Play as a Mode of Research

PLAYAS AMODE OF RESEARCH

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e USING PLAY TO EXAMINE RURAL CHILDREN'S PERSPECTIVES ON HEALTH AND CARE

I Sienna Ruiz,

Eric Wiedenman, Jean Hunleth

Text by Sienna Ruiz, Eric Wiedenman, Jean Hunleth. Layout and zine design by Dionisia Ruiz.

Intenriews with participants were conducted by Sienna Ruiz, Eric Wiedenman. Other contributors include Hannah Fechtel, Laurel Schmidt, Angeline Gacad, Katherine Sleckman. Study funded by National Cancer Institute (P50 CA244451) - PI: Hunleth and National Cancer Institute Training Grant G32 CA190194) - co-I: Wiedenman.

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We'would like to thank all of the PHRAME participants and their families, without whom this work would not be possible.l C hickenr

Sienna Ruiz is a research coordinator at Washington

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University in St. Iouis. She has a BA in anthropolory

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and Spanish, and she is cunently obsessed with

playing with her cats, and reading Lord of the Rings-

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Jean Hunletb, PhD, MPH is an associate professor at

Washington University in St. Louis, and the author of the book Children as Caregivers: The Global Fieht agaiirst Tuberculosis and HtV in Zambia (you can read the book for free at: https://library.oapen.org/handle 120.50O.L2657/3 1490).

She is a life-long learner of play and, currently, her 6 year old is teaching her how to be Ghost Spider and beating her at Beyblad.e. You can find out *"*41? at https://hunleth. wustl- edu/.

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l All the children who participated are de-identified pseudonyms of their choice.

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Eric Wiedenman, PhD, MPH is a postdoc at Washington University in St. Louis- He absolutely loves penguins, his two dogs Jack and.Ziggy, and has recently gotten into bonsai. More information (and future bonsai photos!) can be found at emwiedenman.com.

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you do need to know that children's opinions

matter. Take that into mind.

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We will be making future zines based on this project!

They will focus on rurality, health, and care as they are understood. by children. If you are interested in learning more, go to issuu.com/hunlethlab or check https://hunleth.wustl.edu/ for more updates. .Lq

Thank you for going on that playful journey with us!

We hope you had fun and learned a lot about

to

what

about health

care.

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To conclude, we would like to say that play as a mode

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Jean, and we are

and Eric,

researchers who aim to listen to children's perspectives and experiences in health research.

Jean

lsa Transform power dynamics (not escape them)

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e are

Eric's research is

who studies children's contributions to

with children and tion in rural areas.

health inZambia and the U.S.

Lead to new types of data, or texts And I'm Sienna!

Offer an approach to listening to children rooted in context '' Provide new or of children's lives

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I do work on health geographY, and I'11be the one taking

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Together' we'll explore ways we can learn from

uses of PlaY in children's research.

you througb this zine'

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We

wrote this zine because children's perspectives on health issues often go unheard by adults despite the fact that children have critical knowledge to share, especially when children are the targets of many health policies and programs. This happens even though we know children shape health in their households and communities.

Adults who are connected to institutions like universities, research organizations, or the government often assume what children know and need, and can view children's perspectives as undeveloped or unworthy of adult attention. Or, they may not have experience listening to children. For example, many research methods in the health fields were developed with adults in mind. To counter such trends in research, we developed the Picturing Health

by Rural Adolescents in the MidwEst (PHRAME)

When talking about this photo, l3-year-old Josh explained, "\Mhen I look at jeltyfrsh, for some reason, I see just a major calm and quiet setting, like swimming in an open water," and that a friend could show him this photo if he was worried about a test or bad grade and it might calm him down.

jellyfish to !p*QS,AL-O"I9, Josh used his photo of the "ME" explain how a friend could show it to him to calm him down.

This moves the methodology of photo-elicitation beyond the notions of photos-as-representations and sources of elicitation 'Instead", he showed the agency of the image-that images do things. Jean (Ilunleth 2019) has written about how children do things with imagesthey create as part of research projects,ra based on D.W. Winnicott's suggestion that play creates a transitional space of creativity and communication, and that image ) creation and circulation between people can serve as a form of play.rs What children do with images during a projectsuch as showing their uses or giftingte-should not be diminished or viewed as outside of data collection. This is true also of adult participants in image-based projects, and such using and gifting offers critical insight into relationality.

