Product Details

Author Information

Corresponding Author
MIchael Montoya
University of California-Irvine
3263 Social Sciences Plaza B
Irvine, CA 92697
United States
p: (949) 824-1585
mmontoya@uci.edu

Authors (listed in order of authorship):
Michael Montoya
University of California-Irvine

Product Description and Application Narrative Submitted by Corresponding Author

What general topics does your product address?

Public Health

What specific topics does your product address?

Access to health care, Built environment, Community coalition , Community health , Community organizing, Environmental justice, Health disparities, Health equity, Homeless health, Housing, Minority health, Physical activity/exercise, Poverty, Race & health, Social determinants of health, Urban health

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

Homeless, Uninsured, Urban

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

NA

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

inspirational video

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 Youtube video Community is a Verb was inspired and co-developed by a team of students, professionals and lay health advocates to make the case that the social factors of inequity make people ill. The video is designed for 3 main purposes:

1) Make the case that social factors of inequity make people ill;
2) Make the case that community making is thriving, meaningful and necessary;
3) Make the case that everyone has something to offer and must get involved in making community;

Additionally, there are two secondary purposes.

1) Affirm those already involved in making community and point them toward additional resources;
2) Make the case that community makers are part of something as global as it is local

2. What are the goals of the product?

The video is designed for 3 main purposes:
1) Make the case that social factors of inequity make people ill;
2) Make the case that community making is thriving, meaningful and necessary;
3) Make the case that everyone has something to offer and must get involved in making community;

Additionally, there are two secondary purposes.
1) Affirm those already involved in making community and point them toward additional resources;
2) Make the case that community makers are part of something as global as it is local.

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

The audience are all interested persons with at least 7th grade education. It is especially of interest to public health professionals, community organizers and lay health advocates broadly defined.

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.

To view the video an internet capable web browser is all that is necessary. The video is best used as part of an ongoing community partnership. Users should also use the following resources as companion pieces:
1) www.unnaturalcauses.org, especially the tools for action pages and videos.
2) David Williams Yale School of Nursing Lecture, delivered May 2008, http://nursing.yale.edu/News/Events/Bellos/2008/index.html
3) Institute for Peoples Education and Action, especially the resources pages, http://www.peopleseducation.org/populareducation.htm

Special requests for embeddable formats, CD copies or Spanish Translation should be sent to: Michael Montoya, mmontoya@uci.edu

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.

The majority of health research reduces disease down to its most basic pathophysiological processes and in so doing, bypasses the most powerful influence on human health. To wit, the conditions under which humans live. However, 95% of the trillion dollars spent on health in the US is spent on medical care, care that minorities and the poor disproportionately survive without. Researchers report that behavior (e.g. diet, tobacco) and social factors ( e.g. poverty, education, environmental exposure, health care) account for at least 70% of premature death (1). However these factors account for approximately one third of the federally funded research budget, (2). The discrepancy between what we know accounts for premature death and those factors on which we spend our precious resources, is a double jeopardy for minorities and the poor who suffer disproportionate rates of common diseases.


Community Knowledge Needed Now More than Ever
There is a long tradition of research into the effects of social context on health. Socioeconomic status (4), neighborhood (5), ethnicity (6), social interaction and behavior (7) have all been documented as related to health outcomes for particular communities. Yet research into many of these variables suffers from fundamental identification errors (8) that prevent the isolation of basic causes of diseases and deploy top-down rather than locally derived social constructs. Thus, by characterizing both biophysiological and social conditions of specific communities, my research seeks to identify and operationalize health variables derived from locally manifested social and historical forces. Anchoring research in community enables action research that includes the histories, knowledges and aspirations of affected community members while offering finer grained data that both predicts health and illness and points to sociocultural and ecological triggers of diseases like diabetes (9). In other words, what is needed are better ways to learn and join with the community knowledge that lay experts have acquired over a lifetime of living and working as a member of an impacted community.

