Incorporating Photovoice Into a Community-Based Intervention With Latinx Families: Lessons Learned From Your Family, Your Neighborhood

Photovoice is a qualitative community-based participatory research (CBPR) method used by researchers and communities to inform policy and advocate for community change. Photovoice was piloted within an established community-based intervention, Your Family, Your Neighborhood (YFYN), within a predominantly Latinx community. YFYN is a dual-generation, evidence-based, manualized curriculum supporting and strengthening bonds between parents and their children while fostering neighborhood social cohesion among families living in low-income communities. The photovoice project was conducted with five families (n=20 participants) in English and Spanish. Participants guided the photovoice process to uncover complex community issues from their direct perspectives to accurately capture the challenges and strengths they encounter in their community. Community challenges identified by participants included the dumping of trash in their neighborhood, inadequate space for their children to play, and heavy traffic that impedes their ability to walk their children to school safely. Participants identified three main community strengths: the local park, the Boys & Girls Club, and personal connections with other YFYN family participants. When participants guide the photovoice process, it helps stakeholders understand and uncover complex issues from community members’ direct perspectives to capture the meaning of the issues accurately. Production of knowledge from the community rooted in their lived experience can help reshape the narrative of Latinx families living in low-income communities and allows for social workers to more adequately respond to their specific needs.

Photovoice is a qualitative community-based participatory research (CBPR) method developed by Wang and colleagues (1996) in the early 1990s to assist rural Chinese women in documenting their everyday health and work conditions. The method has three primary goals: 1) recording and reflecting on community strengths and concerns, 2) promoting critical dialogue and knowledge about important issues through large and small group discussions, and 3) communicating with policymakers and those in power to advocate for change (Wang & Burris, 1997). In developing photovoice, Wang and colleagues were influenced by Paulo Freire's (1970) concept of empowerment education that integrates consciousness-raising and dialogue with teaching efforts to promote individual and community quality of life and promote policy changes to achieve equity (Wang et al., 1996). Through Freire's influence, photovoice recognizes how power informs oppression and domination, as one party's interests dominate and oppress other parties' well-being based on their position of power within society (Wang & Burris, 1997). Further, the approach is designed to empower action as community members advocate for creating positive community change. Photovoice has proven to be a convenient research method that can be used by a variety of researchers and communities, and it supports elevating community members into the policy sphere to advocate for local community change (Harley, 2015;Jarldorn, 2019;Lennon-Dearing & Hirschi, 2019;Mitchell, 2018;Rahman et al., 2020). Wang and Burris (1997) advise that photovoice should be "creatively and flexibly adapted to the needs of its users" (p. 383). The creative and flexible allowances of photovoice are especially crucial for research contexts that emphasize CBPR principles of community input and choice (Israel et al., 2010;Minkler, 2005;Wallerstein & Duran, 2010). In particular, photovoice uses participant-generated photographs and storytelling to convey perspectives on central issues that can then be communicated to key stakeholders and other people outside of the community. The photos become part of data analysis, as they are connected to the community's broader story and serve an illustrative purpose beyond the basic description of the place, object, or person photographed. Photovoice has been used to convey a variety of issues and concerns with diverse communities, including food justice with youth of color (Leung et al., 2017), environmental change and water with American Indians (Mitchell, 2018), and health and nutrition education with Latinx groups, among others (Alcazar et al., 2017).
In this project, photovoice was incorporated into an established community-based intervention, Your Family, Your Neighborhood (YFYN), to support the curriculum's original goals and highlight accommodations made to honor community preferences and the realities of community-based participatory research (CBPR). YFYN is a 12-week community-based dual-generation intervention developed and launched in 2012 in Denver, Colorado and Phoenix, Arizona in 2019 (Lechuga-Peña & Brisson, 2018a). YFYN aims to build socially cohesive communities among family cohort participants to address adverse conditions in neighborhoods with a high concentration of poverty by fostering a network of trusting and cohesive relationships among participants (Brisson et al., 2019). This photovoice project was piloted with a Latinx community in English and Spanish simultaneously to accommodate the participant's preferred language.