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study to

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to children,s stories,

opinions, and imaginings of health and care.

In PHRAME, we are interviewing children ages g 14 on their perspectives of health and care in the rural Midwest. These interviews are happening in the midst of the ongoing COVID-l9 pandemic, so we are carrying out the project virtually. We are using methods like

il Hunleth. "Zambianchildren's imaginal caring: on fantasy, play, and anticipation in an epidemic."

15

D. W. Winnicott, Playing and. Reality. (Routledge 2005).

Originaly published 1971. l6Hunleth. "Beyond on or with: Questioning Power Dynamics and Knowledge Production in'Child-Oriented' Research Methodolory."

5

ae-

NOW, please consider the image below. What do you feel when you iook at this photo?

conversational interviews, drawing activities, photography, and storytelling. Children received cameras, took photos between interviews, and these photos became the focus of the interviews.

Throughout the study, children shared their thoughts and experiences with us in many ways through their photos and drawings, in response to our questions and in story form. They did so in many ways, including through

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play ml Play is usually thought

research?

of as a set of activities.

However, we mean something a bit different when we use the term. We view play as an orientation, a way of approaching the interviews. We are inspired by anthropologist Helen Schwartzma4. Helen Schwartzman studied children-s play and identified that play is a:

sienna drewthe trail and surrounding forest on the whiteboard feature on Zoom, Cinderella began to share a story of consoling her friend after her father passed away. Cinderella described how she talked with her friend and gave her the space to share about her dad, who Cinderella never met. Cinderella said that talking with her fiend while on their walks helped her friend "get it offher cheqll'and Cinderella ' "[got] to know [her dadrs] personality and seeing how ,t each relationship he was

How did Cinderella's story go beyond her understanding of health as "getting outside"?

Where did

'x1ind go while drawing? . your ' .-\dE-IILQ9_F-:NqTElHere, Cinderella and Sienna played

defrning context that players adopt toward somethirg, which produces a text charactefizedby "allusion (not distortion or illusion), transformation (not presen/ation)", and'opurported

imitation." " 2 Ilelen B. Schwarbzm an,

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Thansforrnatbns: thc Anthropology of Child,renb Play. (Spnnger, 1978): 330.

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with the photo itself, transforrning its meaning. Photos are not straightforward imitations of children's worlds. firey are always open to interpretation. Cinderella and Sienna embraced multiple interpretations and the ambiguity of meaning within the photos through drawing on them using theZoom annotate function. Michael Taussig has identified that drawing provides "a zone of mediation" and a "means

of getting close to" the object drawn.lz As Sienna drew on the photo, Cinderella took her onto a path and along on a walk. This play-as all play- is charactenzedby transforrnaflon which, to quote Schwartzman, "gives shape as well as exlrression to individual and societal affective and cognitive systems. These are play's products, and they are extremely consequential."ls lzTaussig, '"What Do Drawings t3

Want?,, 26b.

Schwartzm an, TTonsformatinns, BBO.

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years old) sent in the photo below and said that it related to health because the shoes allowed her to exercise and go outside.

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Transformation is important here because it means that, through play, we can arrive at new understandings and meanings.

In PHRAIVIE, we are prioritizing spontaneous play and the imagined and fantastical to learn about health and care. Play varied during the interviews and children led play-filled interactions that innovated our approach. This entailed trusting children and entering into play with them as co-researchers. Doing so without :judgment or rigidity was key.

q.schorarD.

{

Soyini Madison

"in order to be playful,

it is not the n *l

t

Then Sienna asked where Cinderella usually wore these shoes, and Cinderella responded that she wore them to walk on a trail near her house.

Please draw your character in these shoes and on a trail

I

Il ,

individual that must change but the unplaYful world.." 3 ,B$

We want to extend this world into this zine and invite you enter and play along with us to learn more about lives. health and care in the children s

f {'tolo ? D. Soyini

by o el;ko Ethnography: Method, Etltics, and

Performance, 2od ed. (Sage, 2OI2).

I

We specifically invite you to play with images in our zine. This invitation is inspired by Max Liboiron,s

"rules of exchange for reciprocal readingr,+ where both author and reader work together to produce meaning from a piece of work.

