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Pictographic Ambiguity and the “Go Along” Interview in Health Promotion Research

Ann Marie Corrado

posted November 20, 2016

Throughout our lives we are all likely to encounter examples of pictographic ambiguity, where carefully looking at a single drawing presents more than one image.  The cartoonist W.E. Hill published a popular example in 1915, which contains two images – an older woman and a younger woman – that become evident depending on how you look at the picture (Grand Illusions, n.d.). When I first looked at this image, I became frustrated because I could only see the young woman.  I believe that the inability to see both images represents the rich information that researchers are often lacking when doing a typical qualitative interview or a quantitative survey. In this sense, researchers are only seeing one image of the two, and are therefore not fully appreciating the bigger picture of health.







To me, this image represents the importance of the “go-along” interview in health promotion research.  According to Carpiano (2008), the go-along interview is a “novel qualitative method for studying the health issues of neighbourhood or local-area contexts” (p.263).  It involves researchers accompanying people during their outings in familiar environments, in the form of walking with the participants, driving with the participants, or a combination of both (Carpiano, 2008).  When researchers have the opportunity to ask questions and observe the environment at the same time, they are “able to examine the informant’s experiences, interpretations, and practices within this environment” (Carpiano, 2008, p.264).  It is important for researchers to examine participants’ interpretations of their context while simultaneously experiencing the environment themselves, as it allows the researchers to better appreciate how place matters for individual health and well-being (Carpiano, 2008). This understanding relates to the idea of pictographic ambiguity, as reading about people’s experiences in a survey or through an interview will not necessarily give an interviewer a comprehensive picture of the circumstances surrounding their responses.  In the same sense, having someone tell you that both a young and old woman can be seen in Hill’s drawing will not necessarily make you see them.  However, if someone is present with you while you are looking at the picture and outlining the ways in which they see both images, you will be more likely to see both the young woman and the old woman.

The methodology of the go-along interview is incredibly powerful because it has potential to generate personal and community empowerment.  In particular, “go-alongs can be used to help residents better recognize the sources of the problems facing their neighbourhood and larger local area – both proximal… and distal” (Carpiano, 2008, p.268).  This method “in conjunction with other individual and collective activities can be used to help people realize their role in challenging those conditions and confronting power, inequality, and structural violence” (Carpiano, 2008, p.268). In this way, a feeling of empowerment allows communities to find the second image of the pictographic ambiguity on their own. As stated by Narayan (2007), empowering individuals is pivotal as it expands their assets and capabilities to “participate in, negotiate with, influence, control, and hold accountable institutions that affect people’s lives” (p.120). 

As health researchers, it is important that we enter communities to observe and analyze, but not impose our beliefs and ideas on the community members.  The go-along interview offers us a way to listen, embrace, and be mindful of how the community sees health in the context of their environment.  As stated by Seear (2012), “imposed solutions based on a colonial mindset usually lead to passivity and dependence among a targeted population” (p.467).  This relates to the bottom-up approach in health promotion because we want to empower individuals so they are more likely to have sustainable solutions for their health.  It has been shown that a top-down approach to health is not beneficial, as telling people what to do without respecting their needs will result in negative consequences (Obregon & Waisbord, 2010).  This is similar to pictographic ambiguity, as it is not helpful to simply tell people how things should be or what they should see in a picture.  Instead, it is imperative we work with them and give them the tools they require to be successful. This will result in them feeling more confident in their abilities and they are therefore more likely to see both perspectives on their own.

In summary, this piece highlights that we cannot force our solutions on others, as a top-down approach is unlikely to be successful.  This is shown through Hill’s classic example of pictographic ambiguity, where we cannot force someone to see both images, but instead by working with them we can empower them to see both the young woman and old woman. In addition, it represents the need for us as individuals in health promotion to always look deeper and examine why things are the way are, so that we can make meaningful changes to improve health.




Carpiano, R.M., (2009). Come take a walk with me: The ‘‘Go-Along’’ interview as a novel method for studying the implications of place for health and well- being. Health & Place, 15, 263– 272. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/18606557

Grand Illusions.  (n.d.) Pictographic Ambiguity.  Retrieved from http://www.grand-illusions.com/opticalillusions/woman/

Hill, W.E. (1915).  My wife and my mother-in-law [photograph]. Retrieved from http://www.grand-illusions.com/opticalillusions/woman/

Narayan, D. (2007).  Empowerment.  Journal of Ambulatory Care Management, 30(2), 120-125.

Obregon & Waisbord (2010).  The complexity of social mobilization in health communication: top-down and bottom-up experiences in polio eradication. Journal of Health Communication, 15, 25-47.

Seear, M. (2012). An Introduction to International Health.  Canadian Scholars’ Press Inc. Toronto, Canada.