Item 3 - Community Health Improvement Project (CHIP) Proposal — original pdf

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Community Health Improvement Project (CHIP) Proposal: Understanding the Needs of Older Adults in Austin, TX through a Community-Engaged, Participatory Lens by Implementing a Photovoice Methodology Presented To: City of Austin, Commission on Aging City of Austin, Asian American Quality of Life Advisory Commission Proposal Prepared by: Nirali Thakkar, MSSW-MPH Candidate Culture &Arts Activity Specialist, Asian American Resource Center Under the Guidance of: Van Doan, Culture & Arts Education Coordinator, Asian American Resource Center Tony Vo, Culture & Arts Education Manager, Asian American Resource Center Rafael Samper-Ternent, Associate Professor, UTHealth Science Center School of Public Health Table of Contents Executive Summary The Growing Portion of Older Adults Imagining an Age-Friendly City Gaps in Bringing Diverse Perspectives to the Age-Friendly Austin Survey What is Photovoice, and How Can it Address the Engagement Gap? Photovoice at the Asian American Resource Center Integrating Intergenerational Voices Bringing Together Participant Photos Why Replicate this Project? Final Thoughts Appendices References Adapting and Replicating the Project: A Step-by-Step Guide and Helpful Practices 14 2 3 3 3 4 5 6 12 13 14 17 18 25 3 Executive Summary This community health improvement project (CHIP) proposal identifies a need for public health professionals and city staff to implement unique engagement methods to include older adults in the planning and development of age-friendly cities in alignment with the World Health Organization’s (WHO) framework. This need is especially prevalent in Austin, TX, where older adults represent the fastest-growing population group. Photovoice is a method that encourages participants to take photos that display their experiences, perspectives, and needs on a specific topic. This method has been used successfully with older adults in different settings. The Asian American Resource Center, a city-funded pan-ethnic center in Northeast Austin, implemented a photovoice project and an intergenerational session between February- March of 2024 with a cohort of 14 participants. The organization’s project serves as an example of successful community engagement for the City of Austin to adapt and replicate at its centers to best understand the needs of older adults. This proposal uses the terms older adults and senior programming participants interchangeably—with senior programming participants aligning with language used within the City of Austin. The Growing Portion of Older Adults Older adults aged 65 and older represent a large and growing proportion of the U.S. population. The U.S. Census Bureau predicts that from 2034 onwards, there will be 83.7 million older adults in the US, outnumbering minors. 1 This trend extends locally—The City of Austin’s most recent Census report found that although 25–34-year-olds remain the majority age group, older adults are the fastest growing. These changes are disproportionate across Austin city limits. West Austin is experiencing an influx of older adults and East Austin is experiencing a decrease in Black and Hispanic/Latino older adults who are native to that community. 2 The city, in response to these trends, is prioritizing aging and equity. Imagining an Age-Friendly City A majority of older adults prefer to independently age in their own homes. 3 To honor these preferences, the American Association of Retired Persons (AARP) and the World Health Organization (WHO) created a framework for age-friendly cities and communities. This framework helps guide the creation of friendly environments at local, state, and national levels. A total of 8 domains makes up this framework: outdoor spaces and buildings, transportation, housing, social participation, respect and social inclusion, civic participation and employment, communication and information, and community support and health services. Austin, TX is part of the AARP’s Network of Age-Friendly States and Communities. The City’s Commission on Aging created a strategic plan for this framework in 2016. 4 Since then, the Commission has given yearly budget recommendations to council members across the 8 domains. 4 Image Credit: Area Agency on Aging, Southeastern Minnesota Gaps in Bringing Diverse Perspectives to the Age-Friendly Austin Survey Older adults in Austin face challenges in accessing health care services and transportation, 9 two of the eight age-friendly domains. Thus, the City of Austin has set community engagement and cultural relevance as two key methods to reduce health disparities. 9 This is especially true for working with older adults. The Commission on Aging conducted an Age-Friendly Austin Community Feedback Survey as one community engagement tool. They made the survey available in Spanish, Chinese, and Vietnamese to help bring cultural diversity to their outreach. The survey closed on February 10th, 2023, and received 527 responses. Despite the multiple languages, most respondents identified as white (78%). 15 In addition, the zip codes with the highest number of responses were neighbors to the wealthiest zip codes in Austin. Many were to the west of I-35, reinforcing an equity gap on the east side of the highway (See Appendix B). A new survey was redistributed and closed in February of 2024. Austin Public Health staff reported preliminary results in the March Commission on Aging meeting: 17 1. The survey received 409 responses total. 2. A majority of respondents identified as white (76.8%). 3. Respondents predominantly resided in Districts 5, 9, and 10. 4. The zip codes with the highest number of responses were 78745, 78759, 78723, 78749, 78704. 5 Compared to the 2023 survey, the number of respondents decreased by 22.4%. In addition, the number of respondents remained predominantly white and the highest responding zip codes remained the same as 2023. During the commission meeting, Austin Public Health staff reflected on “need a more diverse engagement strategy” and many City of Austin centers expressing that seniors were “surveyed out”. 