We suggest ihat

PlaYlngwith the IMe aim to recreaie our ptay-filled conversatio*

photos chiilren took

might offer a way of

i

*iif,

the children. In doing so,

rrstenrng to children.

we aim to clalle-nge

extractive readings of children's p hoto graphs,

METHODS NOTE: Much research with children is ethnographic or participatory, and premised on proximity and co-presence. A challenge of virtual interviews is that they can feel fistanced and superficial. At the same time, they can also feel invasive and voyeuristic, with researchers' and participants' home environments and dynamics on display. Sienna drew on the screen to respectfully disengage foom the family conversation, making her decision to disengage both visible and understated. Sienna's drawing eventually brought Noodles' and Rainbow's attention back to the photo, who noticed drawings appear and playfully guided Sienna on what to draw next. Drawing, in this case, held potentiai to maintain rapport and bring interviewees back to the dig:ital interview space. Digital interviews may prevent the physical closeness and togetherness ethnographic researchers are accustomed to, but creative methods and their playful potential can also facilitate co-presence and I cioseness in a d.igital space.'o

or a glossing over of their

l,

flkoto by J o.rnes

important messages. \\

ra?

We also hope that through

you

playing with this zine, readers will come away

transformed, with

allts new understandings of be

wilt

join us?

aad

online participatory research-

'oHelen Lomax, et al.. "Creating research with spaces: insights from creative, d'igitally mediated

during the CO\IID-19 pandemic;' Farnilies'

"irild""n iJiiii"tni'psZnd' Societies ,l!, no' l (2022): 19-37' DOI: L0.1332 20 46?432 lx 16 27 482893407 0 t'Julie Spray, Hannah Fechtel, Jean Hunleth, "What Do ArtsBased Methods Do? A Story of (What Is) Art and Online Research With Chiidren During a Pandemic." Sociologiral Research Online, t

(2022) : 1- 1 3. http s ://doi. org/ 1 0 . I 17 7 I 13607 80 42IL0 55 492

v

'8%

(9 a Max

Liboiron, "Exchanging," in Transmissions: Critical Tactics Making and Cornmunicating Research. Ed. Kat Jungnickel. for (tr{IT Press, 2020),95.

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To start:

-

"!Rainbow: To eat stuffthat would be good and

Please draw a character ofyourself:s

stufffor a [treat]...And the car can talk

D"a w two

by the way.

saraller rnsjde of that shape!

Interviewer: Oh whoa, what's it saying? :--

Rainbow : tt's grvi l

iffIBiiiliii!-

1'P_*l!_!{:

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Those are your eyes.

i

draw this car going to a healthy pla ce of Your own

random shapes

ota

your ears!

roaf]c

Draw the rest ofyour body,

What mouth

: "t\

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and donT a cool

Give your

outfifl

t? a name,

any namg. 6

@

6 In

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asking you to draw yourseU, we would like you to become what scholar Michael Taussig calls a ,,maker-viewer,' who not only views images but engages in conversation with images in a .What Do Drawings _{9"ply,p",""onal way. From Michael Taussig Want?', Culture, Theory & Criteue, (ZO}q:.265.

5O:2-3, 263-27 4, DOI: 10. 1080t L47 gSTSOgOgZ4OZgg 6 Exercise drawn from Lynda Barry, Making Cornics @rawn &

Quarterly,2019).

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FOf the next activity, please read. the dialogue

Please draw your characte_r s l am, dunking a

below that occurred between an interviewer and participant Rainbow Glitter LJnicorn Sparkles, age 8.

Sienna interviewed Rainbow Glitter Unicorn Sparkles and her sister Noodles, two sisters with high enerry who bantered often. Over Zoom, Sienna saw and heard details of their life - scheduling conversations, snack requests, light disputes between sisters.

basketball

Not wanting to intrude, Sienna drew on the photo Rainbow took of a car.

,i

.--',t , tl,:l!', ,.

This dialogue is what happened when, after aisp,rtios':,, with Noodles, Rainbow noticed the drawings:

[Interviewer draws on the photo] th ._

Can you give it wings?

Sgi"bqyi .qi;-+-'

Interviewer: Yes...where's this car flying to?

This car is flying to heaven... ;Rainbow: '--.-

L

Interviewer: Do you think health or care relate to heaven in anyway?

-Ruittbo*: If you re good then you go there, and if you're bad then you dont So you have to be good and healthy.

hoto b/ CihJere'\ o\ Amazing! Now, please hold the bottom right corner of the nextpage and flip the page back and forth. Watch what happens to the photos as you do so.

L7-

I

Interviewer: What does it mean to be good and healthy?

