Product Details

Author Information

Corresponding Author
Cindy G. Jardine
Centre for Health Promotion Studies, School of Public Health
3-295 Edmonton Clinic Health Academy
University of Alberta
Edmonton, AB T6G 1C9
Canada
p: (780) 492-2626
cindy.jardine@ualberta.ca

Authors (listed in order of authorship):
Shelagh K. Genuis
Centre for Health Promotion Studies, School of Pub

Cindy G. Jardine
Centre for Health Promotion Studies, School of Pub

Chekoa Program
Yellowknives Dene First Nation

Product Description and Application Narrative Submitted by Corresponding Author

What general topics does your product address?

Public Health, Social & Behavioral Sciences

What specific topics does your product address?

Community engagement, Community health , Community-based education, Health behavior, Prevention, Tobacco use, social media, Community-based participatory research

Does your product focus on a specific population(s)?

Adolescents, Indigenous/Aboriginal

What methodological approaches were used in the development of your product, or are discussed in your product?

Community-based participatory research , Qualitative research, Videovoice, Interview

What resource type(s) best describe(s) your product?

Case study, Health promotion

Application Narrative

1. Please provide a 1600 character abstract describing your product, its intended use and the audiences for which it would be appropriate.*

The "Youth smoking videos" are thought-provoking, entertaining, youth-focused videos which communicate antismoking messages in ways suitable to Aboriginal contexts and responsive to how youth seek information. Two videos were designed and produced by youth from the Yellowknives Dene First Nation (YKDFN) communities of Ndilo and Dettah as part of a partnership between researchers at the University of Alberta's School of Public Health and the Chekoa Program, a holistic community-based program for YKDFN children and youth. Videos present effective antismoking messages relevant to young teenagers, particularly First Nation youth, and their communities. The Ndilo video presents three 'acts' with creative themes including a boxing match between healthy lungs and a cigarette. The video encourages viewers to ‘say no' to cigarettes. The video produced by Dettah youth presents a moving re-enactment suggested by a story related by a Tobacco Health Promotion Specialist who spoke to the youth. This video highlights the strong addictive power of tobacco and its serious health consequences. Videos represent a unique way to engage YKDFN youth in antismoking messages through product creation and sharing of the videos both on an individual level and within YKDFN schools and communities. For example, the videos have been and will continue to be used at community events to showcase youth accomplishments and to promote smoking prevention/cessation. Given high levels of youth engagement with social media, the videos were also designed to influence the smoking decisions and behaviors of a broader youth and Aboriginal audience via YouTube.

2. What are the goals of the product?

We used a participatory approach to explore if a social media intervention developed by Aboriginal youth can effectively engage youth and others in Aboriginal communities in discussions around smoking risks and potentially influence smoking decisions and behaviors. There were three primary goals for this product. (i) We sought to positively and productively engage Aboriginal youth in smoking prevention and/or cessation through a participatory approach which focused on skill development, positive peer interaction, and the development of health promoting, youth-oriented videos published via popular mediums (DVDs and YouTube publication). (ii) Our second goal was to effect behavioral change in youth participants. We sought to foster critical thinking about smoking risks and about effective communication of tobacco prevention/cessation messages in short videos; encourage participation in all aspects of filmmaking including script development, directing, filming, and editing; and build capacity, confidence and leadership skills through involvement in the research process and in the development of specific products. (iii) Our final goal was to effect behavioral change in the broader community. The goal of the videos was to use culturally relevant, peer developed messaging to encourage a general audience of First Nation youth to consider the health risks associated with tobacco use. We also sought to encourage families, communities, and Aboriginal peoples in Canada and elsewhere to consider positive choices with respect to tobacco use, and to work towards changing environmental conditions that affect youth decisions about smoking.

3. Who are the intended audiences or expected users of the product?

Intended users include youth participants, their local peers, families, community members and leaders, and the wider online audience who access social media. Participants were given DVDs to share with peers, as well as information about accessing videos via YouTube. DVDs were provided to key community representatives for distribution to community leaders, Elders, and community organizations. In order to reach community members, the videos have also been showcased at well-attended ‘Pizza and Movie’ nights in the participants’ communities. Plans are in place for further showings at community meetings and events. Additional DVDs have been produced for distribution to academics and policy-makers with interest in social media as a means for youth and community engagement with health promoting messages. The research process and videos will, furthermore, be shared through planned conference presentations.