17 While survey engagement yielded meaningful feedback for the Commission on Aging and Age-Friendly Austin, there remains a gap in bringing unique, diverse voices into engagement. What is Photovoice, and How Can it Address the Engagement Gap? Photovoice is a form of qualitative research rooted in a community-based participatory approach. Rather than participate in surveys, focus groups, or interviews that rely on written or verbal data, individuals are prompted to take photographs that answer the research questions. They can document each photo’s time, location, and personal meaning in a language that is most comfortable to them. This method, which can help fill a gap in survey engagement, can fulfill three purposes: 6 1. To enable people to record and reflect on strengths and concerns, 2. To promote dialogue and enhance knowledge about important issues through group 3. To produce a visual aid that can be shared with policy makers that reflects the voice of discussions of photographs, and the community. A literature review that analyzed 39 different photovoice studies with older adults (See Appendix A). These projects took place in the US and countries such as China and England, to name a few. To view the full-text articles included in the literature review, visit bit.ly/photovoicematerials. This review identified several benefits to this approach, especially in mediating the barriers to engaging with older adults, listed below: 1. Participants are prompted to share their lived experiences without the time commitment 2. or potential language barriers a survey has. Participating in photovoice does not require a high level of literacy or education. 7 Participants can complete the project in a language that is most comfortable to them compared to a translated survey. 3. Photovoice can be completed using participants’ cameras and does not require a high level of financial resources (for example, interviews or focus groups can be completed virtually). This allows for organizations to implement this approach successfully. Finally, photovoice is a process-oriented methodology. It initiates experiences that a survey can overlook: 1. Photovoice methodology encourages sharing lived experiences and can provide more depth to feedback to decision-makers than a survey tool, especially if it is anonymous. 8 2. Participants of a photovoice project that uses focus groups can also feel a sense of connectivity with one another. 6 3. Photovoice shares narratives and encourages storytelling as valuable data, which a survey may not provide space for or facilitate. 4. Given that photovoice projects use photos with time, location, and date stamps, it can provide useful and specific information for immediate changes needed within a community. a. For example, the Age-Friendly Austin survey asked participants, “Do you face any of the following barriers in accessing parks or recreation opportunities near your residence?”, and included safety concerns (such as limited lighting, uneven sidewalks, illicit behavior) as one barrier. While this provides useful information, in a photovoice project, an individual could take a picture of the exact location where a sidewalk is uneven, documenting an immediate need and providing effective feedback on where city resources can address this age-friendly issue. b. The photos can be combined with additional research methods to increase the impact. Multiple photos of safety issues could be mapped using GIS (Geographic Information Systems) technology to show the exact locations and areas with the highest need. 5. Exhibits from a photovoice project can travel to organizations and be shared externally. Thus, the engagement gap in survey methodology can be mediated by implementing photovoice projects across senior-serving centers in Austin. These centers serve a diverse set of older adults and provide services in the age-friendly framework, such as transportation and health care services. Partnering with senior centers as sites for community engagement can help bring more diverse perspectives to inform age-friendliness planning at the City of Austin. Photovoice at the Asian American Resource Center: The Asian American Resource Center (AARC) is a city-funded, pan-ethnic space housed in Northeast Austin. The center hosts educational programming across the lifespan, artist exhibits, and family events. In addition, AARC hosts a senior program from 10-1 PM every Monday-Thursday. In February and March of 2024, the AARC completed a photovoice project with its senior programming participants. Their process can serve as an example for other senior-serving centers to adapt and replicate with their cohort of older adults. The following portion of this proposal describes the photovoice project conducted with senior programming participants at the Asian American Resource Center (AARC). This project was culturally tailored to predominantly Asian/Asian American participants. It brought together a cohort of 14 senior programming participants and incorporated one intergenerational engagement session with young adults and working professionals. Each subsection features a summary of helpful tips that can also be found in “Adapting and Replicating the Project: A Step-by-Step Guide and Helpful Practices”. Engagement Focus: Respect and Social Inclusion Domain Respect and social inclusion are an unexplored domain of the age-friendly framework. Only one photovoice study has explored it with older adults. 13 However, this study took place in England 7 with a racially homogeneous demographic (white). Thus, the current literature has a gap: how cultural and ethnic identity factor into respect and social inclusion. Asian American Pacific Islander (AAPI) communities often interact in multigenerational families and communities. 