research essay on photography

While all of the thirty-one articles reviewed for this paper focused on learners in compulsory education, they covered a wide range of topics within education in a variety of countries. These included gender and bullying in schools in England ( ), inclusion of learners with special educational needs and disabilities in UK, Zambia and Indonesia ( ), the school experiences of Black middle-class male youth in high school in usa ( ), the views of learners in Nordic countries on healthy and unhealthy eating ( ), transition of learners from primary to secondary schools in Bangladesh ( ), the understandings of inclusion held by migrant learners in schools in England ( ) and friendship and meaning in young people’s lives in Australia ( ). The themes explored are necessarily selective and not intended to be exhaustive. However, this thematic section is offered as a summary of some of the key focal points, highlighting significant diversities and commonalities, and with these, some gaps and critical questions that will be discussed and suggested to be taken forward in future research. The two themes are: why photography is used; and how photography and photographs are used. Each of these themes will be treated individually below. Key points from the themes are noted in table .

As referred to earlier, has stated that research methods in social research should be ‘fit for purpose’. This means that a researcher should think carefully about what method would best fit the research topic and the research participants with whom they wish to engage.

It appears that the photographic method is viewed within the selected articles as appropriate for use with a range of different learners in education, and this raises a question about motivation in choosing this method from the vast array of options that are available to any researcher. Despite some critical discussion of the use of the photographic method, most authors were drawn to this approach as an alternative to traditional qualitative methods that focus on the spoken word or observable phenomena, due to its potential to uncover issues that are not often explored, with groups who aren’t often asked, thus adding a richness that may otherwise be absent. Subsequently, three dominant and, in some cases, interlinked terms that emerged were ‘representation’, ‘participation’ and ‘emancipation’. In many cases the researchers discussed more than one of these terms as the focus of the research.

A number of the papers stated that they used photographic methods in order to better ‘represent’ the views or experiences of a particular group of research participants. These were often used in conjunction with other methods, such as in study with teenage female Aboriginal and Maori learners in Australia and New Zealand, that innovated to create the method of ‘photoyarn’ that combined photography with indigenous yarning and yarning circles to represent these students’ experiences. study on spatial mobility of learners viewed representation of children’s ‘real’ experiences as key, as did work with Traveller children and research with learners with special educational needs and disabilities. study on sexual cultures within secondary schools viewed photography as offering participants ‘alternative means of recounting their stories’ (p. 550). Taking representation further, work with children (as part of families) wished to ‘disrupt normative representations of families’ (p. 48). Therefore it was not just about offering a standardized representation of experience, but also challenging current or common representations. Nevertheless, the question remains, and is often raised by these and other authors, about the extent to which a photograph can be described as truly representative of a person, place, time or concept. Reflecting the background debates of many of the studies included in this review, Newman et al., (2006) describe representation as a debate between ‘realist’ and ‘critical’ approaches, between the idea that a photograph can be accurately representative, and the idea that any image invites interpretation and a construction of meaning among a number of actors. There are also significant issues of power, given that it is normally the adult researchers who ultimately get to decide what gets shared from the research work with learners ( ). In this way, it is a deeply ethical issue and researchers need to very carefully consider whether what they are offering is a representation that is in line with what the photographer and/or the photographed intended, in addition to be cognizant of the fact that what the image represents may be viewed differently by the audience (particularly salient in projects where the images are displayed, such as ) and also that this may change over time.

A large number of papers foregrounded the ‘participatory’ side of the photography, where it was chosen in order to promote participation and ‘voice’ in educational research on a particular topic. In paper that focused on the inclusion of learners with special educational needs in education and research, they describe visual methods as appropriate to their study as they ‘gave ‘voice’ and agency to those less able in number, language and textual skills which have systematically biased accounts in past qualitative research.’ (p. 59) work on understandings of learning stated their view that photography ‘offers a very accessible way for young people to become active in the research process themselves, to reverse the normal role of having research done to them, and allow them to participate more in this process’ (p. 366). Similarly, used photography as a way of promoting participation of migrant learners, some non-native speakers of English, in research, due to the lack of competence in English language required to engage with visual methods. , in her extensive research in South Africa, suggested that using such methods forms part of a researcher’s social responsibility to encourage participation in educational research of a variety of groups. Several studies went further to suggest that photographic methods were specifically child-friendly (e.g., ; ; ). However, a question does arise as to the particular ways in which participants might be participating or not participating – such as whether lack of enthusiasm for taking photographs might represent a withdrawal of consent ( ) – as well as whether that creates a false sense of agency to effect change ( ). Furthermore, it must not be assumed that photography is automatically a more ‘child-friendly’ method than any other; returning to , all methods should be ‘fit for purpose’ and adapted to the particular context of the research.

