Drawing insights: exploring how participants experience rich picture interviews for studying complex issues in health...

Innovative qualitative approaches are essential for exploring how health professions education (HPE) can address complex, value-laden constructs such as social accountability. Visual elicitation techniques, including rich picture interviews (RPIs), offer distinctive opportunities to surface layered, affective, and contextually embedded understandings. This methodological study examines participant perspectives on the use of RPIs within a broader qualitative interpretive description on social accountability. 46 participants, including learners, community representatives, faculty, and institutional leaders, created rich pictures (20-30 min) followed by semi-structured interviews (60 min) conducted virtually in English or French. Importantly, a dedicated segment of each interview explicitly elicited participants' reflections on the RPI process itself, including its accessibility, relevance, and perceived value. Data were analyzed using Braun and Clarke's reflexive thematic analysis. Three overarching themes captured participants' experiences: (a) from hesitation to reflective engagement, (b) visual thinking as a catalyst for dialogue and adaptability, and (c) affordances and boundaries of RPIs. Many began with apprehension, often tied to artistic skill or ambiguity of the task, yet valued RPIs for structuring reflection, deepening emotional engagement, and anchoring abstract concepts in personalized, tangible representations. Participants noted the method's adaptability across cultural, linguistic, and professional contexts, while also identifying barriers such as discomfort with drawing or the abstract nature of social accountability. By documenting these experiences across diverse partner groups, this study offers practical guidance for employing RPIs in HPE and related fields. RPIs can serve not only as data collection tools but as reflective, generative spaces that bridge abstract ideals with concrete experiences.