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). .

1. McGinnis, JM, Williams-Russo, P, Knickman, JR. (2002) The case for More Active Policy Attention to Health Promotion. Health Affairs 21(2).
2. Zerhouni, Elias, (2006) Director NIH, Fiscal Year 2007 Budget Request House Subcommittee on Labor - HHS - Education Appropriations, April 6, 2006. http://www.nih.gov/about/director/budgetrequest/fy2007directorsbudgetrequest.htm, Accessed September 21, 2007.
3 Kaufman JS, Cooper RS, McGee DL. (1997) Socioeconomic status and health in blacks and whites: The problem of residual confounding and the resiliency of race. Epidemiology 8(6), 609-611.
4 Diez-Roux, AV. (2001). Investigating Neighborhood and Area Effects on Health. American Journal of Public Health 91(11), 1783-1789.
5 Kaufman, JS, Cooper, RS (2001). Commentary: Considerations for Use of Racial/Ethnic Classification in Etiologic Research. American Journal of Epidemiology 154(4), 291-298.
6 Durlauf, SC (2001) A framework for the study of individual behavior social interactions, In Becker, MP (Ed.) Sociological Methodology, 31: 47-128.
7 Oaks, JM (2004) The (mis)estimation of neighborhood effects: causal inference for a practicable social epidemiology. Soc. Sci. Medicine 58: 1929-1952.
8 Krieger, N. 2005. Introduction: Embodiment, Inequality, and Epidemiology: what are the Connections? In Embodying Inequality: Epidemiological Perspectives, ed. N. Krieger. Amityville: Baywood Publishing.
9 Blakey, Michael L. (2001) Beyond European Enlightenment: Toward a Critical and Humanistic Human biology, In, Building a New Biocultural Synthesis: Political – Economic Perspectives on Human Biology (Alan Goodman and Thomas Leatherman (eds) . Michigan Press: Ann Arbor.
10 O'Fallon, L. R., & Dearry, A. (2002). Community-based participatory research as a tool to advance environmental health sciences. Environmental Health Perspectives, 110(s2): 155-159.
11 Higgins, D. L., & Metzler, M. (2001). Implementing community-based participatory research centers in diverse urban settings. Journal of Urban Health, 78(3): 488-494.
12 Israel, Schulz, Parker, Becker, Allen, Guzman, (2000). Critical Issues in developing and following CBPR principles, in, Community-Based Participatory Research in Health, Minkler and Wallerstein, Jossey Bass, New York, NY.
13 Minkler, Meredith and Nina Wallerstein (eds). 2008. Community-Based Participatory Research for Health. San Francisco, CA: Jossey-Bass Inc.
14 Hale, Charles (Ed) (2008) Engaging Contradictions: Theory, Politics, and Methods of Activist Scholarship. University of California Press: Berkeley.
15 Kent, E. and Montoya, M. Dialogical Action: From community-based to community-driven action research. Under review.
16 Morgan, L. M. (2001). Community participation in health: perpetual allure, persistent challenge. Health Policy and Planning, 16(3), 221-230.
17 Flores, B., Cousin, P.T., & Diaz, E. (1991). Critiquing and transforming the deficit myths about learning, language and culture. Language Arts, 68(5): 369-379.