4. Please provide any special instructions for successful use of the product, if necessary. If your product has been previously published, please provide the appropriate citation below.

The product does not require specialized instructions for use. DVDs have been provided directly to the community for targeted local dissemination; extra copies have been given to strategic community members and leaders. Ongoing research involvement with the community ensures access to additional DVDs, if requested, over at least the next two years. DVDs allow viewers without an internet connection to watch one or both videos on a computer or on a DVD player. The videos have also been published on YouTube for online dissemination to local YKDFN youth, and potentially to First Nation youth in other locations and to a wider audience. Publication on YouTube contributes to the sustainability of product availability.

5. Please describe how your product or the project that resulted in the product builds on a relevant field, discipline or prior work. You may cite the literature and provide a bibliography in the next question if appropriate.

Smoking rates among First Nation people are approximately three times the rate for the general population (1); smoking among teenagers and young adults in these populations is also much higher than national rates for these age groups (2). Tobacco use among Aboriginal youth in remote communities tends to be even higher, with youth aged 10-14 in remote regions being up to five times more likely to be current smokers than are their non-Aboriginal peers (3). The need to prevent youth smoking is well supported in the literature. Effective tobacco control policies, however, must be both culturally appropriate (4,5,6) and responsive to youth preferences for information delivery (7).

This study builds not only on smoking prevention/cessation literature but also on the emerging body of literature demonstrating the efficacy of social media based interventions as a means for smoking prevention in youth (8,9,10). Our product contributes to work indicating that visual and social media interventions effectively engage Aboriginal youth with health information in unique and provocative ways (11,12,13). It also demonstrates that through video production, Aboriginal youth develop critical consciousness with respect to their communities and in regards to their choices and control over their environments and health (14,15).

Despite the rapid escalation of online forums for user-generated content (for example, YouTube (16, 17)), interactivity with social media appears to “still be in its infancy among tobacco control-relevant sites” (18). Online interactive communication is, however, consistent with Aboriginal ways of knowing (19). Given the very serious health impacts of smoking among Aboriginal peoples (20), it is critical that smoking prevention/cessation interventions begin to adopt both youth-oriented mediums and those which are suited to traditional forms of Indigenous communication, for example, digital storytelling (21).

Finally, it is becoming increasingly important that programs for Aboriginal youth incorporate their unique needs and strengths (22). This includes promoting the view of “youth as resources” as opposed to the more common image of “youth as problems” (23). This study builds on this asset-based perspective and, through the products of the project (the created videos), strengthened youth self-perception as agents of change (24).

6. Please provide a bibliography for work cited above or in other parts of this application. Provide full references, in the order sited in the text (i.e. according to number order). .

References

1. First Nations Centre. First Nations Regional Longitudinal Health Survey (RHS) 2002/03. Ottawa: First Nations Centre; 2005. Available from http://www.rhs-ers.ca/sites/default/files/ENpdf/RHS_2002/rhs2002-03-technical_report.pdf

2. Retnakaran R, Hanley AJG, Connelly PW, Harris SB, Zinman B. Cigarette smoking and cardiovascular risk factors among Aboriginal Canadian youths. CMAJ 2005;173:885-889.

3. Government of the Northwest Territories Health and Social Services. Youth Smoking in the NWT: A Descriptive Summary of Smoking Behaviour among Grades 5 to 9 Students. A report of the Northwest Territories Health and Social Services Department; 2009. Available from http://www.hss.gov.nt.ca/sites/default/files/youth_smoking_in_the_nwt.pdf

4. Canadian Tobacco Control Research Initiative. Towards a Coordinated Research Agenda to Reduce Tobacco-related Problems in Canada. A report on the Canadian Tobacco Control Research Summit, April 19-21. Ottawa, Canada; 2002. Available from http://www.ctcri.ca/en/index.php?option=content&task=view&id=33&Itemid=52

5. Briggs VL, Lindorff KJ, Ivers RG. Aboriginal and Torres Strait Islander Australians and tobacco. Tobacco Control 2003;12: ii15-ii18.

