Food and eating habits in the Cuncani community (Photo Journals for PhotoVoice Research)

Photovoice Research Food and Eating Habits in the Cuncani Community

Abstract

Photovoice is an innovative participatory action research methodology where individuals use photography to identify and address their social issues in their community. The objective of this study was to document and uncover the reality of the food environments and eating habits of children in small isolated communities of the Peruvian Andes. Data was collected from eight students in sixth grade of the local school. The results showed that the majority of meals consisted of accessible local crops such as potatoes and meat from sheep, suggesting a lack of variety of food within the community. The study also portrays the images of food and the surrounding environment to gain a deeper insight of their daily consumption in the community and its relationship to the current health condition of the community.

This study was conducted and written by Kenji Misawa of Nexos Comunitarios

Nexos Comunitarios 2018 Urubamba –Cusco Electronic Version.

Peru.

Nexos Comunitarios Š 2018

Table of Contents Abstract ............................................................................................................................. 1 Abbreviation ...................................................................................................................... 1 Glossary ............................................................................................................................. 1 Acknowledgement ............................................................................................................. 2 Nexos Comunitarios ........................................................................................................... 3 Introduction ...................................................................................................................... 4 Methodology ..................................................................................................................... 5 Context ...................................................................................................................................... 5 Procedure .................................................................................................................................. 6 Result & Finding ................................................................................................................ 8 I) Enable people to document and share their life circumstances and experiences ................ 9 Children’s Eating Habits ................................................................................................................ 9 Reality of food environment in the community .......................................................................... 10 II) Facilitate public dialogue and knowledge of communities’ social issues. .......................... 11 Lack of Food Variety .................................................................................................................... 11 Limited Food Access .................................................................................................................... 14 Conclusion ....................................................................................................................... 15 Lessons learned .............................................................................. ¡Error! Marcador no definido.

What’s Next? ........................................................................................................................... 16 Bibliography .................................................................................................................... 17

Abbreviations

NC Nexos Comunitarios NGO Non-profit Governmental Organization PAR Participatory Action Research

Glossary Community Development The process of community members coming together to take collective action and generate positive social impact for the community or to generate solutions for common problems.

Data Information gained through the research process. In Photovoice, data refers to all the available information extracted from the physical photos and words describing their photos.

Photo Journals Hand-made paper booklets created by the participants of Photovoice containing photos of their daily food. The objective of the journal is to illustrate their eating habits through the captured photos.

Human Development The process of enlarging people’s freedoms and opportunities and of improving their wellbeing.

Free Prior Informed Consent A standard to protect indigenous rights to self-determination and right to participate.

Agreement to do something based on having all the knowledge and information of the potential risks and benefits.

Marginalized Group Group of individuals that are excluded from society and have limited access to resources and participation to decision-making processes and systems.

Participatory Action Research A collaborative research method, which entails the collective, self inquiry effort of the participants to identify their existing social issues with a scope to increase their control over their lives and improve overall social condition.

Photovoice 1 Nexos Comunitarios Š 2018

PAR method that involves photography and dialogue as a means for the marginalized group of people to deepen their understanding of their community issues and concerns.

Acknowledgement

The creation of photo journals in 2017 is the notable accomplishment of the Photovoice methodology adopted by NC. To reach this point, we have gone through many challenges, where we gained valuable experience and sufficient adaptation skills. Without our continuous commitment and effort in the past, this Photovoice report would not have been possible. Therefore, NC would like to recognize all the members of our staff, former interns, and volunteers who have contributed to the development of Photovoice up until now.

All the student participants from the local school of Cuncani earned our deepest appreciation for their active participation and engagement in Photovoice. We would also like to give an immense thank you to all the parents of participants and the local school of Cuncani for their support and understanding. It is our hope to continue developing Photovoice methodology in aims to collectively enhance the community’s social conditions in the future.

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Nexos Comunitarios1

Nexos Comunitarios (NC) is a Peruvian non-profit civil association, formed by a group of citizens and professionals committed to reducing poverty in isolated communities within Peru. In addition, NC promotes a better understanding and true respect between different societies and cultures, nationally and internationally.

