Product Details

Author Information

Corresponding Author
Brigitte Frett
University of Miami Miller School of Medicine
1963 Brandywine Rd.
#104
West Palm Beach, FL 33409
United States
p: 847-302-9316
bafrett@med.miami.edu

Authors (listed in order of authorship):
Myra Aquino
University of Miami Miller School of Medicine

Marie Fatil
University of Miami Miller School of Medicine

Julia Seay
University of Miami, Department of Psychology

Dinah Trevil
University of Miami

Michèle Jessica Fièvre

Valentine Cesar
University of Miami

Erin Kobetz
University of Miami

Product Description and Application Narrative Submitted by Corresponding Author

What general topics does your product address?

Medicine, Public Health, Social & Behavioral Sciences

What specific topics does your product address?

Cancer, Community health , Health behavior, Health disparities, Health education , Women's health , Community-based participatory research

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

Immigrant, Women, Haitian

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

Community-based participatory research , Focus group

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

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.*

We created two brief educational films on cervical cancer prevention for a Haitian audience. The films focus on primary and secondary prevention through HPV vaccination and Pap testing. The dialogue is in Haitian Kreyol with English subtitles. The films were written and produced by a Haitian writer and producer, star Kreyol-speaking actors, and incorporate medical and public health knowledge shared by partners at the University of Miami Miller School of Medicine. The films’ storyline revolves around a Haitian family and how they approach a cervical cancer diagnosis and options for screening and prevention. The films are designed to convey information on how cervical cancer can be prevented and detected early. The videos are intended to appeal to a broad Haitian audience including young men and women age appropriate for HPV vaccination (ages 9-26), women recommended to receive cervical cancer screening (ages 21-65), parents, grandparents, and community leaders. The videos are being disseminated to the community through local organizations in Little Haiti, Miami, the largest Haitian enclave in the U.S. Via the internet, the videos will be made available to other Haitian audiences throughout the U.S. and around the world to promote widespread awareness and action on cervical cancer.

2. What are the goals of the product?

The overarching goal of this project is to expand ongoing efforts to decrease rates of cervical cancer among Haitian women in South Florida and around the world. Towards this aim, the films are designed to inspire discussion and dialogue about cervical cancer in the Haitian community, promote education on cervical cancer prevention, and influence screening and vaccination rates. Through a storyline that revolves around a Haitian family, the videos convey information on screening options for cervical cancer and how women can go about seeking testing. The videos also include information about the HPV vaccine such as eligibility, risks, benefits, and costs. The videos also explicitly address issues that have been raised over the course of the Community-based Participatory Research (CBPR) project these videos are a part of, such as addressing the belief that HPV only affects individuals who are promiscuous. Because Haitian Kreyol is traditionally a spoken language whose orthography was only recently solidified, the video approach shows particular promise in reaching a monolingual Kreyol-speaking audience to better promote cervical cancer prevention efforts. Furthermore, the video format has the potential for widespread dissemination to a greatly expanded audience in Little Haiti, Haiti, and throughout the Haitian Diaspora. As public health efforts turn to technology-focused solutions, projects like this video will become increasingly emphasized. This project is therefore part of a larger movement to utilize technology and media as public health tools. The results of this project will be shared with members of the Haitian community to promote screening and vaccination, as well as with members of the academic community to help expand technology and media-focused interventions for decreasing health disparities.

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

The target population for the movies is Haitian men and women living in Little Haiti, Miami and other Haitian communities around the globe. The first movie is designed to appeal to women age-eligible for Pap testing (21-65 years old) as well as younger women who will be eligible in the future. We are also targeting Haitian men as the husbands, boyfriends, fathers, and brothers who are often heads of households and key partners in cervical cancer prevention efforts. The second film targets the mothers and fathers of children eligible for HPV vaccination (boys and girls 9-26). Because the film will contain general information about the vaccine, it will also provide knowledge to individual men and women who may be considering the vaccine or recommend it to friends or family.

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.

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.

