‘COVID Can’t Be COVID Without George Floyd’: A Photovoice Exploration of Black Women’s Mental Health During the Dual Pandemics
, Chandra Jennings 2, Kacia Vines 3, Mysha Wynn 4, Tab Battle 2, Wanda Cox-Bailey 2, Wanda Fearrington 2, Latasha Little 2, Gwendolyn Parmley-McCloud 2, Jalynn Woods 2, Margaret E. Petersen 5, Alexandra F. Lightfoot 1,†and Anissa I. Vines 6,†
Round 1
Reviewer 1 Report
Comments and Suggestions for AuthorsThe untold havoc that COVID-19 wreaked on the Black community in America, especially from the experiences of Black women, coupled with racial injustice, are the "dual pandemics" that form the bedrock of the research. In a powerful introduction, the authors point out that while "The COVID-19 pandemic disproportionately impacted Black communities across nearly every measured dimension--infection, hospitalization, mortality, economic hardship, and mental health burden"--that thus exposed social and structural inequities, "a wave of highly publicized racial violence: the murders of George Floyd, Breonna Taylor, [and] Ahmaud Arbery," among others, converged to be known by scholars and activists as the "dual pandemics." The authors are clear in stating then the focus of their research as an exploration, through a photovoice study, of how Black women in North Carolina "understood, navigated, and coped with these intersecting crises."
The research materials and methods are well explained. This is a a well conducted and meaningful research. It is well organized and presented in flawless Standard English. Except for the number of participants in the research--only seven--the work is excellent. One would expect more participants in a community-based participatory research (CBPR), certainly more than ten participants the research started with before three of them dropped out of the research. Despite this shortcoming, the research is good overall. The use of photovoice is a perfect choice that helps to make the research a product of the authors and the community. It also makes the research more believable and readily acceptable.
The authors did this by exposing the interesting evolution of the research questions--from the initial one which was to investigate how Black women navigated their mental health during the COVID-19 pandemic, to the community participants' preferred question of how Black women coped with the dual pandemics of COVID-19 and racial injustice. This organizing, foundational question then helped in the framing of four related organizing and procedural questions of the research by the participants. It is also a credit to the authors that, even though the original ten participants dwindled to seven, they were able to make the selected participants to vary in age, educational attainment, and work status/sector, as well as their domicile (urban, suburban. and rural) spread across central and eastern North Carolina.
The data analysis is meticulously and conscientiously executed by the authors. Because the research was a cooperative venture that was primarily carried out by two people from different races--one white, the other Black--both of them had to adhere strictly to a reflexivity process during the data analysis to prevent their subconscious and conscious individual biases and life experiences encroaching into, and unintentionally influencing, their analytical points of view. This awareness of their humanity as a product of their racial and cultural experiences accumulated over the years of their lives collectively and individually was important to avoid personal corruption of their interpretation of the photos in their study. They also made available the trigger photos in Figures 1, 2, 3, and 4 respectively. Through this process and by making the photos available for all to see and judge their data analysis, they showed research transparency and successfully avoided the dreaded Type 1 and Type 2 research errors of either reading into their research what is not there, or arguing that what is there is not there.
The authors present the research results in five appropriately titled interconnected themes: (1) "COVID Can't Be COVID Without George Floyd": The Impossibility of Separating Crises" (2) "All that and Some More": What Black Womanhood Demands" (3) I Must Not Know Because I Am Black": Everyday Racism and Professional Delegitimization" (4) "Talk It Out": Healing as Resistance Through Nature, Faith, and Sister Circles" and (5) "It is the Groundwater": Structural Racism Rebuilding Community Infrastructure." Each of these thematic research results receives appropriate and relevant descriptive treatment. Though the five themes are interconnected, one may find the fifth theme with its "groundwater" metaphor most impactful because it uses the past Black experiences as a trampoline from which the present can leap to prepare for whatever an unfolding future has in store for it. It is about what can be done by Black or African American women to prepare for the next national crisis. This is from an awareness that "racism operates like contaminated groundwater, flowing through all systems simultaneously, such that addressing any single manifestation without addressing the underlying contamination will not produce lasting change." In the robust discussion section of the paper, the authors build within it their recommendations. The authors realize the limitations of their research, especially the sample size of only seven photovoice participants, and caution against any generalized application of the study. Perhaps, it is this awareness of this limitation that influences the authors' recommendation that future research should "examine how Black women's mental-health strategies and needs differ across geographic contexts, particularly rural versus urban settings and regions with differing racial demographics and political climates." They recommend extending similar research to other minority and marginalized groups that would make a comparative study possible. The references are perfect, and limited only to sources actually used in the research.