Finally, another tranche of papers in this review focused more on the ‘emancipatory’ potential of using photography as a method in educational research. used photography to highlight the lack of representation for women of colour in the media, and thereby ‘provoked critical conversations about race and gender in their school community.’ (p. 299) viewed photography by Latino/a youth on challenging racism in schools as a way of ‘unsilencing’ them, allowing their voices to be heard as a way of empowering them. used the term ‘counter storytelling’ (Stovall, 2006) to describe how she viewed photography, offering young people of color in usa high schools the chance to counter the dominant narratives about their lives, through not only taking but also displaying their photos. stated that Black male youth participants in his study ‘expressed excitement over getting to share their stories and were hopeful that schoolteachers and administrators would understand them better.’ (p. 452) It is interesting to note that the distinctly emancipatory tone appears to come out most strongly from studies based in the usa where the research participants were secondary school age. This raises questions about whether the perception of agency is absent in many other countries, particularly among primary-age learners, perhaps showing that in compulsory education there remains the sense, introduced earlier, that younger learners are ‘human becomings’ in need of development and adult protection rather than fully-fledged ‘human beings’ with valid opinions and agency ( ).

In addition to the motivation behind using photography, another key theme was how photography and the photographs themselves were used. This is the second theme and is considered below.

Many of the studies in this review paid tribute to the development of specific sub-methods within photography-as-method, such as ‘photo-voice’ (Wang & Burris, 1997) and ‘photo-elicitation’ (Collier & Collier, 1986). However, even where these tried-and-tested methods were employed, researchers used photography and photographs in a variety of ways. There was a clear distinction between those studies that used ‘found’ or pre-generated photographs and those where the participants generated the photographs themselves.

There were only a small number of papers that used pre-generated and/or researcher-generated photographs. These were normally shown to the participants as a way of prompting discussion. study on learners’ perceptions of un/healthy food used pre-generated photographs that were shared with focus groups of children who looked at and then discussed them. Pang et al.’s, (2016) research on subjectivities of un/healthy bodies among Chinese Australian youth used photographs of different bodies from magazines to elicit their views. In part of study, researcher-generated photographs of one school (in Zambia) were shown to learners in another school (in Tanzania) to prompt discussion. study on primary-secondary transition for learners in Bangladesh (2012) used researcher-generated photographs of the learners’ primary school to bring back memories for the learners. Unusually for the selected studies, two papers described researcher-generated photography: uses the photographs taken by herself of a school, and then analyses them herself to explore the school experiences of learners in socioeconomically divergent schools; and uses researcher-generated photographs of shifts in stages of play among young primary school learners. While such studies may raise questions about representation and interpretation (see Rose, 2011), the apparent effectiveness that authors report does pose a challenge to the popular idea that photographs must be generated by participants in order to promote participation in research. It may be that pre-generated photographs are more suitable than participant-generated photographs for exploring particular topics, especially where the issues might be deemed too sensitive to warrant the production of photographs that might be attributed to particular individuals. Indeed, confidentiality is another ethical concern that was mentioned frequently in the articles under review (see, for example, ).

Much more popular than the use of pre-generated photographs was the approach whereby research participants themselves generated photographs. Unsurprisingly, this appears to overlap with studies that saw themselves as overtly ‘representative’, ‘participatory’ or ‘emancipatory’. Many of these studies stated that photo-voice was used, such as Mitchell et al.,’s (2006) work on school absenteeism in rural South Africa, study with Latino/a youth in usa, research on literacy with high school students in usa, and study on wellbeing among adolescents in usa. Usually, research participants were provided with a disposable (e.g. ) or digital camera (e.g. ) and were given the task of taking photographs relating to a particular topic, either within school, with the researcher being present (e.g., ) or outside school, independently and without the researcher being present (e.g. ). Then these cameras were returned to the researcher and at least some of the photographs were developed/printed for the participants to view. The majority of studies that involved participants taking photographs themselves used a version of ‘photo-elicitation’ following the photograph-taking in order to find out participants’ meanings and intentions in taking the photographs, and/or to promote discussion or debate on a particular topic. In O’Donaghue’s (2007) study on gender and masculinities in Irish primary schools, participants added written captions to their images, based also on notes that they had taken down as they took their photographs. paper describes two different approaches: one where a written inscription was added to the photos and another where the photographs were used as a stimulus for oral discussion during individual interviews rather than pinpointing a caption. In their study on deaf children’s experiences of school, used computers to allow participants to edit the images and to add their own interpretations to them. In these kinds of studies, then, the issue of representation and interpretation again came to the fore, with many selecting photo-elicitation as a way of trying to foreground the interpretations of learners rather than those of the adult researchers.

It is worth adding that a small number of studies combined the use of pre-generated and participant-generated photographs. For example, Kirby, Levin and Inchley (2013) investigated the environmental factors that influence physical activity participation among young people in Scotland, where primary school participants created blogs using some of their own and ‘found’ images as a way of capturing the full extent of what they wanted to say, or to keep their own images private. It may be that this offers a more inclusive approach as learner-participants have the choice of creating or finding images that satisfy them, rather than experiencing discomfort in viewing their own ‘inadequate’ photographs or sharing their own images without fully informed consent. Indeed, given that most studies stated that their aim was to be inclusive, then this approach may go some way towards achieving this.

