https://orcid.org/0009-0001-3794-6970
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Figures
Abstract
Background
Neglected tropical diseases (NTDs) affect over one billion people worldwide and are closely linked to environmental determinants, including unsafe water, poor sanitation, inadequate housing, and vector-borne exposure. Yet, the voices of affected communities remain insufficiently centred in research or policy. Photovoice, a participatory visual method, has potential to reframe the neglect of NTDs by centring affected communities and their lived experiences. This scoping review aims to explore the application of photovoice in NTD research and its related environmental determinants.
Methodology/findings
Six electronic databases were searched using terms related to photovoice and NTDs and reported in accordance with the PRISMA Extension for Scoping Reviews. Data from thirteen included studies were extracted and synthesised using thematic analysis. Most studies were conducted in Africa and focussed on skin-related NTDs. Photovoice methods were adopted across studies, including variations in participant training, equipment, and discussion formats, while retaining its core principles of ethical practice, participant-driven image production, and reflective dialogue. The degree of participation and power-sharing varied across studies. Community members were engaged as co-researchers to differing extent, with uneven inclusion across gender and age groups and limited transparency in shared analysis and decision-making. Reported outcomes included increased visibility of lived experiences, strengthened participant confidence, enhanced community dialogue, locally initiated actions, and contributions to programme reflection or policy discussions. Nevertheless, few studies implemented dissemination strategies such as exhibitions, community meetings, booklets, videos and policy dialogues to create visibility, which limits opportunities to influence policy.
Conclusion/significance
Photovoice in NTDs research and related environmental and vector-borne determinants demonstrates the potential to reframe neglect by successfully transforming invisibility into evidence and turning community voices into advocacy, while inclusive participation, skilled facilitation, and structured pathways are needed in future studies to translate this visibility into lasting policy impact.
Author summary
Neglected tropical diseases (NTDs) affect millions of people, primarily in marginalised communities, yet the experiences of those affected are often overlooked in research and policy. Photovoice is a participatory research method that allows community members to use photographs to document and share their daily health challenges. This scoping review of 13 studies from Africa and Asia found that photovoice increased visibility of lived experiences, strengthened participant confidence, and encouraged dialogue and locally led actions. However, only a few studies implemented dissemination strategies such as exhibitions, community meetings, booklets, videos, or policy dialogues, limiting opportunities to influence policy. In conclusion, photovoice can reframe neglect in the context of NTDs and related environmental determinants that shape exposure to NTDs, but future research must prioritise inclusive participation, skilled facilitation, and clear pathways to translate findings into lasting policy impact.
Citation: Md Anuar Hussain NA, Hassan MR, Mohammed Nawi A, Ahmad Kamar AF, Md Haniff SA, Ismail FN (2026) Reframing neglect in neglected tropical diseases and related environmental determinants: A scoping review of photovoice studies. PLoS Negl Trop Dis 20(8): e0014655. https://doi.org/10.1371/journal.pntd.0014655
Editor: Richard Odame Phillips, Kwame Nkrumah University of Science and Technology, GHANA
Published: August 21, 2026
Copyright: © 2026 Md Anuar Hussain et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: All relevant data are within the manuscript and its Supporting information files.
Funding: The author(s) received no specific funding for this work.
Competing interests: The authors have declared that no competing interests exist.
Introduction
Neglected tropical diseases (NTDs), comprising 20 diseases recognised by the World Health Organization (WHO), continue to affect over one billion people globally [1]. The burden is greatest among low-income, marginalised, and rural communities in which illness is compounded by systemic neglect, stigma, and inequities [2]. These affected communities often live in environments where access to safe water, sanitation, and hygiene (WASH) is inadequate, and they also encounter recurrent exposure to disease vectors, and close human–animal interaction that increase zoonotic risks [3]. Together, these environmental and vector-borne determinants create interconnected conditions that sustain the transmission and persistence of NTDs.