6. Aboriginal Cancer Care Unit. A Case Study Approach: Lessons Learned in Ontario- Aboriginal Tobacco Cessation. A report of Cancer Care Ontario; 2008. Available from www.cancercare.on.ca/common/pages/DownloadFile.aspx?itemid=13636

7. Patten CA, Enoch C, Renner CC, Offord KP, Nevak C, Kelly SF, Thomas J, Decker PA, Hurt RD, Lanier A, Kaur JS. Focus groups of Alaska native adolescent tobacco users: Preferences for tobacco cessation interventions and barriers to participation. Health Education Behavior 2009;36:711-723.

8. Whittaker R, Maddison R, McRobbie H, Bullen C, Denny S, Dorey E, Ellis-Pegler M, van Rooyen J, Rodgers A. A multimedia mobile phone-based youth smoking cessation intervention: Findings from content development and piloting studies. J Med Internet Res [serial online] 2008 [cited Oct. 15, 2012] Vol. 10(5). Available from http://www.jmir.org/2008/5/e49/

9. Graham C, Rouncefield M, Satchell, C. Blogging as 'therapy'? Exploring personal technologies for smoking cessation. Health Informatics Journal 2009;15:267-281.

10. Norman C D, McIntosh S, Selby P, Eysenbach G. Web-assisted tobacco interventions: Empowering change in the global fight for the public's (e)Health. J Med Internet Res [serial online] 2008 [cited Oct. 15, 2012] Vol. 10(5). Available from http://www.jmir.org/2008/5/e48/

11. Craig Rushing S, Stephens D. Tribal Recommendations for Designing Culturally Appropriate Technology-Based Sexual Health Interventions Targeting Native Youth in the Pacific Northwest. Am Indian Alsk Native Ment Health Res [serial online] 2012 [cited Oct. 15, 2012];19:76-101. Available from http://www.ucdenver.edu/academics/colleges/PublicHealth/research/centers/CAIANH/journal/Documents/Volume%2019/19%281%29_Craig_Rushing_Tribal_Recommendations_Designing_Technology_76-101.pdf

12. Tanjasiri SP, Lew R, Kuratani DG, Wong M, Fu L. Using Photovoice to assess and Promote environmental approaches to tobacco control in AAPI communities. Health Promotion Practice 2011;12:654-665.
13. Montgomery M, Manuelito B, Nass C, Chock T, Buchwald D. The Native Comic Book Project: Native youth making comics and healthy decisions. Journal of Cancer Education 2012;27 (Suppl 1):S41-S46.

14. Singleton G, Rola-Rubzen MF, Muir K, Muir D, McGregor M. Youth empowerment and information and communication technologies: A case study of a remote Australian Aboriginal community. GeoJournal 2009;74:403-413.

15. Stewart S, Riecken T, Scott T, Tanaka M, Riecken J. Expanding health literacy: Indigenous youth creating videos. Journal of Health Psychology 2008;13:180-189.

16. Gill P, Arlittz M, Li Z, Mahanti A. Youtube traffic characterization: A view from the edge. In: Proceedings of the 7th ACM SIGCOMM conference on Internet measurement. New York: AMC; 2007. p. 15-28. Available from http://dmclab.hanyang.ac.kr/files/courseware/graduate/computer_networks/3.pdf

17. YouTube. Statistics. [cited Oct. 15, 2012] Available from http://www.youtube.com/t/press_statistics

18. Freeman B, Chapman S. Measuring interactivity on tobacco control websites. J Health Commun 2012;17:857-865.

19. Smith C, Burke H,Ward GK. Globalisation and indigenous people: Threat or empowerment. In: Smith C, Ward G, editors. Indigenous cultures in an interconnected world. St Leonards, NSW: Allen & Unwin; 2000. p. 1-27.

20. Mody R, Smith M. Smoking status and health related quality of life: Findings from the 2001 behavioral risk factor surveillance system data. Am J Health Promot 2006;20:251-258.