Springing from this, then, is the issue of involvement of research participants in data analysis or in ‘member checking’ once the findings have been drafted. As with the issue of representation, this is an ethical issue, thus showing how ethical dilemmas are threaded through the entire research process, and pertinent often long after the formal research period has come to an end. While it may be argued that photo elicitation goes some way towards involving participants in data analysis, the reality remains that the opportunity to return to the schools and learners and get their input into the analysis of the data was rarely offered or taken (with the exception of computer-based analysis with deaf children). The child rights-based approach developed most extensively by Laura Lundy (see ) would argue that children should be involved at every stage of research, including design, fieldwork, data analysis and dissemination, and so this last stage would be invaluable.

However, it may be argued that the sharing of these photographs (often with captions) is another way of involving participants in data analysis, given that they have some control over what gets shared. This was the case in a number of the studies, where a school- or community-based exhibition was set up (e.g., ; ; ; ; ; ). Nevertheless, it remains the case that the audience has the freedom to interpret the images on display in their own way, which may be entirely different from the intentions of the learner-photographers, and therefore may not promote the kind of ‘counter storytelling’ that scholars such as or might wish for.

This article reviewed 31 research articles from 2001–2019 on the use of photography as a research method with learners in compulsory education. It was set against the background of discussions around ‘visual’, ‘participatory’ and ‘arts-based’ research methods, and the growth of photography as a method in general was attributed to shifts in understandings of children and young people that came around the time of the adoption by the UN of the United Nations Convention on the Rights of the Child in 1989, and the movement within the sociology of childhood that began to more vocally advocate the appreciation of different, agentic childhoods and children. It was highlighted that while photography is popular in some disciplines, it remains a relatively under-utilised research method with learners in school-based compulsory education. Nevertheless, 31 research articles were selected for the qualitative, narrative review, and two themes were drawn out. The first theme related to the motivation behind the authors’ use of photography as a research method. Motivations were classified in three ways: representation, participation and emancipation. While the analysis broadly agreed that these were laudable aims, it also raised issues relating to the extent to which a photograph can represent reality and the issue of interpretation by the photographer, the photographed, and the audience, as well as whether participation always indicates consent and whether participation in research can create a false sense of agency to effect change. Another point that was considered was that it appeared to be the studies based in secondary education in the usa that had an overtly emancipatory agenda, and reflected on whether this indicated that, in other countries and in primary education, there is still the sense that learners cannot effect real change.

The second theme considered how photography and the photographs themselves were used in the studies related in these articles. This was broadly divided into two aspects: the use of pre-generated (or ‘found’) photographs; and the use of participant-generated photographs. While a small number of studies used pre-generated photographs, the overwhelming majority involved participants in generating and sometimes editing photographs, and further sometimes selecting photographs for dissemination. This led to a discussion around involving participants in the interpretation of the photographs, where ‘photo-voice’ and ‘photo-elicitation’ techniques were found to be very popular. It was found that only very few studies managed to return to the participants at a later stage for a final ‘member-check’ on the analysis, which for some authors was regrettable, and perhaps not fully in line with the ‘child rights-based approach’ to research.

Given the relatively small uptake of the photographic research method for use with learners in compulsory education (considering both the articles contained in this review as well as a number of monographs and edited volumes mentioned earlier), it is worth pondering, for a moment, why that is. Its limited use may come as a surprise, given that it feels like we are surrounded (bombarded?) by visual culture on a constant basis in the 21st century. This is not least because of the rapid rise and now pervasiveness of social media, particularly among young people ( ). As , p. 361) notes, there are ‘contradictions between the current widespread practice of visual recordings in public and private spheres and the cautious approach adopted in educational research’. This is a conundrum that this Special Issue on ‘Visual Methods in Educational Research’ seeks, in part, to address, and I would like to make my contribution here too.

One of the biggest concerns that has emerged with the rise of photographic research methods is that of ethics, and certainly ethical concerns were something that many of the authors of the articles in this review very clearly grappled with. It appears to be a particularly thorny issue due to the (perceived or real) higher chance of participants being identified through images of their faces than via text-based methods. There are also ethical considerations around the potential for mis-representation of participants’ images (as mentioned above by ), whether children and young people, unfamiliar with research and researchers, can be said to have given ‘fully informed consent’ and who, ultimately, owns the images. These are challenges over which researchers are not agreed, and different researchers have chosen to use the images in different ways, with some using them in public displays, some using software to turn photographs into cartoons or line drawings, others blurring faces in published work, and still others publishing or even holding on to no images at all. In addition to ethical concerns, allusion was made earlier to understandings of children and young people as ‘human becomings’ rather than ‘human beings’ as it was noted that there has been some shifting in this area, not least thanks to the uncrc 1989. However, it may be that the idea of young people as ‘human becomings’ still prevails and may go some way towards explaining the low uptake of the photographic method in the school environment. While full exploration of these issues is beyond the scope of this study (see , for a good summary), it is important to be aware that the rise of university ethics committees and schools’ increasing concerns about being legally challenged over misuse of images, juxtaposed with the ever-increasing popularity of image-based social media, mean that this debate is likely to continue to evolve. ( ; )

