Logistical lessons learned in designing and executing a photo-elicitation study in the veterans health administration

Participatory photography research methods have been used to successfully engage and collect in-depth information from individuals whose voices have been traditionally marginalized in clinical or research arenas. However, participatory photography methods can introduce unique challenges and considerations regarding study design, human subject protections, and other regulatory barriers, particularly with vulnerable patient populations and in highly regulated institutions. Practical guidance on navigating these complex, interrelated methodological, logistical, and ethical issues is limited. Using a case exemplar, we describe our experiences with the planning, refinement, and initiation of a research study that used photo-elicitation interviews to assess the healthcare experiences of homeless and marginally housed United States Veterans. We discuss practical issues and recommendations related to study design, logistical “pitfalls” during study execution, and ensuring human subjects protections in the context of a study with a highly vulnerable patient population taking place in a highly risk-averse research environment.