7-6

How could photo-taking be a form of care?

what do you learn about Delphox's famrly context through playing with these photos?

METHODS NOTE: Delphox and EriCs interaction is - marked by playfulness. Maria Lugones defines playfulnessis a combination of .. - as "an openness to being a fool, which not worrying about competence, not being seU'important, - not taking norms as sacred and finding ambiguity and double edges a source of wisdom and delight." 7 At ease in 'the inten'iew, Delphox and Eric's playfulness altered the methods and opened new avenues for knowledge creation.

Jean has written about the importance of researchers -- attuning and responding to the playful ways children use and alter research methods as offering wisdom into - children's experiences.8 e In Delphox and EriCs encounter -' we see both wisdom and delight, as the movie they create - offers insight into Delphox's practices of care.

t Mada Lugones. '?layfulness, 'World'-Thavelling, and Loving Perception." H54patia 2, no.2 (1987): 17. http://www jstor.org/stable/38 100 13. sJean Hunleth. "Beyond on or with: Questioning Power Dynamics and lGnowledge Production in'Child-Oriented' Research Methodolory." Childhood 18, no. 1 (2011): 81-93. https://doi.orgl L0.Ll7 7 109075682 10 37 t234. s Jean Hunleth. "Zambian children's imaginal caring: on fantasy, play, and anticipation in an epidemic." Cultural Anthropology 34, no. 2 (2019). DOI: 10.14506/ca34.2.0L

15

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TheSe :submitted by Delphox, a $ Year oldwere Photos-

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lr.r our study. He totd us that his brothers

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took these photos. His brothers wanted to play with him most days, even when ht--preferred to be alone. Opportunities to be-alone were rare, however, as hig entire family was enforcing strict stay at home rules due to his young€r sister's immunocompromissd status.

In this instance, Delphox let each brother take one photo so that neither felt left out

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When discussing the photos with Eric over Zoom, Delpho:r suggested that if Eric "play could be like a video of him witn them" _- itshooting.

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Eric then played --_ *ith th" images by flipPing back andTorth between them, just Iike what You This made the photos seem were moving, like in a video'

1,3

How does play reveal how relationships infl.uence health in Delphox's life?

T4

TheSe :submitted by Delphox, a $ Year oldwere Photos-

i

t

lr.r our study. He totd us that his brothers

)

I tlt I I lt'irr,

a

t.

I I t!

i

1

:r $

?,

tq

''iF; +!

+

t

I

I lIr-

=-;'r

f tt

rtr .rl 'ly

t

lo,

f

I*.

t-

,r

took these photos. His brothers wanted to play with him most days, even when ht--preferred to be alone. Opportunities to be-alone were rare, however, as hig entire family was enforcing strict stay at home rules due to his young€r sister's immunocompromissd status.

In this instance, Delphox let each brother take one photo so that neither felt left out

--..+ttp

l

\

When discussing the photos with Eric over Zoom, Delpho:r suggested that if Eric "play could be like a video of him witn them" _- itshooting.

rh olo De

Eric then played --_ *ith th" images by flipPing back andTorth between them, just Iike what You This made the photos seem were moving, like in a video'

1,3

How does play reveal how relationships infl.uence health in Delphox's life?

T4

How could photo-taking be a form of care?

what do you learn about Delphox's famrly context through playing with these photos?

METHODS NOTE: Delphox and EriCs interaction is - marked by playfulness. Maria Lugones defines playfulnessis a combination of .. - as "an openness to being a fool, which not worrying about competence, not being seU'important, - not taking norms as sacred and finding ambiguity and double edges a source of wisdom and delight." 7 At ease in 'the inten'iew, Delphox and Eric's playfulness altered the methods and opened new avenues for knowledge creation.

Jean has written about the importance of researchers -- attuning and responding to the playful ways children use and alter research methods as offering wisdom into - children's experiences.8 e In Delphox and EriCs encounter -' we see both wisdom and delight, as the movie they create - offers insight into Delphox's practices of care.

t Mada Lugones. '?layfulness, 'World'-Thavelling, and Loving Perception." H54patia 2, no.2 (1987): 17. http://www jstor.org/stable/38 100 13. sJean Hunleth. "Beyond on or with: Questioning Power Dynamics and lGnowledge Production in'Child-Oriented' Research Methodolory." Childhood 18, no. 1 (2011): 81-93. https://doi.orgl L0.Ll7 7 109075682 10 37 t234. s Jean Hunleth. "Zambian children's imaginal caring: on fantasy, play, and anticipation in an epidemic." Cultural Anthropology 34, no. 2 (2019). DOI: 10.14506/ca34.2.0L

15

a2

'

,"' ll

r'

1

f ll,\', 1,,i1/r,i;

ltl

I

FOf the next activity, please read. the dialogue

Please draw your characte_r s l am, dunking a

below that occurred between an interviewer and participant Rainbow Glitter LJnicorn Sparkles, age 8.