16 In addition, given that the AARC’s photovoice project included an intergenerational engagement portion, respect and social is a valuable domain that can be explored across generations, Replications of this project can be adapted to domains that are relevant for participants or empower participants to vote on the domain they would like to explore. The World Health Organization (WHO) defines respect and social inclusion as: 12 Respect Social Inclusion “...negative preconceptions of aging still exist. There is a need to facilitate intergenerational interactions to dispel such notions. Education about aging should also begin early to raise awareness on aging and associated issues, so that people learn to appreciate their elderly.” “Social engagement can contribute to seniors’ esteem. Age-friendly initiatives to involve all seniors in activities where they have experience can keep them engaged with the community, and help them feel valued in their community...” Recruitment. This project used a purposive sample and recruited all participants from the AARC given that the participants had familiarity with one another and the staff. The final cohort totaled 14 seniors. One couple elected to complete the project as a unit. Flyers were made available in English and Mandarin Chinese (See Appendix C). In addition, one Korean staff member at the AARC completed outreach to seniors who felt most comfortable speaking in Korean. To encourage participation from a diverse group of seniors in this sample, recruitment emphasized seniors that met any of the following criteria: 1. Limited English Proficiency 2. Living alone or with a partner/spouse 3. 4. Asian American and Pacific Islander (AAPI) or another ethnic minority Immigrant to the US Helpful tips during recruitment: 1. Mobilize a staff member with an existing rapport with participants to recruit and 2. Allow ample time for translation of materials to facilitate intentional and inclusive facilitate the photovoice project. engagement. 3. Create a list of potential participants to reach out individually to. 4. When selecting a domain of the age-friendly framework, collaborate with center staff to identify one that will be relevant to participants, or provide them the autonomy to vote and choose themselves. 8 Data Collection. The cohort of seniors met weekly for one-hour sessions from February 8th- March 14th. These sessions took place during the lunch hour within the senior programming calendar to ensure participants could participate in their wellness and skills classes without committing additional time to do the project. The AARC selected to run the project in group sessions given that participants were already familiar with one another. The project aimed to bring this cohort together in a new setting and promote a sense of deeper understanding of one another. Before the project began, the AARC developed objectives and Canva presentations for each week’s session that were modified as needed weekly. Organizations replicating the photovoice project can use the same example below after adapting to their participants’ needs and timeline. Helpful tips during data collection: 1. Organize sessions during programming hours to ensure additional time or transportation commitment is not required. 2. Provide an example photovoice project to participants before they begin their own. 3. Teach participants new skills and facilitate connection among them. 4. Share slide handouts each week. 5. Discuss the project timeline and progress each session. 6. Facilitate autonomy for participants, such as voting on the timeline. 7. Create a meaningful exhibit for the community within the organization’s budget and obtain participant photo waivers. The next section outlines each objective and its duration. This proposal uses session and week interchangeably. See Appendix F for key dates. Objective 1: Introduction to Photovoice. This objective took 1 session. In this session, participants: 1. Met one another, familiarized themselves with the photovoice method and 8 domains of age-friendly cities, and learned about the AARC’s project. 2. Obtained resources, specifically education about ethical photography for the project. Participants clarified what constitutes a public space versus needing to ask for permission to take a photo. All participants had a phone camera—organizations replicating the project may need to provide this resource to some participants. 3. Decided on a forum of communication, if needed, for the duration of the project (ex: WhatsApp, Gmail, text chain). Participants received reminders for the sessions in person during programming hours and could send their photos in through this forum. 4. Obtained a practice prompt, “What are your favorite things to do in Austin outdoors?” This question relates to the Outdoor Spaces and Buildings domain of the age-friendly framework. Participants were encouraged to take one photo of something they enjoy doing outdoors and document the photo’s time, location, and brief description. This practice prompt helped the participants gain familiarity with the photovoice method and build confidence in their photo documenting skills. 9 Objective 2: Sharing Practice Photos and Preparing for Photovoice (1 week). This objective took 1 session to complete. In this session, participants: 1. Learned about Airdrop ™, a technology that allows two iPhone users to share photos and other files instantly. Participants with an iPhone ™ (10 of the 14) learned how to use this technology to share their photovoice pictures. The remaining participants were provided with a phone number or email they could send their pictures to. 2. Shared their photo in response to “What are your favorite things to do in Austin outdoors?” with one another. 