Using Videovoice Methods to Enhance Community Outreach and Engagement for the National Children’s Study

Abstract

The National Children’s Study (NCS) is a prospective observational study examining the effects of environmental influences on child health and development in the United States. Videovoice is a health advocacy and promotion methodology wherein participants use participatory videography and interviewing techniques to identify issues of concern, communicate knowledge, and advocate for community health. This study describes a videovoice project, implemented in six Cook County, IL, communities targeted by the NCS for participant recruitment. A 6-week, videovoice training was conducted to train and empower NCS community outreach and engagement personnel. Pre/post evaluations were administered, and participant footage was qualitatively analyzed to identify overarching themes informing future outreach. Participants reported significant increases (p < .05) in videography/photography skills, community outreach/communication abilities, and awareness of important community health issues. Major themes included the following: high community knowledge of local health issues, low community knowledge of the NCS, and identification of barriers to participation. Two promotional videos were created to address these barriers and educate communities about the NCS. A 6-week, videovoice project was effective in training NCS community outreach personnel and enhancing NCS community engagement within six target Cook County, IL, communities via the production of community-engaged NCS promotional videos.

Keywords

child/adolescent health community organization environmental health community-based participatory research health research lay health advisors/community health workers maternal and infant health technology Internet/electronic interventions social marketing/health communication

Introduction

The National Children’s Study (NCS) is an observational longitudinal study that intends to study the impact of a broad array of environmental influences on child health and development. This landmark study aims to recruit and follow a sample of approximately 100,000 children from before birth until age 21 (Hirschfeld, Songco, Kramer, & Guttmacher, 2011). The NCS Vanguard, Alternative Recruitment Study (ARS), a pilot study of recruitment approaches, was launched in 2011 in 30 communities across the United States. Community outreach and engagement in each community was a key strategy for participant recruitment. Therefore, cultivation of relationships with local maternal and child health stakeholders was critical. Community-based participatory research (CBPR) methods have been shown to enhance trust and collaboration between researchers and target communities, enhancing the quality and relevance of the data collected (Israel et al., 2005; Sapienza, Corbie-Smith, Keim, & Fleischman, 2007). In fall 2011, the NCS Greater Chicago Study Center (GCSC) selected videovoice as a method to train newly hired neighborhood ambassadors (NAs). Videovoice is a participatory technique that trains lay community members in videography and outreach, thus enabling and empowering them to explore, document, and critically engage with issues of local importance (C. E. Catalani et al., 2012). This article describes the design, implementation, and evaluation of a 6-week, videovoice training, which culminated in the development of two videos used to promote the NCS throughout Cook County, IL.

Background

As the most comprehensive investigation of environmental influences on child health and development ever undertaken in the United States, the NCS plans to recruit, enroll, and systematically observe 100,000+ children and their families from before birth through age 21 (Hirschfeld et al., 2011). However, prior studies seeking to enroll and retain a large maternal and child cohort have encountered significant barriers such as high rates of subject attrition and refusal to participate in data collection (Katz et al., 2001), which can adversely affect study integrity and generalizability (Miranda, Nakamura, & Bernal, 2003). Given the long study period and robust local data collection inherent in a study with the broad scope of the NCS, a growing body of literature recommends taking a community-based, participatory approach to community outreach and engagement (Israel et al., 2005; Sapienza et al., 2007).

The NCS GCSC was tasked with coordinating the recruitment and retention of study participants throughout Cook County, IL. Though diverse overall, Chicago remains a highly segregated city, with 68 of its 77 community areas predominantly inhabited by a single racial/ethnic group (Glaeser & Jacob, 2012). Additionally, recent reports on health inequities in Chicago (Yonek & Hasnain-Wynia, 2011) and Cook County (Joint Center for Political and Economic Studies, 2012) have found that health status of local residents varies significantly by neighborhood. Together, these facts suggest that targeting NCS outreach and engagement to address community-level health concerns may be an effective strategy for recruitment.