Sienna interviewed Rainbow Glitter Unicorn Sparkles and her sister Noodles, two sisters with high enerry who bantered often. Over Zoom, Sienna saw and heard details of their life - scheduling conversations, snack requests, light disputes between sisters.

basketball

Not wanting to intrude, Sienna drew on the photo Rainbow took of a car.

,i

.--',t , tl,:l!', ,.

This dialogue is what happened when, after aisp,rtios':,, with Noodles, Rainbow noticed the drawings:

[Interviewer draws on the photo] th ._

Can you give it wings?

Sgi"bqyi .qi;-+-'

Interviewer: Yes...where's this car flying to?

This car is flying to heaven... ;Rainbow: '--.-

L

Interviewer: Do you think health or care relate to heaven in anyway?

-Ruittbo*: If you re good then you go there, and if you're bad then you dont So you have to be good and healthy.

hoto b/ CihJere'\ o\ Amazing! Now, please hold the bottom right corner of the nextpage and flip the page back and forth. Watch what happens to the photos as you do so.

L7-

I

Interviewer: What does it mean to be good and healthy?

7-6

. i4:-

To start:

-

"!Rainbow: To eat stuffthat would be good and

Please draw a character ofyourself:s

stufffor a [treat]...And the car can talk

D"a w two

by the way.

saraller rnsjde of that shape!

Interviewer: Oh whoa, what's it saying? :--

Rainbow : tt's grvi l

iffIBiiiliii!-

1'P_*l!_!{:

s$APgt

Those are your eyes.

i

draw this car going to a healthy pla ce of Your own

random shapes

ota

your ears!

roaf]c

Draw the rest ofyour body,

What mouth

: "t\

$:

and donT a cool

Give your

outfifl

t? a name,

any namg. 6

@

6 In

*

asking you to draw yourseU, we would like you to become what scholar Michael Taussig calls a ,,maker-viewer,' who not only views images but engages in conversation with images in a .What Do Drawings _{9"ply,p",""onal way. From Michael Taussig Want?', Culture, Theory & Criteue, (ZO}q:.265.

5O:2-3, 263-27 4, DOI: 10. 1080t L47 gSTSOgOgZ4OZgg 6 Exercise drawn from Lynda Barry, Making Cornics @rawn &

Quarterly,2019).

10

We specifically invite you to play with images in our zine. This invitation is inspired by Max Liboiron,s

"rules of exchange for reciprocal readingr,+ where both author and reader work together to produce meaning from a piece of work.

We suggest ihat

PlaYlngwith the IMe aim to recreaie our ptay-filled conversatio*

photos chiilren took

might offer a way of

i

*iif,

the children. In doing so,

rrstenrng to children.

we aim to clalle-nge

extractive readings of children's p hoto graphs,

METHODS NOTE: Much research with children is ethnographic or participatory, and premised on proximity and co-presence. A challenge of virtual interviews is that they can feel fistanced and superficial. At the same time, they can also feel invasive and voyeuristic, with researchers' and participants' home environments and dynamics on display. Sienna drew on the screen to respectfully disengage foom the family conversation, making her decision to disengage both visible and understated. Sienna's drawing eventually brought Noodles' and Rainbow's attention back to the photo, who noticed drawings appear and playfully guided Sienna on what to draw next. Drawing, in this case, held potentiai to maintain rapport and bring interviewees back to the dig:ital interview space. Digital interviews may prevent the physical closeness and togetherness ethnographic researchers are accustomed to, but creative methods and their playful potential can also facilitate co-presence and I cioseness in a d.igital space.'o

or a glossing over of their

l,

flkoto by J o.rnes

important messages. \\

ra?