3. Transitioned to the photovoice project for respect and social inclusion and received their photo journals, which contained: prompts on respect and social inclusion, the SHARED method (see Objective 3), and reflection questions (see Objective 5). These photo journals were translated into both Korean and Mandarin for participants with Limited English Proficiency (LEP). These prompts helped provide clarity to abstract concepts like respect and social inclusion. The participants were instructed that throughout the project, they would take one photo to answer each prompt, collecting 6 photos for the project. They could answer the prompts in any order they wished. Organizations adapting the project for this age-friendly domain, or another may choose to have prompts or leave the research question broad, depending on what staff members and participants agree upon. The prompts the AARC used are as follows: Prompt 1: Where or when do you feel most connected to your culture in Austin? (Inclusion) Prompt 2: What is a misconception that you believe other generations have about your age group? A misconception is a belief that is incorrect because it is based on judgement or incorrect facts. (Respect) Prompt 3: What does loneliness look like in your world? (Inclusion) Prompt 4: What is an activity that you wish you could do (or do more of) in Austin? (Inclusion) Prompt 5: What is something you want others to know about yourself? (Respect) Prompt 6: When or where do you feel most understood/seen/valued? (Respect) 4. Finally, participants viewed an example photo for each of the prompts. The facilitator completed the photovoice project herself and shared it with participants to help them understand the wide range of photos they could take for their collection. Organizations replicating the project are highly encouraged to do the same. To view this example, visit bit.ly/photovoicematerials. Upon concluding this session, participants could vote on whether they wanted to split the photo collection period into two weeks or take all 6 photos in one week. Participants voted to split their photos, extending the total time of the project by one week. Organizations adopting and replicating the project are highly encouraged to empower participants to decide on a timeline that works best for them. 10 Objective 3: Focus Groups to Share Photos (2-3 weeks). This objective took 2.5 weeks to complete. Participants received reminders to share their photos onsite during senior programming hours. Those with an iPhone practiced their Airdrop skills by sharing the photos onsite with the facilitator. Others sent their photos in through text or email. Before the session, the facilitator compiled all photos into a Canva presentation for viewing and sharing, matching each one to the participant and prompt. As mentioned above, participants received the SHARED method 6 in their photo journals to help guide their discussion. Various photovoice studies (see Appendix D) have facilitated focus group discussions using this method for consistency. While it was not required for individuals to answer each question, the SHOWED method prompted them to think deeply and share the meaning of each photo beyond surface level. The SHOWED method is outlined below: 1. What do you SEE here? 2. What is really HAPPENING here? 3. How does this relate to OUR lives? 4. WHY does this situation, concern, or strength exist? 5. How could this image EDUCATE others (the community, policy makers, etc.)? 6. WHAT can we do about it? To view the Canva compilation of photos and each week’s presentation, visit bit.ly/photovoicematerials. Objective 4: Creating an Exhibit. This objective took about half of a session to complete. During this session, participants, 1. Learned about the exhibit plan AARC staff, including the exhibits specialist, created to showcase their project. of their photos. 2. Received photo printouts (4x6) of each of their photos and 4x6 notecards to caption each 3. Began creating their captions for each photo. Participants who completed their captions before the end of the session gave them back to the facilitator. The remaining participants took their photos and notecards home to finish and bring back for the final session. Captions contained the following information listed below. a. Prompt number b. Date/Time/Location (if applicable) c. The meaning of the photo to the participant The AARC obtained signed waivers from participants to use their photos for the exhibit and public materials. The AARC’s exhibit was shared in 2 parts and went up for display at the end of March. Part 1 was an individual photo booklet that contained all pictures and captions for each participant. Part 2 compiled participant’s photos by prompts to create 6 collages. See below for photos of the exhibit pieces. The exhibit will remain on display for the AARC’s yearly CelebrASIA festival on May 18th, 2024, in honor of AAPI Heritage Month (May). This event attracts about 1,000 attendees each year. 11 booklet. Individual photo and caption Photo collage for prompt 2. The AARC used a total budget of $93.96 to complete the photovoice exhibit, not including staffing and printing costs (completed in-house). To see a full budget breakdown, visit Appendix E. Organizations adapting and replicating the photovoice project can work within their own budget and feasibility to create a final exhibit. 12 Objective 5: Feedback and Reflection on the Photovoice Process. This objective took 1 session to complete. Participants received the reflection questions in English, Korean, and Mandarin in their photo journals. Previous research that utilized photovoice with older adults used the following questions to guide this discussion, listed below 8: 1. “What was this process of going through a photovoice project like for you?” 2. “How has this project impacted your life, if at all?” 3. “What aspects did you like about the process?” 4. “What aspects did you dislike about the process?” 5. “After doing this project, what is one thing you would want city council to know about age-friendliness?” 6. “Is there anything else you would like for us to know that we did not discuss today?” The facilitator did not audio record this session to promote authentic sharing and instead took detailed notes to capture thoughts. A few quotes from the reflection session are highlighted below: 1. “Photos transcend language. So being able to use photos to express ourselves was ideal (Participant B, M, Mixed-Race, 66 years).” 