Neglect in the context of NTDs is a product of the structural invisibility of affected populations [4]. NTDs thrive in settings of poverty, fragile health systems, and the lack of political influence, leaving them in the shadow of high-profile diseases such as HIV, tuberculosis, and malaria [2]. Inadequate investment in research and development, poor policy prioritisation, and the stigma attached to those people affected reinforce their marginalisation. This cycle of neglect keeps the lived realities of affected people marked by disability, poverty, and exclusion, remaining largely absent from policy debates and global health agendas. Overcoming neglect therefore requires approaches that expose these realities and amplify the voices of those affected, rather than relying solely on biomedical interventions [5].
Traditional research approaches rarely reflect the lived realities of affected populations, who were rarely engaged in the creation of knowledge [6,7]. As a result, policy responses risk perpetuating top-down interventions that ignore the structural conditions that perpetuate disease. Community-based participatory research (CBPR) offers an alternative by shifting power towards communities and valuing local knowledge in public health decision-making [8]. Photovoice, a participatory visual methodology introduced by Wang & Burris, exemplifies this shift [9]. By equipping affected communities with cameras and developing platforms for critical reflection, photovoice enables them to document, interpret, and communicate their lived experiences [10,11]. Beyond its role in data collection, photovoice is a participatory tool that acts as a platform for reflection, dialogue, advocacy, and engagement with decision-makers [12,13].
As photovoice gains traction within public health, there is an opportunity to examine how this participatory approach has been applied in NTDs research and related environmental and vector-borne determinants, and how it may help reframe neglect and promote equity in global health. Given the emerging and methodologically diverse nature of photovoice research in this field, a scoping review approach was used to map the available evidence. Specifically, this scoping review aimed to describe the contexts in which photovoice has been used, with particular attention to the populations involved, methodological adaptations, participatory depth, reported outcomes, and implications for future public health research, practice and policy. The review was guided by three questions:
- What NTDs and related environmental or vector-borne determinants have been examined using photovoice methods?
- How has photovoice been operationalised in these studies, including participant groups, training, data generation, facilitation, analysis, and dissemination?
- What forms of community insight, public health relevance, policy linkage and reported impact have emerged from photovoice studies in this field?
Methodology
Ethics statement
This scoping review used data from previously published literature and did not involve the direct recruitment of human participants. Therefore, institutional ethical approval was not required for this review. Ethical approval and informed consent procedures were reported variably across the included studies by the respective original authors. Studies involving adult participants generally described informed consent procedures, while studies involving children additionally reported parental or legal guardians’ consent and child assent, where applicable, in accordance with the requirements of the approving institutional review boards or ethics committees.
This review was conducted as a scoping review using systematic search, screening, data charting, and synthesis methods. Reporting was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). The review protocol was registered in PROSPERO (CRD420251039130). A scoping review approach was considered appropriate because the purpose was to map the extent, characteristics, and applications of photovoice in research on NTDs and related environmental or vector-borne determinants, rather than to estimate intervention effectiveness or generate pooled effect estimates.
Preferred reporting items for systematic reviews and meta-analyses extension for scoping review (PRISMA-ScR)
PRISMA-ScR was introduced in 2018 as a reporting guideline specifically designed for scoping reviews [14]. It provides two main advantages which include 1) enhancement of research transparency and credibility by requiring authors to report 20 key items, and 2) provision of structured guidance tailored specifically to scoping reviews rather than depending on PRISMA, the systematic review standards [15]. In this review, the PRISMA-ScR framework enabled a rigorous and reproducible search process to identify photovoice applications in NTDs and their associated environmental determinants.
Search strategy and information sources
The literature search was conducted in March 2025 using six electronic databases to obtain adequate coverage of the peer-reviewed literature: Web of Science (WoS), Scopus, PubMed, Ovid, SAGE Journals, and EBSCOhost. The search strategy was developed through review of relevant literature, thesaurus, and expert consultation. Search terms were organised into three core concepts: (1) neglected tropical diseases and related environmental or vector-borne determinants, (2) photovoice or participatory visual methods, and (3) public health action, participation, or reported outcomes. Boolean operators and database-specific syntax were adapted for each database. Full database-specific search strategies are provided in Supporting Information (S1), with a simplified PubMed search string presented in Table 1.