Videovoice

Following the model of its progenitor, photovoice (C. Catalani & Minkler, 2010; Wang & Burris, 1997), participatory videography—or videovoice—has been used to document and share the lived experiences of local residents both to raise their own consciousness and to influence decision makers to affect community-level change (C. E. Catalani et al., 2012; Chavez et al., 2004). In the context of CBPR, videovoice—like photovoice—is a method of inquiry designed to elicit the participation of those affected by a health-related issue in the research process. Participation can benefit research by (a) enhancing the cultural sensitivity of academic researchers, (b) uncovering lay knowledge critical to understanding health, (c) increasing accuracy in the interpretation of findings, (d) facilitating the dissemination and use of study findings, and (e) increasing the potential for turning research into action (Israel, Schulz, Parker, & Becker, 1998). Though the two aforementioned projects found participatory videographic methods to be effective in engaging and mobilizing local residents around community health issues, both projects took place over an implementation period of at least 9 months. Given both the potential benefits of taking a community-based participatory approach and the limited timeline afforded in many research projects, the NCS GCSC videovoice project sought to explore the feasibility of conducting a videovoice intervention on an abridged, 6-week timeline. This 6-week, videovoice training was conducted with lay, community residents of six Cook County, IL, communities in which the NCS was recruiting study participants as well as in collaboration with NCS community outreach and engagement (COE) personnel.

Method

NCS GCSC Videovoice Project

Setting

The NCS Vanguard sampling frame was based on a national geographic probability sample wherein Cook County, IL, comprised a primary sampling unit. Fifteen secondary sampling units of nonadjacent U.S. Census blocks were then randomly selected by the NCS Program Office for participant recruitment. Furthermore, Cook County was selected to participate in the Hi-Lo Alternative Recruitment Strategy where community outreach and engagement by lay, community members constituted one of the principal strategies for engaging potential participants in community settings and recruiting them into the NCS.

Community selection

Six of the 15 NCS target communities were selected for the videovoice project because they were categorized as hard-to-reach given that two or more of the following conditions were present:

Ranked in bottom third of number of participants who had been consented as of August 1, 2011

Had a high concentration of Latinos

Had a high concentration of children living in poverty

Requested NCS materials in languages other than English

Lacked identifiable outreach opportunities

Had low attendance at community events

These six communities are predominantly inhabited by ethnic minority populations. The first two target communities are composed of mostly Spanish-speaking residents of Mexican descent. Two target communities are primarily African American and had the highest percentage of children living in poverty, and the final two communities are more ethnically diverse, but lacked identifiable avenues for outreach. Since one of the final two communities contained a major research university, the local population included a high concentration of college students and staff. The final community is one of the most diverse communities in the United States, with high concentrations of first-generation Latin American, Caribbean, and African immigrants.

Neighborhood ambassador recruitment

The COE team recruited lay community members through word-of-mouth efforts including referrals from local community organizations, announcements at community meetings, and posting on community boards. After in-person interviews, six community members—one from each target community—were hired as part-time NAs. All six NAs were female, five were mothers, and all had extensive life and work experience within their respective communities and were ethnically and linguistically representative of the local populations.

Curriculum development and implementation

A curriculum (Figure 1) and evaluation plan were developed de novo in collaboration with a team of experts over five planning meetings. The team included the PI and co-PI, a videographer, the NCS-GCSC Community Outreach and Engagement coordinator, and the NCS videovoice project coordinator.

Figure 1

NCS GCSC Videovoice Training Curriculum and Activity Summary

The videovoice curriculum consisted of six weekly 2-hour training sessions. Participants included the six NAs as well as two NCS-GCSC COE staff.

After receiving training in research ethics, interviewing technique, and videography, participants conducted videotaped interviews with key stakeholders in their respective communities. Footage was reviewed at subsequent training sessions, using a three-part participatory visual analysis used by C. E. Catalani et al. (2012) and originally detailed by Wang and Burris (1997). First, participants selected <5 minute excerpts from their interview footage, which they felt most accurately reflected community needs and assets related to NCS community outreach and engagement, or community health more generally. Next participants contextualized their selections by sharing details that they felt were necessary to situate the footage in its particular community context. Finally, participants codified qualitative themes relating to NCS community outreach and engagement through collective discussion at Training Sessions 3 to 6. Footage selected by participants was then compiled into promotional videos, based on storyboards created through an iterative process of participatory editing. Once videos were finalized and gained approval from each videovoice participant appearing therein, they were disseminated by the NCS-GCSC online and at community events.

Evaluation approach

Pre/post questionnaires (Appendix A), developed for the present project, were administered at the first and last videovoice training sessions to all participants, which included six neighborhood ambassadors and two community outreach and engagement liaisons. These questionnaires aimed to evaluate the curriculum with regard to three principal domains: (a) community knowledge/awareness, (b) interviewing/videography skills, and (c) confidence in community outreach and engagement abilities. Paired-sample t tests were used to compare participants’ pre- and posttest scores. Videovoice training sessions were also recorded and transcribed. In addition, participants recorded two videotaped “debriefings” after each session. These debriefings were posted each week on the videovoice project blog (http://ncs-gcsc.blogspot.com/).

