Insights from Integrating Novel Community Practices of Shared Reading and Arts-Based Research in a Study of the Tertulias Women’s Peer Support Group Model

1. Introduction

Figure 1. Participant Expressions: Shared Reading & Arts-Based Research.

Figure 1. Participant Expressions: Shared Reading & Arts-Based Research.

1.1. Participatory Meaning-Making

In the literature, a great deal of emphasis has been given to acknowledging the extent to which traditional research practices have tended to erase participant voices in favor of positivistic and quantitative metrics derived from sources that do not reflect participant, patient, or community perspectives [1,2,3]. Community-engaged/participatory research methods seek to move beyond treating people simply as research participants or sources of data. Participatory approaches can create opportunities for participants to contribute experiential knowledge, shape interpretation, and influence how knowledge is represented and shared. In health research, embracing “co-creation” is a hallmark of the pivot toward better and deeper community-engaged research, a recognition of the importance of patient and participant engagement, and an acknowledgement (if begrudgingly) of the scientific value of expanding the purview of scientific inquiry.[4,5] However, this pivot requires consciously developing and incorporating practices that allow participants to reflect on, articulate, represent, and collectively interpret both their ongoing lived experience, but also their experience as participants in a research study.[6]

To achieve this paradigmatic shift, there has been increasing appreciation of the need to move beyond the bio-medical model in the design of health promotion initiatives to include not only novel interventions but also novel research methods for gathering data on outcomes and for incorporating participant voices. Davies[7] explores how the privileging of written texts can reinforce structural relations of power that diminish participant perspectives and contributions, including multi-layered meaning from sensory and embodied evidence that is ignored in traditional research approaches. This highlights the importance of developing different, and novel multi-modal methods. Given these concerns, there has been a move toward creative arts and narrative practices as providing particularly useful mechanisms for transforming the way researchers work and what we know. Duea and colleagues[8] discuss participatory art-making, including collage, drawing, tapestry, murals, and mandalas, as approaches that can elicit everyday knowledge, creativity, lived experience, and multiple ways of knowing. Importantly, they emphasize the evolving standard for participatory research to include participation of diverse stakeholders in both creating art as data collection, but also in interpretation and analysis. Insights from these innovations are changing the way that we think about health research and about how “evidence” is produced.[9,10]

Group Shared Reading (SR)

Out-loud reading in group settings has been proposed as a feasible and cost-effective strategy for engaging people in a different way that can be implemented in hospital, clinic, or community settings, including libraries [11,12,13,14,15,16,17,18,19,20,21]. Although the terms bibliotherapy and out-loud group Shared Reading (SR) are often used interchangeably, the concept of bibliotherapy has focused primarily on targeting specific populations such as individuals with dementia, caregivers, or as prevention for individuals at risk of developing an illness or condition, and reading is not necessarily done out-loud. Bibliotherapy reading activities are designed to help participants improve health, develop skills, and achieve personal insights related to illness and wellness [17,22,23,24]. Outcomes of bibliotherapy have included behavioral and cognitive shifts, enhanced social support, and improved ability to goal-set and problem-solve.

Alternatively, shared reading (SR) uses participatory, facilitated, group-based, out-loud reading of works from literature as a community practice to promote health through a strengths-based lens centered on wellbeing and assets rather than a deficits-based approach focused on disease and illness[12,13,16,25,26,27,28]. SR allows people to approach difficult experiences indirectly through fictional characters/stories and to foster social connection and shared meaning-making. SR has been associated with a variety of positive health benefits, including improving memory[26] and reducing depression[12,13,15]. But there are suggestions that the benefits of SR go further, with broad emotional, interpersonal, and social impacts such as increases in self-esteem, empathy, self-reflectiveness, and social cohesion[16,25]. Several studies have begun to identify and catalogue the characteristics and mechanisms of SR[12,16,25,29]. Some key dynamics of the “intrinsic benefits of shared reading practice”[25] (p. 124) include “joint focus” on the reading, collaborative meaning-making, and positive changes in participant self-perception and perspective—what Gustafsson and colleagues[25] (p. 123) call the “intricate dance of inter-subjectivity.” In SR, these dynamics that occur between readers in interpretive discussions of the reading also accrue positive social impacts from belonging to a group. These dynamics create connectivity and reduce social isolation. Importantly for participatory research, these characteristics also suggest that SR may also have value as a participatory practice through which participants reflect upon, articulate, and collectively interpret lived experience.

Figure 2. Out Loud Shared Group Reading (SR) Process.

Figure 2. Out Loud Shared Group Reading (SR) Process.

However, the body of literature related to SR is still nascent, with most of this work focusing on impacts on the participant rather than on the group dynamics. The bulk of the research has been conducted in the United Kingdom, and studies done have been based on small sample sizes, relatively short duration, and most have lacked systematic scientific controls or designs. Still, results have been promising, and they align with community-driven, community-engaged practices[30].

1.2. Arts-Based Research (ABR)

Arts-based research (ABR) is the use of any artistic activity as part of the research process[31,32,33]. But ABR specifically as a participatory methodological approach has gained interest over the past two decades, especially among researchers who work with populations that have been excluded from research[34,35,36,37,38,39,40], and as a way to promote participation and engagement in the research enterprise[41]. ABR encompasses literary methods (such as poetry, narrative writing, and fiction), video and photographic methods (such as digital storytelling, photovoice, and animation), performance art (such as theatre and dance), sound art (such as music or “soundscapes”), visual art (such as murals, drawings, and paintings), manual art (such as quilting, beadwork, and handwork of all types), or crossover methods that combine multiple methods (such as “zines”) [42,43]. Since ABR is so diverse, a number of studies have attempted to scope, review, catalogue, and categorize different types of ABR[37,38,40,44,45]. ABR approaches have been shown to increase empowerment[46] and resilience[47,48,49,50], and to enhance feelings of community[51] and social connectedness[52].

But ABR does not merely convey benefits to individual participants from doing art. The focus of ABR differs from art therapy as a form of treatment, where the purpose of the creative process is to heal individual patients[53,54,55]. As discussed above,[8] creative production can function as a research methodology. The focus of ABR is more about creating processes for socially engaged research, incorporating art as an “other way of knowing”[34] in order to make inquiry in health and health sciences more participatory, and producing broader social wellbeing beyond individual benefit[39,40,44,56,57]. But Lenette[58] warns of the importance of reflexivity in how ABR practices are implemented and the need for attention to the creation of culturally “safe” spaces through which ABR can become a mechanism for decolonizing the research enterprise. When implemented thoughtfully and meaningfully, ABR has the power to transform the hierarchical dynamics of research through the act of co-creation.