Photovoice With Families and Latinx Communities
Although photovoice has gained popularity in recent years (Harley, 2015;Lennon-Dearing & Hirschi, 2019;Mitchell, 2018;Rahman et al., 2020), few studies have used the family unit as participants, in which both parents and children work together in all aspects of the project. Bredesen and Stevens (2013) worked with homeless families living in St. Paul, Minnesota, to offer health providers insight into where to focus their efforts and resources. Using photovoice, they provided cameras to participants to capture their everyday experiences of homelessness. Photos were used to guide the participant interviews to identify their health and basic living needs. Other projects have used photovoice with families as a tool to assess community programs and their impact on participants. For example, the Brighter Bites program solicited low-income Spanishspeaking families' perspectives to learn about the effects of the weekly distribution of fresh produce, recipe tastings, and nutrition education to improve dietary habits (Alcazar et al., 2017). Woodgate and colleagues (2016) used photovoice to explore youth perspectives of health, including the impact of chronic illness on families, to develop better policy and services.
Latinx communities have utilized photovoice to address a range of issues including public housing conditions and health (Evans-Agnew et al., 2016), childhood obesity (Torres et al., 2013), and youth engagement (Kia-Keating et al., 2017;Madrigal et al., 2014;Noone et al., 2016). Public housing communities across the United States experience deteriorating neighborhoods and a lack of resources (Gennetian et al., 2012;Lechuga-Peña, & Brisson, 2018b). Researchers have found photovoice to be a valuable tool at the mezzo level to visually represent a community's self-identified issues visually. Goals from previous photovoice studies include documentation of community pride through positive well-being (Aber et al., 2017), reducing mental health disparities to advocate for enhanced housing policies (Duffy, 2010), and improving housing wraparound service models (Keller, 2011). From a micro-level system perspective, photovoice research with lowincome Latina mothers enhanced their ability to communicate pressures related to parenting as a result of acculturation to child-rearing norms and values in the United States. Latina mothers utilized photovoice to demonstrate to local policymakers evidence of environmental injustice in their neighborhood affecting their children's health (Evans-Agnew et al., 2016;Torres et al., 2013). Latinx youth face unique cultural stressors related to teen pregnancy, environmental injustice, and violent and lethal assaults. These studies illustrate how the youth had the opportunity to provide their perspective as active and knowledgeable members of their community. In most studies, youth were able to enhance their leadership skills while addressing relevant issues identified as barriers to their ability to thrive (Kia-Keating et al., 2017;Madrigal et al., 2014;Noone et al., 2014).
Limited studies exist that use photovoice with the entire family unit as participants, in which parents and children work together in all aspects of the photovoice project. Additionally, to our knowledge, no studies have explored the practice implications of photovoice and its integration into an established community-based intervention with families, offered in both English and Spanish.

Your Family, Your Neighborhood
YFYN is a 12 session, family-based program offered in local community settings at convenient locations to eliminate barriers to program access that low-income families commonly face. Research indicates that serving a group of people who live near each other increases the likelihood that participants will form social networks and friendships beyond the intervention period (CDC, 2011). YFYN strengthens the bonds between children and parents, builds parents' attachment to their child's school, fosters neighborhood social cohesion, promotes positive youth development, and improves health and well-being (Lechuga-Peña & Brisson, 2018a). YFYN focuses on issues that impact parent-child relationships and family functioning within the context of local neighborhood schools. The manualized curriculum is available in English and Spanish. It includes information about parental school engagement, problem-solving, developing coping skills, and building relationships and communication skills within families and communities. Each two-hour session begins with a family dinner where families interact with one another and focus on their familial bonds through active engagement in a neutral environment (i.e., school building). After dinner, parents/guardians participate in group-based sessions to learn ways to engage in their child's school, support academic achievement, advocate for their children, and create healthy communities. The children participate in concurrent sessions that mirror the parent curriculum, where they engage in skill-based learning activities aligned with the program's goals. Each session concludes with parents/guardians and children coming back together as a large group to discuss what they learned and how to apply it to improve their lives and their community.
The program's final sessions are focused on completing a community project together to promote family and neighborhood cohesion. Together, families identify a community concern and then plan and carry out a project designed to address the issue. Active engagement in the community develops neighborhood social cohesion among YFYN participants and within the broader community. Neighborhood social cohesion is defined as the trusting relationships and shared values and norms of residents (Lin, 2001;Sampson et al., 1997) and is a protective factor for the health and well-being of families living in low-income neighborhoods (Kawachi et al., 2008). In 2019, photovoice was piloted with YFYN to enhance community engagement and provide participants a greater participatory, collaborative experience during their community project. Photovoice is a way for community members to share about their lives from their perspective to promote understanding and ultimately improve the health and well-being of their community.

