Steps outlining the typical approach to a photovoice project as applicable to this study
| Step 1 | Select a target audience of policy-makers | The target audience of policy-makers included elected persons responsible for community-based health from the regional health agency of Loreto previously known as the Regional Health Directorate of Loreto, the Regional Government of Loreto, the Peruvian Ministry of Health, and the Pan American Health Organization. |
| Step 2 | Recruit participants | 20 CHWs from the districts of Nauta and parinari were recruited by a coordinator from MDR through purposive sampling. A total of 14 CHWs participated in the project. |
| Step 3 | Train participants | Participants were trained in photovoice methodology, study objectives, photography and ethics during a 2-day orientation in each district. Ethics training included field safety and the importance of obtaining informed consent from the people they chose to photograph. |
| Step 4 | Obtain informed consent | CHWs were consented to participate in the project before the training session. Participants were provided with consent forms to obtain from individuals whom they planned to photograph in the community on a weekly basis. |
| Step 5 | Pose a theme for pictures | Researchers presented CHWs from both districts with the predefined question: how did the COVID-19 pandemic impact my life and work as a CHW? |
| Step 6 | Distribute materials for picture taking | CHWs used electronic tablets provided by MDR to take photos. They were given an orientation handbook, pens, photo logs, informed consents/media release forms and SHOwED worksheets to facilitate photo taking and discussion. |
| Step 7 | Allow time for photo taking | Participants were given between 5 and 7 days to take photos in their communities depending on how far away they lived from the primary study site. |
| Step 8 | Meet to discuss photos and form a call to action | Discussions were held once per week in each district. Steps 5–8 were repeated until data saturation was met and a call to action was developed. A total of four discussion sessions (two in each district) were held. See table 2 for further breakdown of meeting objectives and discussion |
| Step 9 | Share photos and call to action with policy-makers in the form of an exhibition | The photos and call to action were shared with the target audience in two separate galleries in Iquitos and Lima. |
CHW, community health worker; MDR, Mamás del Río.