21. Iseke J, Moore S. Community-based indigenous digital storytelling with Elders and youth. American Indian Culture & Research Journal 2011;35(4):19-38.

22. Crooks CV, Chiodo D, Thomas D. Engaging and empowering Aboriginal youth: A toolkit for service providers. Trafford Publishing: http://www.trafford.com/; 2009. Available from http://youthrelationships.org/documents/Engaging%20and%20Empowering%20Aboriginal%20Youth%20-%20Toolkit%20for%20Service%20Providers.pdf

23. Checkoway BN, Gutierrez LM. Youth participation and community change: An introduction. Journal of Community Practice 2006;14:1-9.

24. Irvine J, Onyett H, Saylor K, Wong S, Young M, Carson J, Godel JC, Schindel M. Use and misuse of tobacco among Aboriginal peoples - Update 2006. Paediatrics and Child Health 2006;11:681-692.

25. Israel, BA, Schulz AJ, Parker EA, Becker AB. Review of community-based research: Assessing partnership approaches to improve public health. Annual Review of Public Health 1998;19:173-202.

26. Talja S, Tuominen K, Savolainen R. 2005. “Isms” in Information Science: Constructivism, collectivism and constructionism. Journal of Documentation 2005;61:70-101.

27. Freire, P. Education for Critical Consciousness. New York: Continuum; 2005.

28. Cargo M, Mercer SL. The value and challenges of participatory research: Strengthening its practice. Annu Rev Publ Health 2008;29:325-350.

29. Lunch N, Lunch C. Insights into participatory video: A handbook for the field (1st ed.). Oxford: Insight; 2006. Available from http://insightshare.org/resources/pv-handbook

30. White SA. (editor). Participatory Video: Images that Transform and Empower. London: SAGE Publications; 2003.

31. Wang CC, Burris MA. Photovoice: Concept, methodology, and use for participatory needs assessment. Health Educ Behav 1997;24:369-387.

32. Charmaz K. Constructing grounded theory: A practical guide through qualitative analysis. London: Sage Publications; 2006.

33. Lincoln YS, Guba EG. Naturalistic inquiry. Beverly Hills, CA: Sage Publications; 1985.

34. Jardine CG, Furgal C. Factors affecting the communication and understanding of known and potential/theoretical risks to health in northern Aboriginal communities. A report prepared for the Health Policy Research Program, Health Canada; 2006.

35. Jardine CG, James A. Youth researching youth: Benefits, limitations and ethical considerations within a participatory research process. Int J Circumpolar Health 2012;71:1-9.

36. Chen PG, Diaz N, Lucas G, Rosenthal MS. Dissemination of results in community-based participatory research. Am J Prev Med 2010;39:372-278.

37. Andrews JO, Newman SD, Heath J, Williams LB, Tingen MS. Community-based participatory research and smoking cessation interventions: A review of the evidence. Nurs Clin N Am 2012;47:81-96.

38. Bery R. Participatory video that empowers. In: White SA, editor. Participatory video: Images that transform and empower. London: SAGE Publications; 2003. p. 102-121.

39. Canadian Institutes of Health Research, Natural Sciences and Engineering Research Council of Canada, and Social Sciences and Humanities Research Council of Canada. Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans. 2010. Available from http://www.pre.ethics.gc.ca/pdf/eng/tcps2/TCPS_2_FINAL_Web.pdf

40. Ermine W, Sinclair R, Jeffery B. The ethics of research involving indigenous peoples. A Report of the Indigenous Peoples' Health Research Centre to the Interagency Panel on Research Ethics (PRE). Regina Sask: Indigenous Peoples’ Health Research Centre; 2004. Available from http://www.academia.edu/458662/The_Ethics_of_Research_involving_Aboriginal_Peoples

7. Please describe the project or body of work from which the submitted product developed. Describe the ways that community and academic/institutional expertise contributed to the project. Pay particular attention to demonstrating the quality or rigor of the work:

• For research-related work, describe (if relevant) study aims, design, sample, measurement instruments, and analysis and interpretation. Discuss how you verified the accuracy of your data.
• For education-related work, describe (if relevant) any needs assessment conducted, learning objectives, educational strategies incorporated, and evaluation of learning.
• For other types of work, discuss how the project was developed and reasons for the methodological choices made.

