Background Population ageing and urbanisation make it increasingly important to involve older people in creating social and physical environments (age-friendly communities) to better support healthy ageing. Using photo-voice methodology, this study aimed to engage older people and stakeholders (local policy makers and service providers for older people) in identifying and addressing issues for respect and social inclusion in Liverpool city.

Methods

1. Four groups of older people (N = 26; <60 years) from two disadvantaged and two affluent areas in Liverpool city were recruited purposively. Participants photographed perceived positive and negative aspects of social inclusion in the city and reflected on the meanings of the photographs in individual (n = 25) and group interviews (n = 9). Photographs (n = 127) were selected by participants. Captions were prepared to capture participants’ meaning of the images, and their validity checked with participants. Thematic, visual and content analysis was conducted using NVivo 10 software with written and visual data being triangulated in tables. This photo-voice method has not been previously applied to explore this topic.

2. Purposively recruited stakeholders (N = 23) received semi-structured interviews to explore the current situation of respect and social inclusion in Liverpool city. Thematic analysis was undertaken with NVivo 10 software.

Results a) The use of photography became a method of investigation as well as a tool for enabling older people to think critically about their community, bringing out interesting aspects that would have been difficult to explore solely through individual and group interviews.

Physical environmental features were crucial in older people’s perceptions of social inclusion, including access to parks, health services, public toilets, and libraries. Conversely, disrespectful attitudes towards the elderly and the city itself, and a poorly maintained neighbourhood were seen as detrimental to social inclusion. Potential solutions to some of these issues emerged. Findings will be communicated through an exhibition of older people’s photographs (May 2015) to stimulate dialogue amongst participants, researchers, and stakeholders in order to influence city policy development that better reflects the needs of older people.

b) City stakeholders reported that despite a commitment to improve the social inclusion of older people, budgetary cuts, service duplication, and lack of political will, inhibited this process.

Conclusion This photo-voice approach to engaging with older people and stakeholders provides an innovative vehicle to be used by public health researchers to address policy/social issues and to critically reflect on cities’ assets/deficits. Methodological limitations included challenges in translating ‘social concepts’  (e.g. social isolation) into photographs.