Method Setting and Participants
During fall 2019, YFYN was administered at a large public Title I elementary school in the Southwest. Nearly 75% of the elementary school students identify as Latinx and live in the surrounding low-income neighborhood. YFYN sessions took place after the traditional school day ended and in the early evenings on the elementary school campus. Participants were recruited through teacher referrals and the school social workers. Flyers were also sent home with students, providing additional information about the program. Five families (n=20 participants) participated in the YFYN intervention and all five families participated in the photovoice project. All project materials were translated and back-translated into Spanish/English. Participant demographics were collected via a survey at the beginning of the YFYN intervention. Three fathers, four mothers, one grandmother, and their respective children between the ages of seven and twelve participated. Two families were bilingual, two families spoke Spanish only, and one family spoke English only. Four families identified as Latinx, and one family identified as White. The families' mean years of residency in their community was 5.7, and approximately half of the parent participants had completed some high school or less, and the other parent participants had a high school degree or equivalent. The parents' mean age was 38.3 years, and the children's mean age was 9.1 years. Nearly 63% of the child participants were female, and 37% were male. The study was approved by the Institutional Review Board at Arizona State University. Informed consent was obtained from all participants in their preferred language.

Procedures
YFYN sessions 1 through 9 focus on the parent-child relationship and parental school engagement, while sessions 10 through 12 address community social cohesion. As part of the community sessions, photovoice was used to visually explore community strengths and challenges from the family unit's perspective. In preparation for the photovoice project, families were asked during Session 10 to create an Asset Map that included resources they value in their community (see Table 1). Next, they were asked to write or draw the components they liked about their community on one side of the paper, and on the other side, the aspects they did not like or would like to change in their neighborhood. Participants were prompted to consider the many different aspects, including, but not limited to, community associations, institutions, individuals, physical spaces, and the local economy. This exercise was an essential starting point for both parents/guardians and children to consider their community's strengths and challenges as they prepared for the photovoice project. During Session 11, participants were provided an overview of photovoice and its related procedures, including a training and ethics component informed by Wang and Burris (1997). During the training and ethics learning session, participants were asked to consider the following questions when deciding what they would photograph: 1) How might my community react to this photo? 2) Will it create a scandal or conflict in my community? 3) Could the photo create negative perceptions of some individuals or groups in my community? The following instructions were also given to participants: 1. Please do not intrude into a person's private space, and respect people's wishes if they do not want their photograph taken. 2. If you do take photographs of people, you MUST get a signed photo release from EVERY person that can be identified in the photographs you take. 3. Avoid taking photos of embarrassing things about yourself or others. Do not take photos that show people or yourself in a false or negative way. 4. Please do not take photographs of people, places, or things that should not be photographed or shared outside your community. What will this photo say about my community?
During the photovoice learning session, families were given a photography assignment and asked to photograph a total of eight images, including four strengths and four challenges in their community. Participants were also asked to take these photographs during the following week. Their photographs would build upon the asset map activity from Session 10. Parent participants were reminded to encourage their children to participate in decision-making while taking photographs in their community.

