Health in Hartford: A Community-Based Participatory Research Project Identifying Solutions to Health Inequities

Overall poor health status and unfair, disparate health outcomes for vulnerable population groups are of grave concern in the United States. Rooted in unequal access to and the disparate quality of the social determinants of health, health inequities disproportionately affect people of lower socioeconomic status and people of color. Defined as the willingness of people to intervene for the good of the community and associated with positive health outcomes, collective efficacy has the potential to reduce health inequities for urban Americans. Hartford, Connecticut is one urban city which unduly suffers from health inequities. Photovoice was the primary methodology used in this qualitative, multistage, longitudinal community-based participatory research (CBPR) study. Photovoice integrates photography, storytelling, and political advocacy. This study aimed to: 1) understand how community members perceive the relationship between place and health in their city; 2) identify participants’ recommendations for improving health in Hartford, Connecticut; and 3) assess how the critical consciousness-building process inherent in photovoice affected participants’ collective efficacy. A total of 24 Hartford residents participated in at least one stage of this study; 11 completed all four stages. Findings revealed that participants conceptualized health into three domains—physical wellness, mental and emotional health, and spirituality. Eight themes were identified involving participants’ perceptions of the critical factors that affect the health of city residents; these are access to healthy food, access to nature, housing and homelessness, substance abuse, litter, education and role models for young people, community investment, and community engagement. Recommendations to improve health were identified for each theme. Participants’ suggestions may be used to develop innovative and practical community interventions; once implemented, these may be evaluated to assess their impact on health. Findings demonstrated that participants’ critical consciousness increased during the photovoice process; however, no changes in their collective efficacy were detected during this study. Methodological constraints posed significant limitations and more robust research is needed to better assess the impact of photovoice on collective efficacy. Implications for professional social work include interprofessional training, specialized education for social workers in community practice, and CBPR methodologies that integrate a human rights framework