Product Details

Author Information

Corresponding Author
Catherine Carry
Inuit Tuttarvingat, National Aboriginal Health Organization
Suite 1200, 220 Laurier Avenue West
Please note this organization closes on June 30, 2012
Ottawa, ON K1P5Z9
Canada
p: 613-710-0193
CatherineCarry@yahoo.ca

Authors (listed in order of authorship):
Kath Clarida
Entheos Films

Dianne Kinnon
Inuit Tuttarvingat, NAHO

Jacob Partridge

Leesie Naqitarvik

Herb Nakimayak

Fred Andersen

Product Description and Application Narrative Submitted by Corresponding Author

What general topics does your product address?

Public Health, Social & Behavioral Sciences, Social Work, Indigenous Health and Wellness

What specific topics does your product address?

Access to health care, Advocacy, Chronic disease, Community development, Community engagement, Community health , Community organizing, Diabetes, Health behavior, Men’s health, Mental health, Minority health, Physical activity/exercise, Race & health, Social determinants of health, Social services, Substance use, Tobacco use

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

Indigenous/Aboriginal, Men

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

Focus group , Participatory evaluation, Content Working Groups; Public Phone-in; Community Program Video Profiles, Participant observation

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

Documentary, Indigenous public engagement - recorded live

Application Narrative

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

Inuit men have experienced many changes to their way of life in just two generations. This has sometimes left Inuit men feeling lost and unsure of their place in the family and community. Their level of distress can be seen in the low school completion rates and high levels of incarceration and suicide. Men need a voice.

Programs and services for men – many created and led by men – are giving them an opportunity to seek help, better understand their needs and strengths, and revive their traditions and culture. “Angutiilli qanuiliqpat? – How are we as men?,” is the first of a three-part live, public TV series, “Qanuqtuurniq – Finding the Balance,” on Inuit health and wellness issues and solutions. In this episode (now an on-line video product) viewers will see live discussions, information from the International Polar Year's Inuit Health Survey, and stories of community programs that are helping Inuit men to improve their physical, mental, emotional, and spiritual health.

Led by Inuit Tuttarvingat of the National Aboriginal Health Organization in Canada, it was broadcast in May 2009 on the Aboriginal Peoples Television Network – North and in Alaska on 360North. The series was a communications and outreach project for International Polar Year aired in the Inuit language (with English captions/sub-titles) and simultaneously webcast. The goal of each episode was to engage the Inuit public (the primary audience), and others in ‘real time’ dialogue about health and wellness issues and health research, and to deliver key messages.

2. What are the goals of the product?

The goals for dissemination of the on-line video (and the DVD), are to: 1) demonstrate the integration of several communication methods for engagement on a health topic in remote and/or geographically spread Indigenous regions including the use of: live public broadcast; pre-recorded community program videos; and a live panel, studio audience, public phone-in, and community focus groups, and 2) promote community dialogue in new venues on Indigenous men's health and wellness issues and solutions.

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

Almost 1200 DVD sets, which include the “Angutiilli qanuiliqpat? – How are we as men?” episode were mailed to: project stakeholders and participants; health, wellness and addiction workers, and high schools, colleges and libraries in Canada's Inuit regions; and, to those requesting copies. We hope the on-line video will reach circumpolar and international audiences, particularly those engaged in Indigenous community development and mobilization concerning men's health and wellness, whether through research, policy initiatives or community programming. The product should also be of interest to those using communications for public engagement and those assisting Indigenous men involved with the justice system.

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 link brings you to the Inuit Tuttarvingat channel of the 'vimeo' website where the video product is loaded. Scroll through the videos looking for "TV Show – Men’s Wellness Chapter 1" /Chapter 2/Chapter 3, to find the three chapters (two hours total) of "How are we as men?" Click on the respective video thumbnails and the video viewer should pop up for you to begin to play.

Citation: Inuit Tuttarvingat of NAHO (Executive Producer). (2009). How are we as men? [Television series episode]. In "Qanuqtuurniq – Finding The Balance." Iqaluit: Inuit Communications (ICSL).

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.

Our TV series project builds on the fields of 'community engagement' (1) and 'communications for social change' (4).