However, I would like to posit that it is not only such important ethical and age-related concerns that may be contributing to the lack of use of photography in school-based research; it may also be that access to schools is restricted as research using photography is not strictly related to the ‘core’ subjects of literacy or numeracy. Therefore, it is a challenge for researchers to convince schools of the benefits of their research and may explain why so many of the studies included in this review were very clear about their intentions in using photography and photographs: many of them had to engage in a process of negotiation with schools in order to gain access ( , is a case in point). This is certainly a challenge that I, as a user of photographic research methods, have faced (see ).

A final conundrum that arises from this research review is the fact that the photographic research method is not widely used in compulsory education outside the ‘West’. This is of particular significance to a journal like this one – the – as there is so little published work on the use of photography as a research method in education in China – in English or, I am reliably informed by my local colleagues, in Chinese. The usa and UK show most often in searches for research papers. It would be useful for future research to consider more extensively why that might be, so that all methods might be considered, and so that we can all work towards using methods that are ‘fit for purpose’ and inclusive of all groups in education.

To close, it is important to return to the motivation behind using photography, and why at least some researchers continue to forge ahead in developing the method. I am convinced that photography can be a useful research method in education as long as one remembers that it is imperfect and partial, and should be understood within and adapted to a context, where the researcher is always ready to abandon the method if it is not effective or appropriate. It can contribute to answering some of the most important questions within education, but it cannot answer any one question in full. The final word is left for the author of one of the articles in this review:

As I have written elsewhere ( ) as have many others, this need to reflect the narratives of those within the education systems that we, as social researchers, hope to benefit, continues to be a moral imperative and one that requires our continual engagement.

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• 4.1 Why Photography is Used: Representation, Participation and Emancipation
• 4.2 How Photography and Photographs are Used: Pre-generated, Researcher-generated and Participant-generated Photographs
• 5 Summary and Reflecting on the Prospects for Photography as a Research Method in Education
• Review Articles

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• v.10(4); 2021 Aug

The visual vernacular: embracing photographs in research

Jennifer cleland.

1 Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore

Anna MacLeod

2 Division of Medical Education, Dalhousie University, Halifax, NS Canada

Associated Data

The increasing use of digital images for communication and interaction in everyday life can give a new lease of life to photographs in research. In contexts where smartphones are ubiquitous and many people are “digital natives”, asking participants to share and engage with photographs aligns with their everyday activities and norms more than textual or analogue approaches to data collection. Thus, it is time to consider fully the opportunities afforded by digital images and photographs for research purposes. This paper joins a long-standing conversation in the social science literature to move beyond the “linguistic imperialism” of text and embrace visual methodologies. Our aim is to explain the photograph as qualitative data and introduce different ways of using still images/photographs for qualitative research purposes in health professions education (HPE) research: photo-documentation, photo-elicitation and photovoice, as well as use of existing images. We discuss the strengths of photographs in research, particularly in participatory research inquiry. We consider ethical and philosophical challenges associated with photography research, specifically issues of power, informed consent, confidentiality, dignity, ambiguity and censorship. We outline approaches to analysing photographs. We propose some applications and opportunities for photographs in HPE, before concluding that using photographs opens up new vistas of research possibilities.

Supplementary Information

The online version of this article (10.1007/s40037-021-00672-x) contains supplementary material, which is available to authorized users.

A Qualitative Space highlights research approaches that push readers and scholars deeper into qualitative methods and methodologies. Contributors to A Qualitative Space may: advance new ideas about qualitative methodologies, methods, and/or techniques; debate current and historical trends in qualitative research; craft and share nuanced reflections on how data collection methods should be revised or modified; reflect on the epistemological bases of qualitative research; or argue that some qualitative practices should end. Share your thoughts on Twitter using the hashtag: #aqualspace

Introduction

Smartphones, tablets, and other devices are increasingly embedded in everyday life, influencing how many people interact, think, behave and connect with other people [ 1 , 2 ]. Many people Whatsapp, tweet and text, and/or use Facebook, Instagram and Twitter for professional, social, educational and entertainment purposes. Images are increasingly accessed and used where words would have been used in the past. Indeed, more than 10 years ago, van Dijck [ 3 ] suggested that “digital cameras, camera phones, photoblogs and other multipurpose devices are used to promote the use of images as the preferred idiom of a new generation of users.”

