Finding Meanings: Using Photovoice to Explore Smoking in Rural Low-Income Women

2.50
Hdl Handle:
http://hdl.handle.net/10755/621735
Category:
Full-text
Format:
Text-based Document
Type:
Presentation
Level of Evidence:
N/A
Research Approach:
N/A
Title:
Finding Meanings: Using Photovoice to Explore Smoking in Rural Low-Income Women
Other Titles:
Using Photovoice in Healthcare
Author(s):
Mitchell, Star
Lead Author STTI Affiliation:
Chi Psi
Author Details:
Star Mitchell, PhD, RN, CCRN, Professional Experience: Dr. Mitchell has over 30 years’ experience as a nurse educator and program administrator. As a nurse researcher she has developed a program of study focused on reducing health disparities in rural low-income women through the use of photovoice and focused ethnography. She has presented her research findings on the relationship between place and the social context of smoking at national and international professional conferences. In addition, Dr. Mitchell uses arts-based teaching strategies to enhance affective learning in undergraduate students during critical care clinical experiences. Currently she is Assistant Professor of Nursing and Undergraduate Program Director at Texas State University and has extensive critical care experience in critical care nursing. She also has experience as a Research Nurse, Legal Nurse Consultant, and Education Program Consultant. Author Summary: Dr. Mitchell has worked with rural low-income women for over 30 years in the role of nurse educator, critical care nurse, and researcher. More recently she has turned her research focus to the relationship of place and social context to smoking and associated health disparities in disadvantaged and marginalized populations using photovoice, ethnography, and other qualitative methods of discovery.
Abstract:

Background: High rates of smoking-related chronic disease in low-income rural women and limited access to and use of quality health care has created a challenge to tobacco cessation efforts. These factors support the international call for creative and targeted research approaches that offer new insight and meaning into the relationship between smoking and social determinants of health (Garrett, Dube, Bann, & McAfee, 2015; World Health Organization, 2008). Research has provided a clear picture of how many people smoke, who smokes, and how much they smoke. Unanswered questions remain that are relative to why certain demographic groups of people continue to smoke and how to effectively reduce cigarette use in populations that embrace smoking. Smoking rates in low-income rural women are stagnant while rates in non-poor and non-rural populations continue to decline, disproportionately increasing the tobacco-related disease and health burden of rural communities when compared to other sectors of society (American Lung Association, 2012; Centers for Disease and Control, 2014).

Purpose: This study explored the meaning of smoking from the perspective of rural low-income women and its effect on the relationship to social identity, sociocultural factors, and smoking behavior. Using photovoice from a relativist's perspective, the purposes of this study were to (a) explore cultural and social factors that give meaning to being a smoker in rural low-income women and (b) explore the relationships between social support, social networks, social identity, and the meaning of smoking in rural low-income women's decision to smoke and attempt smoking cessation.

Methods: This is an interpretive focused ethnography using photovoice as the primary method of inquiry to collect data from low-income rural women residing in three homogeneic and neighboring counties located in the mid-Atlantic portion of the United States. Counties selected for recruitment presented high rates of poverty, smoking, and unemployment with similar cultural, economic, geographic, and social characteristics. This naturalistic approach to inquiry included community assessments and individual photo elicited interviews. Participants completed an initial interview focusing on their current smoking behaviors and smoking history. After completing self-produced photographs of smoking experiences, a second individual interview was conducted using the photos as a mechanism to elicit deeper discussion and gain insight into what it means to smoke and be a smoker. Demographic data were recorded and analyzed for similarities and nuances. Transcribed narratives and photographs were analyzed for the complexity of participants' stories, focusing on the phenomenon of smoking in various aspects of their lives, including identity development and the socio-cultural meaning of smoking (Goodall, 2000; Saldana, 2013). ATLAS.ti was used to support descriptive, thematic, and theoretical coding of transcripts and photos to facilitate identifying variations and patterns reflective of the women's experiences, relationships, social and cultural beliefs, and behaviors within the social context of smoking.