Since 2013, NC has been working with the Andean community, Cuncani2, promoting community development following NC’s development model focused on health, education and economic empowerment. Recognizing Cuncani’s hardships, one of which is malnutrition, NC has been overseeing and implementing a series of projects with an aim to improve the nutrition of the children residents. Insufficient nutrients can hinder the children from proper development, acquisition of new skills and/or opportunities for future growth.

As an extension to our health improvement projects such as the school Lunch Program and Sustainable Homes Project, NC has adopted the Photovoice approach to search for new knowledge and information to solve malnutrition in the community. The Photovoice tool allows us to obtain better understanding of their daily food through the eyes of children, while empowering the rights of children’s freedom of expression.

NC has been keeps its commitment to combat poverty in the marginalized societies within the country.

1 2

Visit http://www.nexos.org.pe/.

Visit https://vimeo.com/169644249

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Introduction

Child health conditions are directly linked to their diet and food environment. Especially, in marginalized communities like Cuncani, where malnutrition has been a major problem, gathering data with regards to food is crucial. Nonetheless, acquiring information surrounding eating habits is often difficult. Confronting this challenge, NC has applied the Photovoice method with the aim to gather this key information from the hands of children.

This innovative PAR method has appealed to children’s interest and has successfully engaged the participants to share their perspectives about food environment and eating habits.

Eight students in grade six from the local Cuncani school have participated in this Photovoice method. The research is designed for the students to capture their daily food with a camera and to create their own unique photo journal. With thorough training and workshop sessions, participants have completed their food journals and have expressed their voice through their photos.

This paper analyzes data from two angles to fulfill its objective of information gathering. It first assesses data collected from the interviews with students and from the stories behind their captured photos. It provides first hand genuine perspectives of their food through the eyes of children. Furthermore, this study also provides a quantitative data analysis of all the photos taken by the participants. It helps to gain a clearer picture of their food environment in the community.

Integrated data analysis revealed the major patterns of food consumption at the household level. The most commonly consumed ingredients were potatoes, rice and meat. It concluded that the community lacked sufficient access to a wider variety of food, especially fruit and vegetables in the house. Ultimately, the result allowed NC to develop a new lunch program to combat malnutrition.

Overall, the observation of this research has shown Photovoice as an effective research method to gather valuable insight with regards to their daily diet. At the same time, it can be used to help inform future research with children to gain a better understanding about the food environment and eating habits. We are enthusiastic about our Photovoice approach in Cuncani, and want to share our discoveries to inform and spark interest in community-based research to others and open the gateway for the community to recognize the challenge and translate this into action.

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Methodology

Photovoice is a ground-breaking approach of Participatory Action Research (PAR) methodology that allows the researched person to convey their real-life experience of the community with the use of photos. Photojournalism is adopted to develop further research on the specific social issues of marginalized groups from the community. This design is specifically drawn from Wang and Burris’ pioneering work of using photography in PAR.3 There are three goals of Photovoice: 1) Enable people to document and share their life circumstances and experiences 2) Facilitate public dialogue and knowledge of communities’ social issues 3) Share information with community and reach key-policy makers to bring social change.

THREE GOALS

II

III

Share information with community and reach key-policy makers to bring social change

Facilitate public dialogue and knowledge of communities’ social issues

I

Enable people to document and share their life circumstances and experiences

The purpose of Photovoice is to allow participants to determine the social issues in their environment through expression of photography and convert into social action.

Context

The beauty of Photovoice is its wide range of adaptability. It provides plenty of room for flexibility. Based on its framework, the methodology and focus can vary depending on each setting and purpose of research. Despite the differences, every Photovoice project shares the impactful similarity of revealing realities and empowering marginalized individuals.4 3

Wang, C., and Burris, M. (1997). Photovoice: Concept, methodology, and use of participatory needs assessment. Health Education and Behavior, 24(3), 369-387.