This project is part of a national movement to utilize media to influence health behaviors including cervical cancer screening. This national emphasis on technology is reflected in the statements of the United States Community Preventative Services Task Force who recommend the use of small media, such as videos, to increase cervical cancer screening (1). These videos are complementary to similarly targeted video projects on cervical cancer screening that have been created for Hispanic audiences but are the first designed for a Haitian Kreyol-speaking audience (2). They are also a component of the National Cancer Institute-funded Community Networks Program initiative to conduct community-based outreach that is innovative and measurable. These videos are part of an ongoing nine-year community-academic partnership between members of the Little Haiti neighborhood of Miami and the University of Miami Miller School of Medicine (UMMSM). A primary aim of this relationship is to reduce the burden of cervical cancer among Haitian women in South Florida. Women in Little Haiti, the largest Haitian enclave in the United States, experience excess cervical cancer incidence with rates four times higher than the Miami metropolitan area overall (38/100,000 vs. 9/100,000) as well as higher than rates among non-Haitian black women in Miami (12/100,000) (3,4). Since 2004, community stakeholders, community health workers, and academic investigators from the UMMSM have worked collaboratively to address this disparity through complementary, community-based primary and secondary prevention efforts. The partnership is grounded in the principles of community-based participatory research and enables an in-depth exploration of the risk factors and risk conditions that account, in large part, for the high rate of cervical cancer observed in Little Haiti (5, 6). These factors include socioeconomic marginalization, language barriers, distrust of researchers, humoral concepts of illness, and immigration status, among others (7). Through this CBPR project, it has become clear that successful prevention efforts must address these multiple barriers simultaneously to ensure timely screening and treatment for cervical cancer among women in Little Haiti. This video project was created as a novel approach to address these issues using a medium with potential for widespread dissemination.

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) Community Preventative Services Task Force. Guide to Community Preventative Services. Cancer Prevention and Control: Client-Oriented Screening Interventions. December 2005. Available at: http://www.thecommunityguide.org/cancer/screening/client-oriented/index.html.

(2) Byrd TL, Wilson KM, Smith JL, Coronado G, Vernon SW, Fernandez-Esquer ME, Thompson B, Ortiz M, Lairson D, Fernandez ME. AMIGAS: a multicity, multicomponent cervical cancer prevention trial among Mexican American women. Cancer 2013; 119(7):1365-1372.

(3) Kobetz E, Menard J, Hazan G, Koru-Sengul T, Joseph T, Nissan J, Barton B, Blanco J, Kornfeld J. Perceptions of HPV and cervical cancer among Haitian immigrant women: Implications for vaccine acceptability. Education for Health 2011; 24:479-489.

(4) Kobetz E, Kish JK, Campos NG, Koru-Sengul T, Bishop I, Lipshultz H, Barton B, Barbee L. Burden of the Human Papillomavirus among Haitian Immigrants in Miami, Florida: Community Based Participatory Research in Action. Journal of Oncology 2012; 2012:728397.

(5) Israel B, Schulz A, Parker E, Becker A, Allen A, Guzman R. Critical Issues in Developing and Following Community Based Participatory Research Principles. In: M M, N W, editors. Community-Based Participatory Research for Health. San Francisco, CA: Jossey-Bass Publishers; 2003.

(6) Minkler M, Wallerstein N. Community-Based Participatory Research for Health. San Francisco, CA: Jossey-Bass; 2003.

(7) Barbee L, Kobetz E, Menard J, Cook N, Blanco J, Barton B, Auguste P, McKenzie N. Assessing the acceptability of self-sampling for HPV among Haitian immigrant women: CBPR in action. Cancer Causes Control 2010; 21(3):421-431.

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.

