How to effectively engage children in a discussion about factors that influence their health and behavior is a research topic that researchers in the field of children’s health promotion are always interested in. Meanwhile, existing research indicates that children and adolescents still lack sufficient opportunities to have their voices heard and taken seriously during the process of receiving healthcare services (Davies et al., 2023). It is crucial for children to express their “voices” as subjects of their own health management.

Therefore, I would like to introduce a methodology named Photovoice. It is a participatory action research (PAR) method that involves organizing individuals to take photos on specific themes, followed by discussions and reflections to deepen understanding of life experiences (Plunkett et al., 2013). In 2011, Dawn et al. introduced this method into the field of nursing research. Photovoice is less language-oriented compared to traditional research methods, thus enhancing the potential for children to express their viewpoints and participate more fully in research (Abma et al., 2022). As a child-friendly methodological approach, Photovoice is increasingly being applied in various fields (Abma & Schrijver, 2020). There is existing research demonstrating the utility of Photovoice in the field of pediatric oncology (Ebrahimpour et al., 2021).

We recently applied this method in our research to explore the experiences of dietary management in children with leukemia. We aim to analyze the motivations, abilities, and prompts influencing dietary management behavior change in these children. By identifying these elements, the study aims to provide insights for further exploration of suitable dietary management interventions. However, there are some obstacles encountered when applying this in children with leukemia undergoing chemotherapy.

Firstly, if we don’t ask about the meaning behind the photos, most of them won’t voluntarily express their feelings. Secondly, they easily lose interest in photography. For example, when a child cannot eat anything on a particular day, she just doesn’t feel like taking any photos because she seems to have lost interest. Thirdly, some of them are too weak to take photos, for example, there is one child is too weak to even press the photo-taking button. Lastly, their parents are concerned about the risk of infection for their children, so they are unwilling to let them participate in offline group photography classes and activities.

Regarding the challenges above, our current solutions are as follows: Firstly, we spend one month or even longer establishing friendly relationships with children with leukemia and their parents, gaining their trust before conducting in-depth interviews. Secondly, we integrate gamification elements into the Photovoice application to increase their interest in photography activities. Thirdly, children decide what to photograph, with parents assisting in taking pictures, or waiting until the children have recovered somewhat before they take the photos themselves. Lastly, to organize online photography teaching activities, and to change offline group activities to one-on-one photography guidance.

References

DAVIES C, FRASER J, WATERS D. Establishing a framework for listening to children in healthcare [J]. Journal of Child Health Care, 2023, 27(2): 279-88.

PLUNKETT R, LEIPERT B D, RAY S L. Unspoken phenomena: Using the photovoice method to enrich phenomenological inquiry [J]. Nursing Inquiry, 2013, 20(2): 156-64.

ABMA T, BREED M, LIPS S, et al. Whose voice is it really? ethics of photovoice with children in health promotion [J]. International Journal of Qualitative Methods, 2022, 21: 16094069211072419.

ABMA T A, SCHRIJVER J. ‘Are we famous or something?’Participatory Health Research with children using photovoice [J]. Educational Action Research, 2020, 28(3): 405-26.

EBRAHIMPOUR F, MIRLASHARI J, HOSSEINI A S S, et al. Symbols of Hope on Pediatric Oncology Ward: Children’s Perspective Using Photovoice [J]. Journal of Pediatric Oncology Nursing, 2021, 38(6): 385-98.