Int. J. Environ. Res. Public Health 2009, 6 2496 and supports in the maintenance of health related behaviour change. Hence, their expertise strengthened the credibility of the study. However, this also resulted in recruitment of a sample that was deeply sensitized to the discourses of heart health. While this sensitization may have resulted in guarding of details around what some participants referred to as “cheating”, “laziness”, or “escapades”, we approached all interactions with participants in the understanding that change is inherently difficult, but barriers are not insurmountable. Most were open about such issues and supplied considerable detail. The research was conducted by three sub-teams, one in Toronto, and two in Sudbury. The communication constraints created by distance should be weighed against the benefits of each sub- team‟s familiarity with the local context during fieldwork and analysis. This was particularly important in working with the francophone subgroup in Sudbury. Intensive site meetings and frequent teleconferences facilitated reflexive analytic discussion, which was concurrent with data collection. The use of photo-elicitation enabled most participants to tap into deeper insights and descriptions than might have been possible without the use of participant-generated images. However, photography may hold different meanings and challenges for people depending on social class, life experience and the subject matter [39]. Four participants declined to take pictures but remained willing to engage in rich discussion of their insights about everyday places and situations. One woman explained that she simply could not portray in a photograph the stressful situations she encountered due to illness of a family member. This suggests that use of photo-elicitation may not be appropriate for some topics and that some people may not be comfortable with this technique. We recommend that photo-elicitation interviews include additional questions such as: “Are there other places, things, circumstances you would like to discuss that could not be captured in a photograph?” 5. Conclusions We sought to illuminate the complex interplay between geographic location (place), sociodemographic position, and people‟s efforts to understand and modify their risk for CHD. This qualitative study drew on critical ethnography and concepts of place and space [32] to examine and compare CHD risk modification experiences in two selected regions: Sudbury and Districts (northern Ontario) and the Greater Toronto Area (southern Ontario). We also sought to compare the experiences of anglophones and francophones in Sudbury. The analysis was attentive to the places or physical locations of everyday life, as well as participants‟ spatial practices or activities within these places. Participants‟ photographs and interviews demonstrated how places are implicated within cardiovascular risk modification. All participants described the effort involved in initiating and maintaining recommended lifestyle changes, but different patterns of constraint and resources were seen between regions and subgroups. Access to supportive health resources was different in the two regions. A fast food culture was deeply entrenched in both regions, but it was anchored by different pressures. Even within regions, individual risk modification efforts were not fixed in place and time. Participants moved through several places in the course of daily activity, creating „itineraries‟ or chains of spatial practice where constraints and supports to healthy behaviour shifted continually. Health behaviours were integral within these itineraries and were continuously challenged and reconstituted.