Eligibility criteria
Studies were eligible if they were original research articles that applied photovoice or closely related participatory visual methods to NTDs or related environmental and vector-borne determinants. No restrictions were imposed on the date of publication or language. Although malaria is not classified as an NTD, malaria-related studies were considered eligible only if they examined related environmental or vector-borne determinants relevant to community-based disease prevention, health equity, or disease control in neglected settings. The full inclusion and exclusion criteria are summarised in Table 2
Study selection
All retrieved records were exported into Microsoft Excel, and duplicates were removed by checking titles, authors, years, and digital object identifiers where available. Screening was performed in two stages. First, titles and abstracts were independently screened by two reviewers (NA and AF) using predefined eligibility criteria. Second, the full texts of potentially eligible articles were retrieved and independently assessed by the same two reviewers. Discrepancies between reviewers during both screening phases were resolved through discussion and consensus with arbitration by a third reviewer (MRH) where necessary.
Data extraction
Data from included studies were extracted using a structured data charting form developed for this review. The variables extracted in accordance with the review questions included: (i) author(s), publication year and country; (ii) NTD focus or associated environmental determinant; (iii) participant characteristics; (iv) description of photovoice purposes and methodology applied, and (v) reported outcomes. Data charting was conducted by NA and independently verified by MRH for accuracy, consistency, and completeness. Any discrepancies were resolved through discussion and consensus. The charting form was refined during the process to ensure that relevant methodological and outcome-relevant information was captured consistently across included studies.
Data synthesis
An inductive thematic approach was used to synthesise findings. The synthesis focussed on how photovoice was applied, the populations and disease or determinant contexts involved, methodological adaptations, participatory depth, reported outcomes, and implications for public health practice and policy. Patterns were compared across studies to identify common applications, methodological variations, forms of community insight, and reported links to programme or policy influence. Given the heterogeneity of study aims, designs, and outcomes, no meta-analysis was undertaken.
Quality appraisal
Methodological quality was appraised using the Mixed Methods Appraisal Tool (MMAT). This tool measures study quality across research designs such as qualitative, quantitative, and mixed methods studies. Nevertheless, the appraisal was not used to exclude studies, consistent with the mapping purpose of this scoping review. Instead, the MMAT findings were used to support interpretation of the credibility, transferability, and reporting strength of the included studies. This process identified that all 13 articles are of high-quality, with no studies excluded based on appraisal outcomes, as shown in Table 3.
Results
The initial total of 208 records was found, of which 205 were from database searches and an additional three records from citation searches. After removing duplicates (n = 53), 155 records remained for title and abstract screening, of which 137 were excluded for failing to meet the inclusion criteria. In total, 18 full-text articles were assessed in detail. Of these, five were excluded for not using photovoice (n = 3) or not addressing NTDs or their environmental determinants (n = 2). Ultimately, 13 studies met the eligibility criteria and were included in the review. The complete results of the screening and selection process are presented in Fig 1.
Characteristics of studies included
Thirteen studies were included in this review. The studies were published between 2012 and 2025, with a surge in publications after 2020, reflecting an increased interest in photovoice as a participatory approach in NTD-related public health research. Most studies were carried out in Sub-Saharan Africa (n = 9), including Kenya (n = 4), Nigeria (n = 2), Tanzania (n = 1), Côte d’Ivoire/Mauritania (n = 1), and Ghana–Madagascar (n = 1). Three studies were conducted in Southeast Asia, including Malaysia (n = 2) and Indonesia (n = 1). One study was conducted in Latin America (Brazil). Six studies used photovoice to directly examine NTDs, including skin NTDs, schistosomiasis (including female genital schistosomiasis (FGS)) and trachoma [13,16–19,26]. The remaining seven studies examined related environmental or vector-borne determinants, including WASH practices (n = 3) [20–22], and vector-borne determinants (n = 4) [23–25,27]. Although malaria is not classified as an NTD, these studies were retained because they addressed shared environmental and vector-borne determinants relevant to disease prevention and control in neglected settings. Methodologically, most studies used qualitative community-based participatory designs (n = 12), including two studies that combined photovoice with survey or mixed-methods components [18,20]. A detailed summary of the study characteristics, photovoice purposes, participants, implementation approaches and major reported insights is presented in Table 4.
