A participatory photovoice investigation of community assets, barriers, and opportunities to curb the opioid epidemic.

The opioid epidemic remains an entrenched issue in communities due to its multiple and interrelated risk factors. As part of the HEALing Communities Study, we recruited people with lived experience of substance use disorder and practitioners in the field to participate in multi-session Photovoice projects to contextualize the opioid use landscape in their respective communities. Photovoice combines photography and group discussion to explore concerns and strengths in a community. Researchers facilitated 21 Photovoice projects (N = 127 participants) across 19 communities in the Kentucky, Massachusetts, and Ohio HCS sites. We performed template analysis on the Photovoice discussion transcripts to develop a codebook organized by the Socioecological Model domains, analyzed the transcripts, and developed themes reflecting barriers to and facilitators of responding to the opioid crisis at each socioecological level. We engaged a subset of participants across sites to prioritize these results by importance in addressing the opioid epidemic in their communities. A comprehensive list of themes from the 64 photo discussion sessions are presented, with a focus on the themes prioritized by participants that included the importance of peer recovery support, diverse and collaborative services, advocacy and education to diminish stigma, and the need for resources to address social determinants of health such as housing, recreation, and transportation. Our findings offer key insights to address the opioid crisis within communities. Using participatory methods such as Photovoice to engage experts with lived experience and/or direct work with substance use disorder can help identify gaps and opportunities for potential solutions.