College Students’ Reflections on Their Experience Facilitating a Photovoice Research Project with BIPOC Older Adults and Frontline Healthcare Workers

Round 1

Reviewer 1 Report

Dear authors

 

Congratulations on the chosen theme!

 

I will recommend the article for publication because I found a good organization of the theoretical context, a clear presentation of the methodology and an interesting and innovative analysis of the research data.

 

Good luck in your work!

Author Response

Thank you for the feedback.

Reviewer 2 Report

1. Overall I found the literature review a bit too loose in its language. But here is what I gathered. The paper's literature review and therefore discursive foundation seems to suggest a few things. First, that photovoice might be good for student learning. Second, that health outcomes are worse for BIPOC frontline workers. Third, that photovoice is a desirable methodology. Fourth, that transformative learning theory is the "basis of this study."

For point 1, the literature needs to be more fleshed out by way of a review of what the findings actually say in detail about using PV with students for learning. I think this is an interesting idea - research as pedagogy - but it cannot be simply stated and assumed to be true or without nuance or texture. 

For point 2, I would imagine the same critique applies. Moreover, there's very little time devoted to unpacking two distinct BIPOC groups - frontline workers and the elderly, and in fact, BIPOC elderly in nursing homes which is a subsample of the latter. 

For point 3, same critique. Most of what you've written here is debatable so it's best to soften the language and strenghten the argument or rationale.  PV is a new methodology and one that I think has potential but, in my opinion, again, it has to be fleshed out and argued a bit more in this paper and in general. So for instance, one can't simply write that "there is a need to shift from a traditional, dominant culture research paradigm to research methods that respect and respond to diverse culture and meaning-making practices" and sweep all of the nuance and debate around epistemology under the rug, to say nothing of the fact that suggesting certain methods of research are better or more appropriate by way of race is something that should be treated more carefully. Consider also that there is some literature to suggest that qualitative research was heavily influenced by the feminist movement and at the very least consistent with postcolonialism; I have even read of it being consistent with Indigenous methodologies. If this is true, even tentatively, then qualitative research part of the "traditional, dominant culture research paradigm?" In fact, what is meant by “traditional, dominant culture research paradigm?” My guess is that many of the articles in the social sciences outside of psychology and public health and the like are increasingly qualitative and yet probably not considered "dominant" - so why use this as the background to justify PV? Perhaps there’s a reason but it’s not clear. Either way, I think the authors would do better to simply sidestep the epistemological landmines here - and there are many, many more I could offer up - and argue why PV is good to answer their research question and show us how. 

For point 4, this theory doesn't seem very well known and there is one person's name behind it in two separate publications, one of which doesn't seem to me to be peer reviewed and another of which is a book, which, while peer-reviewed by Routledge is still not the same as a peer review in a high tier journal. I am uneasy, in other words, about having as the "basis for this study" an untested theory that is presented as if there was no debate or discussion around what it can show or explain or predict. I think even if the authors wanted to explore this theory that would be fine, but to present in that way would be the requirement for me. 

2. On to the research questions. The literature review is supposed to set up the research questions by pointing out a gap - there are problems with this approach, of course, but this is the most common one used. The only other method of which I'm aware is to generate research questions vis-a-vis community in community based research. Neither of these seem to be how the research questions are fashioned. What's more is that I'm not sure what sets up the research question if not these two. It's not clear to me the literature does so because the research questions are about student "impressions and experiences" working with BIPOC older adults and frontline workers but what does knowing about their impressions and experiences tell us about any of the four points in the literature review - point 1, the importance of PV in pedagogy, point 2,  health outcomes for BIPOC elderly and frontline workers, point 3, the utility of PV in supporting BIPOC, or point 4, supporting, refuting, testing, "transformative learning theory"? This is certainly not clear and as a result the first research question seems to have little to no foundation. The other issue about the first research question is that there are two distinct groups here - older adults and frontline workers - lumped into one research question, which I think creates some methodological issues. What if the findings were different for each group? Doesn't each group warrant its own focus, not the least of which because of their almost opposite roles in healthcare?

The second research question, to me, is a non sequitur. There is questionable utility in asking what students perceive of photovoice in understanding anything if they don't have prior training in any other methodology. So the question is what's the comparator? Is it simply a perception of photovoice against the backdrop of their lives? If so, how is this useful to any of the points established in the literature review? What aspect of their lives would be useful in understanding PV? What does this tell me about youth? Or BIPOC?

3. The methodology. Given how complicated qualitative research can be, including PV, I find it very hard to believe that in 3 hours, the students were able to have a good enough orientation to PV, which includes in this case an interview. I have, to date, not met even the brightest of students who might be able to accomplish this. 

You seem to have had fewer SFs than older adults/frontline to pair them with - how did you manage that? Any implications for the data? What about the methods?

