Elsevier

Health & Place

Volume 43, January 2017, Pages 95-103
Health & Place

Understanding the local food environment: A participatory photovoice project in a low-income area in Madrid, Spain

https://doi.org/10.1016/j.healthplace.2016.11.012Get rights and content

Highlights

  • Residents reflected their local food environment, engaging in a Photovoice project.

  • They identified 5 main themes, related to both structural and social determinants influencing residents' diets.

  • Project results included a photobook, a photographic exhibit, a video and a website with an interactive cartography.

  • Results may inform local action for designing community-generated interventions.

  • Participants were actively involved, analyzing their data and sharing their results.

Abstract

There is a need to partner between researchers, practitioners and residents to increase our understanding of environmental influences on dietary behaviors. We used the participatory method of Photovoice to understand key determinants of the local food environment influencing residents' diets. This project was conducted in Villaverde, a low-income area located in Madrid, Spain. From February to May 2015, 24 residents working in four Photovoice groups, took photographs related to their local food environment. Each group analyzed and critically discussed their photographs in small group sessions. Through a consensus-building process, participants identified 30 emerging categories, which followed five conceptual themes related to their food environment: 1) eating in moderation, 2) cultural diversity, 3) food stores, 4) social relationships and 5) economic crisis and poverty. Participants, researchers and practitioners successfully collaborated in analyzing, writing, disseminating the project results, and directly informing local policy-makers, media, and other residents. The project results may guide community-generated interventions for promoting a healthier food environment.

Introduction

In an effort to counter the obesity pandemic, many cities and countries are struggling to define effective policies, which go beyond individual behavior changes, and have started developing different population strategies for prevention (Franco et al., 2015, Chow et al., 2009, Rose, 1985). Tackling unhealthy diets and diet-related health outcomes at the population level requires a deep understanding of their social determinants (Schwartz and Diez-RouX, 2001, Rose, 1985). So far, approaches targeting individuals have had low success rates as individual choices are shaped by the local food environments where people live and work (Katan, 2009, Rose, 1985).

Over the last two decades, there has been a surge in addressing the relationship of urban food environments and diet-related health outcomes (Cobb et al., 2015, Caspi et al., 2012, Giskes et al., 2010, Feng et al., 2010, Holsten, 2009). As a result, research focusing on the link between local food environments and diet quality has emerged (Black et al., 2014, Ni Mhurchu et al., 2013, Caspi et al., 2012, Glanz, 2009, Mckinnon et al., 2009, Franco et al., 2009). Many of these studies have looked for associations between objectively measured aspects of the food environment and health behaviors, using mainly quantitative methodologies (Thornton et al., 2013, Kelly et al., 2011, Charreire et al., 2010). These studies have highlighted that unhealthier local food environments tend to correlate with low-socioeconomic neighborhoods (Stark et al., 2013, Feng et al., 2010, Rundle et al., 2009, Lovasi et al., 2009, Franco et al., 2008). Thus, understanding the processes by which food environment aspects influence dietary behaviors, particularly in low-income neighborhoods, is warranted.

One of the challenges when studying this relationship is including residents' insights on their local food environment (Bridle-Fitzpatrick, 2015, Caspi et al., 2012, Gustafson et al., 2011, Munoz-Plaza et al., 2008, Moore et al., 2008). Therefore, Participatory Action Research (P.A.R) may be a suitable approach for understanding the local food environment from a residents' perspective, in order to design more effective interventions that promote healthier food environments (Cannuscio et al., 2014, Vasquez et al., 2007, Israel et al., 2006).

Community-Based Participatory Research (CBPR) is an approach that acknowledges community as an equal partner throughout the research and action process (Caldwell et al., 2015, Israel et al., 2010). Photovoice is a participatory method coming out of CBPR and PAR, defined as “a process by which people can identify, represent, and enhance their community through a specific photographic technique” (Wang and Burris, 1997). In the Photovoice process, participants use photography to document the features they think that are related to a particular community issue, and to inform social action (Wang and Burris, 1997). Thereby, Photovoice can facilitate a process of social action by: 1) involving residents in documenting their community needs and concerns with their photographs and narratives; 2) engaging participants in a reflective process, where they critically discuss and analyze their local food environment; and 3) disseminating participant-generated results with the community (e.g. with a photography exhibition) and local policy-makers (e.g. translating project results into food policies) (Murray and Nash, 2016, Catalani and Minkler, 2010, Belon et al., 2014). Thus, Photovoice allows researchers to detect salient aspects of the community, otherwise hidden behind quantitative assessments (Murray and Nash, 2016, Sanon et al., 2014, Belon et al., 2014). Previous seminal articles on Photovoice have highlighted how this methodology remains underused by public health researchers (Bugos et al., 2014, Fitzpatrick et al., 2012, Catalani and Minkler, 2010, Hergenrather et al., 2009).

This study reports on a participatory research initiative that brought together residents from a low-income area, public health practitioners (Madrid Public Health Institute) and academia (university-based researchers specialized in Social Epidemiology and Urban Health).

Our aim was to conduct a Photovoice project with adult residents of a low-income urban area to understand the characteristics of the local food environment influencing residents' diets.

Section snippets

Methods

This Photovoice project was conducted from January to December 2015, as part of the larger project Heart Healthy Hoods (hhhproject.eu), focusing on how social and physical characteristics of the Madrid city affect residents' cardiovascular health (Bilal et al., 2016, Carreno et al., 2015). The Ethics Research Committee of the Madrid Health Care System approved the study.

Results

Twenty-four residents, aged 31–72 (mean age, 51.4) enrolled in this Photovoice project. More than half were female and five were foreign-born. Fifteen participants had a low educational level, seven lived with monthly household incomes lower than 900€ (≈982$), and four with monthly household incomes lower than 600€ (≈655$). A broader description of participants’ sociodemographic characteristics is presented in Table 1.

Participants took a total of 163 photographs during the entire Photovoice

Discussion

This Photovoice project illustrated which characteristics of the local food environment mattered most to residents of a low-income area in Madrid. To our knowledge, this is the first study involving residents in the entire research process. They participated as co-researchers, gathering and analyzing data, selecting the photographs and narratives to be used in all project dissemination activities, and communicating project results.

Participants' photographs and narratives have revealed how the

Conclusions

This Photovoice study offered residents a space and an opportunity to critically debate and inform about their local food environment in relation to dietary behaviors. Photovoice was an engaging and useful method for understanding residents' perspectives. Participants identified five salient themes related to their food environment: 1) eating in moderation; 2) cultural diversity; 3) food stores; 4) social relationships; and 5) economic crisis and poverty.

Participants generated new knowledge on

Conflict of interest

The authors of this paper do not report any conflict of interests.

Acknowledgements

This project would not have been possible without the successful collaboration and support of over 50 people from different backgrounds and organizations. We want to thank Madrid's Public Health Institute (Madrid Salud) professionals, who have been part of the project from its very beginning, its conduction and analysis. Victor G. Carreño for being the project photographer. César García, for the design and layout of the photobook. Roberto Valiente, for creating Fig. 1. Finally, we would like to

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