Author Response
Manuscript ID: societies-4353706 — “COVID Can’t Be COVID Without George Floyd”: A Photovoice Exploration of Black Women’s Mental Health During the Dual Pandemics
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Response to Reviewer 1 Comments |
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1. Summary |
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Thank you very much for taking the time to review this manuscript. Please find the detailed responses below and the corresponding revisions in track changes in the re-submitted files. |
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2. Questions for General Evaluation |
Reviewer’s Evaluation |
Response and Revisions |
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Is the content succinctly described and contextualized with respect to previous and present theoretical background and empirical research (if applicable) on the topic? |
Yes |
We thank the reviewer. |
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Are the research design, questions, hypotheses and methods clearly stated? |
Yes |
We thank the reviewer. |
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Are the arguments and discussion of findings coherent, balanced and compelling? |
Yes |
We thank the reviewer. |
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For empirical research, are the results clearly presented? |
Not applicable |
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Is the article adequately referenced? |
Yes |
We thank the reviewer. |
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Are the conclusions thoroughly supported by the results presented in the article or referenced in secondary literature? |
Yes |
We thank the reviewer. |
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3. Point-by-point response to Comments and Suggestions for Authors |
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Comments 1: The research materials and methods are well explained. This is a well conducted and meaningful research. It is well organized and presented in flawless Standard English… The use of photovoice is a perfect choice that helps to make the research a product of the authors and the community… The data analysis is meticulously and conscientiously executed by the authors… The references are perfect, and limited only to sources actually used in the research. |
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Response 1: Thank you so much for this generous and remarkably careful reading of our work, including your attention to the evolution of the research question, the reflexivity process, the thematic structure of the findings, and the “groundwater” theme. Your engagement means a great deal to our full team of academic and community co-researchers. |
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Comments 2: Except for the number of participants in the research—only seven—the work is excellent. One would expect more participants in a community-based participatory research (CBPR), certainly more than ten participants the research started with before three of them dropped out of the research. |
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Response 2: Thank you for raising this concern, which Reviewer 2 shared. We agree the recruitment process deserved fuller description, and we have strengthened the manuscript in three places. (1) We expanded Section 2.1 (p. 3, lines 124–129) to describe recruitment in greater detail: the community leader’s personal and professional networks; the second channel of outreach at NC CEAL community events; and the fact that word-of-mouth referral entails no fixed sampling frame. Recruitment required five months of active outreach (December 2023–April 2024) despite intentionally broad eligibility criteria, reflecting the very barriers this study documents — research mistrust rooted in histories of research harm, competing work and caregiving demands, and the substantial commitment a seven-session study entails. Three of the ten enrolled women withdrew before the first photovoice session for capacity and caregiving reasons. Added text: “The community leader, a longtime resident and trusted community health advocate, shared study information across her personal and professional networks—family, friends, church congregations, and community organizations—while NC CEAL distributed information at community events across the state. Because recruitment relied on word-of-mouth referral rather than a fixed sampling frame, the number of women who received study information was not tracked, and distribution and response rates cannot be calculated.” (2) We would also emphasize that photovoice is, by design, a small-group methodology. While larger samples are expected in many CBPR designs, in photovoice a substantially larger group would have compromised, not strengthened, the study; our final sample of seven reflects adherence to methodological guidance rather than a shortfall from it. Added to the Limitations, Section 4.7 (p. 15, lines 652–655): “Small samples are not incidental to photovoice but constitutive of it: the method’s originators recommend groups of no more than 7–10 participants, because the trust-building, sustained dialogue, and collaborative analysis at its core depend on small groups [24,34].” (3) We also added a sentence to Section 4.7 (p. 15, lines 658–663) explicitly naming network-based convenience sampling, its rationale, and its constraints; we further note that Section 2.1 (p. 3, line 115) states enrollment was capped at 10 participants by design, consistent with this methodological guidance; and a recommendation in Section 4.8 (p. 16, lines 684–687) that future studies convene multiple concurrent photovoice groups across sites. |
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4. Response to Comments on the Quality of English Language |
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Point 1: “The English is fine and does not require any improvement.” |
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Response 1: We thank the reviewer; no changes to the English were required. |
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5. Additional clarifications |
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We would also like to note one author-initiated change. We replaced the Session 3 trigger photograph shown in Figure 1c (caption p. 5, lines 197–199) — previously a photograph of a participant’s commercial album cover — with the session’s other original trigger photograph, the “HEALING” statue, which formerly appeared as standalone Figure 2. The statue is now referenced as Figure 1c where it is discussed in the Results (Section 3.3, p. 8, line 340), and the standalone figure has been removed; subsequent figures have been renumbered accordingly (former Figures 3 and 4 are now Figures 2 and 3). This consolidates the figures and avoids reproducing third-party copyrighted album artwork. No findings or interpretations were affected. |
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Reviewer 2 Report
Comments and Suggestions for AuthorsStrengths:
This manuscript presents a unique way to explore relationships between psychological trauma, emotional trauma, racism, and discriminatory behavior. I believe the comparison between two pandemics is an innovative approach. The qualitative approach using photovoice is a strong scientific methodology. The stages of the research, the sessions, and themes are explained in an adequate and comprehensive manner.