The increasing use of digital images for communication and interaction in everyday life has given a new lease of life to a source of research data long embraced by sociology and anthropology [ 4 , 5 ]. In contexts where smartphones are ubiquitous and with groups of “digital natives” asking participants to share and engage with photographs, this aligns with their everyday activities and norms more than textual or analogue approaches to data collection. Thus, it is time to consider fully the opportunities afforded by digital images and photographs for research purposes [ 6 , 7 ].

This paper joins a long-standing conversation in the social science literature which advocates moving beyond the “linguistic imperialism” of text [ 8 ] to embrace visual methodologies. This conversation has relatively recently made its way into health professions education (HPE): for example, various authors have proposed video [ 9 ], video-reflexivity [ 10 ] and drawings [ 11 ] for research purposes. However, the use of still images or photographs in research remains niche to some areas of inquiry (e.g., exploring patient experiences, particularly mental health and experiences of serious illness (e.g., [ 12 – 14 ]) and some healthcare professions disciplines (e.g., nursing: [ 15 ])), and is an under-exploited approach in HPE research (see below for notable exceptions). Yet it is a method which offers many possibilities, particularly in respect to giving research participants more agency and power in the research process than is the case in traditional qualitative data collection approaches such as interviews.

In this paper, we discuss ways of using photographs in research, focusing on the use of photography within participatory research inquiry. We consider ethical and philosophical challenges associated with photography research, as well as its unique strengths. We outline some popular approaches to analysing photographic data. We finish with a brief consideration of how photographs could be used more in HPE research.

The photograph as data

Photography has been described as a silent voice, another language to communicate with and understand others, and a way of accessing complexities which may not be captured by text or oral language [ 16 ]. As instances of Latour’s “immutable, combinable mobiles” [ 17 ]—literally things which do not change but which carry action and meaning across time and place, as objects of memory and of relationship—photographs allow us to see what was “happening” at a particular point in time.

Photographs can be a source of data (photo-documentation and existing images) and a tool for eliciting data (photo-elicitation and photovoice). Each of these approaches are explained below.

Photo-documentation

Photo-documentation has been used in clinical medicine for nearly two centuries [ 18 ] Clinical photographs and images are vital for training purposes, to illustrate a clinical finding, steps in a process or procedure, or for comparative (“before” and “after”) purposes. They are an integral part of patient’s clinical notes in numerous specialties and are also used to offer the patient insight into realized or expected treatment results [ 19 ].

This way of using photographs—as objective records documenting an objective something—is quite different from how photographs are used in social science research. In fields such as sociology and social anthropology, photography has been used as a tool for the exploration of society [ 4 , 5 ]. Photographs help others understand how societies are culturally and socially constructed, to critically uncover the meaning people place on certain activities, places, things and rituals and to record and analyse important social events and problems. It is on this second use of photographs in research that we focus from this point onwards.

Existing images

A second way of using photographs in research is analysis of publicly available images: in other words, analysis of secondary (photographic) data. There are examples of this approach in medical education in relation to the messages given by images on public-facing documents and webpages, and how these might influence student choice of medical school [ 20 , 21 ]. Visual data is also used in research examining the relationships between architecture/space and learning [ 22 , 23 ]. Photographs can show us how people and things relate to each other. For example, what can we learn from a photo illustrating how staff are distributed around a coffee room, or around the table during a morbidity and mortality (M&M) meeting? Documenting the materials of a research space in a photograph serves as a mechanism for tracing the complexity of the field (see Fig.  1 and its accompanying explanation).

A photograph as an elicitation tool. Collected as part of a sociomaterial study to document the material complexity of simulation led by MacLeod. This photograph of a manikin in a typical simulation suite could serve as a useful elicitation tool in a study of simulation. Rather than asking research participants to use their memories to imagine a simulation suite, the photograph provides concrete detail, helping to reorient participants to the space. Rather than using a phrase like “simulation is complex”, the photograph serves as “evidence” of the complexity, documenting multiple non-human elements involved in a simulation at a particular time and place. This clarity can provide a jumping-off point for more detailed and specific conversations about the topic being studied

Photo-elicitation

In photo-elicitation (sometimes called photo production [ 24 ] or auto-photography), the specific area of focus is typically decided by the researcher. The photos are either taken by the researcher or participants.

In researcher-driven photo-elicitation the researcher decides on what people, objects, settings and/or scenes they find interesting or potentially important enough for a picture. These photographs are then used as prompts for discussion within an interview with the researcher. The photo(s) is a prompt to elicit data, akin to an open question in a semi-structured interview. Unlike interview or focus group questions however, participants not only respond to photographs with extended narratives but also supply interpretations of the images, drawing from and reflecting their experiences.

In participant-driven photo-elicitation, control of data collection is handed over to participants who have the freedom to pick and choose the representation(s) which is most salient to them in relation to the question under study. For example, to explore children’s experiences of hospital, Adams and colleagues [ 25 ] asked children to photograph architectural or design features that most interested them in a vast hospital atrium (the hospital’s primary non-medical space, full of shops, restaurants and so on). The children’s photographs were then used as the anchor to dialogue [ 26 ].