We also hope that through

you

playing with this zine, readers will come away

transformed, with

allts new understandings of be

wilt

join us?

aad

online participatory research-

'oHelen Lomax, et al.. "Creating research with spaces: insights from creative, d'igitally mediated

during the CO\IID-19 pandemic;' Farnilies'

"irild""n iJiiii"tni'psZnd' Societies ,l!, no' l (2022): 19-37' DOI: L0.1332 20 46?432 lx 16 27 482893407 0 t'Julie Spray, Hannah Fechtel, Jean Hunleth, "What Do ArtsBased Methods Do? A Story of (What Is) Art and Online Research With Chiidren During a Pandemic." Sociologiral Research Online, t

(2022) : 1- 1 3. http s ://doi. org/ 1 0 . I 17 7 I 13607 80 42IL0 55 492

v

'8%

(9 a Max

Liboiron, "Exchanging," in Transmissions: Critical Tactics Making and Cornmunicating Research. Ed. Kat Jungnickel. for (tr{IT Press, 2020),95.

q

,< j'l

.v_.,

-

r8

o

years old) sent in the photo below and said that it related to health because the shoes allowed her to exercise and go outside.

ri:

{

,.'il

-. "'z

i..f

.tl

Transformation is important here because it means that, through play, we can arrive at new understandings and meanings.

In PHRAIVIE, we are prioritizing spontaneous play and the imagined and fantastical to learn about health and care. Play varied during the interviews and children led play-filled interactions that innovated our approach. This entailed trusting children and entering into play with them as co-researchers. Doing so without :judgment or rigidity was key.

q.schorarD.

{

Soyini Madison

"in order to be playful,

it is not the n *l

t

Then Sienna asked where Cinderella usually wore these shoes, and Cinderella responded that she wore them to walk on a trail near her house.

Please draw your character in these shoes and on a trail

I

Il ,

individual that must change but the unplaYful world.." 3 ,B$

We want to extend this world into this zine and invite you enter and play along with us to learn more about lives. health and care in the children s

f {'tolo ? D. Soyini

by o el;ko Ethnography: Method, Etltics, and

Performance, 2od ed. (Sage, 2OI2).

I

What

Whgn

1S a

play ml Play is usually thought

research?

of as a set of activities.

However, we mean something a bit different when we use the term. We view play as an orientation, a way of approaching the interviews. We are inspired by anthropologist Helen Schwartzma4. Helen Schwartzman studied children-s play and identified that play is a:

sienna drewthe trail and surrounding forest on the whiteboard feature on Zoom, Cinderella began to share a story of consoling her friend after her father passed away. Cinderella described how she talked with her friend and gave her the space to share about her dad, who Cinderella never met. Cinderella said that talking with her fiend while on their walks helped her friend "get it offher cheqll'and Cinderella ' "[got] to know [her dadrs] personality and seeing how ,t each relationship he was

How did Cinderella's story go beyond her understanding of health as "getting outside"?

Where did

'x1ind go while drawing? . your ' .-\dE-IILQ9_F-:NqTElHere, Cinderella and Sienna played

defrning context that players adopt toward somethirg, which produces a text charactefizedby "allusion (not distortion or illusion), transformation (not presen/ation)", and'opurported

imitation." " 2 Ilelen B. Schwarbzm an,

Fhol" ty feff

Thansforrnatbns: thc Anthropology of Child,renb Play. (Spnnger, 1978): 330.

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with the photo itself, transforrning its meaning. Photos are not straightforward imitations of children's worlds. firey are always open to interpretation. Cinderella and Sienna embraced multiple interpretations and the ambiguity of meaning within the photos through drawing on them using theZoom annotate function. Michael Taussig has identified that drawing provides "a zone of mediation" and a "means

of getting close to" the object drawn.lz As Sienna drew on the photo, Cinderella took her onto a path and along on a walk. This play-as all play- is charactenzedby transforrnaflon which, to quote Schwartzman, "gives shape as well as exlrression to individual and societal affective and cognitive systems. These are play's products, and they are extremely consequential."ls lzTaussig, '"What Do Drawings t3

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NOW, please consider the image below. What do you feel when you iook at this photo?

conversational interviews, drawing activities, photography, and storytelling. Children received cameras, took photos between interviews, and these photos became the focus of the interviews.

Throughout the study, children shared their thoughts and experiences with us in many ways through their photos and drawings, in response to our questions and in story form. They did so in many ways, including through

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wrote this zine because children's perspectives on health issues often go unheard by adults despite the fact that children have critical knowledge to share, especially when children are the targets of many health policies and programs. This happens even though we know children shape health in their households and communities.