2. “We go to learn about each other’s history and share our own experiences. It was nice to meet new people and see different ideas (Participant L, M, Bangladeshi, 73 years).” 3. “We want to be able to continue our active lives as we age. We don’t want to be a burden on our families (Participant G, F, Thai, 75 years).” 4. “Austin really needs to improve its infrastructure. There should be transportation for seniors and spaces for us to do activities, not just rehabs (Participant A, F, Hispanic, 75 years)." 5. “We are in a bubble. People stick with their own age. We need cross-communication between age groups (Participant J, M, Thai, 75 years).” 6. “We are still capable of doing what young people do (Participant C, Mixed-Race, 66 years).” “This experience boosted my self-esteem (Participant E, Korean, 86 years).” 7. To conclude the session, the facilitator discussed transitioning back to communicating in-person during programming hours or using city email, and the goals for the future of the project. Integrating Intergenerational Voices Research literature has explored the benefits of intergenerational relationships, specifically for AAPI older adults. One study found that for Korean older adults, having a satisfactory intergenerational relationship helped mediate depressive symptoms. 14 In addition, the World Health Organization’s (WHO) conceptualization of respect recognizes a need for intergenerational interactions to break down stigmas toward aging. Thus, AAPI Austinites who do not identify as older adults were incorporated into the photovoice project to bring forward the stories of older adults and facilitate forming intergenerational relationships. 13 The Asian American Resource Center hosted its first Teen Mentorship Program, beginning in January of 2024. In this program, mentors (20s-40s) and mentees (aged 16-18) met twice a week to learn about public service within the City of Austin, discuss and explore AAPI identity and history, and learn further about professional development. One requirement of the mentorship program is to complete a community-engaged capstone project on any topic/forum of their choosing. After data collection with the senior participants completed, the photovoice project facilitator and 2 senior participants presented the project to mentors and mentees. This presentation served 2 purposes: 1. Demonstrate an example of a community-engaged project, photovoice. 2. Participate in a reflection activity, answering the same prompts as the senior programming photovoice participants. The goal of this intergenerational session was to facilitate understanding across generations. After completing the activity, participants were encouraged to talk further with the senior programming participants that attended the Teen Mentorship Program meeting and engage further with the photovoice exhibit during CelebrASIA Fest. To view the materials from the teen mentorship program and their responses to the photovoice prompts, visit https://bit.ly/photovoicematerials. Bringing Together Participant Photos The total participant attendance rate in the project was 86%. All participants submitted photos for each of the 6 prompts. The final step in the photovoice process was identifying any themes across participant photos and captions. The facilitator analyzed the photos and captions for any themes. Previous photovoice studies have used a thematic analysis approach 10, a framework developed by Morse and Richards 11: 1. Topic coding. In a process called open coding, identify meaningful quotes and phrases (codes). 2. Creating categories. After this process is complete, all the units of meaning will be compiled, and compared for similarities and differences to create categories, or themes. All codes are reviewed multiple times until they fall into categories or subcategories. 3. Conceptualizing. The final step involves analyzing how all categories and subcategories relate to one another, and the creation of more abstract, overarching themes that represent the data. Helpful Tip during this process: 1. Report back to participants or conduct an additional session where participants can discuss themes together with the facilitator. 14 The table below summarizes main themes from the cohort of participants at the AARC: Theme A desire to continue skills and hobbies The value of family and community Desiring recognition for expertise and experiences Appreciation for spaces that connect individuals to their culture Dispelling stigmas about remaining physically active in old age Number of Participants N= 7 N= 11 N= 10 N= 9 N= 6 The final themes were presented to the senior programming participants in April. These themes were also incorporated into the Commission presentations (Commission on Aging and Asian American Quality of Life Commission) in April, serving as valuable insight into planning for age-friendliness. The final section of this proposal provides a justification for replicating this project and a brief step-by-step guide for organizations preparing to do so. Why Replicate this Project? The AARC’s project is a step towards more inclusive and equitable engagement with older adults. Yet, this project is still limited data, providing a small glimpse into respect and social inclusion for predominantly AAPI older adults. To get a more thorough understanding of how older adults in Austin envision age-friendliness across all 8 domains, this project needs to be replicated with different cohorts of participants and age-friendliness domains. This includes seeking feedback from older adults with varying races/ethnicities, socioeconomic status, language proficiency, and other identities. To build capacity for replicating this project, AARC staff scheduled visits to meet staff and build relationships at 2 senior-serving sites in the City of Austin, Gus Garcia Recreation Center, and Conley-Guerrero Senior Activity Center. In April, upon completion of the project and exhibit installation, AARC staff invited staff from these