Perceptions of the alcohol environment may influence alcohol consumption patterns. The purpose of this study was to describe changes in perceptions of the urban alcohol environment as experienced by residents of two districts with different socio-economic status after taking part in a Photovoice study. The study was conducted in Madrid, Spain, in a district with a high socio-economic status (HSES) and another district with a low socio-economic status (LSES).

A Photovoice project was conducted with 26 participants divided into four groups based on sex and district. Groups met over five sessions in which they discussed photographs taken by the participants themselves on the subject of alcohol in their neighbourhood. A qualitative, descriptive and thematic analysis of participants' discourses was performed to explore changes in their perceptions of the alcohol environment over the project sessions. Changes in perceptions of the alcohol environment were observed in all groups over the project. The process of change varied by districts' socio-economic characteristics and gender. Greater changes in perceptions of the alcohol environment were observed in HSES, especially among women, as the participants had a much more positive initial view of their alcohol environment. In LSES, participants showed a more critical perception of the alcohol environment from the beginning of the study, and this broadened and intensified over the course of the sessions. Changes in perceptions also varied by thematic categories, including some categories that were discussed from the start (e.g. socialising and alcohol consumption) and categories that only emerged in later sessions (e.g. alcohol advertising). Involvement in a Photovoice project has favoured a shift in the participant's perceptions of their alcohol environment towards more critical positions, widening their scope of perceived elements and raising their awareness of specific problems, such as alcohol advertising and social role of alcohol consumption in relation to alcohol exposure.