Building on the detailed study characteristics presented in Table 4, the key thematic pathways through which photovoice has contributed to research on NTDs and their related environmental determinants are mapped in Fig 2.
Adaptation to the photovoice method
Photovoice was adopted with flexibility but retained its key principles of community photography, group reflection, and dialogue. All studies were initiated with training sessions covering camera use, basic photography, and ethics, including consent for images that could be identified. The training duration ranged from single-day workshops to multi-week trainings. The equipment used differed; six studies offered disposable or instant cameras, three used digital cameras, and three used smartphones. Meanwhile two studies used mixed approaches, such as WhatsApp for sharing photos and continuous conversation [25,27]. The photo-taking periods lasted from less than a day to several weeks. One study had three (3) iterative cycles of photo-taking and group discussion [24]. Participants tended to choose up to 10 photographs for analysis. Thirteen studies (93%) used the SHOWeD framework to guide interpretation and meaning-making. Reflection was mediated through individual interviews, group discussions, or a combination of both. Analytical strategies included thematic analysis, content analysis, and photo analysis. Most used transcripts as their primary data, but several used photographs as their core analytical material. Dissemination went beyond journal articles: nine studies hosted exhibitions or community events, three developed photo-booklets, and one created video documentation to bring results back to participants and stakeholders.
Participation of participants in photovoice processes
Most studies recruited adults aged 18 years and above. Only one study in Brazil involved younger participants, i.e., elementary schoolchildren from Grades 4–9 [23]. Nine studies included both men and women, while three studies were undertaken on women only [16,21,26]. Sex distribution was not reported in two studies. Sample sizes ranged from 8 to 56 participants, and the most common sampling strategy was purposive sampling. Participant composition varied, including persons affected by NTDs, caregivers, community health volunteers, villagers, schoolchildren, and frontline health workers. Eleven studies (79%) explicitly targeted marginalised groups such as women, rural villagers, and people living with stigmatising skin conditions. The purpose of involvement also differed between studies. Five studies used photovoice to identify problems and lived realities, such as stigma and barriers to prevention [17,19,24–25]. Two studies explored knowledge, attitudes, and practices (KAP) around NTDs and their determinants [13,22]. Another three used it as a health promotion or empowerment tool [16,26,27], and two evaluated the acceptability and effects of the intervention [26,27].
Outcome of the photovoice process
Photovoice research produced results at the individual, community, and policy levels, as presented in Table 5.
Discussion
This scoping review focuses on photovoice application in NTDs research and their related environmental and vector-borne determinants, with particular attention to its capacity to reframe neglect by making marginalised experiences visible and actionable. Guided by the framework of Wang & Burris, previous studies were evaluated to determine whether they achieved the three foundational aims of photovoice: (1) recording and reflecting community realities, (2) promoting critical dialogue, and (3) reaching policymakers [11]. When these aims are achieved, an issue and a population that was once invisible becomes visible, reframing neglect and positioning NTDs as issues that cannot be ignored.