Results

Impact on Videovoice Participants

Videovoice participants (N = 8) reported significantly improved understanding of their community’s needs, t(7) = −4.00, p = .005, strengths, t(7) = −3.86, p = .006, and interests, t(7) = −3.27, p = .014. Additionally, participants reported significant increases in their abilities with regard to photography, t(7) = −3.21, p = .015, and videography, t(7) = −4.97, p = .002. Though not statistically significant, participants’ interviewing skills trended toward improvement, t(7) = −1.93, p = .095. Finally, participants reported that they were significantly more confident in their ability to both approach unknown community members, t(7) = −2.38, p = .049, and present the NCS in a manner that encouraged community participation, t(7) = −2.99, p = .02.

These results suggest that the training was effective in accomplishing videovoice goals and validated qualitative data collected during the project.

Table 1

What Did Neighborhood Ambassadors Learn Through the Videovoice Process?

Participant 1

“I learned a lot about how my community feels, what their fears are, what their strengths are, how they view life, what their motivations are, and what is it that precisely keeps us living in the same community. . . . I also learned to listen a little bit more, to take my time to understand the thought process that people have when they are conversing with you, to understand their motivations, to see from an even more human point of view those motivations that make you live in such a beautiful community like ours. I also learned to feel more secure when talking to people. When doing the interviews, each one gave me more strength, more security, more confidence in finding out what we are thinking, what is going on with us and how can we project that.”

Participant 2

“I learned through the videovoice process how to interview people from a different perspective. Previously it was just one to one questioning, but when you televise or record an interview, there are different issues you need to be concerned about: lighting, placement of the interview subject and also then you have the additional issue of making them comfortable so they’re more open with you and that they can discuss the topic more fully.”

Table 2

What Issues Did Neighborhood Ambassadors Find to be Important to Residents of Their Communities?

Participant 4

“The other major issues in my community for people is obesity, diabetes, asthma, and possibly even autism, but so far I’ve heard a lot more about diabetes, obesity, and the lead.”

Participant 3

“Almost every parent that I’ve talked to has mentioned lead in children and also high rates of asthma, which they aren’t sure is associated with that environmental pollutant. They just know that it’s at really, really, really high rates and that most of their children’s friends have asthma if their children do not. . . . Insofar as how they say the NCS will help them? They don’t know some of the ways that the NCS can help combat those environmental issues. In which case I tell them that having this data available can assist in fighting some of these pollutants and show that there is a direct cause and effect relationship to their children’s health. So those are some of the big issues and if the NCS can really promote that data collected can go towards fighting those issues, I think the community would be much more receptive.”

Qualitative Themes of the NCS GCSC Videovoice Project

Beyond capacitating participants with relevant skills, the second major goal of the videovoice project was to ascertain community perspectives about the NCS. Comments made during the training sessions and interviews with NAs elucidated three principal themes: (a) high awareness of local health issues among residents, (b) limited knowledge about the NCS, and (c) perceived barriers to participation in the NCS within target communities.

High awareness of local health issues

Community residents were eager to share their perspectives regarding health concerns that they felt most adversely affected their communities. Local concerns about lead poisoning (Fokum, 2012), obesity (Consortium to Lower Obesity in Chicago Children, 2010), asthma (Gupta, Zhang, Sharp, Shannon, & Weiss, 2008), and diabetes (Centers for Disease Control and Prevention, 2009) mirrored high prevalence of these conditions regionally with low-income minority communities suffering disproportionately. However, despite high awareness of the adverse health impact of these conditions, community residents largely did not understand how the NCS might improve health in their communities.

Limited knowledge

In general, the more details known about the NCS by community residents, the more positively they viewed the study and the more open residents were to engaging with study personnel about their potential involvement.

Table 3

What Obstacles Will the NCS Encounter While Reaching Out to Mothers in Each Target Community?

Participant 2

“In my community as I have gone from presentations explaining to residents, community leaders and even at city hall, they have been very open in explaining that this is an observational study and once people know clearly what your focus is and what you’re going to do they’re more open to me and open to the idea of a children’s study because they knew the parameters of their study and they weren’t going to be given medicine that they didn’t know. They weren’t going to be a guinea pig, there wasn’t going to be that guinea pig approach that they’re used to in most studies, like they did with Tuskegee you know with the STDs.”

Table 4

How Did Neighborhood Ambassadors Convince Community Residents to Consider Participating in the NCS?

Participant 3

“Any discussion that I had regarding recruitment and some of the barriers to overcome would be focused on the value of research. There are quite a few members of the community that work through the university or are surrounded by university institutions and understand the value of good research. And when I think those points are brought up, then they can see how their influence directly relates to how they can improve the health of the United States or of the community.”