In the US National Institutes of Health (NIH) publication, "Principles of Community Engagement," the US Surgeon General says that the 1997 1st edition “filled an important vacuum, providing community members, health professionals, and researchers with clear principles to guide and assess their collaborative efforts” (2, p. xi). Community engagement is defined as:

“…The process of working collaboratively with and through groups of people affiliated by geographic proximity, special interest, or similar situations to address issues affecting the well-being of those people. It is a powerful vehicle for bringing about environmental and behavioral changes that will improve the health of the community and its members. It often involves partnerships and coalitions that help mobilize resources and influence systems, change relationships among partners, and serve as catalysts for changing policies, programs, and practices” (2, p. 7).

The 2011 NIH authors note that “community involvement is essential to the identification of health concerns and interventions” (2, p. vi). While community engagement can take many forms, it is probably better viewed as a continuum of ever deepening levels of involvement (2). The development phase of “Qanuqtuurniq – Finding the Balance” included several of the key elements of engagement that NIH identifies, such as participation in the “generation of ideas, contributions to decision making, and sharing of responsibility” (2, p. 13).

Leaders in the development of a 1994 Inuit communications model, which was used in developing the 2009 TV series, view their project as an initiative in ‘communication for social change’ (CFSC). Likewise, the 2009 series, set out to encourage Inuit facing health and social issues to develop their own solutions. Gray-Felder (3, Foreword) defines the CFSC approach as “the act of people coming together to decide who they are, what they want and how they will obtain what they want.” Gray-Felder’s (3) description identifies a number of the elements of CFSC – interestingly, the language is very similar to that used to describe community engagement. Essentially then, CFSC uses communications for community engagement, and community engagement is about social change.

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. Carry CL et al. Qanuqtuurniq–finding the balance: an IPY television series using community engagement. Polar Research 2011 [serial online], 30, 11514. Available from http://www.polarresearch.net/index.php/polar/article/view/11514.

2. Clinical and Translational Science Awards Consortium Community Engagement Key Function Committee Task Force on the Principles of Community Engagement. Principles of Community Engagement (2nd edition). National Institutes of Health, US Department of Human and Health Services; 2011. NIH Publication No. 11-7782. Available from http://www.atsdr.cdc.gov/communityengagement/pdf/PCE_Report_508_FINAL.pdf.

3. Figueroa ME et al. Communication for social change: An integrated model for measuring the process and its outcomes. The Communication for Social Change Working Paper Series. New York: The Rockefeller Foundation and Johns Hopkins University Center for Communication Programs; 2002:1.

4. Johnson RM et al. Pan-Arctic TV series on Inuit wellness: A northern model of communication for social change? Int J Circ Hlth 2011 [serial online];70(3):229-340. Available from http://www.circumpolarhealthjournal.net/index.php/ijch/article/view/17827/20308.

5. Johnson RM. Final evaluation report: Pan-Arctic Inuit wellness TV series. Ottawa: National Aboriginal Health Organization; 2009. Available from http://www.naho.ca/wellnessTV/documents/IPYTVSeriesFINALEVALUATIONREPORTDec2009.pdf.

6. National Aboriginal Health Organization. Qanuqtuurniq – Finding the Balance, a TV phone-in series on Inuit wellness: Summary report. Ottawa: National Aboriginal Health Organization; 2010. Available from http://www.naho.ca/wellnessTV/documents/2010-03-31_FinalTVSeriesSummaryReport_IT-NAHO.pdf

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.

Inuit Tuttarvingat (IT) of the National Aboriginal Health Organization advances and promotes the health and well-being of Inuit individuals, families and communities by working in strong partnerships to collect information and share knowledge.

Of Inuit Tuttarvingat’s six main goals, the following three are most relevant to this project:
• Conduct and promote research to enhance the health and well-being of Inuit.
• Increase understanding and awareness of the health issues affecting Inuit.
• Preserve and promote Inuit traditional knowledge and healing practices.

In 2002 (early in its development), IT held a series of community workshops in Inuit regions in Canada to gather residents' ideas about health and health-related needs. Inuit have been experiencing rapid societal change and many resulting traumas. It was not surprising that at all of the workshops, participants expressed concerns that Inuit men were not getting the help they needed to move forward in their lives in positive and productive ways. Those concerns lead to a research study in which 19 Inuit men across the country were interviewed about their needs and views on health. The purpose of the study and the resulting 2008 report "Inuit men talking about health," was to give a stronger voice to Inuit men, and to contribute to discussions about how health and social programs can be adapted to better serve them.