Recording and reflecting community realities
Photovoice has long been applied across health, education, and social justice to bring hidden realities to the surface and promote the agency of participants [28–31]. Consistent with evidence from broader public health and social research, photovoice in NTD-related studies enabled participants to document environmental, social, and behavioural factors that sustain disease transmission. Visual narratives captured key environmental risks, including stagnant water, unsafe sanitation, housing conditions, and daily practices linked to malaria, zoonotic exposure, and WASH-related transmission, while also revealing psychosocial dimensions, such as stigma, caregiving burdens, and gendered responsibilities [20,25]. The process of taking photos made participants more aware of risky behaviours they previously had not noticed or been normalised to, such as open defaecation and lack of water treatment [21]. In a study on trachoma, Maasai women were documented as they made efforts to educate others, recording their successes promoting hygiene with clean faces, compound cleaning, and leaky-tin handwashing stations and their struggles as community health ambassadors [16]. The process helps participants to think critically and develop a deeper understanding of the problems and possible solutions for their community [32]. Through such narratives, photovoice achieved the first aim of documenting community strength and concern.
Yet, important gaps remain. Although skin NTDs formed one important subset of the included studies, photovoice was also applied to schistosomiasis, FGS, trachoma, dengue-related determinants, WASH-related determinants, and malaria-related environmental or vector-borne determinants. This suggests a relatively diverse but still small evidence base. Less visible but equally burdensome NTDs remain under-represented, particularly where disease experience and transmission pathways are not easily captured through external visual documentation [33].
Participation was also uneven across gender and age groups. The participant selection varied according to study objectives, disease focus, and photovoice design. Some studies intentionally recruited specific groups, such as women, young people, people affected by skin NTDs or communities exposed to environmental risks, while others included broader community samples. These patterns suggest that, without deliberate attention to inclusivity, photovoice may reproduce existing silences rather than challenge them, limiting its ability to fully reframe neglect. Without attention to diversity, photovoice runs the risk of becoming tokenism that is valued for its participatory label but does not shift power or create meaningful change [34]. Future applications must therefore extend disease focus, diversify participation, and embed photovoice in iterative cycles that capture evolving risks and responses. Only then can photovoice go beyond documenting to transformation and sharpen its role as a tool for confronting inequities and disrupting the structural neglect that sustains NTDs.
Promoting critical dialogue through group discussion of photographs
Critical dialogue involves engaging with different perspectives to encourage mutual understanding and critique. It is not simply about exchanging views but about probing and critically examining the values and assumptions that underpin the views [35]. Group discussion of photographs was central to translating individual observations into shared understanding [36]. In Kenya, images of unsafe lake washing stimulated women to organise a baraza (community meeting) with the elders and chiefs, translating recognition into concrete plans for provision of well covers, latrine closures, and community clean-ups [21]. In Tanzania, Maasai women organised village discussion groups to share trachoma photographs with mothers and grandmothers, transforming educational content into social solidarity and positioning participants as educators within the community [37]. In Nigeria, co-researchers who were living with skin-related NTDs demanded to be published by their names and pictures in order to claim the ownership of their stories [17]. Facilitators in Sabah employed iterative rounds and member-checking to ensure that participants were able to refine or challenge interpretations [25]. These processes reflect photovoice’s second aim, using dialogue to move beyond description toward collective meaning-making. When effectively facilitated, discussions allowed participants to connect personal experiences to broader structural conditions, including access to services, local governance, and gender norms.
However, critical dialogue was not automatic. Skilled facilitation is essential not only to keep conversations inclusive but to push participants beyond surface observations toward structural critique [38]. Many studies provided limited detail on facilitation strategies or how power dynamics within groups were addressed. In the absence of specific approaches to link dialogue to collective problem-solving, conversations risked remaining descriptive rather than transformative [39]. This highlights a key challenge of photovoice in moving discussions from the recording of consensus to critical consciousness, which is necessary to confront structural neglect effectively.