Aim and approach: The aim of this project was to assess the efficacy of Participatory Video as a means for engaging Aboriginal youth in developing culturally relevant, anti-tobacco messages. The study draws on social constructivist (25,26) and critical theoretical perspectives (27). It is grounded in participatory research approaches, which recognize “the value of engaging in the research process (rather than including only as subjects for the research) those who are intended to be the beneficiaries, users, and stakeholders of the research” (28). These theoretical perspectives fundamentally embrace the vital contribution of participants who define and determine what is documented. Because of this theoretical underpinning and our interest in both process and product, we used Participatory Video (29,30), an approach similar to Photovoice (31). We sought to facilitate skill development, encourage creative exploration of smoking as an issue of concern for youth, and empower youth as active agents for advocacy and change. We aimed to give ‘voice’ to participants and effectively engage peers, community members and leaders, and decision-makers in dialogue about tobacco prevention/cessation. Through both process and product participatory video allowed youth to share their perspectives and interpretations with viewers, thus providing peers, community members and decision-makers a glimpse of the world through their eyes.

Partnership with the Chekoa Program was initiated by a community member in conjunction with university researchers. The project developed in cooperation with the following community partners and collaborators: a representative from the YKDFN Community Wellness Department, representatives from the Chekoa Program, a representative from the Tobacco Harm Reduction and Cessation Program in the Department of Health and Social Services of the Government of the Northwest Territories (Canada), and a project coordinator. Partners contributed to all aspects of project planning and execution. They were critical to promoting youth and community involvement, ensuring a culturally appropriate approach, maintaining relevance to community and territorial initiatives, and communication and dissemination of the final product. Investigators contributed experience in health risk communication, visual research methods, community-based participatory methods, and research in Aboriginal communities and with Aboriginal youth.

Methods: Sixteen youth from two YKDFN communities were recruited through the Chekoa summer programming. Youth from Ndilo ranged in age from 7 to 15; youth from Dettah ranged from 9 to 16. Although not a project requirement, participants reported that they were non-smokers. Parental consent and youth assent were obtained for participants; written consent was obtained from all others featured in the videos. Youth participated in a presentation by a Tobacco Health Promotion Specialist who provided an overview of the effects of tobacco. They engaged in training activities (video production and editing) facilitated by an Aboriginal filmmaker. Following these activities, participants scripted, directed, filmed and edited two short videos.
Youth informally interviewed one another about tobacco knowledge, perceptions and behavioral intentions at project onset; post-project information was gathered from semi-structured individual and group interviews. Semi-structured interviews exploring project impact and efficacy were conducted at study initiation and conclusion with five community partners. These latter interviews were conducted at convenient locations and lasted on average 25 minutes. All interviews were recorded and transcribed verbatim. Qualitative analysis, facilitated by NVivo10 software, incorporated a constant-comparative and concept-development approach based on emergent themes (32,33). Data accuracy was determined using member checking of the assessed process and results with the community partners.

8. Please describe the process of developing the product, including the ways that community and academic/institutional expertise were integrated in the development of this product.

The focus on youth and smoking resulted from a 2006 research partnership with the YKDFN (34). That study, conducted on risks and risk behaviors, found that 56% of the 50 community members who participated in interviews smoked (30% had previously smoked). Even more distressing was that 71% had started smoking between 11 and 18 years of age; 11% had starting smoking at age 10 or younger. Based on this information, the community identified youth smoking as an important research area. This current project builds on this body of research and on a successful 2009 school-based, PhotoVoice research project (35), which was borne of this identified need (34). The successful previous collaborations between researchers at the University of Alberta’s School of Public Health, the YKDFN and the K’álemi Dene School provided a foundation of community trust for the current project.

The initial invitation to assess the efficacy of Participatory Video in the context of the summer activity program was made by the community, who welcomed the opportunities which filmmaking provided to YKDFN youth. The proposed project was supported in a subsequent meeting with community partners and collaborators (affiliations detailed in Section 7). Timelines and goals were established at this meeting. Project support was also provided through consultation with an Aboriginal filmmaker, local filmmakers and film editors. This project and product development was funded by the Canadian Institutes of Health Research through the Institute for Aboriginal Peoples’ Health.

