical narrative intervention. We conclude by discussing implications for critical public health research and practice.

Since the 2003 call by the Institute of Medicine to educate undergraduates in public health, various models have emerged for incorporating public health into the liberal arts and sciences. One model is a professionalized public health major that uses core public health competencies to prepare a workforce of health professionals. A second model offers a broad-based public health major rooted in liberal arts principles, resisting the utilitarian trend toward human capital formation. A third model resists even the label of “public health,” preferring instead to introduce undergraduates to many ways of analyzing human health and healing. The multidisciplinary Culture, Health, and Science Program, based on six key commitments for preparing liberal arts students to analyze health and respond to global health challenges, is offered as an alternative to the public health major.

The nexus of migration and family offers a conjuncture to enrich understanding of teen pregnancy and parenting. This article draws findings from a project centered on participant-produced new media to reveal how young mothers negotiate reproductive health disparities. We focus on young mothers' experiences of migration and movement, captured in local vernacular through participants' digital story depictions and follow-up interviews. We argue that disparities link up with the single story of teen mothering, involve public shaming, continue hand-in-hand with institutional humiliation, and are exacerbated through migration and movement. To disrupt the normative notions that shadow young mothers, we take seriously the young women's narratives. We theorize how the richness of stories and storytelling may serve as a potent intervention-a narrative shock-for articulating meanings and cultivating dignity for young mothers and their families, especially those who do not fit the sedentary and age biases of parenting ideals.

The University of Massachusetts Amherst is part of Five-Colleges Inc, a consortium that includes the university and four liberal arts colleges. Consortium faculty from the School of Public Health and Health Sciences at the university and from the colleges are working to bridge liberal arts with public health graduate education. We outline four key themes guiding this effort and exemplary curricular tools for innovative community-based and multidisciplinary academic and research programs. The structure of the consortium has created a novel trajectory for student learning and engagement, with important ramifications for pedagogy and professional practice in public health. We show how graduate public health education and liberal arts can, and must, work in tandem to transform public health practice in the 21st century.

Background Young Latinas living in the United States experience inordinate sexual and reproductive health outcome disparities. However, though prioritized as subjects for prevention, they are also often denied sexual agency. Purpose This article reports the results of a study conducted to examine young Latino/a participants' perspectives on communicating and learning about sexuality in school and family settings. Methods A Photovoice project was conducted with 20 Latino/a high school students. Each participant received a digital camera to take photos for 2 discussion sessions. Participants discussed select photos in relation to self-generated topics. Results One overarching theme, double standards in expectations about sexual communication, and 2 related subthemes, contrasting gender expectations in sexual desire and pleasure and confirming ideologies in sexual taboos and disconnections, emerged during discussions. Discussion The persistence of a double standard placing responsibility for sexual protectio...

This collection of original articles, a companion to the authors' Participatory Visual and Digital Methods, illustrates how innovative visual and digital research techniques are being used in various field projects in health care, environmental policy, urban planning, education and youth development, and heritage management settings. These methodologies produce rich visual and narrative data guided by participant interests and priorities, key tools for collaborative work. The 16 chapters-include digital storytelling, PhotoVoice, community-based filmmaking, participatory mapping and GIS, and participatory digital archival research;-provide a portfolio of model research projects for researchers who wish to collaborate on community-based studies;-will appeal to an audience across social science, heritage, health, education, and social service fields.An open-access companion website will allow readers to view the research products presented in each contributor's chapter.

Predominant approaches to teen pregnancy focus on decreasing numbers of teen mothers, babies born to them, and state dollars spent to support their families. This overshadows the structural violence interwoven into daily existence for these young parents. This paper argues for the increased use of participatory visual methods to compliment traditional research methods in shifting notions of what counts as evidence in response to teen pregnancy and parenting. We present the methods and results from a body mapping workshop as part of 'Hear Our Stories: Diasporic Youth for Sexual Rights and Justice', a project that examines structural barriers faced by young parenting Latinas and seeks to develop relevant messaging and programming to support and engage youth. Body mapping, as an engaging, innovative participatory visual methodology, involves young parenting women and other marginalised populations in drawing out a deeper understanding of sexual health inequities. Our findings highlight the ways body mapping elicits bodies as evidence to understand young motherhood and wellbeing.

This chapter discusses a digital storytelling project that combined aims to gain fine-grained understanding of, and address, sexual health inequities among Puerto Rican Latinas in the project community. The authors begin by introducing digital storytelling as a culture-centered approach for use in public health research and intervention. They then trace two emerging ethical issues in research using digital storytelling, both related to key project findings of current and historical trauma among participants: (1) conflicting aims in the project and (2) the ethical standard to minimize harm. The authors conclude that these issues can be resolved if projects are guided by a sensitive ethical protocol, and that digital storytelling and other participatory, visual, and arts-based methods can be harnessed for the design of effective sexual health interventions.