Reaching policymakers for action and change
The third aim of photovoice is engagement with policymakers. Few studies went beyond community-level dialogue to influence policy. Exhibitions, community meetings, and photo booklets were the common outputs [17,19]. The ability to visually represent community structures and issues through participatory approaches such as photovoice can result in more effective implementation strategies [40–42]. The challenge is not in producing evidence but integrating it into decision-making spaces. In the Netherlands, children’s stories about poverty have reached policymakers but fall short of influencing action, pointing to a disparity between visibility and uptake [43]. Without advocacy planning, alignment with policy cycles, and institutional partnerships, photovoice risks being confined to awareness-raising. Translating photovoice evidence into actionable policy is possible when advocacy channels are built; in Madrid, photovoice informed policy recommendations on improving urban environments for physical activity [44].
Strength and limitation
To our knowledge, this is the first synthesis of photovoice applications across NTD research and related environmental and vector-borne contexts, extending beyond single diseases to shared determinants affecting marginalised populations. By intentionally incorporating WASH behaviours and malaria that intersect within the same vulnerable population, we widen the lens to the broader determinants. Framing Wang and Burris’ three foundational aims of photovoice as an evaluative lens proved to be a replicable framework for assessing the translation of participatory intent into practice and determining persistent gaps. Taken together, our findings highlight that photovoice can meaningfully reframe neglect in NTD research, but its impact depends on careful design across participation, dialogue, and policy engagement. For practice, this calls for inclusive recruitment strategies and investment in skilled facilitation to ensure diverse voices are heard. For policy, early alignment with decision-making processes and sustained partnerships is essential to translate visibility into actionable change. For research, future studies should adopt longitudinal and iterative designs, expand coverage to diverse NTDs and settings, and clearly document participatory processes to strengthen evidence on lasting impact.
Nevertheless, this scoping review has several limitations and should be interpreted carefully. First, the evidence base was small, with only 13 included studies, limiting the extent to which the findings can be generalised across all NTDs, endemic settings, or participatory visual research contexts. Second, the geographical distribution of studies was uneven, with most studies conducted in African settings and fewer studies from Southeast Asia, Latin America, and other endemic regions. Third, the included studies varied in methodological quality and in the depth of community participation. In some studies, photovoice functioned mainly as participatory data collection technique. Whereas in others, it was embedded more fully within community interpretation, dissemination, advocacy, or engagement with decision-makers. Fourth, the disease and determinant focus was heterogeneous. Malaria-related studies were retained because of their relevance to shared environmental and vector-borne determinants, although malaria is not classified as an NTD. Finally, most studies did not report long-term health, behavioural, programme, or policy outcomes. As a result, we could not determine the sustainability of photovoice-informed changes or whether visual evidence translated into sustained programme or policy influence. Future studies would benefit from clearer documentation of participatory processes, longer follow-up, and application across a broader range of NTDs, environmental determinants, and endemic settings to assess the versatility of photovoice as a strategy for confronting neglect.
Conclusion
Reframing neglect in the context of NTDs and their related environmental and vector-borne determinants through photovoice is possible. Functioning both as a research method and an intervention, it centres affected communities, makes hidden realities visible, challenges stigma, and generates locally grounded evidences that ultimately advances equity in NTD prevention, control, and policy decision-making.
Declaration of generative AI and AI-assisted technologies in the writing process
During the preparation of this work, the author(s) used Grammarly to support language refinement, grammar checking, and improvement of clarity and conciseness. A generative AI tool was also used to assist with the visual design of Fig 2. The substantive content of the manuscript and Fig 2, including study counts, categories, thematic interpretation, and conclusion, was developed, reviewed, clarified, and finalised by the author(s). The author(s) take full responsibility for the accuracy, integrity, and final content of the submitted manuscript.
Supporting information
SI Checklist. PRISMA-ScR checklist.
Preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews checklist for this scoping review.
https://doi.org/10.1371/journal.pntd.0014655.s001
(DOCX)
SI Table. Full database-specific search strategies.
Database-specific search strategies used to identify studies on photovoice applications in neglected tropical diseases and related environmental or vector-borne determinants.
https://doi.org/10.1371/journal.pntd.0014655.s002
(DOCX)
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