The project was introduced to parents and youth at a community dinner celebrating the ‘kickoff’ of the summer activity program. Recruitment and acquisition of consent/assent took place in the following two weeks as researchers and summer program workers talked to the youth about the project and making videos. Eight participants from each of the communities were recruited. On the recommendation of a representative from the Community Wellness Department, a dedicated onsite project coordinator was hired from the community. This individual played a critical role as she encouraged youth participation, guided project progress and supervised participants. Project activities were arranged at times which were suitable for participants. The project coordinator spent time in both communities, working separately with each group of youth to identify narratives, develop a video script, film, and edit videos. Video storylines were proposed and developed by the youth participants, with the Ndilo youth drawing on ideas rooted in popular culture, and the Dettah youth finding inspiration in a story told by the Tobacco Health Promotion Specialist who spoke to the YKDFN youth. Although community collaborators had suggested possible foci for the videos and some of these ideas were mentioned to the youth in early discussions of the project (for example, interviewing an elder about traditional uses for tobacco), participants were encouraged to develop their own storylines and scripts. The intent of the project was to provide youth with the opportunity to address this issue from their own perspectives and through the stories that they wanted to share. As a result, the project empowered youth with the notion that they and their narratives were valuable resources within their communities.

After filming, editing instruction and support was made available to the project coordinator and participants. However, one of the participants had editing experience and took a lead in this part of the project. Youth engaged with all aspects of editing including choice of footage and music, transitions between scenes, and the use of text to support storylines. In consultation with the project coordinator and community partners we made final edits to the videos before posting them on YouTube: we shortened some sections to make the videos suitable for YouTube audiences (final videos are 5.51 and 4.28 minutes in length), and removed participants’ last names from the video credits. Subtitles were added where the audio portions of the videos were faint or unclear.

In order to provide ongoing support and guidance throughout video production, researchers spent 16 days (6 visits) in the YKDFN communities during the 8 week project period. This onsite support included spending time in the community interacting with key stakeholders and community members, regular meetings with the project coordinator, making practical arrangements for video-related activities, purchasing supplies, and participating with the youth as they worked on video-related tasks. In addition, we maintained ongoing contact via email and telephone with the project coordinator and community collaborators.

9. Please discuss the significance and impact of your product. In your response, discuss ways your product has added to existing knowledge and benefited the community; ways others may have utilized your product; and any relevant evaluation data about impact, if available. If the impact of the product is not yet known, discuss its potential significance.

Significance for youth participants. Through research process youth engaged with smoking prevention/cessation messages. They explored why their peers begin smoking: “They want to be cool, try to fit in, or they have problems so they just start smoking.” And they explained why they chose not to smoke. For example: “because it will destroy your lungs”; and, “because I’m athletic. I do soccer, I do track and field ... I just want to stay active.” Participants learned new skills: “They’re learning how to communicate well with each other and how to communicate to a larger audience” (community partner). They were empowered by the process: “It’s not necessarily what the story is, it’s about being able to tell the story and that [the youth] actually have a voice” (community partner). And they developed a peer group of non-smokers: “It was prevention at its finest, because instead of being out with all their peers who are asking them to smoke, they were inside working on a video” (community partner). Finally, youth were empowered by the experience; several subsequently applied to a youth program at an international film festival and workshop.

Significance for community: At the end of the summer program the videos were showcased at two well-attended community ‘Pizza and Movie’ nights. Interviews with youth and community partners suggest that the videos made an impact: “every time I watch [the videos] I get tears in my eye” (community partner and parent); and “[viewers will] think twice about smoking” (youth). Plans have been made to show the videos at other community meetings. It is anticipated that the videos will continue to impact the community by encouraging youth to consider peer generated antismoking messages, and by encouraging older community members to reconsider prevalent attitudes towards smoking and smoking behaviors.