Figure 3. Arts-Based Research (ABR) Process.

Figure 3. Arts-Based Research (ABR) Process.

However, although artistic expression and creative works are becoming part of community health promotion and practice[37,59,60], they continue to be underappreciated in mainstream biomedical health contexts either as therapeutic strategy or as research method. In 2012, Clift[61] called for moving ABR toward being considered an “evidence-based practice,” but we are not there yet.

1.3. SR & ABR as Methodological Practice

Although SR and ABR have developed largely independently, their respective literatures point to important parallels in their potential contributions to participatory research. Both approaches can:

• Enable expression of experiences difficult to communicate verbally;
• Elicit knowledge not readily captured through interviews or surveys;
• Give participants greater control over how an intervention is experienced and how that experience is represented; and
• Facilitate reflection, meaning-making, and communication.

Yet despite these parallel implications for participatory practice, SR and ABR have been discussed in the literature primarily as separate approaches. We are not aware of studies in which these two practices have been used, tested, or examined together. Conceptually, however, they are highly complementary. SR provides an external narrative or story that can prompt self-reflection and connections to one’s own experience. Group discussion can then transform individual reflection into shared storytelling and collective interpretation. ABR provides another means through which participants can reflect upon and represent those experiences, including experiences that may be difficult to articulate verbally. Sharing creative work with others can, in turn, generate further storytelling, interpretation, and dialogue. These complementary processes raise an important methodological question: What happens when SR and ABR are intentionally integrated within a participatory research context? Moreover, particularly in the case of SR, what happens when a practice introduced as a component of an intervention simultaneously becomes a participatory research process through which participants generate, interpret, and communicate knowledge about their own experience?

1.4. Tertulias: Integrating SR & ABR in a Peer Support Group Intervention

“Tertulias” (Spanish for “conversational gatherings”) was a five-year randomized controlled trial of a peer support group intervention designed to reduce depression and social isolation and increase empowerment and resilience among women of Mexican origin. The study included 252 participants in four cohorts followed over 12 months. SR and ABR were incorporated as components of the intervention. Importantly, however, SR and ABR did not occur independently of the peer support environment in which they were embedded. The peer support group created a relational and generative space in which participants developed trust, shared experiences, and engaged in self-reflection and collective reflection. This is the type of “safe” space that Lenette[58] emphasized as key. Within this environment, SR provided a shared encounter with stories that participants could connect to their own lives and experiences, while ABR provided additional ways to reflect upon, express, and represent those experiences. Thus, rather than functioning as three discrete components, peer support, SR, and ABR became increasingly intertwined processes through which participants reflected, shared, interpreted, and created meaning from lived experience.

The fact that we did not begin by selecting two participatory research methods and intentionally integrating them is of note. SR and ABR were initially incorporated into Tertulias as separate participant-engagement strategies within the peer support intervention, designed to deepen participant experience of the intervention and to provide novel ways for them to both communicate and relate to what they were experiencing. But during the process of implementing the study, something unexpected happened: participants began actively and agentively integrating the practices themselves. SR and ABR—and increasingly their intersection within the peer support environment—generated forms of participation, self-reflection, storytelling, creative expression, and collective meaning-making that we had not entirely anticipated. In the process, practices we initially incorporated as intervention components began to do methodological work, generating forms of participant knowledge and researcher understanding that extended beyond what was captured through the study’s conventional research methods.

This article therefore does not primarily evaluate whether SR or ABR improved depression, social isolation, resilience, or other individual outcomes; those questions belong to the larger Tertulias study. Instead, the focus here is on what happened when these practices became intertwined within the participatory peer support environment. Specifically, we examine how participants experienced SR and ABR; the forms of reflection, storytelling, expression, and knowledge the practices generated; what occurred as SR and ABR became integrated; and how these processes contributed to researchers’ understanding of Tertulias. We further examine how participant expression moved beyond individual experience to become research data and a basis for co-interpretation and co-production, participant curation, public knowledge dissemination, and ultimately participant and community action. In doing so, we identify practical and methodological lessons for researchers interested in SR and ABR not only as community practices, but as interconnected participatory processes of knowledge production.

2. Methods

2.1. Community-Driven, Community-Engaged Research (CD-CEnR)

Tertulias used a Community-Driven, Community-Engaged Research (CD-CEnR) approach with participation across the life of the research. Community members not only engaged with Tertulias but actively drove and shaped the intervention into something that aligned with their own identified interests. The original impetus for study came from community partners who identified the research questions and hypotheses. A pilot study in 2014 involved participation at every step of the research, including as paid members of the research team and co-authorship of publications [AUTHORS]. Using results of the pilot study, partners and researchers worked with a paid community advisory board of six participants from the pilot study plus members of our community partner agencies to develop the Tertulias study which was conducted from 2020 to 2024. This group continued to convene quarterly throughout the investigation. Individuals from the community of study (female Mexican immigrants from low-income households) participated as paid members of the research team and were involved in recruitment, implementation, data collection, data analysis, translation of materials, interpretation of results, presentation of outcomes, authorship, and publication [AUTHORS]. In addition, as described below, we convened a group of nine paid participants from the Tertulias study to lead planning and curation of a public exhibition of participant creative works discussed here. Participants continue to be involved in multiple ways as we move forward into future stages of the research, including several participants who have been hired as research or implementation team members with our projects or other projects. All of these design features and practices address Lenette’s[58] concern for decolonizing and reflective practice to create cultural safety. This was a foundational aspect of the Tertulias CD-CEnR design.

2.2. Study Design & Theory

Tertulias is described in detail in our publications [AUTHORS]. We designed the study to align with a theoretical “architecture” combining four theoretical frameworks:

• Women’s Funds of Knowledge recognizes and values women’s experiential knowledge and skills [62].
• Gendered Emplacement Theory recognizes that because of hierarchical gender dynamics, women often require protected spaces for social interaction and self-actuation [63,64].
• Cultural and Contextual Situatedness recognizes the need for an intervention to fit synergistically with the participants’ culture and context [65].
• Syndemics/Counter-Syndemics conceptualize how adverse social conditions can amplify adverse health processes and how supporting mind-body practices in a social setting may represent a pathway to disrupt these processes.[66,67,68,69,70] Our model is designed to foster counter-syndemic dynamics such resilience and empowerment to counter negative syndemic dynamics including violence and abuse, unresolved trauma, and unmet social needs.