In 2007, we took advantage of a unique funding opportunity presented by the International Polar Year, to prepare “Qanuqtuurniq – Finding the Balance,” a three-part TV broadcast and webcast on Inuit health and wellness issues. This project was not a research project, but a contribution to knowledge translation. The goal was to engage the Inuit public and others in ‘real time’ dialogue about health and wellness issues and health research, and to deliver key messages. Partnering with Inuit organizations, communications agencies, medical professionals and researchers, we designed a multi-faceted public engagement process for development and delivery of the broadcasts. Through this initiative, we were able to do further outreach on the men's health and wellness topic resulting in the TV program "How are we as men?"

Methods:

We applied an Inuit communications model developed in 1994 by the Inuit Broadcasting Corporation/Inuit Communications (ICSL) for remote and underserved communities in the Arctic/North. Its components were:

"Live broadcast via a public broadcaster for first level information dissemination; the use of traditional and developing communication tools (telephony, videoconference and fax) to ensure public engagement and interactivity with the broadcast; input from multiple groups that encouraged dialogue from different perspectives; a focus on community engagement on issues and solutions of concern to Inuit/Northerners; use of multi-language formats to ensure cultural inclusiveness" (1, p. 4).

One of our project partners had experience in the development and implementation of the 1994 model. A key objective of that initiative was to create a model that was economical, replicable, and effective for community consultation on any issue. While the model had been used for an entirely different topic, we wanted to demonstrate that it could work for dialogue on Inuit health and wellness issues and solutions, and on health research. As they did in 1994, we also used several newer communications tools for engagement and delivery.

Our project partners at the University of Alaska Anchorage conducted a participatory utilization-focused evaluation during the development phase and following the broadcasts. Results and evaluation data from key informant interviews, surveys, visits to participating communities and website traffic confirm the project goal was achieved and objectives of the project, including those relating to the engagement efforts, were successful.

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.

Content for the two-hour, public, men's health and wellness TV program (and webcast) was designed with the guidance of a working group including a federal government representative and four Inuit, with men's health and wellness expertise: an elder working in men's healing and spirituality; a young hunter running an outfitter business; a coordinater of abuse prevention initiatives and Inuit knowledge research; and, a men's counsellor (with a Master of Social Work). A larger working group involving the Inuit Diabetes Network contributed messaging on healthy living, based on evidence. Content from the International Polar Year's Inuit Health Survey (IHS) was included on the program through the Primary Investigator and the IHS coordinating committees in the Inuit regions. A video explained the survey showing the Amundsen, the Canadian Coast Guard research ship that visited Inuit communities to gather data. To ensure that there was public awareness of the men's program and the series, we implemented a multi-faceted and intensive communications strategy. Specifically for the men's program, we developed a public service announcement in the Inuit language and English, which was distributed to all Inuit community radio stations.

The working group members and the director of cultural and social development at Nunavut's Inuit land claim organization formed the panel on the live program. Short vignettes of promising community programs assisting Inuit men were prepared in advance and aired on the program to promote solution-oriented dialogue and encourage mobilization. Two out of the six community focus groups, which were spread out across Canada's Inuit regions and watching the show, were prepared in advance to discuss questions and to phone-in with their responses. One of the questions was "What did you want to learn from research on Inuit men?" There were also public phone-in segments and first-time efforts to use Skype (which failed for this program only). Along with the panelists, audience members, including a long-serving local physician, gave their views on a variety of the topics discussed.

The live web stream was accessible through several websites. The live version of the program continued to stream for months afterwards while we prepared an edited on-line version (the product) along with DVDs. This involved fixing the most major errors. These were primarily due to the nature of live programming and included errors related to the simultaneous translation from the Inuit language to English (which were then captioned).

Working group members were able to debrief on their experiences by teleconference shortly after the broadcast, and along with many others involved, participated in the evaluation.

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.

The evaluation report (5) states that Qanuqtuurniq – Finding the Balance “was an innovative, multi-dimensional, collaborative health communication project,” (p. 1) and further that:

“[b]y its use of active engagement of community partners in project development, implementation and evaluation, this project took an explicitly ‘communication for social change’ (CFSC) approach. As noted ... [in (3)], this type of approach is still relatively uncommon, yet increasingly important, particularly in regions of the North that have been the sites of cultural misunderstanding and conflict and rapid societal change” (5, p. 3).

