Assessing the Effectiveness of Informational Video Clips on Iranian Immigrants' Attitudes Toward and Intention to Use the BC HealthGuide Program in the Greater Vancouver Area

Iraj Poureslami, PhD; David Murphy, MS; Anne-Marie Nicol, PhD; Ellen Balka, PhD; Irving Rootman, PhD

Disclosures
In This Article

Methods

The culturally sensitive nature of this project required an extensive pre-production stage, involving:

  1. Initial demographic research into the target community;

  2. Analysis of geographic concentrations, such as location and distribution of the community;

  3. Assessment and analysis of the cultural composition of the community, including family size, living conditions, and socioeconomic status;

  4. Focus groups and in-person interviews with members of the target community to gain insight into issues, such as who they trust to receive medical information from and where they get their health information from;

  5. Working with an expert advisory panel consisting of members of the target community who are professionals in related fields (such as health, culture, and television production);

  6. Script writing and development workshops with members of the target community to provide cultural grounding; and

  7. Final consultation with members of the target community to review scripts and storyboards for cultural accuracy and credibility.

Findings from the pre-production focus groups and interviews suggested that a majority of the Iranian community in the GVA believe "word of mouth" to be the most effective way for them to learn about the BCHG services, a method identified as an effective approach in ethnocultural communities.[18] The target community also appears to rate the advantages and disadvantages of engaging in a health-related activity that is based on the experience of others and from the advice received from highly trusted, well-educated individuals, such as Farsi-speaking doctors. Given the importance of trust in communication strategies, the identification of trusted individuals for the delivery of health information provided the basis for the development of the videos produced in this study.

It was decided that the best way to provide word of mouth from community members' experiences was through the creation of short dramas that recreate specific experiences.[19] The scenarios for the short clips were developed with the intention of presenting actors as members of the target community engaged in resolving health-related problems[16,17] with the BC HealthGuide services. Development of the scripts for numerous clips was done in consultation with the expert advisory panel, and 4 scenarios were chosen on the basis of their appropriateness to the use of the BCHG Program.

In order to include representation from trusted medical professionals, and to provide an evaluative comparison to the clips, a documentary script was also developed. The documentary script was designed to provide health information (specifically about the BC NurseLine) directly from an Iranian physician in an interview setting. Other community members and medical professionals were also interviewed, either in Farsi or with Farsi translation.

The actual production stage of this process required the recruitment of community members who in effect played themselves in short videos that were developed in the pre-production stage. The participatory aspect of this stage was interesting because not only did the community members find it engaging and empowering to be involved in a television production, but they were able to make comments and suggestions throughout the production process aimed at making it more accurate and credible.[16,20,21,22] For example, community members suggested the inclusion of culturally specific household items in the background of the shot, as well as changes to the script to make the dialogue more appropriate to the context. The actors and locations were all situated within the target community to make the videos more realistic and to incorporate implicit cultural references in order to improve reception of the videos by the target community.

The final videos were all produced in Farsi. They included one 13-minute documentary, which provided direct health information and included interviews with health professionals and members of the community explaining health issues and the use of the BC HealthGuide and NurseLine, and 4 short (less than 2 minutes each) videos clips, which were dramatizations targeted toward specific age and sex groups that had been identified in the pre-production stage as being the groups most likely to require the BCHG services. The short videos were based on health issues common to the target population.

During the postproduction stage, it was essential to have constant consultation from Iranian health experts. This was necessary to ensure that both the language and health information were accurate, consistent, and appropriate throughout the editing and titling process.[17] Draft edits of the productions were reviewed and commented on by community members before final cuts were made. Finally, the videos were reviewed by all sponsors of the project. The developed videos were aired on local Iranian TV channels (City TV, Channel 8, and the Shaw Multicultural channel) between October and December 2004 (prior to the data collection phase of this study). Each of the short videos was shown 12 times, for a total of 48 viewings, and the documentary was shown 6 times.

A 2-stage quasi-experimental study design, which used a combination of quantitative (structured telephone questionnaire) and qualitative (initial and follow-up focus groups) research methods, was then employed among a randomly selected sample of the target population.[23] The study sample was recruited with the Iranian yellow pages and residential telephone books in 7 major district areas of the GVA (Burnaby, Vancouver, North Vancouver, West Vancouver, Richmond, Surrey, and Coquitlam). Eligibility for participation in the study was based on 2 criteria: (1) being an Iranian adult over 19 years of age (either someone who was born in Iran or people who were born in Canada with 1 or more Iranian parents immigrated to Canada) and (2) being a resident of the GVA during the airing period of the video clips.

Telephone Surveys. In the initial quantitative phase, a randomly selected sample of 800 eligible residents of the GVA's Iranian community participated in a structured telephone interview. They were selected from the GVA's Iranian language telephone books. The survey was developed on the basis of information gathered from the pre-production focus groups and interviews as well as a panel discussion involving scientists and health professionals, held within the GVA Iranian community. The survey was pilot-tested with a group of 10 Iranian families and was refined with feedback from these sessions. The final survey was administered in Farsi over the telephone. Participants in the telephone survey were asked whether they had seen the BCHG videos already aired on local television channels, and if so, which ones. They were also asked general demographic questions, how they access health information, and specific questions in regard to the BCHG services and their use. All participants in the survey were asked whether they would like to be involved in one of the postintervention focus group sessions planned for the spring of 2005.

Focus Groups. In the qualitative phase, 98 randomly selected volunteers from the telephone interview stage were asked to participate in 7 focus group sessions held in the spring of 2005. Participants were allocated to particular focus groups according to which, if any, of the video clips they had reported viewing at home. Between 10 and 15 participants who had seen the videos at home were randomly selected to form the first 3 focus groups (groups A, B, and C), which were considered the "control groups." A further 50 participants who had not seen any of the videos were randomly selected to form group D or the "experimental group." Group D was randomly divided into 4 subgroups:

  • Subgroup D1: All videos are watched and discussed during the focus group;

  • Subgroup D2: Only the documentary is watched and discussed during the focus group;

  • Subgroup D3: Only the short videos are watched and discussed during the focus group; and

  • Subgroup D4: Discussion without watching any of the videos during the focus group.

Findings from the telephone survey were used to develop the core discussion questions for the 7 focus group sessions. In addition, 2 follow-up focus group sessions were held in November 2005 with 33 randomly selected participants from the initial focus group sample. Ethics clearance for the study was given by the University of Victoria (Victoria, British Columbia) and Simon Fraser University (Burnaby, British Columbia) Ethics committees.

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