2.3. Inclusion Criteria

All participants self-identified as adult women who were born in Mexico, spoke and understood Spanish fluently, and self-reported income below 250% of the Federal Poverty Level (i.e., low-income). All participant-facing activities and components of the study were conducted in Spanish. All participants provided signed informed consent, including with respect to the use of their names, photos, and creative works.

2.4. Recruitment

We recruited 252 participants. Each participant was enrolled in the study for 12 months and there were four annual cohorts of approximately 60 women from 2020 and 2024. Participants were randomly assigned with equal allocation between two study arms. The intervention was a weekly, two-hour peer support group for 10 months that, because of pandemic social distancing requirements, was held remotely using Zoom, and included a WhatsApp chat group. Each year in the intervention arm, participants were divided into three peer support groups of approximately 10 women each. The control was a placebo, receiving no intervention.

2.5. Data Collection

As described in detail in our published protocol [AUTHORS], we gathered data at baseline and 12-months through demographic and health questions; validated surveys about depression, social support, stress, resilience, and empowerment; Social Network Analysis (SNA) questions, paired Retrospective Pre-Test questions based on identified domains of interest, post-intervention evaluation questions, and hair samples to test for hair cortisol as a biomarker of chronic stress. Ongoing throughout the study, we gathered data on recruitment, attrition, attendance, and unmet social needs and requests for assistance, and through meeting notes, facilitator observations, debriefs, and summaries, WhatsApp chat streams, group evaluation discussions, interviews, focus groups, and Ripple Effects Mapping (REM)[71,72,73]. Here, we focus specifically on outcomes and implications of two components of the project: SR and ABR.

2.6. The Nuts and Bolts of SR & ABR

Tertulias Shared Reading (SR). As per our use of a Women’s Funds of Knowledge theoretical framework[62], a key component of the Tertulias peer support group model involves storytelling and valuation of women’s knowledge from lived experience. In the model, the experiential knowledge and skills that participants bring to the intervention, regardless of educational level, is acknowledged and valued. Information shared between participants often takes the form of stories, individual testimonials, and narratives with which other participants are able to relate and empathize. As a group, participants also engage in SR, reading stories and excerpts from literature out loud as a group.

During the study, Tertulias meetings followed a “curriculum” of presentations or discussion prompts—some selected by the facilitators, some elected by the participants. Based on the expertise of the facilitators as experienced Community Health Workers (CHWs) and as members of the population (Spanish-speaking women of Mexican origin), the facilitators developed a calendar of discussion themes and group activities designed to provide social support, expand participants’ perspectives, and create a generative space for sharing and a “therapeutic landscape” for healing[74] (e.g., self-care, rediscovering and embracing your inner child, identity and culture, domestic violence, family financial wellbeing, etc.) At the start of each year, we also conducted a “brainstorming” session where participants in each group decided on a list of priority topics that they wanted to discuss or learn more about over the next 12 months (e.g., parenting, dealing with bullying at their child’s school, dealing with toxic people, menopause, women’s health, setting boundaries). The facilitators created the calendar schedule of weekly session themes based on weaving together topics that they chose together with the topics identified by the participants. It was no coincidence that these two strands always already overlapped.

For the SR, the facilitators chose the readings that they felt would be evocative of topics of interest in the curriculum. The lead facilitator would share the text being read on the Zoom screen, and when feasible, the participants were also given a paper or electronic copy prior to the meeting. Members of the group volunteered and took turns reading out loud. The meetings were 2 hours long and the first portion of every meeting involved an opening greeting conversation to catch-up with each of the participants for the group to learn how each of them were doing and what they had been up to since the last meeting. This opening discussion normally took about 45 minutes. The SR would follow-on this group discussion. Excerpts for reading would take 30 minutes. That would leave about 45 minutes for the group to discuss the text, consider the reading in relation to their own lives, experiences, and memories, and discuss what they thought about the story, how it made them feel, and what they learned.

Tertulias Arts-Based Research (ABR). ABR is another component of our model that aligns with our Women’s Funds of Knowledge approach. In our pilot study,[75] participants dedicated a great deal of time talking about food and its meanings in their lives. We invited them to share a recipe that was important to them. At the end of the study, we created a group cookbook and gave all of the participants a binder with all of the recipes. Much to our surprise, a couple of the participants, of their own accord, created illustrations and poerty that they wanted to be included in the cookbook! Our intention to include a mechanism for women to share their expert knowledge and wisdom around food was expanded by participants themselves into other creative realms. Therefore, when we designed the Tertulias RCT, we consciously included an ABR component to honor this lesson.

As part of the Tertulias group process, intervention participants were invited to develop a creative project of their choice in the form of a written story, poem, reflection, painting, drawing, photograph, recipe, photo, handcraft, other manual art, or other creative form and to present their work to the others in their group. The focus was on expressing themselves through the creation of a narrative, visual, or in one case musical representation of the participant’s unique personal experience and life journey. If possible and appropriate, participants were encouraged to provide written content describing what the project meant to them, why they wanted to share it, and how it connected to their experience in Tertulias.

The creative work component of the intervention was mentioned in the consent form and introduced briefly at the beginning of the year. After participants had already developed a group rapport and created a trusting space, during one of the group sessions in month five, we re-introduced the creative work component and the participants discussed ideas for what each thought they might work on. In the Year 1 cohort, we showed participants a cookbook with illustrations that the participants in the pilot study created as an example. In subsequent cohorts, we shared the creative works from previous cohorts.

Following announcement of the creative works activity, the facilitators met independently with each participant to help them plan and conceptualize their projects. Some participants required more assistance in the process, and a few participants declined to submit anything or said that they did not have time. However, generally speaking, participants were very excited about the opportunity. Some were able to say definitively what they planned to during the session where we discussed the details of the creative work activity. More than one participant announced that they knew what they wanted to do and planned to begin immediately after the activity was mentioned in passing at the beginning of the year.