Some highlights from the findings include: “Key informant interviews, surveys, document review and site visits … all confirmed that the project successfully achieved each of the four objectives …” (5, p. 8). “Most people who worked on the project thought it was a ‘success’ and would like to do something like it again. Most audience members who participated in the evaluation said that they liked the programs and learned something new and helpful and several of these planned to do more to promote wellness in their own communities” (6, p. 2).

The project demonstrated that: “New technologies like Internet, Skype, and Web sites can help Inuit and others interested in wellness to work more closely together to solve problems, even across great distances and across different cultures” (6, p. 2).

A TV series community focus group facilitator commented: “With the new computer age, people are becoming involved, it’s taking away being alone, alcohol, drugs, and getting in trouble. And, young people are getting more involved with the community” (5, p. 23).

“People chosen [for focus groups] had discussions they never had discussed before and to sit together and talk opened up a lot of amazing discussion and dialogue. …That was the highlight for me – Technical crew member" (5, p. 23).

In the audience surveys and key informant interviews, when asked “Will you do anything differently because of the program?”, a selection of viewers of the men’s program provided these comments:

• “Continue to include men in the work I do and seek out more resources available to men.”
• “Work harder to integrate looking at men’s issues in my work.”
• “Help support programs for Inuit men.”
• “We need to do more of this. Keep up the great work. It’s been an honour” (5, p. 20).

Responding to questions about how they will use key messages from the programs, a men's wellness program audience member said : “I want to try and facilitate programs in my region to help Inuit” (5, p. 22).

While our evaluation was able to explore short-term impact only, results showed how participants planned to take action in their own lives and also in terms of involving others. The programs shared information on initiatives having positive impacts in communities. While our limited evaluation data does not provide evidence of long-term change, sharing promising practices from one community/region of a population (with so many historical, social, economic and environmental similarities) with other regions of that population can lead others to consider related changes in policies, programs, and practices.

From peer review comments relating to a journal article submission on the overall TV series project and its engagement efforts (1), we have been told that the article contributes to the literature on communications in the North and that our use of the Inuit communications model and our findings are not only innovative, but are relevant to those engaged and/or interested in polar research.

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

Our first product on the topic of Inuit men's health was the 2008 report based on interviews with Inuit men as described above. At that time, most of Inuit Tuttarvingat's products were in print formats. In Inuit communities, dissemination and uptake of knowledge (especially research findings) through print media is often low. Our governing committee had begun encouraging us to 'get off the page,' because oral and visual communications are particularly integral to Inuit culture. Radio, for example, is likely the most popular means of communication for Inuit and has particular social importance for communication locally and between communities regionally. Television is also a primary means of communication to the general public, most particularly in the Arctic. It has the advantage of national (and potentially international) reach. Documentaries and live phone-ins are very popular. However, television programs may only be aired once, with an occasional rebroadcast. We wanted to extend the dissemination, so we taped the live programs, preparing edited on-line files and DVDs in the year that followed.

As a supplement to the video format with English captions and subtitles, we prepared an edited English transcript to assist others in their content research. The transcript is available on-line and can be cited as: Inuit Tuttarvingat of NAHO (Executive Producer). (2009). How are we as men? [Television series episode]. In "Qanuqtuurniq - Finding The Balance." Iqaluit: Inuit Communications (ICSL).

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.

Feedback was sought monthly throughout the content development process (approx. eight months) by teleconference meetings with partners and working group members. Partners largely controlled their content. All financially feasible ideas were implemented and evidence-based input added to the script guides during development. The evaluator was a full project team member sharing observations and suggestions as needed. Decision records and action lists for the men's content working group were kept, circulated to members, and all items followed up. The evaluator received this information as well. A national committee concerned with Inuit health policy and research also gave input along with others.

As our TV series project was time-limited by funding, it could not establish long-term goals. It would have been very illuminating to conduct a longer term impact evaluation asking what changes and actions people actually made as a result of participation in the programs.
However, we “stimulated community dialogue and the potential for both local and regional collaborative action to address those conditions” (5, p. 1).

We also faced some significant challenges, particularly regarding phone-in callers: there was never enough time to hear from all the callers. Scheduling fewer pre-planned interactions would have helped, but as more and more people phone in to a show, chances are that some will never make it to air. To reduce the complexity of live programming, future broadcasts should be simplified and shortened with reduced numbers of participants, sub-themes, program elements and communications tools because “too many communication channels can dilute key messages and ‘community voice’” (5, p. 24).