18 Trueba, Enrique T. and Bartolome, Lilia I. (1997) The Education of Latino Students: Is School Reform Enough? ERIC/CUE Digest, 123. ERIC Clearinghouse on Urban Education New York NY.
19 Wright, Nick and Brigitte Nerlich (2006). Use of the deficit model in a shared culture of argumentation: the case of foot and mouth science. Public Understanding of Science, 15(3): 331-342.
20 Corburn, Jason (2005). Street Science: Community Knowledge and Environmental Health Justice. MIT Press: Cambridge.
21 Checker, Melissa (2005) Polluted Promises: Environmental Racism and the earch for Justice in a Southern Town. NYU Press: New York.
22 Fortun, Kim (2001) Advocacy After Bhopal: Environmentalism, Disaster, New Global Orders. U Chicago Press: Chicago.
23 Haraway, Donna (1988) Situated Knowledges: The Science Question in Feminism as a Site of Discourse on the Privilege of Partial Perspective. Feminist Studies 14(3):575-599.
24 Closing the gap in a generation: Health equity through action on the social determinants of health. Commission on social determinants of Health: Final report, World Health Organization, 2008.
25 Eugenia Eng, The Save Our Sisters Project: A Social Network Strategy for Reaching Rural Black Women. Cancer, 1993; Volume 72, Issue S3 (p 1071-1077).
26 O’Donnell, CR, O’Donnell, L., Doval, A, Duran, R, Labes, K.
Reductions in STD Infections Subsequent to an STD Clinic Visit: Using Video-Based Patient Education to Supplement Provider Interactions. Sexually Transmitted Diseases:
March 1998; Volume 25 - Issue 3 - pp 161-168.
27 Sweat, Michael; O'Donnell, Carl; O'Donnell, Lydia. Cost-effectiveness of a brief video-based HIV intervention for African American and Latino sexually transmitted disease clinic clients. AIDS: 13 April 2001 - Volume 15 - Issue 6 - pp 781-787
28 Oliveira, Ali, Gevirtz, Richard, Hubbard, David
A Psycho-Educational Video Used in the Emergency Department Provides Effective Treatment for Whiplash Injuries . Spine: 1 July 2006 - Volume 31 - Issue 15 - pp 1652-1657.
29 Carol F. Roye and Margaret Hudson
Developing a Culturally Appropriate Video to Promote Dual-method Use by Urban Teens: Rationale and Methodology. AIDS Education and Prevention, 2003; 15(2), 148–158.
30 Jennifer R. Warren, Michael L. Hecht, David A. Wagstaff, Elvira Elek, Khadidiatou Ndiaye, Patricia Dustman & Flavio F. Marsiglia. Communicating Prevention: The Effects of the keepin’ it REAL Classroom Videotapes and Televised PSAs on Middle-School Students’ Substance Use Journal of Applied Communication Research. Vol. 34, No. 2, May 2006, pp. 209_/227.
31 Carr, Caleb, Choi Scott, DeAndrea, David, Van Der Heide, Brandon, Kim, Jinsuk, Tom Tong, Stephanie, Walther, Joseph. Interaction of Interpersonal, Peer, and Media Influence Sources Online: A Research Agenda for Technology Convergence
Presented at the annual meeting of the International Communication Association,
May 2008, Montreal. Available from http://www.allacademic.com/meta/p_mla_apa_research_citation/2/3/1/9/5/p231950_index.html