In month 8, participants submitted their works to us and we created binders with copies of all of the works from all 3 cohorts that year and distributed the binders to the participants. At a session in month nine, participants presented their individual works to the group and shared their narratives. Having the binders with images of the works allowed each participant to follow-along and to see the works. In addition, because the sessions were conducted by Zoom, the facilitator shared an image of each work as it was being described by each participant.

Data on SR and ABR. Transcripts from group discussions/presentations of participant creative works, group evaluation discussions, interviews, and REM all contained questions or explicit discussion of SR and/or ABR activities. In addition, team member participant observation notes and all creative works and narrative descriptions of creative works submitted by participants were included as qualitative data.

2.7. Data Analysis

As described in detail elsewhere [AUTHORS], we analyzed quantitative data using standard statistical methods, social network questions using social network analysis techniques, and qualitative data using accepted qualitative methods. We also triangulated and integrated data gathered using different methods including through team discussions and the use of “joint displays”[76,77,78,79,80] and participant-generated “Ripple Effects Maps”[71,72,73] that helped us to visualize correspondence and discordance, to identify patterns, and to better understand and interpret the data [AUTHORS].

3. Results

Elsewhere, we describe our pilot study [AUTHORS], methods we used [AUTHORS], interim results [AUTHORS], and final results [AUTHORS] in detail. Outcomes of the intervention were compelling. In alignment with our theoretical architecture and hypotheses as described in our published protocol, the intervention consistently produced positive, meaningful, and powerful outcomes as compared to the control arm in which no such impact was observed. Tertulias improved participants’ mental and emotional health including reducing social isolation and depression, and had a positive impact on social networks and access to/knowledge about resources. We also documented personal growth and increased resilience and sense of empowerment. Although the larger study examined these specific pre/post outcomes, as discussed earlier, this article is not primarily an outcomes paper. Instead, here we focus on what we learned from incorporating SR and ABR methods into Tertulias as community-engaged participatory practices. Our findings illustrate how these practices—individually and in combination—facilitated storytelling, reflection, social connection, creative expression, and participant ownership of knowledge, while revealing aspects of participants’ experiences and study processes that were not readily discernible through conventional research methods, or even through common participatory methods. Here we discuss results and impacts of the SR and ABR components of the Tertulias model related to five domains that we identified in our methodological review as shown in Table 1.

Methodological Insights from Participant-Generated Knowledge

After reviewing participants’ creative works submitted by Cohort #1, we decided to amend our IRB protocol, and we obtained approval to hold a public exhibition of the creative works at the end of the study. All participants provided signed informed consent for their work to be displayed and used, they indicated whether or not they wanted their name associated with their work, and they provided consent regarding use of their photo. One participant wanted us to only use her initials rather than her name, four participants wanted us to use only their first name, and six participants requested that we use their first name and last initial. Notably, allwanted to be identified in some way with their creative work, and nonedeclined to consent to the use of their photo or their creative work.

We called the bilingual (Spanish/English) gala exhibition of the creative works from the Tertulias project, “Tertulias: Women Constructing Other Women: Social Practice, Co-Construction, and Self-Discovery Through Creative Works in the Tertulias Peer Support Project with Women from Mexico.” We obtained funding from the Alfonso Ortiz Center for Intercultural Studies at [BLINDED] to support all physical aspects of creating an exhibition (e.g., NHCC site set-up fee, graphic design for event posters, printing posters and programs, display supplies such as small easels) and the Ortiz Center award allowed us to convene and provide stipends to a group of nine participants to plan and curate the event over a 9-month period. We also received funding through the Society for Applied Anthropology (SFAA) for our team and the event planning group to attend the SFAA Annual Conference in March 2024 in Santa Fe, New Mexico. Our event planning group was invited to give a panel presentation discussing the Tertulias project, their participation in it, and the Tertulias model for peer support (Figure 4 & Figure 5).

In October 2024, we held the exhibition at the National Hispanic Cultural Center (NHCC) in Albuquerque, New Mexico featuring 84 creative works. The event was attended by more than 400 attendees, including many participants and their families (Figure 6).

In January, 2025, participant members of the planning committee together with members of our team were featured in a program on local cultural activities on the local public radio station. From March to May 2026, we held a 10-week public installation exhibit of a subset of 25 of the works on the campus of [BLINDED] (Figure 7). The event was designed and curated by a Museum Studies graduate student, but participants participated in disseminating information about the event and co-hosted an open house reception that was attended by over 100 people including many participants and their families.

4. Discussion

4.1. Transformation & Cementing

An important common facet of SR and ABR is that in asking participants to use shared readings to evoke memories and to produce creative projects representative of their lived experience, the result was that participants created and engaged with concrete, tangible manifestations of their own inner thoughts and feelings, and the ways in which those were being transformed through their experience in Tertulias. Psychologist Tobin Hart [81] discusses the process of self-transformation, writing that that “the process of human transformation is activated by the force of creativity or creation and by an expansion of awareness (p. 157).” Such self-transformation requires entering the depths of oneself and becoming more introspective and self-knowledgeable. The creative force or process starts with an original act, which is an event that originates from within, extends outward, and is then reflected back in consideration of the created work [82]. This process reshapes perspectives, minds, realities, and ultimately, the creator themself. As this change takes place, the experience of art-making and the interaction between the creator and the work of art—along with the dialogue that emerges from their relationship—all play key roles in this transformational journey. Psychiatrist and researcher Dr. Michael Krausz [83] explains this phenomenon as he considers his own journey with art-making and self-transformation: “What I produce has affected my ways of experiencing. I think of my art-making as a process in which who I am is enriched and transformed. In short, my art-production fosters my self-transformation, and my self-transformation fosters my art-making.” This transformative quality that happens through creative expression has been described elsewhere in the literature as poesis, autoethnographic expression, and transformative artistic practice [84,85,86].