Participant-driven photo-elicitation empowers the participant to both choose the image and drive the dialogue about the image. Consider a picture of an alarm clock set to an early hour. This becomes meaningful only when the photographer explains that this image signifies their transition from student to first trained job. While the participant’s perspective on the transition to practice could potentially be accessed using traditional words-alone methodologies, photographs are different because they present what the participant felt was worthy to record, help capture the immediacy of the experience and stimulate memories and feelings. In other words, one of photo-elicitation’s strengths, and how it differs from interviews and focus groups, is its potential to collect data that not only taps into the perspective of the participant but does so at the time of the experience.

Images seem to prompt a different kind of reflection on lived experiences. Harper [ 26 ] suggests that images prompt emotions and thoughts in ways that narrative alone cannot. By seeing what they did, informants may help the researcher to better understand their behaviour. Moreover, by viewing and discussing photos together, the researcher and participant actively co-construct meaning. In this way photo-elicitation offers a way to potentially enrich and extend existing interview methodologies and give a combination of visual and verbal data for analysis purposes [ 27 ]. Furthermore, the act of interpreting an image creates a critically reflective space within the research process which is lacking in interview methods. Leibenberg suggests that “collectively then, images introduced into narrative research create important links that participants can use to more critically reflect on their lived experiences and to more accurately discuss and share these experiences with others” [ 28 , p. 4].

Arguably however, if the main source of data is not the photographs themselves but the transcripts from photo-elicited discussions, this may still privilege participants who are more skilled verbally—maintaining the “linguistic imperialism” of text, or, more accurately, of transcribed responses [ 8 ]. While this criticism cannot be wholly dismissed, the many empirical studies referred to in this paper suggest that photographs help make abstract ideas accessible and encourage reflection in groups which are less literate and who do not routinely engage in reflection. Moreover, there are approaches to data analysis which privilege the image, not the accompanying text (see below).

A specific research method within the bracket of photo-elicitation is photovoice. Developed by Wang and Buriss in 1997, photovoice involves asking community members to identify and represent their community through specific photographs and tell the stories of what these pictures mean, promoting critical dialogue and potentially catalysing social action and change [ 29 ]. Photovoice allows people to see the viewpoint of the people who live the lives, and as such is considered an example of participatory research [ 30 ]. For example, MacLeod et al. [ 31 ] asked adolescent youth to take photographs pertaining to the health of their community. The adolescents created a platform for discussion, and helped the researchers, who were medical students, learn about the community they were serving. Photovoice is often used to access and explore patient experiences, particularly mental health and experiences of serious and/or life-threatening illness [ 12 – 14 ].

The ease of taking photographs with a mobile phone has opened up new ways to utilise the photovoice methodology, particularly the method of “time-space diaries” [ 32 ] or digital journals. Participants record what is meaningful to them across time and activities, such as what and where they ate over a full day, or salient events in the first few weeks of medical school. Just like non-research social media activity, a series of images can provide insight into real, lived experiences and give participants a voice to reflect on their everyday lives on issues relevant to the research topic. Consider a resident taking pictures of things and people who were significant to their first experience of a full weekend shift. The nature of the images may change over time, reflecting exposure to different patients, working with different colleagues, task demands and fatigue.

In summary, the nature of photographs as data varies according to who produces them, whether they are independent of the research or created specifically for the research, how they are used in the research process and whether they are used in conjunction with narrative (verbal) data. These key decisions can be synthesised, according to Epstein et al. [ 33 ], into three basic questions:

• Who is going to make or select the images to be used in the interviews?
• What is the content of the images going to be?
• Where are the images going to be used, and how?

How photographs and accompanying narratives can be analysed is discussed next.

Data analysis

There are two main ways of approaching photographic data analysis. The first, the dialogic approach, focuses on analysing the verbal or written reflection on the content of photographs and what they symbolise. This approach is fundamentally constructivist, “locating visual meaning as foundational in the social construction of reality” [ 34 , p. 492]. Traditional ways of analysing verbal/transcribed data such as thematic analysis [ 35 ], content analysis [ 36 ], grounded theory [ 37 ] and various forms of discourse analyses [ 38 ] are appropriate for analysis of photograph-prompted dialogue. In this approach, the photographs themselves are usually used merely for illustration purposes, if at all [ 38 ].

Alternatively, the data can be within the photograph itself, separate from its capacity to generate dialogue and independent of any explanation. Photographs can provide new ways of seeing the phenomena under study from their visual features. For example, in their analysis of existing images on medical school websites and prospectuses in 2019, MacArthur, Eaton and Marrick [ 21 ] recorded information including gender, ethnicity, assumed role and setting, of each person on each image. They found a predominance of hospital-themed images, compared to few community-themed images. They concluded that these images signalled to students a strong preference for hospital-based settings, despite a strong national drive to recruit more general practitioners.

