Using Photovoice to Examine Physical Activity in the Urban Context and Generate Policy Recommendations: The Heart Healthy Hoods Study

A current challenge in physical activity research is engaging citizens with co-creating policies that support physical activity participation. Using Photovoice, a participatory action research method, the objectives of this study were to: 1) Identify community perceptions of urban built, social, and political/economic environment factors associated with physical activity; and 2) generate community-driven policy recommendations to increase physical activity. Two districts in Madrid of varying socio-economic status (SES) were selected. Overall, 24 residents participated in 4 groups stratified by sex and district (6 participants per group). Groups met weekly for 4 weeks to discuss and analyze their photographs. Participants coded photographs into categories, which were then regrouped into broader themes. The categories were transformed into policy recommendations using an adaptation of the logical framework approach. Participants took 161 photos, which were classified into 61 categories and 14 broader themes (e.g., active transportation, sport in the city). After this, participants generated a set of 34 policy recommendations to improve the urban environment to support physical activity (e.g., to redistribute sports facilities). Collaboration between citizens and researchers led to a deeper understanding of the community perceptions of urban built, social, and political/economic environment factors associated with physical activity in two districts of Madrid, while engaging citizens in recommending public policies.