In Tertulias, SR and ABR allowed thoughts, feelings, and transformations to be clearly articulated in a way which made them become actualized and more real for the participants. The concept of “concretizing” has been used to describe the process of when an idea, or the idea of a thing, is transmuted into something tangible and concrete [87]. In the context of Tertulias, we have coined the term “cementing” to capture what happened in the act of participants creating interpretations of readings, a physical piece of creative expression, or a written narrative to represent and characterize their personal experience or internal transformation. These acts inherently memorialize that experience or transformation, actualizing feelings and memories, making them become “real,” and revealing personal change. For some participants, the inner transformation reflected in their creative works served as a visual reminder to stay true to themselves and to continue that journey, “cementing” the positive changes that occurred and providing a visual impetus to carry those positive changes further forward. In her creative project, “Virtuous” (Figure 8), M.G. describes her drawing of a woman with creativity and experiences flowing out of her head as, “In this drawing I express how my mind opened up again and not just to remember but to put in practice the gifts God gave me.” In a separate but remarkably similar creative work, “Flourishing Woman in the Face of Life’s Adversities,” (Figure 9) Patricia Escajeda created a sculptural image of a woman’s head with emergent emotions and experiences to represent how Tertulias gave her resilience and the tools to heal her personal traumas.

Martha Gutierrez included a photo of herself, transcendently reaching up into the sky as her creative project, “Me…& My Dreams” (Figure 10), as a depiction of power and liberation:

Martha’s image serves as concrete proof of her strength and resolve, and the lived experiences that she now embodies and firmly stands upon. But she also explains that the photo is both a reminder and a projection into the future of what she hopes for herself as she continues to embrace change and move forward. Another participant, Mary, created a narrative work she called “Survival and Overcoming,” in which she used the metaphor of the bamboo plant as a symbol of “strength, flexibility, and growth” that changes while staying fixed and straight. She admonishes us the power of perseverance (Table 2).

The idea of participants undergoing a process or journey in which they must maintain resilience, determination, and endurance is reflected in depictions of challenges that the women have faced either individually or together as Mexican women. SR and ABR gave Tertulias participants new ways to understand this transformation—to cement it—and to enact it more concretely in their lives.

4.2. The Key Role of Stories

Telling One’s Own Story. Storytelling is a practice that is a “narrative way of knowing.” Stories are a powerful way of conveying information and have been used in many initiatives aimed at women’s empowerment [88,89,90,91]. As described in detail in our previous publications [AUTHORS], telling one’s story and listening to the stories of others are essential components to peer support and were core to the Tertulias model. In Tertulias, storytelling in the form of group discussion, SR, and through creative expression was deeply impactful for participants as they learned to tell their own stories as well as to connect with the stories of others. Sharing one’s story entails self-reflection, and listening to the stories told by other group members provided participants with a different perspective on their own lives and situations. Participants’ self-reflections, the advice and wisdom provided by other participants, and listening to others’ stories gave them new ways of thinking about how to approach their own lives. Learning about the challenges faced by others often made them realize their own struggles were small in comparison. Once a safe space for sharing was established, participants began to open-up to the rest of the group regarding their own experiences. One participant explained this as shown in Table 3.

By creating a safe space, participants began to process life’s traumas, both large and small, by sharing their experiences with other members of the group, thereby taking a sense of ownership and autonomy over the telling of their stories and how they survived and overcame events outside of the scope of their control. As we will discuss below, the group read a book of humorous folktales by Joe Hayes called Watch Out for Clever Women! (1996) that made participants laugh approvingly about women in the stories repeatedly overcoming challenges by transcending the cultural positioning of women as timid, weak, and unintelligent, and instead, getting the better of wealthy, powerful, lazy, or deceitful men in very clever and often surprising ways. Despite the light-heartedness of the narratives, discussion of the stories went deep and explored the ways that these folktales reflected and gave voice to serious and meaningful dynamics in their own lives. This is exemplified in Ernestina Mendez’ narrative project, “Being a Clever Woman in Desolation,” (emphasis added) which is a brave and poignant play on Joe Hayes’ trope of the “clever woman” in her personal story and journey of overcoming domestic violence [AUTHORS]. Another participant described the healing quality of sharing personal stories. Of interest, several participants elected to do narrative writing for their project. Carlotta Chavez wrote a reflection on her life prior to Tertulias, considering how her participation in Tertulias changed her perspective and outlook. These perspectives are illustrated in the quotations in Table 4.

For Carlotta, as for many of the participants, engaging in introspection and verbalizing how she had grown as a result of her experience in Tertulias not only allowed her to reflect on and outwardly represent a powerful internal transformation, but also provided her with a means of encouraging other women through her story and what she had learned—what Rosalba Ramirez refers to below in the next section as “going back for the rest” (Figure 11 below).

Hearing and Reading Other Peoples’ Stories. As indicated above, another unique aspect of the Tertulias approach was the integration of SR of works of literature alongside personal storytelling. Participants not only shared their own experiences but also read and discussed works ranging from short stories and folk tales to children’s books and novels. Facilitators used texts like the Watch Out for Clever Women folktales (Hayes 1996), short stories like Can’t You Hear the Dogs Barking and We’re Very Poor by celebrated Mexican author, Juan Rulfo [92,93], simple children’s books like Love You Forever [94], and novels like The House on Mango Street [95], to spark reflection, with members taking turns reading aloud and connecting the stories to their own lives. Even simple readings proved deeply evocative, leading to powerful discussions.

SR provided a safe and indirect way to reflect personal stories, stepping outside of participants’ own pain or shame while resonating with participants’ lived experience, emotions, and feelings in new ways that they found surprising. Participants discovered that the stories intertwined with their own experiences and that through the readings, they were able to move beyond judgment of the characters and recognize that every person’s choices and way of life stems from their own story. This process nurtured empathy and compassion for the struggles of others, including better understanding of the behaviours and choices of their own parents and grandparents. This process also helped them move beyond self-blame for their own past choices or experiences that may have had negative consequences in their own lives, and instead, to embrace and celebrate their own stories and histories. As indicated above, this was a theme that was explored in group readings of Joe Hayes’ folktales, Watch out for Clever Women! The readings spoke to participants’ own experiences, feelings, and emotions in a way that was evocative. Some participants chose to engage even further with the readings by incorporating them directly into their creative projects. This was true of Ernestina Mendez’s use of the clever woman folktales to tell her story of trauma and overcoming. Similarly, many of the women found that The House on Mango Street by Sandra Cisneros was deeply resonant. As shown in Table 5, one participant described why she felt this way.

