Community shows heart health through photo research project

October 5, 2015

People in at-risk communities see heart health as more than just physical health according to research from the University of North Carolina at Chapel Hill’s Gillings School of Global Public Health that was published Oct. 1 in Preventing Chronic Disease.

Sarah Kowitt

Sarah Kowitt

“The project really illustrated how community members feel about cardiovascular health,” said Sarah Kowitt, a doctoral student in UNC Gillings department of health behavior. Kowitt led the analysis of photographs taken by participants, known as the photovoice method.

“People clearly recognized heart disease was a problem and were actively trying to improve their health, but they also reported facing a number of structural barriers, such as unhealthy food environments. The great thing about photovoice is that, in addition to barriers, the approach identifies assets in communities that can be harnessed for health promotion.”

Kowitt and her colleagues with the Heart Healthy Lenoir study worked with two groups of African-American residents of Lenoir County, in eastern North Carolina, to explore barriers to heart health. Using the photovoice method, which gives cameras to participants to take photographs as a way of helping them illustrate and understand the factors influencing health issues. The participants selected topics for each session, took photographs to show their perspectives, then came together to discuss causes and potential solutions to improve health in their community.

One of the photos submitted by participants in the photovoice study,

A photo submitted by one study participant suggested that the abundance of high-fat treats has an impact upon heart health.

The photos and discussions showed that participants thought of heart health as an issue affected by many factors, including food availability and stress. Participants also talked about personal responsibility for heart health as it relates to making healthy choices, and the importance of social support from friends and family to make those healthy changes.

The group included nine adolescents and six adults who live in and around Lenoir County, which has some of the highest rates of death from heart disease in the country, particularly among low-income and minority individuals. The adults in the study talked about being good role models for youth, and the adolescents looked to family members when talking about good role models for healthy lifestyle choices. The adults also discussed faith as integral to helping themselves and adolescents find a purpose for prioritizing their health.

The photovoice study research team was led by Alexandra Lightfoot, EdD, research assistant professor of health behavior at the Gillings School and director of the community engagement core at UNC’s Center for Health Promotion and Disease Prevention (HPDP). The team also included co-investigators in the study, postdoctoral and graduate students, and community partners who live in Lenoir County.

“This formative work using photovoice provided a critical basis for the design of clinical and community-based programs to reduce the risk of heart disease,” Lightfoot said. “Tailoring programs such as this one to the specific concerns and needs of a community makes the chances of success much greater.”

The photovoice project was part of the Heart Healthy Lenoir study, a five-year study designed to develop and test better ways to reduce heart disease in Lenoir County. The study is led by Alice Ammerman, DrPH, professor of nutrition and director of HPDP.

Gillings School of Global Public Health contact: David Pesci, director of communications, (919) 962-2600 or

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