This approach to analysis is referred to as “archaeological” because images inherently reflect the social norms of a point in time. Consider your graduating class photograph. Clothes and hairstyles which were chic at the time may look old-fashioned and incongruous when viewed many years later. In this way, photographs contain “sedimented social knowledge” [ 34 , p. 502], manifest through the photographer’s choices of scenes, subjects, styles, compositions and so on. An educational example of this is presented in Photograph S1, found in the Electronic Supplementary Material (ESM).

Grounded, visual pattern analysis (GVPA) combines both approaches [ 39 ]. Via a structured, multi-step process of analysis, GVPA investigates the meanings individual photographs have for their photographers and also attends to the broader field (sample) level meanings interpreted from analysis of collections of photographs. Paying attention to absence (what is not photographed) is also important [ 40 ]. The analysis process ends by building conceptual contributions rather than purely empirical ones from the photographic data (see Photograph S2 in ESM).

Whichever analysis approach is taken, as with any qualitative research, it is important to consider quality and rigour in respect to the credibility, dependability, confirmability and transferability of the data [ 41 ]. Providing details of the sampling strategy, the depth and volume of data, and the analytical steps taken helps ensure credibility and transferability. Photo-elicitation allows participants to work with and direct the researcher to generate data that is salient to them, thereby increasing the confirmability of research outcomes. Allowing participants to clarify what they meant to convey in their photographs is inherently a form of member checking. As for all research, ethical considerations should be considered and addressed, as well as a clear statement made on formal research ethics committee approval or waiver. Thought must be given to the power relationship between researcher and participants and how this might affect recruitment, the nature of the data and so on. Reflexivity, reflecting on the extent to which similarities or differences between researcher and researched may have influenced the process of research, is particularly critical in photo-elicitation studies [ 42 ]. Keeping written field and methodological notes as well as a reflexive diary is important for dependability and confirmability.

Finally, in terms of data presentation, in our discipline most journals have a limit on the number of tables, figures and/or images allowed per paper, and most do not publish colour photographs. This limits the visual data which can be presented in an article. However, journals also offer the option of supplementary e‑files. We suggest that one or two pictures in an article can support key evidential points, with additional data made available electronically.

Ethical considerations associated with photographs in research

As with any method, care must be taken to ensure the proper use of photographs for research purposes. Here we briefly consider the main ethical issues of power, informed consent, anonymity, dignity and image manipulation. We direct readers to Langmann and Pick [ 43 ] for more in-depth discussion.

In any researcher/participant situation, there is a power dynamic that privileges the “expert” researcher over the object of study, the participant. Certain ways of using photographs in research, specifically photo-elicitation, can change this dynamic and empower participants by giving them an active role in the research process, making them the experts, and allowing the researcher greater insight into participant perspectives [ 29 , 30 ]. Photo-elicitation also gives those who are not verbally fluent another way to express themselves effectively, avoids the use of survey questionnaires and other research instruments that might be culturally biased, and places participants as equals—able to reflect and decide how they want to represent themselves visually [ 43 ]. Photo-elicitation is thus firmly rooted in an approach to inquiry that draws on Paulo Freire’s (1970) critical pedagogy [ 44 ] and fits within the broader participatory action research method [ 29 , 30 , 37 – 40 , 45 ].

The use of mobile phones for data collection is considered a way of connecting younger groups with research [ 46 ], connecting with populations in more remote and rural communities across the globe [ 47 ] and with “difficult to reach” populations (e.g., [ 14 ]). However, it is important to again acknowledge the “digital divide” and the associated power differential: marginalised populations and certain societal groups may not have access to equipment to take and share photographs. Where this is the case, the researcher must consider whether to supply the necessary equipment or whether an alternative method of data collection is more feasible.

Informed consent

Informed consent is particularly challenging with photographs. It is difficult to ensure that every person in an image has given their consent to the photo being taken and used for research purposes. Where images are participant-generated, clear instructions about the purpose of the research and the photographs, and the processes of ethical consent, are essential [ 48 ].

Confidentiality

Confidentiality is an issue, particularly if a photograph includes a person’s face. Faces can be pixelated or blurred to protect participants’ identities, but these approaches may objectify the people in the photo and make the photographs less powerful [ 48 ].

Our third point relates to dignity. Langmann and Pick [ 43 ] suggest three ways of considering dignity in research photography: being sensitive to the social and cultural norms of the communities being researched, being aware that those who are the focus of the research will benefit by the presentation of an authentic view of the situation and considering the impression the photograph will give if and when it is published. In all cases, it is the researcher’s responsibility to exclude photographs which are not covered by ethical approvals, as well as any potentially harmful or compromising photographs.

Photographs can mean different things to different people [ 24 , 49 ] and meanings may change over time, depending on context and how they are associated in terms of text and other images (for example, one’s interpretation of a photograph taken as a teenager is likely to differ when viewing it as an adult). This ambiguity makes some researchers uncomfortable. However, if one takes a social constructivist stance, that we live in a multi-reality world, then this possibility of multiple meanings from a photograph adds to the data.

