Photovoice methodology to raise citizen awareness about the role of the gut microbiome in Non-Communicable Diseases: A pilot study
Authors: Garcia Silvia , Ordoñez Sheyla , de Santa Pau Enrique Carrillo , Marcos-Zambrano Laura Judith 
Published: June 2022

AbstractBackgroundThere is a lack of knowledge for the general public about gut microbiome implications on health and the ability of diet and lifestyle to change it, impacting the well-being and preventing the development of NCDs. Participatory actions with innovative digital methodologies such as photovoice motivate citizens to self-implement healthier habits and improve their health status.MethodsWe conducted a participatory action research initiative #PictureYourMicrobes (https://bit.ly/3wKuRYt), which consisted of a photovoice project accompanied by self-tracking citizen science activities (self-reported nutritional questionnaires and stool sample collection for microbial profiling). Learning outcomes related to recognizing the importance of nutrition over gut microbiome’s health and including prebiotics and probiotic foods in the diet were defined and evaluated through pre-and post-knowledge questionnaires.ResultsWe recruited 70 volunteers to participate and set up six photovoice groups with homogeneous age and educational levels. Each group met online for four sessions composed of guided group discussions, where facilitators helped participants integrate their microbial profiling results with diet and nutritional habits. Participants took 156 photographs they thought best reflected how daily habits influence gut microbiota health. After contextualising and critically analysing the photographs and their reflections, they selected 64 photos sorted into four categories for a photobook (https://bit.ly/3LrUHEF) and exhibitions. They developed policy recommendations as a form of community-based solutions to improve gut microbiome health. Finally, we demonstrate that participants improved their knowledge about microbiota and its relationship with health through learning outcomes evaluation.ConclusionsParticipatory action research, such as photovoice, contributed to the awareness and adoption of new healthy habits, including the consumption of probiotics and prebiotic foods for a healthy gut microbiome. Moreover, it significantly impacted participants and provided a societal impact on other people through photobooks, pictures exhibitions, and digital media.Key questionsWhat is already known on this topic?Recent reports have shown that the gut microbiome (the complex of microorganisms that inhabit the gut) is altered in individuals with non-communicable diseases (NCDs).Citizens are unaware of the importance of the gut microbiome over health and the capability of diet and lifestyle modifications to modulate it and prevent the development of NCDs.What this study adds?The knowledge of the “own microbiome” allows people to reflect on their nutritional decisions and raise awareness about taking care of their microbiome and health.The use of participative action methodologies and co-creation activities in communication and dissemination allow participants to share their experiences and learnings with other citizens.Participative action methodologies used to teach complex health-related issues allows the transmission of knowledge from scientists to citizens.How might this study affect research, practice, or policy?Photovoice activity contributed to the awareness and adoption of new healthy habits, and participants became conscious of their nutritional habits through their reflections.Participatory action research activities allowed participants to propose solutions to maintain a healthy life and prevent NCDs critically and informally.Combining the results of these methodologies with social networks, digital photo books, and physical exhibitions amplifies the outcomes.Citizens developed policy recommendations as a form of community-based solutions to enhance gut microbiome health.