centers, as well as managers of the Parks and Recreation Department that oversee senior-serving sites, to learn about the project and discuss replication. The final section provides where to start for organizations seeking to adapt and replicate this project, including helpful practices from the AARC’s project. For more information or support, contact Nirali Thakkar at nirali.thakkar@austintexas.gov. Adapting and Replicating the Project: A Step-by-Step Guide and Helpful Practices Step Decide on an appropriate facilitator and staff support. Helpful Tips and Best Practices Rapport and relationship building are vital to effectively facilitating a photovoice project. Replicating a photovoice project should not be contracted out to a third-party organization unfamiliar with programming participants and organization staff. The total time 15 commitment for the project is about 2-3 hours per week to prepare materials and host the session. The AARC mobilized staff who worked during senior programming hours to lead the project. These individuals had relationships with the seniors and were familiar to the cohort. In addition, these staff members were onsite during the week outside of the project meeting time. This helped the seniors feel supported and have access to resources if any questions or concerns came up for them. If feasible for the organization, provide participants with autonomy to select the project's focus. If participants select the domain, an extra week may be required to create prompts and materials. Work within the senior programming calendar. At the AARC, participants met for one hour each week during their Meals on Wheels (MOW) lunch hour. This helped ensure that they could still participate in the various activities of the center’s senior programming while completing the project. It is important to schedule sessions during a time that works for participants’ schedules and does not ask for an additional commitment to commute to the center. The facilitator worked with the onsite MOW staff to determine a system that worked best for both parties in delivering meals to the cohort of participants. In this system: 1. The AARC staff determined from MOW registration the number and names of participants who had reserved a meal on the day of the session. 2. AARC staff provided this information to the onsite MOW staff member. 3. AARC staff took meals for participants directly to the meeting room. Translation and Interpretation. Participants should not be excluded from the project if they feel most comfortable participating in a language other than English. Organizations should strive to provide translation/interpretation services where feasible to facilitate access to participation. The AARC used one Korean-speaking and one Mandarin-speaking staff member to work individually with participants who felt most comfortable in these native languages. This included translating flyers, the photo journal, SHARED method for discussion, and reflection questions. These staff members also provided Decide on the age-friendliness domain and research question(s). Decide on the time and date of sessions. Create Flyers and Recruit Participants. 16 interpretation during the photovoice sessions and translated their photo captions for the final exhibit. Create Buy-In. AARC staff designed a flyer and photovoice project plan that provided a mutual benefit to participants of the project, including but not limited to learning new technology (Airdrop), understanding and participating in civic engagement at the local level, meeting new colleagues and facilitating deeper connections, and voicing concerns about age-friendliness and sharing lived experiences. Purposeful Recruiting. AARC staff created a list of 10-15 potential participants who attended programming on the designated day of the sessions and had some level of familiarity with one another. Staff members talked 1:1 with potential participants, sharing information about the project and the flyer. Participants were encouraged to attend the first introduction session to learn more before making a broader commitment to the project. In the AARC’s project, many participants committed after seeing their fellow participants express interest. Prepare Outlines for Each Session and Materials. Before beginning the project, it is helpful to have an outline of objectives and slides for each session. This preparation phase allows staff to begin the project with goals for each session and a timeline to share with participants. To view the AARC’s slide deck and materials, visit bit.ly/photovoicematerials. Utilize the following practices during the project sessions: 1. Prepare an example photovoice to show participants before they begin their own. 2. Print slide handouts for participants each session and incorporate a timeline into each week’s session. 3. Check in 1:1 with participants and practice patience, especially as they learn new technologies and skills. 4. Rather than enforce a timeline or outcome on participants, create a meaningful, autonomous process. Facilitate votes on the project timeline and allow space for questions and concerns. Upon finishing the data analysis process, report back to the participants of the project for their feedback. A more equitable, engaged way to conduct data analysis is to develop themes alongside participants in an additional project session. Obtain waivers to use participant photos. Centers at the AARC likely already have participant waivers available in the RecTrac system—confirm if participants have opted in for photo release. Conduct sessions. Analyze Data. Prepare for an exhibit. 