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.

Researchers have been trained in disciplinary silos. Therefore it is rare that academics can even speak across the conceptual gaps between biomedical and sociocultural understandings of human beings, our bodies and our conditions of life (9). Likewise, living with scarce personal and governmental resources, in socially or environmentally toxic neighborhoods, challenges even the most resourceful persons. This makes action and reflection between neighborhoods or between problems, difficult. However, across campuses, in every neighborhood, school, workplace and organization, there are people with a wealth of talent forming the necessary partnerships to initiate community based and community centered health action projects. The US - National Institutes of Health, the World Health Organization and the academic community have all embraced at some level, the principles of community based research, (10, 11, 12, 13). Sometimes these efforts are coordinated and consistent. More often these efforts are haphazard, ad hoc, post facto attempts to engage the impacted community in agendas not of their choosing.

Begun in 2005, the Community Knowledge Project (CKP) is comprised of an array of community and campus partners who take as their first principle that local expertise or lay knowledge is robust. The CKP aims to create the space for students, faculty and professionals of all kinds to join with lay efforts to improve local conditions of living most important to neighborhood groups. Graduate students in anthropology and social ecology, medical students, clinical researchers, undergraduates and interested volunteers, are all engaged in vital cross-talk and action between academic silos and affected communities. The second principle of the CKP is that the action must not be defined in advance or by those who do not experience the conditions of interest. This entails a radical faith in the process of community engagement in spite of its many contradictions and challenges (14, 15, 16).

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.

One of the largest stumbling blocks for the global health equity movement is the deficit model (17, 18, 19). The deficit model is an approach to human action that begins with the premise that people are not powerful, thoughtful, strategic, or capable of hard work, reflection and action. In 2008, the Community Knowledge Project team decided to tackle this fundamental misconception by creating a video. The CKP team drew upon its current projects, experiences and connections with community making around the globe. Community making the world over convinces all those who practice it, that people are amazingly powerful, capable, intelligent and resilient.

In the development of the video, we used material (lessons learned, histories and images) from our existing and past projects as well as those from partners around the US. We used images sent to us and stories we shared. But more importantly, we used the spirit of hope and possibility and of the radical faith in the human capacity to remake the world a more equitable place. Lessons we all keep learning in our practice of community making. The CKP is also a practice that explicitly addresses the systems and structures of inequality in which all humans live, work, play and learn.

The CKP is inspired by the Environmental Justice Movements around the globe where expertise itself is challenged and redefined. It also draws inspiration from social scientists from a range of fields who have detailed the promise of local community knowledge for a new generation of scholars that seek a connection rather than domination or mastery over their subjects/objects of interest. In this practice, a doorway to knowledge making is created that includes, on equal footing, expert and local knowledge makers (20-23). Neither takes an upper hand. Rather, the this kind of knowledge making views the division between "expert and local" as social and not epistemological.

In conversations with academic and professional partners, we continually sought ways to highlight the powerful contributions of our lay community collaborators. I began to test the idea of a way to argue for the power of community and began pointing this out in informal meetings and conversations. Similarly, while introducing our project to community collaborators, I would mention that I was interested in learning from local experts. Lay health advocates and non univerity professionals appreciated the idea that community knowledge was what I was after. As our relationship developed, I sought ways to convey the immense inspiration that I was receiving. I also sought ways to encourage community organizers, health professionals and lay health advocates. Since conventional academic work products are inaccessible, I consulted with my partners, interns and students to develop the website and video.

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.

Ending the practice of spending human and financial resources on surveillance or treatment after people have become sick, will require a new research and action paradigm. Further more, health research that presumes chronic or infectious diseases are caused by biological or cultural factors unique to poor people has failed to either predict disease or reduce its disproportionate impact. Global inequity is now coming into view as the primary determinant of poor health (24). Thus, it is imperative that those most knowledgable, most impacted by global inequity be included, if not direct our efforts to address it. However, without a radical commitment to and faith in community, and the bounty of knowledge, intelligence, energy that already exists, global experts risk reproducing the same logics and practices that created the inequities that make people sick. Researchers, professionals and lay-practitioners from many segments of society increasingly seek better ways to conceptualize disease and promote health. The Community Knowledge Project, and the thousands of other people who have come together to address countless health challenges, offer one such conceptualization. The YouTube video, Community is a Verb, promises encouragement for those already involved in engaged work, connects campus and community efforts as part of the same broad social movement, and conveys the sense that both campus and lay efforts to improve community health are part of a global movement for social justice.

The impact as measured by the response to the video has been universally positive. When screened with our local partners, people were moved to tears. They commented that they wanted the script printed out, that it showed they were not alone, that their work did matter, and that they – as lay community advocates – were capable. They mentioned that the video inspired them to recruit others to their group(s). One community group requested and received a translation of the video in Spanish.