These videos are one component of a number of collaborative projects that are part of a campus-community partnership called Patnè en Aksyon (Partners in Action) in Little Haiti, Miami. The partnership was first established in 2004 with the goal of reducing cervical cancer disparities among Haitian women in Florida, who face the highest rates of cervical cancer in the state. Ongoing collaboration between community stakeholders, community health workers, and academic investigators from the University of Miami Miller School of Medicine (UMMSM) has focused on the development and utilization of culturally and linguistically appropriate intervention strategies to reduce incident cervical cancer cases through primary and secondary prevention. In keeping with the principles of Community-based Participatory Research (CBPR), where community participation is integral to all aspects of the research process, community leaders take a head role in defining the focus of Patnè en Aksyon’s research strategies through a community advisory board (CAB) which meets regularly to discuss project development and implementation. To date, the work of Patnè en Aksyon has enabled in-depth exploration of the many forces contributing to the high rates of cervical cancer in Little Haiti. This understanding has proven critical to generating successful interventions to reduce these cancer rates. Efforts to promote screening have emphasized the use of a cervical self-sampling device which allows women to take a sample of their cervical cells (similar to a Pap test) in the privacy of their home to circumvent barriers to screening identified over the course of the project. Efforts have also focused on increasing knowledge of cervical cancer and its prevention through HPV vaccination and screening.

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.

There is a long-standing Community-based Participatory Research (CBPR) partnership between members of the Little Haiti, Miami community and the University of Miami Miller School of Medicine. A core feature of this partnership is a community advisory board (CAB), which provides ongoing feedback on all aspects of the partnership. Recently, members of the CAB indicated that educational tools utilized under the partnership should have a stronger base in technology. This feedback inspired the idea to develop videos that can be used for outreach efforts for cervical cancer prevention. The video content came directly from community feedback and insight gathered by a community health worker during formal and informal discussion. The community health worker spent significant time interviewing community members about video content and how to best structure message delivery. Several focus groups were also held to answer specific questions about important medical information to be included as well as storylines that would be appealing and engaging for the target audience. Based on this feedback, the community health worker and UMMSM team drafted an initial screenplay with scientific information for the videos provided by UMMSM. The drafts were shared with a Haitian screenwriter who developed storylines and characters and was able to interweave medical facts into a Haitian plotline. Both screenplays were written in Haitian Kreyol with English translation for subtitles. The scripts were extensively revised for medical accuracy and vetted with the CAB to ensure appropriate and relevant cultural content. Once the scripts were complete, an open call was held and actors were recruited through social networks and word of mouth. All actors were Kreyol speakers. Location scouting also took place during this phase of the project and revolved around South Florida locations that cater to Haitian patrons. Before filming began, a Haitian producer was hired to film, direct, and produce the movies. During the dissemination phase of the project, the community advisory board is deciding the best modes for showcasing the film in partnership with the University of Miami research team. The films are already available over the Internet for free and have been featured as part of poster presentations at multiple disparities and global-health focused scientific meetings. In tandem with dissemination, evaluation of the project's impact will be undertaken through focus groups held in Florida's Miami-Dade and Palm Beach counties to determine the videos' effects on outcomes such as cervical cancer prevention knowledge and vaccine uptake as well as evaluate the applicability of the videos to Haitians living throughout South Florida.

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.

This video project was created with knowledge obtained through nearly ten-years of campus-community collaboration for cervical cancer prevention in Little Haiti, Miami. Reflective of community feedback regarding how to best structure health messages, the films revolve around a storyline of a Haitian family and how they approach a cervical cancer diagnosis and options for screening and prevention. The films address specific issues that have been raised over the course of this CBPR collaboration including clarifying the difference between HPV and HIV, discussing the HPV vaccine and its unfounded association with sexual promiscuity, and the proactive role Haitian men can play in promoting cervical cancer awareness within the community at large. The films have therefore been specifically designed for and tailored to a Haitian audience. Importantly, the film dialogue is exclusively in Haitian Kreyol. Because Haitian Kreyol is traditionally a spoken language whose orthography was only recently solidified, this video approach shows particular promise in reaching a monolingual Kreyol-speaking audience to better promote cervical cancer prevention efforts among Haitians. As we enter the dissemination phase of the project, our community advisory board and production team are collaborating to optimize a plan for circulating the videos throughout Little Haiti, including pairing viewing with ongoing screening and vaccination efforts. We are developing a video premiere night and have already held screenings at a Haitian not-for-profit organization in Little Haiti. Via the Internet, the videos are available for free to other Haitian audiences throughout the United States and around the world to promote widespread awareness and action on cervical cancer. We are planning to further evaluate the impact of these videos on knowledge and behavior through semi-structured focus groups. The question guide for the focus groups has been developed and the project proposal is currently undergoing the IRB approval process.