In her project, Norma Terrazas paraphrased several quotes from the novel, “I want to be like the waves of the sea…free on the fields with the wind. Without fear of being stopped…One day I will jump out of my skin. The skin that was adapted to me. I will make the sky tremble like thunder.” She then reflected that “[these quotes] are what Tertulias is for me. Without fear of expressing myself and to always receive words of encouragement. That is how Tertulias is, together we can surpass any great storm.” Yet another participant, Rosalba Ramirez, created an image she called “Remember to Come Back for the Others,” representing a different quote from the book as shown in Figure 11, and also embracing the responsibility she felt that her transformation through Tertulias had created for her to ensure that other women have a similar opportunity—that she pay it forward.

The inclusion of quotes from literature as part of these participants’ creative projects speaks to the power that words can have in eliciting strong feelings and emotions across audiences. Personal resonance with a literary text proved to be a deeply poignant and generative experience for these women as they not only saw aspects of their lives reflected and illuminated in Sandra Cisneros’ writing but then held on to the words in their memory for use in their creative projects and their lives more broadly. This suggests that for these women, the connection they made to the writing impacted them in a way that went much deeper than simply enjoying the text– they took the words and incorporated them into a method of personal expression that they strongly identified with and wished to share with others. The “joint focus” of the group out-loud reading proved valuable to engage with literature in a group setting, but through incorporating aspects of the reading into their own creative projects, they continued the dialogue. Through this process, they learned how different perspectives lead to different interpretations of the same text, encouraging deeper reflection on how lived experience shapes present reactions and perceptions. As shown in Table 6, one participant explained why this was so impactful during a group evaluation discussion.

The open-ended nature of stories allowed for individual interpretation and reflection, and subsequently sharing these interpretations in a group setting allowed for participants to not only learn in greater depth about the others in the group but then to also empathize with them, and importantly, to self-reflect and learn about themselves.

Identification With and Self-Recognition in the Art and Stories of Others. In alignment with the power and key role of storytelling in the Tertulias group process, several creative projects were based on, or were centered around, pieces of art or written words that were not part of the SRs or produced directly by the participant themselves. Participants alluded to, used, incorporated, or included the stories, art, and creative work of others, suggesting that within other people’s work, as viewers and consumers of art, the participants were able to recognize and identify aspects of their own identity and experience that resonated with them, and that spoke powerfully to their own life trajectories and emotional landscapes. The fact that this internal recognition or realization was elicited by an outside perspective is testament to the power of the shared stories, readings, and creative works, and the fact that many aspects of human existence are relatable if they are shared. Jenny Vasquez shared a well-known painting, saying: “This painting is called ‘Seated Woman Holding a Fan’ by Pablo Picasso. The exposed breast represents maternity; her eyes looking down represent modesty and humbleness; the fan represents vanity and her curves represent beauty.” Claudia Mata blended her own experience and words with those of other women by adapting and paraphrasing a quote often attributed to Frida Kahlo (but which originated with the artist, Oroma Elewa), adding popular affirmations as she explained her choice to include as part of her creative project an image she downloaded from the internet of a confident and bold, feminine-presenting woman proudly holding a Mexican flag above her head (see Table 7).

Taking this further, for her creative project entitled “Awareness of Domestic Violence,” as shown in Table 8, Patricia Bustillos Ramírez chose adapt her own version of a poignant poem written by a survivor of domestic violence:

The experience of encountering art that gives voice and language to convey previously unarticulated emotions or thoughts has been explored in psychology, philosophy, and literary theory. When we consider or contemplate art and other forms of creative work, we can reveal aspects of experience that we may not have been consciously aware of, making the invisible visible [96]. This phenomenon proved to be a meaningful mechanism for participants as they sought to characterize and qualify their own experiences and emotions. Identifying aspects of one’s own inner world in the creative production of another person also appeared to be a deeply impactful experience for participants to undergo as it further contributed to a sense of connectedness and shared experience, ultimately decreasing isolation and reminding participants that they are not alone.

4.3. With New Eyes: Observing and Finding Beauty in the Everyday & Mundane

Another interesting theme that emerged within several creative projects was that of the beauty and significance that participants began to discover in the everyday or the mundane. When asked to create something representative of their experience in Tertulias, a few participants took inspiration from their jobs or daily household tasks. It was almost as if their inner transformation was so significant that their perception of their external environment or daily activities became laden with new meaning. Many of the participants created works that were recipes, instructions on how to can fruit, or pictures of household plants. In her piece, “Burn the Ships, ‘No Turning Back,’” (Figure 12) Guadalupe Hernández included a before-and-after picture of her work renovating old, dilapidated apartment buildings.

In “Clean Your Life Because You are the Reflection of Your Home,” Yesenia Rascón wrote about how her participation in Tertulias was similar to cleaning an old, cluttered house (Table 9).

There is a sense of power in these quotidian metaphors as participants (many of whom are primarily responsible for household upkeep and/or hold jobs in domestic labor) reclaim and assert their autonomy and dignity through their professions and through their everyday life and work, including their “funds of knowledge” and work such as cooking, cleaning, and “homemaking” that for women, are routinely undervalued and ignored.

4.4. Imagination and Re-Connecting with Childhood: Re-Imagining Past & Present

A unique aspect of SR and ABR that repeatedly appeared within participant’s creative projects and in discussions of the readings was that of reconnecting with one’s own childhood. The activity of engaging in creative thought or creative expression is often highly encouraged in childhood– a normalized outlet for childlike wonder and imagination that often becomes diminished or suppressed in adulthood. For many participants, the request to read narratives that had a folktale format (e.g., Beware Clever Women), were from a children’s picture book (e.g., Love You Forever) or explored what it is like to be a child (e.g., the narrator in The House on Mango Street) or to be creative and produce a project, allowed them to re-engage with skills and feelings that they might have initially developed and fostered in childhood and then lost touch with as they got older. As Elia Hernandez explains in her “My Therapy” creative work, “this project helped me to regain part of my life, of the skills that I had set aside for a while. Because of this project, I began to embroider again. I learned to embroider because of my grandma, my mom and school.” In “Coral Reef,” Maria Cristina Sánchez explains that for her creative project, she was celebrating something as seemingly mundane and valueless as a breadcrumb. She chose to recreate a dough recipe using breadcrumbs that she remembers making as a little girl (Table 10).