A lack of understanding of the observational nature of the study constituted one of the greatest barriers to NCS participation, identified in five of the six communities: NAs frequently encountered residents who assumed that the NCS involved giving their child a medication or some other type of intervention, additional physician visits, or unexpected, intrusive home visits. In contrast, community residents who were students or university employees reported a high willingness to participate.

Perceived barriers

For residents who understood the goals of the NCS and its implementation, two principal barriers remained. In English-speaking communities, the greatest barrier was its 21-year duration, whereas in Spanish-speaking communities, the lack of trust between the Latino community and “government” projects like the NCS was of primary concern. In particular, NAs identified suspicion regarding (a) how providing sensitive data to the government might endanger their job, legal status, or those of their friends or families; and (b) why this study was targeting their particular community.

Final NCS Community Voices Videos

Due to the difference in concerns identified among Spanish- and English-speaking participants, it became clear that distinct English- and Spanish-language videos were needed. For example, the English-language video (http://youtu.be/Y_qBrAdR2C8) introduces residents and community leaders from the target communities, each of whom emphasize the study’s potential impact on their community’s health. To address the NCS’s long duration, the video ends with a heartfelt monologue from the director of a local, nonprofit agency who shared a story about her son, who passed away as an infant due to a congenital heart deformity. She explains that, in part, due to long-term studies like the NCS, doctors can now save babies born with that same deformity. She closes with the line, “That’s why I’m passionate about this study . . . it seems like a long time but it’s not.”

In contrast, the Spanish-language video (http://youtu.be/_bT7nrzIuZ4) addresses the lack of trust between the NCS and Latino communities by introducing widely respected individuals who explain the NCS’ relevance to their community. The video is in Spanish, with no subtitles. First, a local pediatrician describes the alarming rates of obesity and related conditions that he sees each day in his clinic. Then a local promotora explains that since the U.S. Latino population is growing rapidly, it is particularly important that Latinos are represented in national studies like the NCS. Next, a local resident describes the immigrant experience as it relates to diet, environment, and health. She is followed by a community organizer who is well known for his local efforts to fight deportations. He discusses speaking with his wife about participating in the NCS—explaining how the study’s long duration is actually a benefit because “as a result we can be a part of something big.” The video ends with a local psychologist sharing examples of major advances in population health that have resulted from studies like the NCS, ending with, “If we want to change the world for the better, we need to be a part of that change . . . and this study.”

Discussion

The NCS-GCSC videovoice project trained community members in interviewing, participatory videography, and community outreach techniques through a 6-week curriculum, culminating in the production of two community-engaged videos. This project constitutes a significant extension of prior videovoice work that used participatory videographic methods to mobilize local residents to conduct an 11-month community assessment of a New Orleans neighborhood post-Hurricane Katrina (C. E. Catalani et al., 2012) and to highlight the accomplishments of the Detroit Community-Academic Urban Research Center via a 9-month-long collaborative video project (Chavez et al., 2004). The present project sought to determine the feasibility of conducting a videovoice project over a much shorter timeframe—6 weeks. The present study found that this timeframe appears to be sufficient for community members with no prior experience to learn basic interviewing and videography skills, as well as to film and produce two NCS Community Voices videos. Furthermore, this article is the first to describe the use of videovoice as a means of enhancing community outreach and engagement efforts in the context of participant recruitment for a longitudinal study.

The benefits of CBPR arising from long-standing community–academic partnerships are frequently touted (Israel et al., 2005), with a recent review of photovoice interventions finding that the quality of community participation elicited by a given intervention generally increases with project duration (C. Catalani & Minkler, 2010). However, in some cases, sustained efforts aimed at catalyzing community change may not be feasible, such as within the present context of the NCS. Accordingly, the 6-week, videovoice training aimed to capacitate residents of local communities, targeted for NCS recruitment, with skills to help them in their roles as NCS NAs. Their responsibilities included educating local residents about the NCS, assessing local opinions about the study, and promoting the NCS within their communities in a culturally appropriate manner. Throughout the videovoice project, participants felt that the process effectively enhanced NCS community outreach by providing a vehicle through which local residents’ own ideas and opinions were actively sought while also permitting study personnel to educate community members about the study. Community residents were eager to be interviewed by the NCS NAs and authorized study personnel to use their footage in the final Community Voices videos. NAs also reported that the iterative process of reviewing, discussing, and selecting representative participant footage for the final NCS Community Voices videos throughout the training sessions improved their understanding of their own communities.