17 Share the project with senior programming participants and the larger public. Some community stakeholders that would be beneficial for a photovoice project include but are not limited to: The Commission on Aging, recreation and cultural centers across the City of Austin, and local community members attending the center. Final Thoughts As mentioned before, the recruitment process requires intention and relationship building. Community-based approaches should first focus on relationship-building before asking for any type of commitment. Even more importantly, a community-based project should have a meaningful and mutual benefit for participants. For the AARC participants, it was learning new technology, being able to share their experiences and expertise, and connecting with peers on a deeper level. Many friendships blossomed as a result of the photovoice project that will sustain beyond the duration of the project. In addition, having an exhibit up for display in the ballroom that participants use daily was extremely meaningful. Staff at the center saw senior programming participants often viewing, discussing, and sharing the project with their peers. Creating an exhibit that can feasibly travel to other centers can really improve the visibility of community voices. Ultimately, while surveys can be more feasible to create, distribute, and analyze, photovoice methodology brings unique perspectives to the table and provides more immediate, specific feedback and amplifies lived experiences. The hope is that this project can continue to mediate the gaps in survey data, helping the Commission on Aging and Austin City Council members develop a more informed, inclusive plan for an age-friendly Austin. For any questions related to this project, please reach out to Nirali Thakkar at nirali.thakkar@austintexas.gov. Appendix A: Included Studies and Year of Publication. Study Title Year Study Title Year Study Title Older Adults Documenting Purpose and Meaning Through Photovoice and Narratives 2023 A photovoice 2012 Being connected to nature, reindeer, and family: findings from a photovoice study on well-being among older South Sámi people 18 Year 2021 Neighbourhood environmental influences on older adults' physical activities and social participation in Singapore: A photovoice study 2022 A photovoice study of older adults' conceptualizations of risk Resilience among older adults during the COVID-19 pandemic: A photovoice study 2023 2022 2012 Exploring Perceived Barriers to Physical Activity in Korean Older Patients with Hypertension: Photovoice Inquiry 2020 The role of leisure within 2014 the dementia context Pandemic Fatigue: It’s Been Going on Since March 2020: A photovoice study of the experiences of BIPOC Older Adults. 2022 Hong Kong 2019 Aging With Cerebral Palsy: A Photovoice Study Into Citizenship 2021 documentation of the role of neighborhood physical and social environments in older adults' physical activity in two metropolitan areas in North America Fostering Civic Awareness and Participation Among Older Adults in Hong Kong: An Empowerment-Ba sed Participatory Photo-Voice Training Model Chinese aging adults voice financial care expectations in changing family and sociocultural contexts: implications for policy and services Photovoice: A Research Method and Intervention to Engage Older Adults 2018 An Age-Friendly Living Environment as Seen by Chinese Older Adults: A "Photovoice" Study 19 2018 2016 Engaging Older Men in Physical Activity: Implications for Health Promotion Practice 2022 Walk-friendly 2015 Health literacy from the 2014 Living as older adults with mental health concerns in rural British Columbia: A photovoice study How is Respect and Social Inclusion Conceptualised by Older Adults in an Aspiring Age-Friendly City? A Photovoice Study in the North-West of England 2020 Application of 2018 A participatory practice 2022 perspective of African immigrant youth and elderly: a PhotoVoice project study for the improvement of sub-regional health vulnerabilities: a qualitative study The Way I See It: Older Adults with Mental Illness Share Their Views of Community Life Using Photovoice 2023 2006 Life after Stroke in an Urban Minority Population: A Photovoice Project 2017 "Another day in paradise": a photovoice journey of rural older adults living with diabetes 2013 Using photovoice 2011 2020 Personal care expectations: Photovoices of Chinese ageing adults in Hong Kong The Diné (Navajo) Hózhó Lifeway: A Focused 2021 "My life after stroke through a 2019 Evaluating 2012 proFamilies-dementia: suburbs for older adults? Exploring the enablers and barriers to walking in a large suburban municipality in Canada Photovoice with Focus Groups to Explore Dietary Behaviors of Older Filipino Adults with Cardiovascular Disease Photovoice: use of a participatory action research method to explore the chronic pain experience in older adults methodology to investigate facilitators and barriers to food acquisition and preparation by rural older women 20 Ethnography on Intergenerational Understanding of American Indian Cultural Wisdom Neighborhood factors relevant for walking in older, urban, African American adults 2010 camera lens": A photovoice study on participation in Sweden "The Social Side Is as Important as the Physical Side": Older Men's Experiences of Physical Activity adopting photovoice to capture clinical significance Photovoicing the neighbourhood: Understanding the situated meaning of intangible places for ageing-in-place 2018 2017 Using photovoice to understand cardiovascular health awareness in Asian elders 2012 The leisure experiences of older US women living with HIV/AIDS 2007 This ain't something you can pray away: grandparents raising grandchildren, a photovoice project 2010 2010 2005 Exploring identity and 2014 Cardiovascular health perceptions in multigenerational Korean immigrants aging: auto-photography and narratives of low-income older adults Through seniors' eyes: an exploratory qualitative study to identify environmental barriers to and facilitators of walking 21 Appendix B: Austin Map of Wealthy Zip Codes and Survey Responses Wealthy zip codes are highlighted in yellow. High-response zip codes are highlighted in green. Not available on the map: 78619 (wealthy zip code) and 78731 (high response rate). Appendix C: Recruitment Flyer (English and Mandarin Chinese) Appendix D: SHOWED Method Studies 22 Study Name Neighbourhood environmental influences on older adults' physical