I think it's really good what the researchers have done to use research as pedagogy in this way, and it seems they were quite involved with the SFs, including during the focus groups. But as a result of that involvement one has to ask to what extent the students themselves felt at liberty to dissent with the authors? What if they didn't like PV? What if they found something that they perceived would run contrary to what they perceived was the held beliefs of the authors? How did you manage this? 

The data collection seems to include a written log of "various aspects of" students' experience. Here there are 4 questions provided. Questions 2 and 3 do not refer to any research question so I'm not sure how or why they were included here. If there are other questions then I'm not sure what those would be either. If they don't help answer the research questions then of what utility are they? 

The fact that the study had 8 females and only 2 were white makes me wonder how this affects the conclusions drawn - i.e., most of the SFs were also BIPOC like the older adults and frontline workers themselves. There is little discussion about this point and its implication for the conclusions, which is a major oversight in my opinion given the paper centers around understanding BIPOC realities. Did the researchers compare the data based on white versus non-white students? If yes, any differences? If not, why? 

4. In the Findings the same issues emerge as the ones above, which I won't spell out fully here again.

But, for instance, themes 3 and 4 presuppose a comparator but there isn't one. Or there isn't one mentioned.

Apropos of my third critique above, here is example of how the race of the student might have influenced the data. On line 305, the authors write "The SFs' expressed greater appreciation, respect, gratitude, and awareness of the struggles of BIPOC frontline healthcare workers." Would we expect this? If yes, what does this data add to our expectation that's worthwhile? If not, why? 

Here is an example of a curious non sequitur in the findings section: line 342 the authors write that "as a result of their engagement with the participants, five of the eight SFs expressed keen interest in working with communities of color or volunteering in nursing homes." The first quote used to support this conclusion goes like this: "I have always wanted to work with the BIPOC older people." How can the authors claim that as a result of their engagement SFs expressed keen interest and then use a statement that contradicts this - the SF always wanted to work with BIPOC communities? 

I hope this helps the authors restructure their paper. I would be uncomfortable with it being published as is and strongly suggest a major revision and resubmission. But as I've said above the idea of using PV as a pedagogical tool is a very interesting idea. 

 

 

 

 

 

Author Response

See the attached.

Author Response File: Author Response.pdf

Reviewer 3 Report

 

I believe this article could be, and should be published, but with number of major modifications.

The main issue with this article is the signposting of the paper which appears to be wanting. I, the reader, want to be led up to what it is you are doing why? The focus is on the student perceptions of the research, but at times this gets confusing, or is missing (e.g. when do you answer the research questions?). If you want to focus on the SF and the usefulness of the methodology, make this clear. Help me, the reader, understand…

The bullet pointed comments may help you below:

Comments on the first paragraph (lines 27-70):

·       I find the first paragraph confusing and it is not obvious what it is you are setting up to do in this paper. For instance, it was only at the end of the paragraph that I discover that it is about the ‘undergraduate students’ experiences of facilitating photovoice research with BIPOC older adults and frontline healthcare workers’ (lines 69-70). This needs to be foregrounded.

·       The initial part of the paragraph is not clear to the reader. It was only through constant referral to the title that I understood. I feel you need to more clearly signpost what it is you are planning to do. For instance, why do I, the reader, need to know about lines 51-59 when the paper is about the student reflections of their photovoice research with BIPOC healthcare workers and not the patients.

·       Lines 27-28: You state there is a lack of literature but there is, however, a developing emergence of undergraduate research using photovoice, especially since the Covid-19 pandemic. 

·       Lines 30-34: Photovoice is not just about collaborations between researchers in academia and community partners. Can you expand here and write about how it encourages participants to document elements of their lives within their own terms (NB: this may include reflective diaries); raise levels of critical consciousness within participants through dialogue and reach policy makers….to catalyse positive change’ (O.Latz, 2017:43)

Ref: O’Latz, A. (2017) Photovoice research in education and beyond. Routledge: Abingdon.

·       Lines 45-46: You state: ‘Such close interaction could consequently help them [the researchers] become more aware and critical of their assumptions’ – What assumptions are you referring to? This seems important considering the content of your paper.

·       A tendency to overuse the world community.

·       A tendency to overuse the article Zhang et al (2020) at the beginning of the article. Can you draw on other sources?

Comments on ‘Photovoice as a research methodology’ (lines 71-105):

·       Lines 79-81: These are bold claims – is this something you achieve or are attempting to do. If the former then I would leave until later in the paper (after you have described the evidence). If the later then tempering your language would be advisable.

·       Lines 89-99: Is this just your opinion? It needs to be justified through further literature.

·       Lines 100-104: If you are aiming to answer the two research questions which relate to the undergrad students then you should bring this to the forefront. It is currently hidden. Guide the reader to the RQs. Why are they important to ask?