4 Palibroda, B., Krieg, B., Murdock, L., and Havelock, J. (2009). A practical guide to Photovoice: sharing pictures, telling stories and changing communities. Retrieved from

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In the case of Cuncani, NC designed Photovoice to target the health issue of the community.

Cuncani is a small village located in the middle of the remote Andeans region with a high altitude of approximately 4000 meters above the sea level. Although the community preserves a unique traditional way of living, its segregated location limits them from receiving adequate government aid and access to essential infrastructures in their village, such as a market or health clinic. Due to their life circumstances, malnutrition amongst children have been a persistent issue in the community.

NC has paid special attention to use Photovoice as a method to gain better understanding of daily eating habits through the eyes of children, which may contribute to discover clues related to current health status of the community. While it allowed the children to freely express their voice using cameras, and support their self-development, it tackles the persistent social challenge of malnutrition in the community.

One significant advantage of using Photovoice in Cuncani is that, unlike other traditional research methodology, where interviews and surveys were commonly used, the Photovoice methodology allows NC to obtain results while respecting the community’s engagement and freedom of expression. The outcome is much more meaningful as it exhibits physical images of the meals served in their homes. It overcomes the limitation of traditional research methodologies where the representative of the household may provide faulty information.

In addition, the design of Photovoice constructs a horizontal relationship between the facilitator and the participants, and introduction of cameras sparks children’s interest and enjoyment in photography. Photovoice’s embedded focus on empowerment, innovative design and social inclusion has greatly appealed to NC as an excellent research methodology for ongoing community development.

Procedure

NC has applied Photovoice approach with eight students in grade 6. Learning from the previous experience, we decided on an age group who have shown a sufficient comprehensive skill to understand the purpose of the methodology, and ability to properly use cameras. After much planning, adjusting, and coordination with the local school the project was carried out from October to December of 2017. Prior to implementation, students and parents were provided a free prior informed consent to participate in Photovoice. Simple language was used to ensure that they fully understood the purpose of the methodology and its expected outcome. Children and their parents were informed that their participation was on a voluntary base and they were given the option to withdraw from the project at any time if ever they wished. With our purpose to protect individual’s privacy, all participants remained anonymous in the final report.

http://www.pwhce.ca/Photovoice/pdf/Photovoice_Manual.pdf

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The research assignment for each participant was to create their own Photo Journal as a final product to demonstrate their eating habits in the community based on the photos of food that they took. Photo journal exhibits the images of food each participant took, conveying to the reader what type of food they eat on a regular basis. The workshops took place regularly on Monday when facilitators visited the community to monitor and supervise the process. All the required resources to make food journals such as four digital cameras, color papers, and printed copies of captured photos were prepared in Urubamba where NC’s office is based.

The first step of the project was to provide sufficient training to equip the children to become comfortable in using cameras and to create their own food journals. Creating a safe and engaging environment with children in the training session was essential to successfully adopting the Photovoice approach. Most participants demonstrated a genuine curiosity to use cameras. After the session, children were given the camera to take pictures of food for an assigned week.

As there were only four functional cameras, participants took turns to use the cameras.

Once all the participants had taken photos, the facilitator printed all the photos and handed them to each student. As each student created their photo journal, the facilitator then asked questions and led conversations with the participants to express their thoughts and insight regarding their photos.

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Results & Findings Following the three goals of Photovoice, we collected data and identified results according to each category. Informal conversations between facilitator and participants and quantitative analysis of captured photos by the children were both applied in the process of determining and examining the result.

I) Enable people to document and share life circumstances and experience Creation of photo journals have led the participants to share and demonstrate their day to day eating habits in the families. Also, stories behind the photos taken have opened up the conversation of revealing the reality of food environment in the small Andean community.

II) Facilitate public dialogue and knowledge of communities’ social issues Discussion around the daily food consumption has naturally evolved into the conversation of revisiting the problem food security. Here, participants have associated their current eating habits with the problem of lack of food variety and limited food access in the community.