Strengths:
This manuscript presents a unique way to explore relationships between psychological trauma, emotional trauma, and racism and discriminatory behavior. I believe the comparison between two pandemics is brilliant. The qualitative approach using photovoice is a strong scientific methodology. The stages of the research, the sessions, and themes are explained in an adequate and comprehensive manner.
Weaknesses:
On question that raises a small concern is that of the sampling technique. Perhaps there could be more information regarding the "personal network" of the local community leader. I understand the community leader is trusted but what can be written to indicate selection bias was not a major problem? Another question is what were the distribution and response rates? The recruitment process raises questions, since there were only 10 people who signed on for the study. It just seems that there would have been more potential participants with the inclusion criteria not being so restrictive.
The weaknesses were adequately addressed in the section on limitations: thank you for being transparent. Even though photovoice is most appropriate with small groups, for future studies, perhaps more than one study group can be used. I believe the manuscript will provoke deep thought among readers. In addition, this study can and should be replicated.
Weaknesses:
On question that raises a small concern is that of the sampling technique. Perhaps there could be more information regarding the "personal network" of the local community leader. I understand the community leader is trusted but what can be written to indicate selection bias was not a major problem? Another question is what were the distribution and response rates? The recruitment process raises questions, since there were only 10 people who signed on for the study. It just seems that there would have been more potential participants with the inclusion criteria not being so restrictive.
Author Response
Manuscript ID: societies-4353706 — “COVID Can’t Be COVID Without George Floyd”: A Photovoice Exploration of Black Women’s Mental Health During the Dual Pandemics
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Response to Reviewer 2 Comments |
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1. Summary |
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Thank you very much for taking the time to review this manuscript. Please find the detailed responses below and the corresponding revisions in track changes in the re-submitted files. |
||
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2. Questions for General Evaluation |
Reviewer’s Evaluation |
Response and Revisions |
|
Is the content succinctly described and contextualized with respect to previous and present theoretical background and empirical research (if applicable) on the topic? |
Yes |
We thank the reviewer. |
|
Are the research design, questions, hypotheses and methods clearly stated? |
Yes |
We thank the reviewer. |
|
Are the arguments and discussion of findings coherent, balanced and compelling? |
Yes |
We thank the reviewer. |
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For empirical research, are the results clearly presented? |
Yes |
We thank the reviewer. |
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Is the article adequately referenced? |
Yes |
We thank the reviewer. |
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Are the conclusions thoroughly supported by the results presented in the article or referenced in secondary literature? |
Yes |
We thank the reviewer. |
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3. Point-by-point response to Comments and Suggestions for Authors |
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Comments 1: This manuscript presents a unique way to explore relationships between psychological trauma, emotional trauma, racism, and discriminatory behavior. I believe the comparison between two pandemics is an innovative approach. The qualitative approach using photovoice is a strong scientific methodology. The stages of the research, the sessions, and themes are explained in an adequate and comprehensive manner. |
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Response 1: Thank you so much for this encouraging assessment and for your careful, signed review. |
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Comments 2: One question that raises a small concern is that of the sampling technique. Perhaps there could be more information regarding the “personal network” of the local community leader. I understand the community leader is trusted but what can be written to indicate selection bias was not a major problem? |
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Response 2: Thank you for this suggestion. We agree the recruitment process deserved fuller description and have expanded Section 2.1 (p. 3, lines 124–129). Recruitment proceeded through two channels: (1) the community leader’s personal and professional networks, spanning family, friends, church congregations, and community organizations; and (2) outreach at community events hosted or attended by NC CEAL across the state. Added text: “The community leader, a longtime resident and trusted community health advocate, shared study information across her personal and professional networks—family, friends, church congregations, and community organizations—while NC CEAL distributed information at community events across the state.” We are careful not to claim that selection effects were absent. As in most community-engaged photovoice