Comments on ‘Methods section’ (lines 106-207)

In this section, generally, there appears to be a lack of justification to the photovoice approach and how this could help you answer your RQs. Who has done the photovoice before (from organising and training students to collect data through to the thematic analysis)? Please justify further with relevant literature (which is currently wanting).

·       Lines 118-119: What are the ‘eligibility criteria identified by the NIH’?

·       Please bring the overall topic the students were covering with the participants to the foreground, rather than leaving it until lines 148-150.

·       Lines 120-136: What did you do the ensure consistency between the SFs during your training sessions?

·       Lines 137-153: I, the reader, want to know what the SF did to facilitate the participate to take the photographs. What did you invite them they say? What did they actually ask the BIPOC to do?

·       Whilst you talk about ethics generally I wonder how you invited the students to talk to the participants about this topic too, especially considering the sensitive nature of the topic. I need a better explanation.

·       Line 161: You state that during the interview the SF asks the participant ‘"how does this answer the research question?"’. Is this from the original research, a question you ask them to ask, or are you referring to the two RQs on lines 100-104. I am confused.

·       Lines 161-163 – Here you state, ‘Once two photos representing challenges and meaning respectively were selected, research assistants supported participants while writing the narratives for each photo’. It is not clear who wrote this narrative. I thought these were semi-structured interviews.

·       Line 168: ‘…recorded the photo selection and narrative process on their phone’. Are you sure you want to say this… what did you do with the data afterwards.

·       It would appear the SFs did a semi-structured interview with each participant and then focus groups with older and younger cohorts. Why is this important? How could this have helped/supported the SFs perspective and reflective notes?

·       Line 181-182: In table 1 where did you train the investigators to write about their experience facilitating the photovoice research activities. Is this part of data collection too, especially for this paper…how are you planning to use it? Make this clear through scaffolding.

·       Line 196-197: Odd phraseology – ‘Each student was assigned a pseudonym (SF)’. Do you give each a number (e.g. SF1-SF5)? Make this clearer

Comments on results section (lines 180-393)

·       I do wonder if this section could be scaffolded to answer your RQs. At the moment the link between the four themes and the RQs is there but it is wanting.

·       Line 211-214: You state that you coded the student reflective entries into four themes. They are: ‘1) Impressions of BIPOC older adults and frontline healthcare workers; 2) Lessons learned from the stories; 3) Outcomes of students’ participation; 4) Usefulness of photovoice in highlighting the struggles of communities of color’. I, as a reader, would like a little more clarity (e.g. you describe having to revisit steps but these are not described as steps initially).

·       Quotations are ample but can feel just placed into the relevant theme. Please provide context and what do they mean to the context of your paper. I wonder if there are two many quotations and not enough brief but apt reflections about, or on, the quotations. How do they reflect on the literature read, themes and ultimately the RQs?

Comments on the discussion section (lines 393-495):

·       Lines 393-401: Early in this section you state that ‘Students were paired with seven BIPOC older adults and five frontline healthcare workers. They facilitated the photovoice research project in four stages. Students shared their impressions about BIPOC older adults and frontline healthcare workers; the lessons learned from their interaction with participants; the benefits of facilitating a photovoice research project with communities of color; and the usefulness of photovoice in portraying the struggles of people of color.’ This needs to be made clearer earlier on…. I am sure it is all there but it is not clearly written.

·       This section of the paper appears to be stating what happened to the students post the results section. However, akin to the results section there is i) no justification, or ii) referral back, to the results. For example:

o   Lines 412-415:  You stated that ‘Our results are consistent with previous studies, which found that 412 communities of color always find ways to recover from adversities… by building strong social networks… and having a sense of personal meaning’.  Can you make it clearer to the reader how the results did this rather than just stating that they did (refer back to the previous section if needed)? A couple more of example lines that require this, from the paper, can be found below.

§  Lines 416-421 you state ‘Students further learned from the stories of BIPOC frontline healthcare workers that they felt underappreciated and undervalued by their bosses’. Briefly reiterate what they said to justify this.

§  Lines 423-427: You also stated ‘Having college students listen to the stories of their BIPOC participants can be an effective way for both the storytellers and their listeners to find meaning in events, transmit emotion along with information, and build empathy and compassion (Freitag et al., 2020). The stories of BIPOC participants can provide models of strength and empowerment and help college students validate their own identities to the self and the world.’ Please explain how?

§  Lines 429-431: How did the ‘Students express appreciation and great admiration for the resilience exhibited by BIPOC frontline healthcare workers in the face of different workplace challenges and the older adults for their valuable contributions to society.’  

§  Lines 431-433: How did the ‘Students note that although each BIPOC participant had their own unique story, the experience of racism, microaggression, and discrimination was a central theme in each story’.  

