Using photo elicitation in interviews to explore link workers’ experiences and intentions to quit

Photo elicitation, traditionally applied in anthropological studies, uses visual stimuli such as photos or pictures to prompt memories and meaningful connections. This method can help gain richer insights by encouraging interviewees to take ownership of thoughts, feelings and experiences through the images they share. At the outset, interviewees can raise issues that are relevant to them and explore topics of interest or concern from their perspective.

We have been using photo elicitation in a mixed method study that is exploring link workers’ experiences of their role and intention to quit. Our study explores different levels of occupational self-efficacy (confidence in the job and the ability to cope with problems) and job discrepancy (the gap between job expectations and how the role is experienced in reality).

Twenty link workers across the UK were invited to take part after they had completed a questionnaire and had agreed to a follow up interview. We selected interviewees to achieve variation in terms of location, employment (primary care, voluntary sector or charity, local council) and different levels of self-efficacy and job discrepancy. All interviewees stated on the questionnaire that they had considered leaving their job in the previous 6 months and/or intended to leave in the following 6 months.

Prior to the interview we asked each link worker to take three photos; one showing a typical part of their working day, one depicting something that gave them confidence in their role and another showing an unexpected part of their role or something that was not in their job description. Link workers were invited to send a variety of photos of their choice that would stimulate a discussion at the beginning of their interview about their day-to-day job, issues that affected how they experienced their role and how this influenced whether they had considered staying or leaving.

The majority of the link workers sent us three photos before their interview. One interviewee emailed a description of each photo rather than the actual photos. For other interviewees without photos, we asked them in the interview to describe what they would have sent. Following these interviews, when people had not sent photos, we chose some clip art that we thought most represented their descriptions and sent these to them for approval.

Interviewees provided thoughtful, insightful and creative photos depicting their typical day (daily signposting and supportive activities for clients and patients, rooms or buildings where they worked, digital related devices, templates and apps); something that gave them confidence (various forms of feedback, images representing a positive outcome or activity, supportive colleagues), and something unexpected (extent of administrative tasks, part of their role that changed or impacted on them emotionally, either a positive activity or outcome of the challenge of working with patients with complex needs). The process of taking these photos helped link workers reflect on their diverse, difficult and rewarding job.

Photo elicitation can increase trust and reduce the power dynamic between researcher and interviewee. We have found this method has enriched the interview process and increased rapport with interviewees. We feel that preparing photos in advance meant that link workers were more reflexive, engaged and focused on describing aspects of their role that are both challenging and rewarding. Several were surprised at how the process of taking the photos, and describing them in the interview, gave them an emotional outlet to share their experiences and consider the reasons why they would leave or stay in their job.

We have also used the photos as a means of engaging with our Patient-Public Involvement (PPI) group. In a meeting with this group, we showed them a range of photos with quotes from interviewees describing what their photos represented. We then invited PPI group members to comment and reflect on the photos and the role of the link worker. It was something that the PPI group said they found helpful as it provided them with an insight that went beyond words.

We are now in the process of preparing the photos for an online gallery that we plan to launch in autumn 2024. This preparation involves modifying the images to ensure anonymity, and selecting accompany quotes from each interviewee’s transcript and creating a summary text. 

The study mentioned in this blog is funded by a grant from NIHR School for Primary Care Research (Award 678). The views expressed are those of the author and not necessarily those of the funder or the author’s host institution.