In a recent Editors Choice column in the American Journal of Public Health Northridge and Coupey1 advocate the increased use of long-acting reversible contraception (LARC) specifically the intrauterine device and the implant as a means to achieve reproductive health equity. They reference the American Academy of Pediatrics recommendation which states that these methods should be considered "first-line contraceptive choices" for adolescents and young adults.2 (Am J Public Health. Published online ahead of print November 12 2015: e1-e2. doi:10.2105/AJPH.2015.302900).

Influenced by Cooke and Kothari's (2001) suggestion that participation "remains a way of talking about rather than doing things" (p. 32), we question to what extent this is true in the public health funding process. Thus, the aim of this article was to investigate the ways in which recent National Institutes of Health (NIH)-funded community-based participatory research (CBPR) projects discursively positioned CBPR in their grant applications. We collected 17 NIH-funded CBPR proposals, analyzed them using a grounded theory approach, and subjected the findings to critical analysis focusing on the definition of community, the type of community "participation" promoted, and the nature of the research proposed. We conclude that certain types of CBPR projects are privileged in the funding review process and discuss the implications of these findings for future CBPR praxis.

Few studies have explored women’s subjective experiences with Depo-Provera, in particular its impact on their sexual selves and everyday lives. Thirty-four (34) women were interviewed about their experiences using Depo-Provera and other methods of contraception, with interviews analyzed using a thematic narrative analysis approach. A key theme emerging in interviews was decrease in libido (sexual desire) in taking Depo-Provera, which was linked with emotions, body image, and had social ramifications. Four participants’ stories serve as exemplars for exploring subjective complexity. "Lived" accounts of user experiences are essential for overcoming a reductive focus on contraceptive side effects, which elides connections and obscures user understanding. A narrative perspective provides an empirical basis for developing family planning programs and sexual health policies that acknowledge more experientially grounded conceptualizations of women's sexual and reproductive health and wellbeing.

This paper presents the Ford Foundation-funded Hear Our Stories: Diasporic Youth for Sexual Rights and Justice project, which explores the subjective experience of structural violence and the ways young parenting Latinas embody and respond to these experiences. We prioritize uprooted young parenting Latinas, whose material conditions and cultural worlds have placed them in tenuous positions, both socially constructed and experientially embodied. Existing programs and policies focused on these women fail to use relevant local knowledge and rarely involve them in messaging efforts. This paper offers a practical road map for rendering relevant and modifying notions of voice as a form of knowledge with the potential to disrupt authoritative knowledge. We present the context and method behind the four digital storytelling workshops that served as a venue for transforming assumptions about young parenting women and producing novel understandings of teen pregnancy and parenting. We end by suggesting an intervention for what we call “strategic authenticity” as it plays out in storytelling, meaning making, and voice, and implications for policy concerned with social justice and equity.

New visual technologies are changing the ways that anthropologists do research and opening up new possibilities for participatory approaches appealing to diverse audiences. Participatory digital methodologies featured in this special issue include digital storytelling, Photovoice, interactive multimedia as new media ethnography, participatory digital archival research, and participatory geographic information systems (GIS). Other methodologies involving participatory digital methodologies that are gaining traction in anthropology include community-based filmmaking (Biella 2006) and collaborative blogging and website production (Hess 2001; Young 2007). Research participants are producing digital representations of their experiences, taking and sharing pictures, and mapping their own environments. These methodologies produce rich visual and narrative data guided by participant interests and priorities, putting the methods literally in the hands of the participants themselves. They appeal to wide audiences, allowing for access to and production of anthropological knowledge beyond the academy.

Using a positive youth development framework, this article describes how a 3-year digital storytelling project and the 566 digital stories produced from it in Northwest Alaska promote protective factors in the lives of Alaska Native youth and serve as digital “hope kits,” a suicide prevention approach that emphasizes young people’s reasons for living. Digital stories are short, participant-produced videos that combine photos, music, and voice. We present process data that indicate the ways that digital stories serve as a platform for youth to reflect on and represent their lives, important relationships and achievements. In so doing, youth use the digital storytelling process to identify and highlight encouraging aspects of their lives, and develop more certain and positive identity formations. These processes are correlated with positive youth health outcomes. In addition, the digital stories themselves serve as reminders of the young people’s personal assets—their reasons for living—after the workshop ends. Young people in this project often showed their digital stories to those who were featured positively within as a way to strengthen these interpersonal relationships. Evaluation data from the project show that digital storytelling workshops and outputs are a promising positive youth development approach. The project and the qualitative data demonstrate the need for further studies focusing on outcomes related to suicide prevention.