Results: Of the 17 women enrolled in the study, 13 completed both interviews and submitted photographs, which resulted in 26 interviews and 196 participant-produced photographs for analysis. For these 13 women between the ages of 25 and 63, social characteristics showed all participants living as single women, most with dependent children, a common history of drug or alcohol abuse, current or previous domestic violence, and exposure to community violence in their current living conditions. All the women wanted to find a job. Seven themes evolved from analysis of the data which add to our understanding of what it means to be a smoker within the social context of low-income rural women: (1) feelings of isolation (2) struggling day to day (3) it’s relaxing (4) looking good and the sense of empowerment (5) family support and expectations (6) being a good mother (7) hope for a better life. Although the interview questions did not specifically ask about rural life, patterns and themes disclosed during narratives and review of the photographs related to social engagement, social identities, and the meaning of the women's social relationships within the context of rural living. Feelings of isolation were associated with the geographic nature of rural living and further amplified by the stigmatization encountered when identified as a smoker. Prominent narrative themes include relationships between smoking and their roles associated with family membership, being a good mother, and their need to feel empowered within their social environments. As established in previous smoking studies, women in the current study described smoking as a tool for relaxation and stress relief.

Conclusion: Photovoice is an effective and creative method for expanding our knowledge of the relationship between smoking and social determinants of health. Findings presented in this study add to our understanding of cultural and social factors that give meaning to smoking in rural low-income woman; and explore the relationships between social support, social networks, social identity, and the decision to smoke or attempt smoking cessation in this marginalized population of smokers that have not responded to current smoking cessation interventions. This knowledge will be useful in the design of smoking cessation interventions that target low-income women living in disadvantaged rural areas and supports the use of this creative research approach in future studies that target disadvantaged or marginalized populations.

Keywords:
photovoice; rural women; smoking
Repository Posting Date:
10-Jul-2017
Date of Publication:
10-Jul-2017
Other Identifiers:
INRC17R09
Conference Date:
2017
Conference Name:
28th International Nursing Research Congress
Conference Host:
Sigma Theta Tau International
Conference Location:
Dublin, Ireland
Description:
Event Theme: Influencing Global Health Through the Advancement of Nursing Scholarship