Moreover, connecting to childhood memories further enabled participants to consider their own personal evolution along their life trajectory. For many, acknowledging and accepting past versions of themselves and linking their adult selves to their child selves proved to be a helpful part of a healing process. In “The Night of Tomorrow / Old Cobbler Patchworker” (Figure 13), Norma Ochoa used a childhood story about a cobbler living in a patched-up boot as a metaphor for her immigration experience. She explained that for her, her cobbler’s boot is the childlike sense of wonder and joy that she lost upon immigrating to the United States. Participating in Tertulias felt to her like taking her boot out again. She likened opening-up and sharing her inner wounds and feelings within the group to taking out her boot and acknowledging the rips and tears in it. As she started to heal and process her trauma she began metaphorically patching-up and renewing her boot–the part of her that resembles joy and happiness–emotions she associated with her childhood, prior to her immigration.

Delfina Alvidréz, in her piece, “Little Cow” (Figure 14), shared a handcraft of a cow that she remembered from her childhood, saying that “to remember is to live again.”

Yet another important implication of participants reflecting on their childhoods was how recognition of common experiences in youth served as further means of bringing participants together and creating a sense of connectedness and community. Discussion of what it was like growing up in Mexico elicited strong ties between participants as they described vivid memories through which they could then relate to each other. In her creative project, Maria A. made a collage of Mexican comic books she called “Sentimentál” (Figure 15). In her narrative description of the work and its meaning, she described her continued love of Mexican comics since her early teenage years, and that her project.

In “Tortillas from Urireo Guanajuato,” (Figure 16) Maribel G. described her memory evoking a morning when she was growing up on her parents’ farm in Mexico.

The selected readings and short stories similarly helped serve as an impetus for participants to remember and connect through memories of shared upbringings and traditions. In the evaluation discussion, one participant recounted that, “I really liked the stories because there were moments that made us travel back in time to precious things, to very beautiful memories…I felt feelings of joy, melancholy, happiness, and I really liked that.” As shown in Table 11, another participant explained why this was so.

Pike & Crocker [97] explore such nostalgia for childhood and one’s past in the context of immigration. They find that for many, this nostalgia operates as a protective blanket of personal experience, comforting and healing, in a way of that confronts and disrupts solitude and loneliness. In Tertulias, the SR and ABR components created opportunities for participants to connect with that nostalgia in a way that contributed to their sense of wellbeing and hope for the future, and at the same time to share these feelings with the group and to co-experience the comfort of nostalgic memory.

4.5. Creative Works & Art: To Create is to Feel Empowered

As we describe elsewhere [AUTHORS], empowerment and confidence are topics that frequently emerged as Tertulias participants explained how the group enabled them to gain confidence in their skills, knowledge, and abilities, while also allowing them to appreciate their accomplishments in overcoming significant past challenges and obstacles. On post-intervention survey questions about the group and empowerment, using the Trauma Informed Practice Scales [98,99], intervention arm participants scored extremely high, across the four measured subscales. The subscales include “agency” (max score=27), “information” (max score=15), “strengths” (max score=9), and “connection” (max score= 9). The 100 participants who completed this assessment had a mean (SD) agency score of 25.9 (3.4), information was 14.3 (1.9), strengths was 8.7 (1.2), and connections was 8.6 (1.5). On post-intervention evaluation questions regarding the benefit of the Tertulias experience, 97% rated their experience participating in the Tertulias group as good or very good (4 or 5 out of a maximum of 5, respectively), and 92% of participants said their experience in the group made them feel a lot or extremely empowered personally (4 or 5 out of a maximum of 5, respectively). The creative projects allowed participants to represent increased empowerment and inner transformation through imagery and written word. Participants had full autonomy in selecting the theme or experience they wished to explore and develop in their projects. By maintaining control over both their subject matter and creative techniques, they were able to engage with the research process on their own terms—determining what they found meaningful from their unique perspectives and expressing themselves beyond the constraints of a research-driven agenda.

Strength and empowerment were themes that permeated both small group conversations and the content of creative projects. Participants explained that Tertulias made them feel powerful and liberated. A recurring metaphor was that of the “guerrera” or female warrior in relation to this feeling of empowerment. This was a symbol that reflected participants’ sense that they had overcome negative life circumstances including the odyssey of immigration, concentrating the emotions of such a transformation into a singular, meaningful focus of a woman with power. One participant described how what she learned in the group allowed to finally say “no” to other people in her life, and that this experience made her feel “free, free, free!” Another said that Tertulias had made her feel like “Wonder Woman.” As shown in Table 12, in her project, “Female Warrior,” Linda expanded upon this.

The enduring power of the woman warrior is like cement—women are not only strong and resilient, they are the ones who hold families and relationships together. The metaphor of the guerrera not only signifies a woman who has fought with dignity and strength against all odds, but a woman who will continue to move forward and meet current or unknown future challenges with resolve and power. In “They, Women of Faith, Tireless Warriors,” Denysse Rangel dedicated her work to the memory of her “Two Greatest Tireless Warriors”—her mother and grandmother, who “never gave up.” This specific conceptualization of the woman warrior was reiterated in several creative projects as participants elected to include imagery of powerful women in armor and arms, or just describing the strength and resilience of their mothers or grandmothers, or the strength and resilience they were finding within themselves and that they saw in all women, celebrating the interplay of femininity with strength and liberation.

The very act of engaging in creative expression was found to be even further empowering. Participants who were not as comfortable with modes of creative expression such as painting, drawing, or handicraft found that engaging in such activities and subsequently succeeding to create something meaningful and worthwhile increased their confidence even further. One example comes from Carmen Cardenas in her painting, “A Dance to Life” (Figure 17 & Figure 18).

The public-engagement aspect of the projects and the fact that they were to be exhibited in a public space was even further empowering for participants (Figure 16) Art in this sense became activism as participants shared their experiences in an exhibition venue and saw that their journeys and perspectives were not only sought out and considered by visitors but also lifted up and celebrated as being beautiful, deserving of attention, and valuable—as creative works of “art.”

4.6. Cementing Resilience, Change, and Growth

Resilience was a recurring theme in the group discussions and the projects. As indicated above in Figure 9, Patricia Escajeda’s sculpture of “Flourishing Women in the Face of Life’s Adversities” was fixed to a platform labelled “Resilience.” Participants developed several tangible and positive coping strategies from facilitators and fellow group members during Tertulias, which supported their personal resilience and resulted in a sense of personal change and growth as a result of the intervention. It is not surprising that among the quantitative variables that were influenced by the intervention, resilience as measured using the Connor-Davidson Resilience Scale increased by 5.1 points (SE=1.4) over the course of their participation. This corresponds to a Cohen’s d effect size of 0.36 when compared to control group participants in the Tertulias study. Group participants described gaining a profound sense of purpose–often surprising themselves as they explored and redefined their ability to be introspective and to cultivate self-perception throughout the intervention. Reflecting on the transformative nature of change that they experienced, with its enhanced resilience, they expressed how the process felt healing. Many also noted positive personal growth and increased confidence in their ability to communicate and articulate their emotions.