Professionals who have viewed it also have responded favorably. Public Health practitioners in Alameda and Los Angeles Counties in California are using the video on their website or in training programs for neighborhood wellness. Requests from Washington State, Minnesota, and Oregon, have also been received. A local partner screened it for the Board of Directors for Community Programming of a hospital as a way to inspire their continued support in a time of cutbacks. At a campus-community meeting of persons interested in clinical research, the video was also screened and received high praise.

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

Before I received my PhD, I worked for nearly a decade in health and human services. I was a food rights organizer, I did outreach for a food bank, I was on the board of a community health clinic, I was a cooperative housing development resident organizer, I worked as a literacy instructor. I know what it means to be in the trenches. I chose a video because I wanted to reach the Youtube generation, the lay health organizations, and professionals who are isolated and need affirmation or direction and encouragement. Further, it has been demonstrated that videos are effective means at conveying health messages and changing behavior, (25-30). Finally, by using an online, video based format, creates an effective bridge between academic knowledge, community knowledge and lay health organizing and advocacy(31).

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.

The video has been evaluated through informal focus groups, at community meetings, after screenings, via YouTube comments and through email messages. The strengths of this product are that its format appeals to a young, technologically sophisticated, and socially committed audience. It is easily accessible to professionals and individuals with a browser. Feedback we have received also includes that is written without academic jargon, and that the music and voice over text powerfully move viewers. Images are diverse, and the text reinforces the message that communities are powerful and engaged. Additionally, we have received feedback that it is inclusive of all kinds of civic engagement (religious, secular, lay, professional, health, economic, etc) and that it conveys the sense that any act makes a difference.

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.

Concretely, with participants in the CKP weekly meetings, we developed a story board and began soliciting images and ideas from the CKP partners. Drafts of the text and story board were circulated and ideas folded in to the finished product. Shared work and credit is labeled in several ways prominantly on the Video. First, their stories and images convey their effort. Second, the main authors include, the submitter (Michael Montoya), Lauren Bienek an undergraduate from Penn State, and the Community Knowledge Project (CKP). The CKP is comprised of an array of individuals and organizations around the US and their contribution is recognized in the credits of the Video.

As to mutal respect, it is truly difficult to convey, other than the statements attached to the Youtube video what I mean by "radical faith in humanity to create healthy commuity." What I can say is that my students are transformed, my partners are transformed, I am transformed by making community.

As to what two professional partners think, these excerpts from my University write up: http://www.uci.edu/features/feature_montoya_081006.php
Shawn Wehan, a community organizer with the Orange County Congregation Community Organization, is working with Montoya and his team of researchers in Fullerton to improve the city’s parks and school lunch programs and develop anti-gang efforts. Recently, they obtained city funding to install overhead lights at a local park for evening soccer matches.

Wehan acknowledges that working for change can be a frustrating, but ultimately gratifying, process. “None of this stuff happens overnight, but when you do get something accomplished it affects thousands of people and, for the most part, can be very lasting.”

Another project, led by Montoya and social ecology graduate student Erin Kent, has helped Fullerton’s St. Jude Medical Center gain a more realistic perspective on the health issues facing its low-income clients. Working with Barry Ross, the hospital’s healthy communities program vice president, the researchers talked with community members, and the results, says Ross, “reinforced the direction of our outreach programs and helped us better set our priorities in meeting their needs.”

Finally, my academic, professional and some lay health partners are excited about the appearance of the video in a venue like CSE4Health. Some of my community partners do not even know that my university exists even though they live 10 miles away and have been working with me on various projects for years. Our social worlds are simply too far apart. Explaining CES4Health to some of my community partners, while sounding "collaborative," would impose academic concerns upon precious engaged meeting space and time. That said, everyone knows that the video exists and has been given prescreenings and screenings. To date, as a result of feedback from campus and community partners, modification to the website and video are planned.

UC-Irvine IRB
HS#2007-6054 The Community Knowledge Project: Moving from Community Participation to Community Designed Action
Lead Researcher - Erin Kent
Faculty Sponsor - Michael Montoya
Approved 01/11/2008-01/10/2011