The challenges of recruiting and retaining participants for research from low-income, minority communities are widely acknowledged (Patel, Doku, & Tenakoon, 2003), and difficulties with either may significantly affect the validity, reliability, and generalizability of a study (Blumenthal, Sung, Coates, Williams, & Liff, 1995). A videovoice project may provide an avenue for engagement with these “hard-to-reach” communities by building trust through the videovoice process and educating and addressing barriers through the resulting videos. Additionally, given the demonstrated effectiveness of lay health workers in health promotion efforts around the world (Lewin et al., 2010), videovoice constitutes an excellent tool for training similar community residents in community outreach and engagement techniques. Finally, with the increasing ubiquity of smartphones with digital video capabilities and free online video-sharing sites like youtube.com and vimeo.com, videovoice presents an attractive and increasingly accessible way to involve communities in research by permitting digital dissemination of research findings or health promotion videos to a global audience.

Limitations and Challenges

Though videovoice is conceptually rooted in CBPR, it is important to be realistic in acknowledging the inherent limits to participatory research within the context of a large research study with a complex, established protocol. Though project videos and qualitative findings will help tailor future NCS outreach and messaging to communities, the national scope of the study and requisite uniformity in data collection across study sites precludes a true CBPR partnership (Israel et al., 1998). Thus, the present article chose to focus on describing the effects of the 6-week, videovoice training on lay, community members and the feasibility of using videovoice methods to enhance community outreach and engagement for the NCS within the context of six Cook County, IL, communities. Moreover, though NAs made significant efforts to engage a variety of stakeholders within each community, these individuals did not constitute a representative sample. As such, the findings are not generalizable.

Given the relatively high initial costs of the project, for the purchase of equipment and in the training of project participants, future videovoice projects may benefit from a longer implementation period. Many NAs identified the relatively brief implementation period as detrimental to their ability to schedule interviews. Thus, a longer timeframe would permit participants to conduct more outreach and gather sufficient footage to create more targeted, community-specific, promotional videos. Additionally, a longer implementation period would permit participants time to learn digital video editing, a marketable skill that would permit greater creative expression and engagement with the project. With regard to cost, although the audiovisual equipment used in the project cost $500/participant, basic videography equipment can be obtained for less than half of this figure with prices steadily dropping. Robust free video-editing software is also widely available, making videovoice a relatively cost-effective technique.

Conclusion

Videovoice methods have substantial potential to enhance community outreach and engagement in multiple contexts. NCS GCSC videovoice participants were able to quickly learn basic interviewing, videography, and outreach skills through the training and to film and produce two NCS promotional videos. Research personnel and participants alike felt that videovoice was an effective technique because it provided a means through which local residents’ knowledge and opinions were assessed and validated.

In our present era of increasing access to online videos and media production tools, videovoice is a participatory research technique whose time has come. However, given the lack of peer-reviewed studies, it is clear that more work is needed to fully examine the impact of particular components of the videovoice process, such as evaluating the effectiveness of the resulting videos in achieving project goals. We hope that the experiences and resources shared in this article will guide future videovoice practitioners in these efforts.

Footnotes

Appendix A

Appendix B

Materials Used to Implement NCS GCSC Videovoice in Cook County, IL

Materials	Description
Video Camera	CanonPowershot S95 with 16 gigabyte class 10 SDHC memory card and camera case: These particular cameras were chosen due to their ease of use (being that they are standard point-and-shoot cameras) and superior video quality, particularly in the low-light environments frequently encountered when conducting field interviews.
Microphone	Zoom H1 Handy Recorder with 2 gigabyte microSD memory card and accessory kit (including wind baffle, mini tripod, microSD memory card adapter, and wall charger): We decided to use these portable microphones rather than the built-in camera microphones due to their superior audio quality and flexibility of use, given that when planning the project, we anticipated that some community members would feel more comfortable being interviewed by audio-recorder alone as opposed to with a camera.
Tripod	Sunpak 5200D lightweight tripod: This relatively lightweight yet inexpensive tripod provided a good mix of portability and functionality with its three-way smooth video panhead, 52 inch extendibility, and multiple bubble-levels.
Accessories	One extra camera battery and charger; one lightweight backpack to carry all equipment.
Neck Lanyard	A zippered identification badge with pockets for community footage consent forms and videovoice project information handouts.

The authors have no conflicts of interest.

This project was supported by the Eunice Kennedy Shriver National Institute for Child Health and Human Development, Contract # HHSN275200700027C. All authors received salary support from the aforementioned source. IRB Approval: This study was approved by the institutional review board of Northwestern University in Chicago, IL, STU00050200.

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