Other challenges included:

"Working internationally across cultures and languages was more difficult than expected based on previous experience in Canada. The project’s technical partners also battled with potential and real technology and equipment failures and losses. Equipment upgrades are needed if the North is to keep up with advances in communications. Adding content working groups without extending timelines more than doubled the workload. In future, better strategies for engaging busy academics to participate in content development and delivery need to be employed. Pre- and post-production time lines for gathering video content and editing for DVD production should be lengthened. Due to post-production delays, the evaluation could not include feedback from DVD viewers" (1, p. 8).

In retrospect, our successes outweighed the areas for improvement. As noted in the external evaluation:

• “New informal/formal networks were created.
• “Increased motivation for action was described by many.
• “Increased tools for action were provided in multiple formats.
• “Excitement about new media possibilities were described by many.
• “Opportunities to link traditional knowledge and new technologies.
• “Chance[s] to think about old problems in new ways.
• “Chance[s] to bridge generational and geographic gaps with new tools” (5, p. 26).

Most importantly, we demonstrated that the following project elements worked well and we would recommend them for future projects:

• “Trust in and build upon the wisdom of both community members and professionals to understand and help solve complex health problems,
• “Take time to think about and evaluate efforts, and
• “Use new media technologies to strengthen networks and communication in the North” (6, p. 7).

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.

IRB/mechanism - Not Applicable.

Product co-authors listed have been approached and provided their approval.

“Community engagement must be conducted in a manner that is respectful of all partners and mindful of their need to benefit from collaboration” (2, p. 28). To the best of its ability, Inuit Tuttarvingat identifies and implements respectful processes in all of its initiatives. For the TV series, there are many examples.

“This international, multicultural, geographically-dispersed and technologically-challenging project benefited greatly from the ‘active-reactive-interactive-adaptive’ stance of its leaders. Tolerance for ambiguity, cross-cultural sensitivity, rapid responsiveness, flexibility, skills in understanding and incorporating different perspectives, identifying and using individual skills of team members, conflict resolution and media-handling skills were all demonstrated at different times by the key members of the project team, greatly contributing to overall project success” (5, p. 28).

Other examples follow. Partners largely controlled their content. We also facilitated the last minute request of one funder to have input into the content regarding some evidenced-based information. We gave training to the panelists, to help prepare them and increase their comfort level during the live broadcasts. Everyone was made aware of certain challenges that can come about on live phone-in programs. We put counsellors in place to talk with callers, if they became distressed – fortunately they were not needed. We discussed respectful ways of dealing with disruptive callers, but no instances arose. The programs were accessible to Inuit and English language speakers and even Francophone callers could be accommodated. We offered panelists fair compensation for their time. Working group members had opportunities to debrief after the shows. If we had their current address, participants were sent a DVD of the programs.

We faced challenges regarding the phone-in: "there was never enough time to hear from all the callers. … Because interrupting people who are telling long stories can be culturally inappropriate, this method of allowing more people to participate in the discussion was used sparingly" (1, p. 8).

During the program, all funders, sponsors and participants were thanked. The credits at the end of the TV program were also extensive. The following acknowledgements conclude our article published in Polar Research in 2011:

"Youth researcher/project assistant, Alex Stubbing; project assistant, Cynthia Pitsiulak; partners Inuit Communications, EnTheos Films, Qanuippitali? Inuit Health Survey, National Inuit Youth Council, Pauktuutit Inuit Women of Canada, Inuit Tapiriit Kanatami and several working groups and in-kind contributors; panelists, show moderator, studio audiences, community focus group members, youth virtual focus group members, technical team, videographers, community members, show participants, and viewers. RMJ appreciates and acknowledges the contributions of University of Alaska Anchorage Master of Public Health in Public Health Practice students Robin Morales and Doreen Leavitt to the evaluation project. A list of programme credits is available [on-line] along with the video products and reports stemming from the television series. Funding for Qanuqtuurniq – finding the balance” was provided by: the Government of Canada; the Department of Health and Social Services, Government of Nunavut; the Canadian Institutes of Health Research Team in Circumpolar Health Research; and sponsoring airlines First Air and Canadian North"(1, pp. 9-10).