Dissemination: DVDs have been produced for distribution to youth, the YKDFN communities, academics and decision-makers. This will increase access to the messages contained in the videos. It is expected that the DVDs will contribute to research and policy related to tobacco prevention/cessation programs for Aboriginal youth, community engagement with health promotion, and use of social media as a medium for health promoting messages. The videos have been posted on the social media website, YouTube. While the impact of this on other youth is unknown, growing popularity of social media suggests that this medium is becoming an important means by which consumer gather health information. Participants were excited about having their videos available via this medium.

Methodological contribution: Positive response to this project suggests that Participatory Video and social media has potential to effectively engage youth with health promoting messages. As they developed content for the videos, participants learned about tobacco use and gained experience with communicating antismoking messages. Our approach to product dissemination also makes a valuable contribution to the literature. Research suggests that dissemination from community-based participatory projects and smoking cessation programs typically involves meetings, workshops and newsletters (36,37). This project suggests that visual methods and social media are valuable avenues for engaging youth and communities in health promotion efforts. Finally, a central aim of the project was to assess the efficacy of Participatory Video as a means of engaging Aboriginal youth in developing relevant health promoting messages. Based on data gathered throughout the project (in particular extensive field notes and formal pre- and post-project interviews with community collaborators), we identified critical areas for improvement. We will use this knowledge as we move forward and use this approach for a larger scale project being conducted in rural and urban schools and with Aboriginal students in grades 9 to 12. This latter project will include longer term impact evaluation.

10. Please describe why you chose the presentation format you did.

Video was chosen because it is a highly flexible medium which allows users to tell stories and voice concerns in many different and creative ways. It is consistent with Aboriginal ways of knowing (19) and facilitates traditional forms of Indigenous communication (21). In addition, while antismoking messages were familiar to participants, experience with video cameras and filmmaking was new to most. This format therefore had significant appeal for participants and in the community. As noted by a project collaborator, “As First Nation people we’re hands on, we’re visual learners.” In addition, while communicating an important health promoting message, the videos retained a direct human dimension by showing the youth engaged in activities within their own communities. Video formatting was also chosen because of its easy accessibility via social media, and the growing popularity of user-generated content.

11. Please reflect on the strengths and limitations of your product. In what ways did community and academic/institutional collaborators provide feedback and how was such feedback used? Include relevant evaluation data about strengths and limitations if available.

Due to our close partnership with a community-based program, the project required significant flexibility and adjustment. Shifting priorities, changing allocation of community partner time, and the discrete timeframe offered by the summer program presented us with logistical challenges. Feedback on the process and video production was therefore critical to the success of the videos. We gathered feedback throughout the project from our community collaborators. For example, the local YKDFN project coordinator was hired on the recommendation of a community partner, and plans for dissemination at community gatherings were based on advice from our collaborators. Formal and informal meetings were held with YKDFN partners on each visit to the community. At other times feedback was gathered through email and telephone contact. In every instance we addressed feedback about process to the satisfaction of collaborators.

Feedback on the product itself was extremely positive. For example, community collaborators indicated that the videos gave the youth “confidence that they can accomplish something that’s new to them.” Participation in scripting and acting also reinforced anti-tobacco messages: “talking about [reasons to avoid smoking] on film makes it more real, so it sticks with you more.” After viewing the video one parent stated: “It kind of blew me away, you know? I would think twice about [smoking], yeah.” And a youth participant noted the positive message in the videos: “It made me think how long I could run for because I don’t smoke.”

Positive feedback highlighted the strengths of the product. Videos gave ‘voice’ to youth participants. This medium allowed them to express their thoughts about tobacco use in ways relevant to youth and Aboriginal culture. Expressing their views and being heard by others fostered self-efficacy. For example, based on their experience producing these videos, some of the participants applied to be youth delegates at an international film festival being held close to their community. Choosing to produce ‘YouTube style’ videos was also an asset. Participants were familiar with this medium, which commonly features short videos with user-generated content. They therefore embraced the opportunity to create a video that might be made available via this popular forum. Although we are not able at this time to evaluate the long term impact of videos on the choices of youth participants, research with Participatory Video methods suggests that the opportunity to actively and creatively engage in this process has powerful potential to empower participants and inspire change in participants and viewers (38).