Participant Photos and Activity
During the week leading up to the 12 th and final YFYN session, parent participants forwarded the photos their family took to the lead YFYN facilitator through text message or email. The lead facilitator then printed two copies of each photo. One copy of each photo was to be used for the photovoice display boards families would create, and one copy was given to the families for them to keep. During the 11 th YFYN session, families were given the option to be divided into mixed groups or work with their family unit to complete their photovoice displays. Participants chose to work together as a family unit to create their photovoice displays and present them to the larger group. In preparing to create their photovoice displays, families were asked to choose two of the photos they took that represented their community's strengths and two that represented challenges in their community. Once families had selected their photos, the facilitators used the PHOTO technique, similar to the SHOWED technique (see Catalani & Minkler, 2010;Hergenrather et al., 2009;Shaffer, 1983), to guide participant discussion and dialogue. Each family was provided a worksheet to capture their responses for each photo they chose and were encouraged to write down their responses in their preferred language. The PHOTO technique worksheet includes the following prompts and questions: Participants primarily wrote their responses to the PHOTO prompts in Spanish; however, some families chose to write their responses in Spanish and English. This activity took approximately 45 minutes to complete, and in total, the families selected 20 photos, including ten strengths and ten challenges. Upon completion of the PHOTO worksheet, a large group discussion was conducted with all participants. One representative chosen by each family shared, at minimum, two photos (one strength and one challenge) and the accompanying worksheet with their responses. As each family presented, a YFYN facilitator wrote down a description of their picture on the whiteboard, while another facilitator took each photo around for participants to view. Participants were invited to ask clarifying questions or provide feedback. Finally, program facilitators worked with the participants to identify the overarching themes (top three challenges and top three strengths) and to select the final photos to be displayed in the dissemination event.

Participant Photos and Dissemination to Key Community Stakeholders
An important aspect of photovoice is the dissemination of findings to key community stakeholders. Dissemination in photovoice is typically done in two ways: (1) the process of creating visual images is often a source of empowerment, and (2) photographs are displayed in the community's public spaces, where people can see the issues captured through photography (Wang et al., 1996). During the last YFYN session, participants were provided a poster board, a copy of the photographs they had taken, the PHOTO worksheets they had completed with their narratives, and additional supplies to create their family's photovoice display. Each family member was encouraged to help create their family's display board. Once each family had created their photovoice display, they were asked to choose one person from their family to present their project to the stakeholders and each other. The families decided that their children would present on each family's behalf. The presentations were both personal and powerful; children read their narratives aloud in Spanish and English and explained what their family had photographed and why.
Community stakeholders, including the school principal and social workers, the afterschool program director, and the grantor of programs, attended the dissemination event that included a celebration of program completion with food and participant presentations about the photovoice project and its findings. Participants shared that the community's challenges include the dumping of trash in their neighborhood (see Figure 1), inadequate space for their children to play (see Figure 2), and heavy traffic that impedes their ability to walk their children to school safely (see Figure 3). Participants identified the local park (see Figure 4), the Boys & Girls Club (see Figure 5), and connections with other YFYN families (see Figure 6) as strengths in their community.
Participants stated they believed their voices were important and felt like they were heard. They also shared how much they appreciated the community stakeholders attending their presentation and thought this demonstrated their commitment to their community. The community stakeholders indicated how impressed they were with the presentations and learned more about the participants' lived experiences. They also noted how pleased they were with participant engagement and supported continuing the intervention at their school with the photovoice component.

Figure 1. Community Challenges-Dumping of Trash in Their Neighborhood
Esta imagen describe cómo se coloca la basura en la ubicación incorrecta y siempre hay basura en todas partes y nunca se limpia. Da

Discussion
This paper highlights the practice implications of integrating photovoice into YFYN, a family-based bilingual intervention. To our knowledge, there are few, if any, familybased interventions that use this community-based approach with the family as the unit of analysis, in dual-languages, in a low-income Latinx community. Photovoice methodologies provide a tool for individuals and communities experiencing marginalization to address broad concerns that directly relate to social equity (Wang & Burris, 1997). While some studies have noted challenges with using photovoice, this approach provides an intimate look into the obstacles encountered from Latinx communities' perspective, potentially resulting in a means to a solution (Evans-Agnew et al., 2016;Torres et al., 2013). Results from our study highlight the range of methodological modifications made to accommodate community preferences and the realities of CBPR in a primarily Latinx bilingual community.

