Using photovoice to explore perceptions on patient-centered care in the veterans affairs health care system

Introduction: Improving the quality of patient-centered care and its delivery requires a comprehensive understanding of its impact on patients and employees. Although the benefits of patient-centered care are well-documented in prior research, there is limited literature on patient and employee perceptions on patient-centered care with the use of visual and participatory research techniques.

Objectives: Using an innovative qualitative research technique known as photovoice, the objective of this study was to explore perceptions on patient-centered care by examining (1) how patients and employees conceptualize patient-centered care and (2) the contextual elements that drive these perspectives. The visual and participatory approach provides an opportunity to advance quality improvement efforts as well as engage patients and employees in a discussion around the topic of patient-centered care.

Method: This study consisted of three stages tailored around two participant samples, patients and employees. Data collection and participant recruitment took place at two VA health care facilities focused on patient-centered care. During the first stage, patients and employees attended an orientation in which they learned about the study, completed a demographics survey, and were given a camera and trained on their use. Participants were provided three basic prompts in order to facilitate their photography, and were asked to capture salient features in their environment that may describe how they feel about patient-centered care. In the second phase, the research team conducted in-depth follow-up interviews with each patient to learn more about their intended meaning. In the third phase, data collected from the shared pictures and the interview process were analyzed collectively by the research team to establish central themes and patterns emerging from the data. The analysis phase was guided by the Social Ecological Model to understand relationships between personal and environmental factors that may impact views on patient-centered care.

Results: The photovoice technique helped establish a detailed understanding of the key factors driving perceptions on patient-centered care at the patient and employee levels. Follow-up in-depth interviews extracted unique personal narratives that (a) built upon participant photography and (2) allowed us to characterize the differences and similarities between the patient and employee viewpoints.

Conclusions: This participatory research technique was valuable in deepening our understanding of the views on patient-centered care at the patient and employee levels in the VA. Additionally, the approach was beneficial in engaging both groups in a discussion on the impact of patient-centered care and building a foundation for improvement of patient-centered initiatives.