Adults who are connected to institutions like universities, research organizations, or the government often assume what children know and need, and can view children's perspectives as undeveloped or unworthy of adult attention. Or, they may not have experience listening to children. For example, many research methods in the health fields were developed with adults in mind. To counter such trends in research, we developed the Picturing Health

by Rural Adolescents in the MidwEst (PHRAME)

When talking about this photo, l3-year-old Josh explained, "\Mhen I look at jeltyfrsh, for some reason, I see just a major calm and quiet setting, like swimming in an open water," and that a friend could show him this photo if he was worried about a test or bad grade and it might calm him down.

jellyfish to !p*QS,AL-O"I9, Josh used his photo of the "ME" explain how a friend could show it to him to calm him down.

This moves the methodology of photo-elicitation beyond the notions of photos-as-representations and sources of elicitation 'Instead", he showed the agency of the image-that images do things. Jean (Ilunleth 2019) has written about how children do things with imagesthey create as part of research projects,ra based on D.W. Winnicott's suggestion that play creates a transitional space of creativity and communication, and that image ) creation and circulation between people can serve as a form of play.rs What children do with images during a projectsuch as showing their uses or giftingte-should not be diminished or viewed as outside of data collection. This is true also of adult participants in image-based projects, and such using and gifting offers critical insight into relationality.

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to children,s stories,

opinions, and imaginings of health and care.

In PHRAME, we are interviewing children ages g 14 on their perspectives of health and care in the rural Midwest. These interviews are happening in the midst of the ongoing COVID-l9 pandemic, so we are carrying out the project virtually. We are using methods like

il Hunleth. "Zambianchildren's imaginal caring: on fantasy, play, and anticipation in an epidemic."

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D. W. Winnicott, Playing and. Reality. (Routledge 2005).

Originaly published 1971. l6Hunleth. "Beyond on or with: Questioning Power Dynamics and Knowledge Production in'Child-Oriented' Research Methodolory."

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Thank you for going on that playful journey with us!

We hope you had fun and learned a lot about

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Lead to new types of data, or texts And I'm Sienna!

Offer an approach to listening to children rooted in context '' Provide new or of children's lives

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I do work on health geographY, and I'11be the one taking

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you do need to know that children's opinions

matter. Take that into mind.

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We will be making future zines based on this project!

They will focus on rurality, health, and care as they are understood. by children. If you are interested in learning more, go to issuu.com/hunlethlab or check https://hunleth.wustl.edu/ for more updates. .Lq

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We'would like to thank all of the PHRAME participants and their families, without whom this work would not be possible.l C hickenr

Sienna Ruiz is a research coordinator at Washington

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University in St. Iouis. She has a BA in anthropolory

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playing with her cats, and reading Lord of the Rings-

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Jean Hunletb, PhD, MPH is an associate professor at

Washington University in St. Louis, and the author of the book Children as Caregivers: The Global Fieht agaiirst Tuberculosis and HtV in Zambia (you can read the book for free at: https://library.oapen.org/handle 120.50O.L2657/3 1490).

She is a life-long learner of play and, currently, her 6 year old is teaching her how to be Ghost Spider and beating her at Beyblad.e. You can find out *"*41? at https://hunleth. wustl- edu/.

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l All the children who participated are de-identified pseudonyms of their choice.

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Eric Wiedenman, PhD, MPH is a postdoc at Washington University in St. Louis- He absolutely loves penguins, his two dogs Jack and.Ziggy, and has recently gotten into bonsai. More information (and future bonsai photos!) can be found at emwiedenman.com.

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Text by Sienna Ruiz, Eric Wiedenman, Jean Hunleth. Layout and zine design by Dionisia Ruiz.

Intenriews with participants were conducted by Sienna Ruiz, Eric Wiedenman. Other contributors include Hannah Fechtel, Laurel Schmidt, Angeline Gacad, Katherine Sleckman. Study funded by National Cancer Institute (P50 CA244451) - PI: Hunleth and National Cancer Institute Training Grant G32 CA190194) - co-I: Wiedenman.

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PLAYAS AMODE OF RESEARCH

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e USING PLAY TO EXAMINE RURAL CHILDREN'S PERSPECTIVES ON HEALTH AND CARE

I Sienna Ruiz,

Eric Wiedenman, Jean Hunleth