activities and social participation in Singapore: A photovoice study How is Respect and Social Inclusion Conceptualised by Older Adults in an Aspiring Age-Friendly City? A Photovoice Study in the North-West of England The Way I See It: Older Adults with Mental Illness Share Their Views of Community Life Using Photovoice Hong Kong Chinese aging adults voice financial care expectations in changing family and sociocultural contexts: implications for policy and services Exploring Perceived Barriers to Physical Activity in Korean Older Patients with Hypertension: Photovoice Inquiry Health literacy from the perspective of African immigrant youth and elderly: a PhotoVoice project A participatory practice study for the improvement of sub-regional health vulnerabilities: a qualitative study Life after Stroke in an Urban Minority Population: A Photovoice Project Evaluating proFamilies-dementia: adopting photovoice to capture clinical significance Year 2022 2020 2023 2019 2022 2014 2022 2017 2012 23 Appendix E: Budget Breakdown Item Cost Pamphlet/Postcard Holders 48.99 Command Strips (to mount holders) 9.99 Foam Boards (6 in existing inventory) 21.99 (20 pack) Laminated Photo holders (100) 6.99 4x6 Postcards (100) 6.00 Photo and Collage Printing Completed In-House 0.00 TOTAL: $93.96 Appendix F: Key Dates Date January 22-25th February 8th February 15th February 22nd February 29th March 7th March 14th March 9th March 14-31st April 4th April 10th and April 16th April 24th May 18th Activity Recruitment of Seniors during Programming (n=10-15) Session 1, Introduction to Photovoice Session 2, Practice Week and Transition to Project Session 3, SHOWED Method, Sharing Photos Session 4, SHOWED Method, Sharing Photos Session 5, Finish Sharing Photos and Creating an Exhibit Session 6, Reflection on Photovoice with Senior Participants Youth Mentorship Engagement Data Analysis Internal Session with Participants to prepare for Commission Presentations Presentations to City of Austin Commissions (Asian American Quality of Life, Aging Commission) on Project Presentation to AARC and Parks and Recreation Department: City of Austin CelebrASIA Festival: Exhibit of Photovoice Appendix G: Participant Characteristics: Sex, Ethnicity, and Age B F, Hispanic, 75 A E F, Thai, 79 D H G F, Thai, 75 J M, Thai, 75 K M M, Hispanic, 72 N M, Mixed-Race, 66 M, Korean, 86 F, Korean, 82 M, Chinese, 66 F, Chinese, 65 C F I L F, Mixed-Race, 66 F, Mixed-Race, 69 F, Bangladeshi, 67 M, Bangladeshi, 73 24 25 References: 1. The United States (Population Estimates and Projections, pp. 1–28) [Current Population Reports]. US Census Bureau. 2. City of Austin Planning Department. (2023). (rep.). Age of Change: Austin’s Transforming Demographics 2010-2020(pp. 1–5). Austin, TX: City of Austin. 3. Binette, J. (2021, November 18). Where We Live, Where We Age: Trends in Home and Community Preferences. AARP. https://www.aarp.org/pri/topics/livable-communities/housing/2021-home-community-pre ferences/ 4. City of Austin Commission on Seniors Working Group. (2016). Age-friendly Austin action plan: Executive summary. Age-friendly Austin Action Plan: Executive Summary. https://services.austintexas.gov/edims/document.cfm?id=260993 5. City of Austin. (2023). (rep.). Annual Internal Review (p. 1–7). Austin, TX: City of Austin. document.cfm (austintexas.gov) 6. Wang, C., & Burris, M. A. (1997). Photovoice: Concept, methodology, and use for participatory needs assessment. Health Education & Behavior, 24(3), 369–387. https://doi.org/10.1177/109019819702400309 7. Adekeye, O., Kimbrough, J., Obafemi, B., & Strack, R. W. (2014). Health literacy from the perspective of African immigrant youth and elderly: A PhotoVoice project. Journal of Health Care for the Poor and Underserved, 25(4), 1730–1747. https://doi.org/10.1353/hpu.2014.0183 8. Chui, C. H.-K., Chan, O. F., Tang, J. Y., & Lum, T. Y. (2019). Fostering civic awareness and participation among older adults in Hong Kong: An empowerment-based participatory photo-voice training model. Journal of Applied Gerontology, 39(9), 1008–1015. https://doi.org/10.1177/0733464819838448 9. Jones , S., Hayden , S., Murillo, R., Sturrup , A., Shemilina , E., Selfe, G., Halgo, P., Overton, M., Caceres, A., Coleman, K., Karman, L., Monsalve, J., & Rojas, P. (2015). (rep.). Health Inequities in Austin Travis County (pp. 1–45). Austin, TX: Austin/Travis County HHS. 10. Rush, K. L., Murphy, M. A., & Kozak, J. F. (2012). A photovoice study of older adults’ conceptualizations of risk. Journal of Aging Studies, 26(4), 448–458. https://doi.org/10.1016/j.jaging.2012.06.004 11. Morse, J. M., & Richards, L. (2002). README FIRST for a User's Guide to Qualitative Methods. Thousand Oaks, CA: Sage. 12. World Health Organization. (n.d.). Respect and Social Inclusion. https://extranet.who.int/agefriendlyworld/age-friendly-practices/respect-and-social-inclus ion/ 13. Ronzi, S., Orton, L., Buckner, S., Bruce, N., & Pope, D. (2020). How is respect and social inclusion conceptualised by older adults in an aspiring age-friendly city? A Photovoice study in the north-west of England. International Journal of Environmental Research and Public Health, 17(24), 9246. https://doi.org/10.3390/ijerph17249246 26 14. Harouni, Mahboubeh et al. “Older People’s Perceptions of Intergenerational Relationships in Nursing Homes: A Qualitative Content Analysis.” Journal of family medicine and primary care 11.8 (2022): 4395–4403. Web. 15. Kaleel, H. (2023). (rep.). FY24 Community Budget Engagement After Action Report. Retrieved 2024, from https://services.austintexas.gov/edims/document.cfm?id=405313. 16. Budiman, A. (2021, April 29). Key facts about Asian Americans, a diverse and growing population. Pew Research Center. https://www.pewresearch.org/short-reads/2021/04/29/key-facts-about-asian-americans/#: ~:text=About%20a%20quarter%20of%20Asian,among%20Americas%20overall%20(19 %25). 17. Kaleel, H. (2024, March 13). March Commission on Aging Meeting. Austin, TX. https://www.austintexas.gov/cityclerk/boards_commissions/meetings/120_1.htm