Date of Award


Document Type

Restricted Access Thesis

Degree Name

Doctor of Nursing Practice (DNP)



First Advisor

Lisa Van Getson

Second Advisor

Sue Cutshall

Third Advisor

Joyce Miller


Indigenous peoples are often excluded in the design of health care delivery models. This leads to a lack of culturally congruent care and unfavorable health outcomes. Photo-elicitation is an innovative method which allows participants to share their perspective through images and speech in contrast to writing or structured surveys/interviews created from a non-indigenous perspective. The literature review identifies only six studies of photo-elicitation methodology with nurses or community health workers (CHWs). This project, however, uses a nursing theoretical framework and employs the use of photo-elicitation in the rural highlands of Guatemala with a group of eight CHWs who identify with the indigenous Mayan K’iche’ population. They photographed, discussed, and critically analyzed their experiences with the following topic; “Where do illnesses come from in Guatemala?” Major themes include; fruit, diabetes, contamination, community hygiene, illnesses of the skin and bones, natural medicines, family planning, and nutrition. Major outcomes of the project include; increased ability to navigate concerns related to sharing of voice, praxis, increased role identity, increased empathy, and networking. Additional outcomes include; communication across language and literacy barriers, communication across power structures, cultural preservation of health practices, shared knowledge of community resources, and increased value of the CHW program at the organizational level. Changes were made to the leadership structure at the clinic to allow for the inclusion of indigenous voice. The organization learned of opportunities to expand their community outreach, referral, follow-up, and patient education processes. Recommendations were provided to further incorporate indigenous voice in health care delivery at the clinic. Photo-elicitation is a method by which Advanced Practice Nurses can collaborate with marginalized peoples groups and can incorporate the voice of recipients of health care into the development of culturally congruent care delivery models. Through the use of this method, health care systems can find solutions to issues with access to care, contextualize biomedical science in culturally congruent ways, and decrease unfavorable health outcomes.