III) Share information with community and reach key-policy makers to bring social change The result of the Photovoice is still in the process of reaching the key-policy makers in the community. Nonetheless, it has reemphasized the importance of the daily intake of the children and the led our organization to step up once again our launch of the school lunch program as a key combatant of malnutrition among children of Cuncani.

Share information with community and reach key-policy makers to bring social change

III II I

•

New Lunch Program

Facilitate public dialogue and knowledge of communities’ social issues

• Lack of Food variety • Limited Food Access

Enable people to document and share their life circumstances and experiences

•

• Children’s Eating Habits Reality of Food Environment in the Community

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I)

Enable people to document and share their life circumstances and experiences

Children’s Eating Habits

The result of photo journals shed light on highlighting traditional dietary habits in the community. This TABLE I illustrates one of the participant’s meals for the week described in the food journal. This food journal of a participant gives us a great deal of detail of the eating habits during the week.

TABLE I

Mon

Tue

Wed

Thu

Fri

Sat

Sun

Breakfast

Tea

Soup

Tea

Tea

Tea

Tea

Lunch

Tea

Tea

Soup Rice

Tea Quinoa Potato Tomato Onion

Meat Potato

Egg Rice Pasta

Dinner

Pasta Potato Egg

Soup Potato Pasta

Soup Rice Potato Tomato

Rice Meat

Soup Rice Pasta

Soup Pasta Potato Cheese Corn Celery Soup Tomato Potato

Soup Potato

FIGURE III

Overall, photos taken by the children demonstrate distinct similarities in their daily meals. In the morning, most of the children had bread, corn, potatoes and fruit with milk tea (See FIGURE III). Because potatoes are the dominant crop grown in the community, it was served in almost every meal. Aside from the potatoes, rice and pasta were often consumed for lunch and dinner. The different kind of meats were also prepared for dinner, including 9 Nexos Comunitarios © 2018

chicken, alpaca, llama and lamb meat. According to the children, the most common meats consumed were lamb and llama, while pigs and guinea pigs are said to be also consumed but are mostly reserved for special occasions. In general, food is most often served in the form of a soup or stew. It is often made with vegetables, (potatoes, carrots, green peas, onion etc.) and meat (chicken, llama, sheep were most common). At the same time, it is worth mentioning that the participant has only consumed tea for lunch on Monday and Tuesday.

Reality of food environment in the community

The benefit of Photovoice is that the perspective of children offers us valuable insight to illustrate the reality of food options in the community. For example, the following photos represent guinea pig culture in Cuncani.

FIGURE IV

FIGURE IV tells the relations between the Andean culture and guinea pigs. In Cuncani, people treats guinea pig as a valuable food source. The student who has taken this photo explains…

These are guinea pigs that we raise in our house. I don’t remember how many there are but there are many guinea pigs. There are eating pastures. I eat guinea pigs on my birthday, or my family’s birthday. I really like it. It is very delicious!

Guinea pigs are considered a feast in Inca’s culture, and are only meant to be served in ceremonial occasions. Interviews with the students revealed that almost every family in the community owns their guinea pigs in their house and it is often shared between community members in the special cases of birthdays, local celebrations or weddings.

Another story from the participants has given more information about potato harvesting.

Through the photo, he explains…

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FIGURE V

I am helping my father cultivate our land. This is for the potato harvest. We dig holes in the land and plant potato seeds afterwards. We always do it in this season (November) and harvest potatoes next year. After harvesting potatoes, we eat or sell them at the market. In fact, we eat potatoes every day. Also, this photo was taken by my little sister (6 years-old).

Potato cultivation in the Andes culture has been inherited from the period of the Inkas. This story provides more insight in their real-life experience and how food is collected in their community. According to the local families, there are almost 100 different varieties of potatoes harvested in their community. Land cultivation and planting season is from September to November. Harvested potatoes are eaten throughout the year, serving as a staple food item for families in Cuncani.

These are not photos of food that they eat but rather they tell a story of their relationship with the food environment. Through voicing their views and reflecting their lifestyle, Photovoice successfully provides participants with space to revisit their life experience.