The videos were limited by the inherent logistical challenges of implementation within the context of a summer program. An important goal of this project was to explore the efficacy of the approach. Therefore, shortcomings in the implementation of this project (e.g. the short time frame, which hindered formal pre-project data gathering from the perspective of the youth, the need to develop and implement better evaluation mechanisms, and the need for video cameras with external microphone capability) have allowed us to refine our methods and approach for subsequent initiatives. Utilizing formal quantitative and qualitative pre- and post-project evaluation with participants in future projects will strengthen findings.

In summary, Participatory Video proved to be an effective approach for engaging Aboriginal youth with antismoking messages. We tested program evaluation, validated the contribution of filmmakers and tobacco experts, and confirmed the benefits of implementation in a structured environment. Findings highlight the importance of a non-smoking peer group and the positive impact of the videos on the community. Results provide a foundation for further study of social media as a means of involving youth in producing and distributing health promoting messages.

12. Please describe ways that the project resulting in the product involved collaboration that embodied principles of mutual respect, shared work and shared credit. If different, describe ways that the product itself involved collaboration that embodied principles of mutual respect, shared work and shared credit. Have all collaborators on the product been notified of and approved submission of the product to CES4Health.info? If not, why not? Please indicate whether the project resulting in the product was approved by an Institutional Review Board (IRB) and/or community-based review mechanism, if applicable, and provide the name(s) of the IRB/mechanism.

This project was developed on the strength of a previous successful collaboration between Dr. Cindy Jardine and the K’àlemì Dene School and Kaw Tay Whee School in the YKDFN communities of Ndilo and Dettah (33). Letters of support for the current project were provided in 2011 by the Chief of the YKDFN, the principal at the K’àlemì Dene School, and several local and Aboriginal filmmakers. The ongoing success of this collaboration is evidenced by additional support letters for the 2013 implementation of an expanded version of this current project with Aboriginal youth in rural and urban contexts. These latter support letters were received from the YKDFN Chief (Dettah), principals of the K’àlemì Dene School in Ndilo and Queen Elizabeth High School in Edmonton, and filmmakers.

This current project was guided by the Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans (TCPS2) (39), with specific reference to chapter 9, “Research involving the First Nations, Inuit, and Métis Peoples of Canada.” During planning phases consideration was given to the concept of ethical space. In the Aboriginal context this is described as the common space between two often disparate knowledge systems, cultures and world views: “The ethical space…requires dialogue about intentions, values, and assumptions of the entities towards the research process. With an agreement to interact, the particulars of cross cultural engagement, along with all the issues of the research process are negotiated towards an amicable research agreement between researchers and Indigenous communities” (40).

Ethical concerns were recognized and dealt with via three primary mechanisms. First, the research protocol and approach was decided among members of the research team, including community collaborators and knowledge users. This ensured culturally and scientifically appropriate and rigorous research practices. Second, ethical approval was obtained from the University of Alberta Health Research Ethics Board (Panel B). Finally, a Northwest Territories (NWT) Scientific Research License was obtained through the Aurora Research Institute. Two further issues are notable for this study. We obtained consent from the parents of youth participants and assent from the youth themselves. And second, film credits were assigned and designed by the youth during the editing process, with exclusive credit for the videos being retained by participating youth.

The videos were a product of cooperation and mutual respect among the participating youth and the project coordinator. The project coordinator was a university student who was a member of the community and had worked for the Chekoa Program during the previous summer. As a result she was familiar with the participants or their families and was able to draw on the strengths of the youth. At the same time as guiding the progress of the project, she fostered new skills among the participants, created a warm and friendly environment which encouraged and supported active participation, and modeled positive life skills and healthy behaviors. Collaboration and mutual respect also resulted in a very positive relationship between the project coordinator and university researchers, and between community partners and researchers. Dialogue about the project was ongoing and positive throughout the summer as we navigated the various challenges associated with community-based research. Community partners have been notified, provided input, and approved submission of the product to CES4Health.info. Shared credit for the project is acknowledged by Chekoa Program authorship on this submission to CES4Health.info.