research, recruitment through trusted relationships is precisely what makes seven sessions of intimate disclosure possible, and the method prioritizes an information-rich, trusting group over statistical representativeness. Several features nonetheless mitigate concerns about a narrow or homogeneous sample: the two distinct recruitment channels; the heterogeneity of the resulting group (ages ranging from college-age to retirees; urban, suburban, and rural communities across central and eastern North Carolina); and participant validation of themes through member checking. We also added the following to the Limitations, Section 4.7 (p. 15, lines 658–663): “Relatedly, network-based convenience sampling through a trusted community leader—while essential to establishing the trust that sustained seven sessions of intimate disclosure—may have yielded participants with shared social ties and more similar perspectives than a more dispersed sample would provide. The resulting group nonetheless varied in age, geography, and community type, and themes were reviewed and validated with participants through member checking.” |
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Comments 3: Another question is what were the distribution and response rates? |
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Response 3: Because recruitment proceeded by word-of-mouth referral through the community leader’s networks and at community events, there was no fixed sampling frame, and the number of women who received study information was not tracked. Distribution and response rates therefore cannot be calculated. We have stated this explicitly in Section 2.1 (p. 3, lines 126–129) rather than leaving it implicit: “Because recruitment relied on word-of-mouth referral rather than a fixed sampling frame, the number of women who received study information was not tracked, and distribution and response rates cannot be calculated.” |
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Comments 4: The recruitment process raises questions, since there were only 10 people who signed on for the study. It just seems that there would have been more potential participants with the inclusion criteria not being so restrictive. |
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Response 4: We agree that the eligibility criteria were intentionally broad; the constraint on enrollment was not eligibility but the recruitment climate. Recruitment required five months of active outreach (December 2023–April 2024), reflecting the same barriers this study documents: research mistrust rooted in histories of research harm, competing work and caregiving demands, limited capacity, and the substantial commitment a seven-session study entails. Three of the ten enrolled women withdrew before the first photovoice session for capacity and caregiving reasons. We view the difficulty of recruitment as corroborating context for the study’s findings rather than a design flaw. We would also emphasize that photovoice is, by design, a small-group methodology whose originators recommend no more than 7–10 participants; our final sample of seven falls within this recommended range, and Section 2.1 notes that enrollment was capped at 10 participants by design. Added to Section 4.7 (p. 15, lines 652–655): “Small samples are not incidental to photovoice but constitutive of it: the method’s originators recommend groups of no more than 7–10 participants, because the trust-building, sustained dialogue, and collaborative analysis at its core depend on small groups [24,34].” |
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Comments 5: Even though photovoice is most appropriate with small groups, for future studies, perhaps more than one study group can be used… I believe the manuscript will provoke deep thought among readers. In addition, this study can and should be replicated. |
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Response 5: Thank you for this constructive suggestion, which we have adopted in Future Directions, Section 4.8 (p. 16, lines 684–687): “Future photovoice studies might also convene multiple concurrent groups across sites, preserving the small-group intimacy the method requires while broadening the range of networks and perspectives represented.” |
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4. Response to Comments on the Quality of English Language |
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Point 1: “The English is fine and does not require any improvement.” |
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Response 1: We thank the reviewer; no changes to the English were required. |
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5. Additional clarifications |
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We would also like to note one author-initiated change. We replaced the Session 3 trigger photograph shown in Figure 1c (caption p. 5, lines 197–199) — previously a photograph of a participant’s commercial album cover — with the session’s other original trigger photograph, the “HEALING” statue, which formerly appeared as standalone Figure 2. The statue is now referenced as Figure 1c where it is discussed in the Results (Section 3.3, p. 8, line 340), and the standalone figure has been removed; subsequent figures have been renumbered accordingly (former Figures 3 and 4 are now Figures 2 and 3). This consolidates the figures and avoids reproducing third-party copyrighted album artwork. No findings or interpretations were affected. |
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