Challenges and Limitations
Challenges and limitations were evident and ultimately informed the photovoice process. First, even though the YFYN facilitators were also the school social workers, it was challenging for some families to submit their photos on time. Phone calls to participants reminded them to take their photos and submit them via text or email to the lead facilitator. Second, due to the 12-week YFYN program's time limitations, only the final three sessions were dedicated to the photovoice project. Participants and facilitators each said they needed more time for each aspect of the project. Facilitators had to be creative when balancing participant approaches while making sure to finish the project in time for the community event. This time constraint may have influenced the participants' photographs and their decisions in determining their emerging themes and findings for the presentation. Third, it was necessary to facilitate the project in the participant's preferred language, adding more time for each step. While most families preferred Spanish, one family was exclusively English speaking. Therefore, all participants' instructions and materials, the focus group, and community presentations were conducted in English and Spanish. Finally, the technology available for the participant photos posed a challenge. Due to limited funding, participants agreed to use their cell phone cameras to take photos for the project. However, we realize this may have put an unexpected burden on families. While it was not an issue for most families, one family had experienced a disruption in their cellular service and relied on an outside family member's phone when taking their photographs.

Lessons Learned
First, building rapport with participants is essential to the success of community projects. YFYN staff, who were also the school social workers, had built a rapport with families before the program and over several program sessions before implementing the photovoice project. Since families had existing relationships and met weekly leading up to the photovoice project, they were much more committed and engaged in all steps of the process. Second, introducing the program's photovoice component including the background and method to participants during the first few sessions of YFYN created excitement and anticipation for the project. Third, although participants were given the initial prompt of identifying community strengths and challenges, it was imperative to give them the lead on all aspects of the project. Participants chose which photos they wanted to use for their photovoice display and determined the focus group's structure (working with their own family first and then coming together as a larger group). Participants also chose who from their family would present to disseminate findings during the community event (they chose their children to present, some of whom were as young as seven-years-old) and conducting the project in two languages, Spanish and English. Fourth, ensuring all family members participated in the project provided parents and children a platform for their voices to be heard as experts on their lived-community experiences. Finally, participants were encouraged to invite community stakeholders to attend the presentation and approve the community stakeholders that requested to attend, including the school principal and after-school program director and grantor of programs.

Implications for Social Work Education
Social work education, research, and practice must reflect our evolving systems to work alongside clients and communities in challenging social injustices (National Association of Social Workers [NASW], 2015). This ethical principle is directly in line with the emancipatory pedagogical work of Paulo Freire (1970), which influenced Wang and colleagues' development of photovoice as a methodology. This philosophy is a practical pedagogical framework that should be deeply rooted at all levels of social work education. Photovoice provides social work educators the ability to demonstrate the intrinsic power that communities hold by centering the voices and lived experiences of the communities we serve. Acknowledgment of the community as leaders is key given the current complex social justice issues in which social work is embedded. Social work education should upend the idea that we enter communities to "save people." As Freire (1970) states, teaching is not the primary objective; instead, teachers must reciprocate the learning process by gaining insights from their students and establishing a critical dialogue; thus, community members become the teacherand social workers become the students.