II)

Facilitate public dialogue and knowledge of communities’ social issues.

Lack of Food Variety

One of most outstanding findings from our quantitative data analysis is a limited variety of ingredients shown in their pictures. Among 105 photos of food (TABLE II), we could only identify 16 different ingredients (TABLE III & GRAPH I).

It is worth noting this conclusion regarding ingredients is based on the captured photos, descriptions and explanations given by the participants. Other ingredients may be used in food preparation. It should also be said that one limitations of using Photovoice is relying on 11 Nexos Comunitarios Š 2018

personal judgement, which may interfere with the perception of the reality of people’s lives.

Nonetheless, even though it does not promise a perfect indication about their life, it still provides some useful insight reflecting their reality of eating habits. Therefore, the indicated information suggests a significantly limited variety of food in the community (considering eight students have taken photos for a week).

The outcome of variety in the community give implications to the existence of malnutrition in the community.

TABLE II5

A

B

C

D

E

F

G

H

Total

Pictures taken Pictures of food Pictures selected for food journals

44 10 19

32 23 1

31 13 16

31 13 16

47 9 11

66 7 6

49 7 0

96 23 18

396 105 87

E 2 2 2 1 0 3 0 0 1 4 0 0 0 0 0 0

F 1 2 2 3 0 2 2 0 3 0 0 1 0 0 0 0

G 1 3 3 1 1 0 1 1 1 0 0 0 0 0 0 0

H 4 6 2 4 0 2 4 0 2 3 0 0 0 0 1 0

Total 32 30 29 27 26 25 13 12 11 7 6 4 4 3 2 1

Ingredients Potatoes Tea Carrots Rice Soup Meat Pasta Green vegetable Egg Fruit Tomato Lentils Onion Corn Bread Cheese

TABLE III6 A 6 5 3 6 5 3 2 2 0 0 0 2 0 2 0 1

B 0 1 2 4 2 5 2 2 3 0 5 0 3 1 0 0

C 12 7 8 6 10 4 0 3 1 0 1 1 1 0 0 0

D 6 4 7 2 8 6 2 4 0 0 0 0 0 0 1 0

GRAPH I7

5

The eight participants have taken in total of 396 photos. Amongst total photos, 105 have shown the picture of food. Besides the pictures of food, students have taken pictures of their community, friends, animals and other things that have interested them (TABLE I) 6 TABLE II categorize the frequency of food appears on the photos. This data is solely based on the interviews (description and explanation of their meals) by the participants and our observation. We must take in to account that there are non-mentioned ingredients that cannot be seen through photos. Although it may be not reflecting the true reality of the frequency of food consumed by the participants, it provides the meaningful insight to their reality.

7 Visualized graph of TABLE II

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INGREDIENTS FREQUENCY 35 30 25 20 15 10 5 0

H G F E D C

As the data shows, there is a limited variety of food ingredients observed. For example, Figure I (below) is a photo of one of the participant’s favorite meal. She mentioned that among all meals, her favorite was definitively the rice and meat soup.

FIGURE I

This is a soup made of potatoes, rice meat, and vegetables. The potatoes are from our land. Also, the meat is from the sheep that we raise. I’ve taken this photo at home. This was the dinner. It tastes delicious.

When the facilitator asked where the ingredients come from, the participant replied…

Potatoes are from our land, and the meat is also from our sheep. But the rice and vegetables are bought from Lares (a neighboring village about an hour away by walk). We usually buy most of the stuff from Lares because we cannot grow them here (Cuncani).

Lack of variety of food is also shown in the other photo taken by different participant.

Sometimes the food can be very plain with just rice and meat.

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FIGURE II

This is rice and sheep meat. I made it at my house.

The story told by the child who took this photo was very short and brief, only describing what the food is and where she made it. Nonetheless, it shows that there are no vegetables in her meal. Indeed, amongst all the food photos she took, there were only two pictures with vegetables in her meal.