Full metadata record

DC FieldValue Language
dc.language.isoen_USen
dc.type.categoryFull-texten
dc.formatText-based Documenten
dc.typePresentationen
dc.evidence.levelN/Aen
dc.research.approachN/Aen
dc.titleFinding Meanings: Using Photovoice to Explore Smoking in Rural Low-Income Womenen_US
dc.title.alternativeUsing Photovoice in Healthcareen
dc.contributor.authorMitchell, Staren
dc.contributor.departmentChi Psien
dc.author.detailsStar Mitchell, PhD, RN, CCRN, Professional Experience: Dr. Mitchell has over 30 years’ experience as a nurse educator and program administrator. As a nurse researcher she has developed a program of study focused on reducing health disparities in rural low-income women through the use of photovoice and focused ethnography. She has presented her research findings on the relationship between place and the social context of smoking at national and international professional conferences. In addition, Dr. Mitchell uses arts-based teaching strategies to enhance affective learning in undergraduate students during critical care clinical experiences. Currently she is Assistant Professor of Nursing and Undergraduate Program Director at Texas State University and has extensive critical care experience in critical care nursing. She also has experience as a Research Nurse, Legal Nurse Consultant, and Education Program Consultant. Author Summary: Dr. Mitchell has worked with rural low-income women for over 30 years in the role of nurse educator, critical care nurse, and researcher. More recently she has turned her research focus to the relationship of place and social context to smoking and associated health disparities in disadvantaged and marginalized populations using photovoice, ethnography, and other qualitative methods of discovery.en
dc.identifier.urihttp://hdl.handle.net/10755/621735-
dc.description.abstract<p><span>Background: High rates of smoking-related chronic disease in low-income rural women and limited access to and use of quality health care has created a challenge to tobacco cessation efforts. These factors support the international call for creative and targeted research approaches that offer new insight and meaning into the relationship between smoking and social determinants of health (Garrett, Dube, Bann, & McAfee, 2015; World Health Organization, 2008). Research has provided a clear picture of how many people smoke, who smokes, and how much they smoke. Unanswered questions remain that are relative to </span><em>why</em><span> certain demographic groups of people continue to smoke and </span><em>how </em><span>to effectively reduce cigarette use in populations that embrace smoking. Smoking rates in low-income rural women are stagnant while rates in non-poor and non-rural populations continue to decline, disproportionately increasing the tobacco-related disease and health burden of rural communities when compared to other sectors of society (American Lung Association, 2012; Centers for Disease and Control, 2014).</span></p> <p><strong>Purpose: </strong>This study explored the meaning of smoking from the perspective of rural low-income women and its effect on the relationship to social identity, sociocultural factors, and smoking behavior. Using photovoice from a relativist's perspective, the purposes of this study were to (a) explore cultural and social factors that give meaning to being a smoker in rural low-income women and (b) explore the relationships between social support, social networks, social identity, and the meaning of smoking in rural low-income women's decision to smoke and attempt smoking cessation.</p> <p><strong>Methods: </strong>This is an interpretive focused ethnography using photovoice as the primary method of inquiry to collect data from low-income rural women residing in three homogeneic and neighboring counties located in the mid-Atlantic portion of the United States. Counties selected for recruitment presented high rates of poverty, smoking, and unemployment with similar cultural, economic, geographic, and social characteristics. This naturalistic approach to inquiry included community assessments and individual photo elicited interviews. Participants completed an initial interview focusing on their current smoking behaviors and smoking history. After completing self-produced photographs of smoking experiences, a second individual interview was conducted using the photos as a mechanism to elicit deeper discussion and gain insight into what it means to smoke and be a smoker. Demographic data were recorded and analyzed for similarities and nuances. Transcribed narratives and photographs were analyzed for the complexity of participants' stories, focusing on the phenomenon of smoking in various aspects of their lives, including identity development and the socio-cultural meaning of smoking (Goodall, 2000; Saldana, 2013). ATLAS.ti was used to support descriptive, thematic, and theoretical coding of transcripts and photos to facilitate identifying variations and patterns reflective of the women's experiences, relationships, social and cultural beliefs, and behaviors within the social context of smoking.</p> <p><strong>Results: </strong>Of the 17 women enrolled in the study, 13 completed both interviews and submitted photographs, which resulted in 26 interviews and 196 participant-produced photographs for analysis. For these 13 women between the ages of 25 and 63, social characteristics showed all participants living as single women, most with dependent children, a common history of drug or alcohol abuse, current or previous domestic violence, and exposure to community violence in their current living conditions. All the women wanted to find a job. Seven themes evolved from analysis of the data which add to our understanding of what it means to be a smoker within the social context of low-income rural women: (1) feelings of isolation (2) struggling day to day (3) it’s relaxing (4) looking good and the sense of empowerment (5) family support and expectations (6) being a good mother (7) hope for a better life. Although the interview questions did not specifically ask about rural life, patterns and themes disclosed during narratives and review of the photographs related to social engagement, social identities, and the meaning of the women's social relationships within the context of rural living. Feelings of isolation were associated with the geographic nature of rural living and further amplified by the stigmatization encountered when identified as a smoker. Prominent narrative themes include relationships between smoking and their roles associated with family membership, being a good mother, and their need to feel empowered within their social environments. As established in previous smoking studies, women in the current study described smoking as a tool for relaxation and stress relief.</p> <p><strong>Conclusion: </strong>Photovoice is an effective and creative method for expanding our knowledge of the relationship between smoking and social determinants of health. Findings presented in this study add to our understanding of cultural and social factors that give meaning to smoking in rural low-income woman; and explore the relationships between social support, social networks, social identity, and the decision to smoke or attempt smoking cessation in this marginalized population of smokers that have not responded to current smoking cessation interventions. This knowledge will be useful in the design of smoking cessation interventions that target low-income women living in disadvantaged rural areas and supports the use of this creative research approach in future studies that target disadvantaged or marginalized populations.</p>en
dc.subjectphotovoiceen
dc.subjectrural womenen
dc.subjectsmokingen
dc.date.available2017-07-10T14:07:34Z-
dc.date.issued2017-07-10-
dc.date.accessioned2017-07-10T14:07:34Z-
dc.conference.date2017en
dc.conference.name28th International Nursing Research Congressen
dc.conference.hostSigma Theta Tau Internationalen
dc.conference.locationDublin, Irelanden
dc.descriptionEvent Theme: Influencing Global Health Through the Advancement of Nursing Scholarshipen
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