Centering Black Veterans’ Voices with Photovoice to Identify Challenges and Solutions for VA Weight Management Care

Jessica Breland, PhD¹; Katherine Hoerster, PhD, MPH² - Health Equity and Military and Veterans Health SIGs

Disparities in Weight Management Care Need to Be Understood

Despite enrolling in VA’s weight management program (MOVE!) at higher rates than other veteran groups, Non-Hispanic Black or African American (hereafter Black) veterans are less likely to lose a clinically meaningful amount of weight after participating in the program. These disparities are also observed in the general population. We know that drivers of racial disparities are rooted in systemic racism and social determinants of health, and that solving disparities is best done through meaningful community-based partnership. Our team set out to understand what drives these disparities—and to highlight Black veteran-led solutions to improve weight management care. 

The Why and How of Our Chosen Method for Participatory Research: Photovoice

To best center the voices of Black veterans, we used a participatory method called Photovoice. In doing so, we both learned about solutions for weight management care and developed a meaningful collaborative partnership among Black veterans, our team, and VA leadership that is ongoing.  Photovoice has variation, but at its heart the idea is to “bring to life” people’s lived experiences through photography to collaboratively identify and directly advocate for solutions to their challenges.

In our project, nine veterans (two women, seven men) met over the course of six ~90-minute sessions. Participants chose missions related to weight management and VHA care, bringing photos or other media (e.g., poems) to discuss during the remaining sessions. Facilitators and participants identified themes related to each session in real time. Between sessions, facilitators and investigators conducted rapid qualitative analysis to identify themes, illustrative quotes/photos/other media, and prepare products. Participants also provided feedback on our dissemination products in an additional session.

Key Results and Recommendations

Themes were identified across three categories: Food in Our Lives and Health Care; Body Image; and Healthcare Bias and Discrimination. Recommendations to improve care included:

• Hire Black providers and provide training so that all providers will understand and respect Black patients
• Update MOVE! materials (e.g., don't vilify culturally important foods)
• De-emphasize body mass index
• Continue to engage Veterans in developing solutions

How We’re Getting the Word Out

The veteran partners asked us to share their recommendations broadly, noting “What’s important…is…we’re not just another study...on a scholarly review page…That [doesn’t] invoke change.” So, in addition to publishing findings, we’re keeping communication channels open between veterans and leaders, and sharing products with key VA staff and other relevant organizations (like SBM). We also partnered with VA’s Office of Health Equity to share veterans' art: https://www.va.gov/HEALTHEQUITY/Veterans_Health_Equity_Art_Gallery.asp. The gallery shares numerous photos and associated quotes and a Veteran-written poem from the Photovoice project, as well as major takeaways and recommendations from the project.

Conclusions and Next Steps

We’re grateful to our veteran and operations partners, and our research team. We encourage researchers and institutions to integrate our veteran partners’ ideas into their policies and practices, and to use participatory methods to authentically partner with marginalized communities to improve care and reduce disparities.

Learn more in our recently published paper in the Journal of General internal Medicine: https://link.springer.com/article/10.1007/s11606-024-08628-7.

Note: Views are those of the authors and do not necessarily represent those of the Department of Veteran Affairs or US government.