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

Feedback from community members through the community advisory board indicated a need for technology-based approaches to delivering cervical cancer education to a Haitian audience. Utilizing technology is seen as an important component to increasing capabilities for outreach and getting cervical cancer prevention messages to a wider range of community members. This format can also best meet Haitian's literacy needs. Haitian Kreyol is historically a spoken language, making an audio-video format particularly useful for ensuring understanding across generations of Haitians with different levels of literacy. Audio-visual media plays an important role in Haitian daily life, with radio in particular being a centerpiece of Haitian cultural life in both Haiti and Miami. The video scripts were therefore designed to be adaptable to both TV and radio-only contexts. Haitian television is a growing industry in Miami, with multiple Haitian television programs airing regularly including a nightly Kreyol-English program entitled "Island TV." Our team therefore decided on a video-based project because it is a familiar and accessible form of media for Haitians. The video format also has the capability to be widely disseminated over the Internet so that Haitian women around the world can access appropriate screening and prevention information. Finally, the films were made utilizing a storyline revolving around a family because feedback obtained by our community health workers indicated this plotline would better engage our intended audience in comparison to a purely educational format.

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 strengths of this video project include the fact that it was developed utilizing a CBPR framework where community participation was integral to all aspects of project development and implementation. This approach is essential to ensuring that the content of the films is relevant to the target audience and therefore capable of increasing knowledge and inspiring action. The campus-community partnership model that provides the backbone for this project enables each member of the team to offer their own areas of expertise to project development. Therefore the community advisory board, which includes leaders from the Little Haiti community, could offer insights as to how outreach efforts should be enhanced utilizing a video format. Community health workers were able to assess community needs in terms of knowledge on cervical cancer and HPV and guide content development. The community health worker could also seek input as to the most effective modes for message delivery in the videos. This feedback led to the decision to create videos with a soap-opera like plotline that included drama and conflict as opposed to a purely educational-style video. The academic team from UMMSM was able to provide medical expertise to the films to ensure the accuracy of scientific discussion. Recruiting actors from the South Florida Haitian community allowed film dialogue to take place in Haitian Kreyol and therefore be understandable to a wider Haitian audience regardless of English speaking ability. Furthermore, the actors offered ongoing feedback on the movie scripts and were able to bring life to the dialogue so that conversations taking place in the film were realistic and reflective of actual interactions that take place within Haitian families.
The most important limitation of this project is that it requires media devices for utilization in the form of a computer or handheld digital device. Furthermore, as the movies are currently only available over the internet, they require web access for viewing. This means that individual access to the films may be limited.

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 product is one component of an ongoing campus-community collaboration known as Patnè en Aksyon (Partners in Action). This partnership first launched in 2004 and has resulted in numerous projects aimed at alleviating cervical cancer disparities in Little Haiti, Miami. These videos were created using Community-based Participatory Research (CBPR) methodology whereby members of the Little Haiti community were integral to project development during all phases and their expertise and insight remain central to the project’s success. Under the CBPR paradigm, the community drives the project’s trajectory through participation on the community advisory board, communication with community health workers, and direct participation in the film’s creation through writing, acting, and producing. The content, storyline, acting, and production of these films came directly from South Florida’s Haitian community in collaboration with the University of Miami research team. The collaborative nature of Patnè en Aksyon ensures that equal participation is provided to all contributors to our projects, including these films. The University of Miami Institutional Review Board and the Patnè en Aksyon community advisory board approved the research protocols for the films and for the ongoing educational and cervical cancer prevention program in Little Haiti. We plan to submit manuscripts to academic journals describing the film project. All collaborators will be recognized in these submissions through written acknowledgments and shared authorship. All collaborators are aware of, and support, this submission to CES4Health.info.