Conscious and unconscious “self-censorship”, including when, where or what to photograph, or editing a photo to convey an intended message, is inherent in photo-elicitation [ 45 ]. However, self-censorship is not an issue if one accepts that the purpose of photo-elicitation is to access the social reality of another individual.

Strengths of using photographs in research

Participation and co-construction.

As mentioned earlier, photo-elicitation and photovoice maximise opportunities for participant agency and engagement in the research process, allowing participants to work with and direct the researcher. Furthermore, in dialogic approaches, research involves a joint process of knowledge-production where narratives are co-constructed between participant and researcher through discussion. By using participant-driven photographs, the researcher gains an understanding of what the content of the photos means to the participants without imposing their own framework or perception of a topic on the process.

Participatory research requires trust, a safe space between participant and researcher, so people can express their thoughts and views. Wicks and Reason [ 50 ] suggest that establishing this safe space must be considered throughout the research process: empowering participants in the earlier stage of the research process can also build the connection and trust between researcher and participant—and reduce participant inhibition later on. This may be particularly useful where the topic is sensitive or taboo. For example, Meo [ 51 ] reported photo-elicitation was useful in tapping “class and gendered practices” (p. 152) in greater depth than with interviews alone.

Giving power to participants within the research process can be challenging for researchers. Adjusting to participants as co-researchers may be new and unfamiliar. Continuous flexibility and reflexivity on a personal (e.g., personal assumptions, values, experiences, etc. that shape the research) and epistemological (e.g., the limits of the research that are determined by the research question, methodology and method of analysis) considerations are critical [ 52 ].

Photographs provide structure to an interview, giving the researcher something to return to, to elicit more detailed discussions and/or trigger memories and reflection [ 53 ]. In addition, participants often give information about people or things outside of the photo (the invisible) as well as on who and what are visible [ 52 ]. Similarly, the researcher may be able to access parts of participants’ lives that would be difficult to see into otherwise. For example, Bourdieu argues that visual methods of research may be particularly helpful in investigating habitus, ways of being, acting and operating in the social environment that are “beyond the grasp of consciousness” [ 54 , 55 ].

Snapshots in time and of space

As mentioned earlier, photographs are inherently snapshots in time. They also provide snapshots of space, a means of examining the material assemblages of space, of how things are ordered and used [ 56 ]. For example, a photo of students in a learning space would illustrate who sits with whom, the spatial relationships between humans (e.g., student and student, students and teachers) and the non-human (e.g., bags, laptops, phones, snacks) (see Fig.  2 as an example).

An example of a photograph representing the assemblage of time and space: Students distributed in the space of a contemporary learning suite. Photograph from a publicly facing webpage on a medical school website. This photograph provides an example of how a photograph captures space and time. It provides a glimpse at a contemporary medical school. The photograph serves to document the complexity of modern medical schools, making clear the digitized learning environment. Such a photograph might evoke emotion and a sense of progress, in particular, when contrasted with more traditional images of students learning in a stadium-style lecture theatre

Applications and opportunities

Looking forward, we encourage researchers to consider the use of photographs as a source of data, as a way of accessing data that might otherwise have been obscured or overlooked if we had relied solely on language-based data. We encourage readers to consider what might be learned were we to augment current understanding by incorporating photographic data sources into healthcare professions research. In Table S1, found in ESM, we suggest some outstanding research questions and topics that could be explored. The list found there is by no means exhaustive. Rather it reflects our own interests and observations and should be regarded as a springboard to help readers consider diverse ways in which photographs may add richness in research endeavours.

There are many ways of conducting qualitative research in health professions education research (HPER). All have their affordances and limitations. In this article, we have offered a critical examination of how photographs can be used to generate rich and potentially different data to that generated through talk-only data collection. Using photographs in HPER research opens up new vistas of research possibilities, whether as a means of accessing snapshots of people and situations in time and space and/or as a means of engaging participants collaboratively, to explore taken-for-granted lived experiences which may not otherwise be accessible. This is a fertile area for future research and the empirical potential is vast, ranging from reflective practice to widening participation to questions which are as yet unknown.

Acknowledgements

This paper was inspired by JC’s move to Singapore, a society which uses photographs rather than text in all spheres of life—as proof of payment or parcel delivery, to illustrate a point, to share information, to advertise an event, etc.

The authors neither sought nor received any funding for this project.

Author Contribution

JC suggested and coordinated this collaborative effort, initiated the writing outlines and drafts. AM helped create and revise outlines and drafts. Both authors contributed significantly to the intellectual contents, gave approval of the version to be published and agree to be accountable for the work.

Declarations

J. Cleland and A. MacLeod declarethat they have no competing interests.

This is not applicable as no human or animal subjects were involved in the creation of this paper.