Limited Food Access

Limited access to food may derive from its difficult geographical conditions. Agriculture is a dominant activity among the many families in Cuncani. Each household cultivates their land and harvest crops. However, due to the high altitude and extreme weather, opportunities for variety in agriculture is significantly inhibited and is mostly limited to potatoes and some herbs. Also, despite the frequency of carrot appearances in the photos were relatively high, the proportion of carrot in each dish is very low.

Above photos of fruits lead the conversation to think about the community’s problem of access to food. As described in the previous story of one participant, the majority of vegetables and fruit are only accessible from Lares. The cold weather and altitude do not 14 Nexos Comunitarios Š 2018

allow families in the community to harvest fruit in the region. Fruit is just an example of several food items not found in the community.

I like fruits. We buy fruits from Lares every Monday on the market days. My mom always go to the market and buy all the food for week.

Combining the result of family interview in 20158, the stories behind the food journals crystalize the social difficulties of the families with access to the market.

As a result, there are two major obstacles: limited harvest and market access. Its high altitude and its weather significantly limits their harvest to only potatoes and some herbs.

Meanwhile, its extraordinary condition in the high land and isolated geography lessen the opportunities to market access.

III)

Share information with community and reach key-policy makers to bring social change

New Lunch Program The result of the research provided NC with deeper understanding and insight towards the community’s current food environment and circumstances. Combined problem of access to food and limited market can be tied to a lack of nutritious food among children and lead to more cases of malnutrition.

Responding to the malnutrition problem, Photovoice analysis served as one of the reasons for NC to relaunch our previous school lunch program under the umbrella of new health promotion POWER Lunch program. To this day, we are successfully carrying out POWER Lunch which is expanded to a lunch program (serving 5 healthy meals during school days throughout the year), a health education program (monthly workshops in relation with important health issues), and using Photovoice as a tool to monitor and evaluate the project.

Conclusion

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What’s Next?

The new lunch program is just the starting phase of Photovoice in realizing social change in the community. Although it has yet to reach other key-stakeholders (such as the parent’s association, the community directory board, and the municipal government) within the community social dynamics, we recognize great possibility to further develop a Photovoice methodology to enlarge the positive social impact for the community.

Our next plan is to continue with our effort to use Photovoice in our POWER Lunch Program.

The purpose of the study is to replicate the previous goal and reveal the issues surrounding their eating habits and food environment. This time, not only limited to their eating at their house, we aim to capture community’s voice/perspectives towards our lunch program.

Searching the questions of “how do children perceive the program?” will not only undercover the food environment but also serve as vital monitoring and evaluation tool for our program.

Furthermore, we hope to extend Photovoice design to include parents’ voices as well. The lunch program is supported by three groups: NC, the local school and the parent’s association. NC organizes the lunch ingredients for the entire school year and the local school is responsible for properly storing the allocation of food ingredients. The parents take the role of visiting school to prepare lunch and provide to student during school days.

As parents take part in the program, there is an increase in stakeholders involved in the project.

We have learned that the Photovoice approach requires substantial time and effort, especially in a community such as Cuncani where communication is limited and culture is distinct from ours. We have faced a series of challenges to reach where we are now. While we are genuinely content with Photovoice, there are much more details to be sorted.. For example, we have yet to determine the best possible method of food storage and timely meal preparation. Discovering the entire food chain will provide further clues to holistically identifying root causes of malnutrition.

The Photovoice has proven to be an innovative and useful tool in planting the seed for the social change with sincere respect for the community involvement. We hope to see that the power of Photovoice permits community members to possess further authority to advocate for a better food environment and combat malnutrition in the future. NC looks forward to sharing our experience and knowledge to others who may be interested in communitybased research projects that further empower marginalized group of people.

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Bibliography

Nexos Comunitarios. Accessed June 04, 2018. http://www.nexos.org.pe/.

Wang, C. C., & Burris, M. (1997). Photovoice: Concept, methodology, and use of participatory needs assessment. Health Education and Behavior, 24, 369-387.

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