Through a global health lens, this research article examines key conceptual framework themes for working with participatory visual methods (PVM) to engage and involve community members in biomedical research and public health. We reflect on our experiences of applying an array of PVM with community members in Vietnam, Kenya, the Philippines and South Africa. The participants that were engaged in these processes were living in under-resourced areas with high prevalence of communicable and non-communicable diseases. The article describes some of the challenges encountered by the research authors while using PVM to foster knowledge exchange, build relationships and facilitate change among individuals and families, community members, health workers, biomedical scientists and researchers. Multiple ethical situations that arose through the work are considered, and the ways in which the researchers navigated and negotiated them are discussed. Reflections and learning from facilitating these processes are offered and novel contributions are made to ethical framework concepts.