§  Lines 433-435: How did the ‘Students state that without their involvement in this photovoice research, they would not have known first-hand the deep struggles of communities of color’.

o A reworking to ensure your justification for your claims is clear is needed throughout this discussion section (i.e. can you provide evidence from the student’s diary entries from the results section).

o   There are also a number of sentences that begin with the word ‘students’ in this section can you reedit please so it is not so repetitive.

o   In addition to these points above, and most importantly, how does knowing these descriptive highlights help you answer your research questions? I am getting a confused as to when and if you are answering them.

Comments on the conclusion section (lines 457-487):

·       The conclusion should focus on how you have answered the research questions and this is currently wanting.

·       Impact is described and so are the limitations of the study mentioned (good) but I feel this conclusion is missing the mark especially when the focus us mean to be on ‘College students’ reflections on the stories of BIPOC older 2 adults and frontline healthcare workers during a photovoice research project’. Please edit and focus.

 

 

Author Response

See the attached.

Author Response File: Author Response.pdf

Round 2

Reviewer 2 Report

I appreciate the amount of work the authors have put into the second version. This is an improvement in my opinion.

But there remain questions in my mind that I don't think will be answered - such as why isn't it meaningful to seperate the analysis between frontline workers and older adults? No substantive reason seems to be given and yet there are very real ways in which those two groups an interact in ways that might bear on their experiences as BIPOC. 

I remain curious about why there is little reflection on the the fact that 2 of the 8 students are white and what that might have meant for their assessment of the BIPOC frontline and older adults. 

There is formatting to be done in multiple places, and this is the sole request in the next revision from me.

I appreciated the increased focus on pedagogy and moderation of some of the language, which I think also improves the paper. The headings and ennumeration are also helpful. 

Author Response

Comments and Suggestions for Authors

Response to Reviewer 2 Comments

I appreciate the amount of work the authors have put into the second version. This is an improvement in my opinion.

But there remain questions in my mind that I don't think will be answered - such as why isn't it meaningful to separate the analysis between frontline workers and older adults? No substantive reason seems to be given and yet there are very real ways in which those two groups an interact in ways that might bear on their experiences as BIPOC. 

RESPONSE: We did not separate the analysis between frontline workers and older adults because we identified common themes in students' responses, so there was no point in having a separate analysis for each group. 

I remain curious about why there is little reflection on the the fact that 2 of the 8 students are white and what that might have meant for their assessment of the BIPOC frontline and older adults. 

RESPONSE: No demographic difference existed in students' perceptions of the BIPOC frontline and older adult participants.

There is formatting to be done in multiple places, and this is the sole request in the next revision from me.

I appreciated the increased focus on pedagogy and moderation of some of the language, which I think also improves the paper. The headings and ennumeration are also helpful. 

Reviewer 3 Report

Thank you for sending you re-edited article. This has now been structured and signposted well. It also feels like it has a more confident academic voice. I found reading it a pleasure. Only a couple of edits suggested

Lines 49-51: You state: ‘Photovoice can also play a role in youth development and leadership by showing youth how they can contribute to making a difference in their community through active engagement in meaningful decision-making’. Photovoice does not show, it helps the participant facilitate….’

 

Line 68: Ref (Chio & Fandt, 2007) properly

Line 138: what does NIH stand for?

Lines 182-183: You write ‘During the week of photography, the SFs remained in contact with their matched participant(s) via phone call’ should it be ‘via a phone call’.

Line 215: ‘were’, not ‘was’.

Author Response

Comments and Suggestions for Authors

Thank you for sending you re-edited article. This has now been structured and signposted well. It also feels like it has a more confident academic voice. I found reading it a pleasure. Only a couple of edits suggested

 

Lines 49-51: You state: ‘Photovoice can also play a role in youth development and leadership by showing youth how they can contribute to making a difference in their community through active engagement in meaningful decision-making’. Photovoice does not show, it helps the participant facilitate….’

RESPONSE: The sentence has been reworded to read:  Photovoice can also play a role in youth development and leadership by empowering the youth to contribute to making a difference in their community through active engagement in meaningful decision-making.

Line 68: Ref (Chio & Fandt, 2007) properly

RESPONSE: The citation has been replaced with the number 3, consistent with the reference.  

Line 138: what does NIH stand for?

RESPONSE: I have spelled out the acronym NIH as the National Institutes of Health.

Lines 182-183: You write ‘During the week of photography, the SFs remained in contact with their matched participant(s) via phone call’ should it be ‘via a phone call’.

RESPONSE: I have added the letter a to the sentence.

Line 215: ‘were’, not ‘was’.

RESPONSE: The original sentence had the word ‘were’ for subject-verb agreement.