SR and ABR added valuable, additional layers of insight to the self-transformation participants underwent as a result of Tertulias, cementing the change. As discussed above, in order to use art and creative expression to explore or portray one’s inner feelings, a reader, artist, or viewer must be introspective. They must be able to first identify what and how they are feeling so that they can then express those concepts in a way that evokes personal meaning and feels true to them. The shared readings and creative projects provided an opportunity for participants to pause and reflect on their lives and experience related to their own change and growth as a result of Tertulias. The additional knowledge that readings were done out-loud as a group, that the creative projects were to be shared in a group setting, and that the creative projects would be exhibited publicly at the end of the project further characterized group discussions of the readings and the projects as something to be perceived and understood by others, with the ultimate intent of conveying the message of the reader and creator to a broader audience in an empathetic way.

The use of metaphor as a modality for self-expression inherent to the creative process proved to be a powerful means of exploring and solidifying inner change and growth for participants as they reflected on their life trajectories and subsequent experience in Tertulias. For metaphors to resonate, there must be a deep understanding of what the metaphor represents by the person utilizing the metaphor to elicit meaning as well as by the audience interpreting the metaphor within a broader social context. The benefits of the project are evident. One of the most simple but elegant and powerful metaphors, was Angélica Borja Holguín’s use of 3-D string art in her piece called “Threadwork” to express how participating in Tertulias changed her life (Figure 19). She described that she developed the idea for her art as she was considering how Tertulias had worked to unite the group members and how this idea was embedded in both the visual image she created but also in the materials she used and the way that she combined them.

Marisol Mejia likened her participation in Tertulias to a tree, creating a drawing in which the names of the group facilitators formed the trunk of a tree and the names of the group members made up the leaves, and the “fruit” of the tree were the impacts of Tertulias on the lives of the participants. She writes, “Harvesting the fruit of dedication, love, compassion, friendship, preparation is a balm for the tormented soul and a refuge in the storm. We are the fruit and you are the support.” (Figure 20).

Perhaps the most recurring theme throughout the data, including group discussions, creative projects, facilitator notes and reflections, and individual participant commentaries was the butterfly, symbolizing their sense that participating in Tertulias had been transformative. Edaísa wrote a beautiful and lengthy fairy tale that she called “Princesses & Butterflies” about “the butterfly princess” that represented women from the group. Others created similar metaphors and images as shown in Figure 21, Figure 22 and Figure 23.

5. Conclusions

The Tertulias study demonstrates how practices initially incorporated as components of a peer support intervention evolved into participatory methods of knowledge production. SR and ABR provided participants with different but complementary ways to reflect upon, express, represent, and share lived experience. Importantly, these practices did not operate independently. As illustrated in Figure 24, they became intertwined within the relational and generative environment of the peer support group. Peer support created conditions for trust, reflection, and sharing; SR introduced shared encounters with stories that stimulated self-reflection, connection, dialogue, and storytelling; and ABR provided additional ways for participants to explore and represent experiences and meanings that could be difficult to express through words alone.

This integration suggests a dynamic rather than linear process. Participants encountered stories, connected them to their own experiences, articulated and shared their own stories, represented experiences creatively, and brought those representations back into the group for further dialogue and collective interpretation. Through this process, participants exercised agency not only over what experiences they considered meaningful, but also over how those experiences were represented—through stories, poems, paintings, drawings, photographs, recipes, handicrafts, and other forms of creative work. SR and ABR consequently generated forms of participant expression and knowledge that were not readily discernible through the study’s conventional research methods and provided the research team with new ways of understanding and interpreting other study data.

The methodological process also extended beyond knowledge generation. Participant-created works initially produced within the research became sufficiently important to participants and the research team that the study protocol was amended to support their broader dissemination. Nine participants were subsequently paid to plan and curate a public exhibition; participants presented the project at the Society for Applied Anthropology annual meeting; 84 participant-created works were ultimately exhibited at the National Hispanic Cultural Center in an exhibition attended by more than 400 people; and later a follow-on exhibit at [Blinded] included the planning committee plus other participants and their families. Thus, ABR did not end with creative production or data collection. Participants assumed increasingly active roles in determining what knowledge would be shared, how it would be represented, and how it would be communicated beyond the research setting.

As depicted in Figure 25, our findings therefore suggest a participatory research pathway in which participant expression becomes research data; research data becomes the subject of co-interpretation and co-production; participant-generated knowledge becomes the basis for participant curation; and participant curation enables public knowledge dissemination and participant and community action. This progression is consistent with emerging participatory-methods scholarship in which participant-generated stories and visual materials function simultaneously as research data, objects of collective interpretation, and resources selected by community participants for public knowledge mobilization.[100] In this sense, dissemination is not simply an activity that occurs after the research has been completed; it can become part of the participatory research method itself.

Our experience also extends existing work within JPRM on arts-based and participatory approaches to generating and interpreting knowledge, including Lenette’s[58] emphasis on culturally safe and reflexive participatory arts-based research. Tertulias demonstrates the potential contribution of integrating group-based SR with participant-directed ABR within a peer support environment and traces how participant-generated knowledge can move from self-reflection and shared storytelling to creative representation, collective interpretation, participant curation, and public dissemination and action.

These findings suggest a broader way of conceptualizing participation in community-engaged research. Participation need not be limited to engaging community members in research designed and interpreted primarily by researchers. Participatory practices can create opportunities for participants to determine what experiences matter, how those experiences are represented, how their meanings are interpreted, and ultimately how the knowledge generated through research is shared and used. The integration of peer support, SR, and ABR in Tertulias offers one model for creating such opportunities and provides practical and methodological lessons for researchers interested in developing more participant-driven processes of knowledge production, interpretation, dissemination, and action.

NOTE: All participant quotes and narratives were gathered in Spanish and translated into English by team members Lidia Regino and María Tellez