Photovoice Methods Pilot Study of Cognitive Impairment in Multiple Sclerosis

Cognitive impairment (CI) affects upwards of 70% of people with multiple sclerosis (MS) and influences daily living and quality of life. Standard assessments capture performance but provide limited insight into how cognitive changes are experienced. Photovoice may help surface these internal and less visible dimensions, yet its feasibility for CI-focused MS research is not well established.

To assess the feasibility and methodological utility of photovoice for examining CI as a lived experience in MS and to identify insights that can guide future qualitative study design.

Adults with MS who identified CI as a significant challenge were recruited from a private online support group. Three participants completed a 7-day photovoice activity (38 images with written reflections) and a 90-minute photo-elicitation interview. Analysis focused on methodological illustration rather than saturation.

Participants generated images and narratives that depicted key aspects of CI in daily life. Photographs illustrated: (1) a mismatch between internal cognitive difficulties and outward appearances of wellness; (2) humor used to express forgetfulness and mental fatigue; (3) reliance on tools such as lists, reminders, and environmental cues; and (4) variation in how CI was framed, including changes in meaning following disability recognition. These findings show that participants were able to visually and narratively represent CI experiences.

Visual narratives align with earlier photovoice work on invisible MS symptoms, suggesting that photovoice can document cognitive experiences that traditional methods may overlook. Results support photovoice as a complementary qualitative approach for understanding how adults with MS interpret and manage cognitive changes in daily life.