Implications for Social Work
Individual Level Influence: Given that photovoice can be taught to all individuals regardless of education or ability, it is a valuable tool to support community members in conveying issues of importance to them. Photovoice, in turn, can educate, inspire, and influence decisions that affect the individual, their family, and their community. Photovoice allows individual voices from groups that experience underrepresentation in the policy arena to frame issues using a readily accessible medium. From a research perspective, photovoice helps the researcher understand and uncover complex issues from the direct perspective of community members to accurately capture the meaning of the issues. The photovoice tool can be used with almost anhyong and gives expertise and insight into communities and worlds that professionals and outsiders cannot access.
Programmatic Level Influence: To support photovoice as a tool for community-based programs like YFYN, introducing photovoice early on in the project is essential to bolster community support. Neighborhood-based programs present many opportunities for communities experiencing marginalization and underrepresentation to collaborate with practitioners and researchers. This cross-collaboration provides focused attention on key community issues that can potentially inform social work practice and strengthen partnerships that benefit the communities that social workers serve. One of the most successful impacts of YFYN is the length of the program. YFYN began in 2012 and has worked alongside approximately 150 families in Denver, Colorado, and Phoenix, Arizona. The YFYN community-led team continues to evaluate the program and challenges the neighborhood perceptions of low-income communities. Community collaborations require a significant amount of planning, with trust being built over time. Therefore, introducing photovoice early on is essential to ensure community buy-in and support.
Policy Level Impact: Another significant aspect of photovoice is reaching policymakers to influence public policy. The YFYN intervention has shown effective results related to the active role community members had in the intervention. As coresearchers, they created knowledge through their photos and promoted their ideas and perception of their neighborhood. This creation of knowledge directly relates to the central tenets of photovoice, where community members are the experts about their own lived experiences. Researchers should be encouraged to work alongside the community to incorporate a policy recommendation into their project. Community members can guide these recommendations and further promote community participation. It is important to acknowledge that photovoice activities do not always result in direct policy change given the varied policy streams and timing (problems, politics, and policies) needed for a specific policy to emerge (Kingdon, 1984). However, Van Wormer's (2004) Anti-Oppressive Policy Analysis differs from the traditional policy framework in that it focuses on the structural barriers that exist and not on pathologizing the individual. This approach attempts to shape and refine policies that relate specifically to oppressed populations and even more to prevent oppression in the first place. Anti-oppressive policy focuses on the client and uses their expertise to contribute to research and policy change to attain social and economic justice. Therefore, collaborating with community members to influence local policy through photovoice can help bring their voices to the forefront. Furthermore, community collaboration is crucial in identifying the public policy problem, and this action alone is key in influencing community change.

Suggestions for Future Photovoice Iterations
Photovoice is still a relatively new research methodology. There can be a learning curve when educating others about the method's validity and its ability to be a powerful research method for marginalized communities. However, photovoice can be an empowering method when added to existing programs and provides opportunities for participants and researchers to work collaboratively to identify important community issues. Recommendations for future iterations include allowing more time for the photovoice project when implemented within an existing program. The photovoice project took place during the final three sessions of YFYN, which lasted two hours each.
Participants need more time to take photos, write their narratives during the PHOTO technique, participate in the focus groups, and create the display boards for the community presentation. Additionally, if funding had been available to purchase digital cameras, this would have prevented barriers with using mobile phone cameras. Further discussions about privacy violations and undue stress placed on families when using personal cellular phones should be considered.
The tenets of photovoice align well with social work, especially given the profession's focus on social justice (NASW, 2015). Therefore, additional iterations of this project could potentially include community awareness and attitudes about the built environment of their communities in low-income neighborhoods (Nykiforuk et al., 2011;Pruitt et al., 2018;Vásquez-Vera et al., 2019). Production of knowledge from the community rooted in their lived experience can help to reshape the narrative of Latinx families living in low-income communities. Thus, photovoice can potentially challenge stereotypes and offer counternarratives for the causes of social problems.

Conclusion
This article contributes to the increasing body of research that demonstrates how community-based participatory research approaches such as photovoice are important in understanding the experiences of historically underrepresented communities in the United States, in this case, a Latinx bilingual (English and Spanish) community. Communitybased programs present many opportunities for marginalized, underrepresented communities to collaborate with practitioners and researchers around key community issues that can inform social work practice and strengthen partnerships that benefit the communities that social workers serve. This approach is a departure from conventional research where those in power with no direct lived experience define the problem for communities. Photovoice is an empowering tool and can be taught to almost anyone because they do not have to know how to read or write to participate; they only need a camera to capture a photo. The photo captured by the individual is used as a communication tool to educate, inspire, and influence decisions that affect the individual, their family, or community. Photovoice allows individuals from groups whose voice is not typically heard in the policy arena to voice their concerns through photography. The use of photovoice methodologies recognizes the commnity members as experts into their communities and worlds that professionals and outsiders lack.