The Practice and Ethics of Participatory Visual Methods for Community Engagement in Public Health and Health Science [Handbook and e-Learning Course]

This handbook provides guidelines on the practice and ethics of participatory visual methods (PVM) for community and public engagement in health and health science, with emphasis on their use in low- and middle-income countries (LMICs). (The content is also presented as a free online course by the Global Health Network training centre.) The resource has been developed for use by engagement practitioners who are relatively new to the field of PVM but who already have some experience in facilitating participatory processes or in using qualitative research methods. It also aims to support health science researchers who wish to include visual methods when engaging local communities and wider publics in their work.

The publishers contend that working with visual methods can enable those who are marginalised and often excluded from discussion and debate about medical research - such as women, youth, less-able people, and the elderly - to take part meaningfully in community and public engagement. PVM encompasses a wide range of techniques that involve people taking part in the production of creative outputs that are used to convey their knowledge, experience, opinions, and ideas. Examples of PVM products include dramatisations, drawings, paintings, maps, photographs, digital stories, and films.

As creative forms of expression, these products can offer platforms for discussion and debate, and open up channels for knowledge exchange and learning. Ideally, both the process and the outcome of working with visual methods for community engagement enables a form of empowerment for all participants. However, as case studies (and a dedicated chapter) in the handbook make clear, working with visual methods on health-related topics also has the potential to increase participant vulnerability.

For example, one case study describes ethical issues that arose with a short documentary entitled 'Facing Our Fears', which was made collaboratively between a community engagement team and members of a local community in Kenya. It aimed to disseminate information on how and why men who have sex with men (MSM) are involved in ongoing HIV prevention research, and associated community engagement. Despite consent from those in the film to show it and recognised potential to reduce stigma around homosexuality, several participants from across stakeholder groups expressed concern that the documentary could cause a backlash for members of the lesbian, gay, bisexual, and transgender (LGBT) community in the film, other individuals appearing in the film, and for the HIV research clinic and broader research institution. Given these concerns, and the engagement team's awareness of the wider context of increasing religious tensions in neighbouring countries, the team made the decision not to release the film on the internet or use it outside of highly facilitated settings.

The 15 chapters in the handbook fall into 4 sections:

• Chapters 2 and 3 provide general guidelines, both practical and ethical, for planning and facilitating PVM processes.
• Chapter 4 suggests ways to disseminate PVM outputs with different audiences.
• Chapters 5 to 14 give examples of visual methodologies and suggestions about how to facilitate them. These chapters are grouped into visual methods that don't require technical equipment (chapters 6-10) and visual methods that do (chapters 11-14). Mini case studies are included for each method.
• Chapter 15 comprises a collection of ethics case studies drawn from the global south. They describe some of the complexities that authors have experienced when facilitating PVM processes, explain how they navigated those challenges, and discuss what they learned from doing so.

Produced as part of the Mesh Community Engagement Network learning and training resources, the 6- to 8-hour course covers the above content, in 4 major sections (progress is automatically saved for each module, so the course does not have to be completed in one attempt): (i) General Guidelines (Modules 1 and 2); (ii) Product Dissemination (Module 3); Methods (Modules 4-7); and (iv) Ethics Case Studies (Module 8).

This work was supported by Wellcome Trust and an OUCRU Seed Award.