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. Author manuscript; available in PMC: 2013 May 29.
Published in final edited form as: J Consum Health Internet. 2012 May 29;16(2):135–146. doi: 10.1080/15398285.2012.673459

Building Health Literacy Among an Urban Teenage Population by Creating Online Health Videos for Public and School Health Curriculum Use

Charles J Greenberg 1, Lei Wang 1
PMCID: PMC3410668  NIHMSID: NIHMS384734  PMID: 22866023

Abstract

Healthflicks is a 2010-2011 National Network of Libraries of Medicine outreach project conducted in New Haven, CT, targeting health information literacy among urban teens through the creation of web videos. Students from a public magnet school with a health careers curriculum track volunteered. Yale University students were hired as video mentors. Partners included the Cushing/Whitney Medical Library, Hill Regional Career High School, the New Haven Free Public Library, and Yale University’s Office of New Haven and State Affairs. Outcomes included a Healthflicks YouTube channel and an ongoing partnership between an academic medical library and a high school with a health careers curriculum track.

BACKGROUND

A 2006 article by Carol Watwood in the Journal of Consumer Health on the Internet, “Teen Health Web Sites” (Watwood 2006, 65-73), offered a useful summary of what distinguishes teen audiences from adults and the observation that attractive health information web sites for teens are hard to construct and few in number. According to Watwood, instead of one-size-fits-all design, it is important to consider the age, interests, and backgrounds of teens to better engage them with web content. (Watwood 2006, 65-73)

Web sites such as TeenHealthFX (Atlantic Health System 2011), GoAskAlice (Health Services at Columbia University 2011), and TeensHealth (The Nemours Foundation 2011) attempt to deliver timely, accurate, and current information for a youth audience. Research done on peer-led health interventions for important public health topics such as tuberculosis, substance abuse, eating disorders, breastfeeding, and smoking prevention (Morisky and others 2001, 568-574; Elliot and others 2004, 1043-1049; Chapman and others 2004, 897-902; Campbell and others 2008, 1595-1602) demonstrate teens can positively influence other teens’ behavior. At least one study has suggested that reaching teens before the onset of risky behavior correlates with positive outcome. (Siegel, Aten, and Enaharo 2001, 1117-1126)

A 2009 Pew Internet & American Life report, The Audience for Online Video-Sharing Sites Shoots Up (Madden 2009), highlighted the survey result that 62% of adult and 89% of young adult internet users have watched a video on online video sharing sites. Despite the relatively short history of online video repositories such as YouTube™, founded in February 2005. (Wikipedia contributors 2011, 1) Online educational video content is apparently very popular with both adults and teenagers, whether they access the internet at school, home, or library. (Madden 2009)

The Healthflicks project was conceived as a short-term collaborative attempt to develop a model of peer-to-peer health literacy education among teenage urban audiences that regularly access online video sharing sites. High school students would be identified by librarians, teachers, and guidance counselors and recruited for an after-school community service activity. Such an activity would translate their ideas about health topics and challenges into web video vignettes, featuring a cohort of authentic and self-motivated teen writers, actors, and production editors in school, public library, and medical library settings.

The grant proposal partnership prepared in the Fall of 2009 included the Harvey Cushing/John Hay Whitney Medical Library of Yale University as the grant applicant and coordinator, equipment procurer, resource for accurate health information, as well as an after-school activity location (only a 10-minute walk from the targeted high school). Two members of the Medical Library staff had explicit leadership roles in the proposal: (1) The Coordinator of Curriculum and Research Support, as Principal Investigator (PI), would recruit the Yale student video mentors and maintain project timelines, goals, and reporting requirements, as well as engage students to associate their scenarios with the greater goal of peer health literacy; (2) The Instructional Design Librarian for the Cushing/Whitney Medical Library would provide leadership on video editing and technical standards for creating, sharing, and backing up project outputs, as well as training both Yale student mentors and high school student participants in video production best practices. The Hill Regional Career Magnet High School was proposed as a source of student actors and directors, having already provided a steady stream of high school interns for the Medical Library during a previous IMLS project (2005-2009) known as CHILI, Careers in Health Information, Librarianship, and Informatics (IMLS LIBRARIANS FOR THE 21ST CENTURY AWARD NO. RE-03-05-0020-05) (Anonymous; Cardenas 2011). Both the Office of New Haven and State Affairs at Yale and the New Haven Free Public Library were proposed as logistical partners, providing access to filming locations and recruiting students. The grant application was directed to the New England Region of the National Network of Libraries of Medicine (NER-NNLM) as a community outreach subcontract proposal. The formal outputs and outcomes suggested in the proposal are:

  • Output: Meaningful after-school and school recess activity for students.

  • Output: 8-10 original student produced videos, available for peers and others in YouTube.

  • Outcome: Guidance for teens to access accurate health information; “edutainment” distributed though on-demand online videos, available anywhere and anytime.

  • Outcome: Improved knowledge of quality health resources among the teens, teachers, and staff supporting the creation of the videos.

  • Outcome: A collaborative working relationship on teen health issues between a public high school, a health sciences library, and the community affairs staff of the university.

  • Outcome: Positive publicity for institutional partners.

The grant funding was approved for the requested 16-month period of January 2010 through April 2011.

In anticipation of working with a high school student population and instructors, guidance counselors, and facility administrators, the PI met with the Principal and staff members of the High School, the new High School Vocational Guidance Counselor, a Career High teacher of a career exploration elective in the Health curriculum, and the Librarian for the nearest branch of the New Haven Free Public Library. All would provide administrative support for a student-driven activity.

Recruiting and participation documents were created and reproduced for distribution in the High School:

  • Healthflicks student participation form, including student contact and availability information.

  • Media authorization/release form requiring parent/guardian signature, granting student appearance in video, and releasing School and University employees and agents from any claims arising from the use of such materials.

  • Recruiting poster placed in high school locations

  • Healthflicks project FAQ for student parents

  • Sign-in sheet to collect student contact information

During the winter of 2010, the PI began alternating weekly after-school meetings in the High School library and the Medical Library, attracting approximately 20 students willing to commit to creating and producing thematic health videos. Student email addresses were added to a Google Groups email discussion list. The Google Group created a single common email address that any student or librarian could use to communicate with all participants simultaneously. Also, a separate email address healthflicks@gmail.com was established for public inquiries that automatically forwarded to the PI’s institutional email account.

Equipment was selected to conform to the project budget. A video camera, a computer, video editing software, and audio microphones were purchased (Figure 2).

Figure 2.

Figure 2

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Audio Visual Budget for Healthflicks

A Yale student position of “video coordinator” was advertised. The largest grant expense category was to subsidize this position reporting to the Medical Library. A Yale student with a flexible schedule was hired to begin assisting the students with filming production for the first video. The Yale student in all likelihood would remain in New Haven during the summer and be eligible for continued employment.

The Project students and Yale student video coordinator started planning and script development. The theme chosen was “stress”, and a small group of students developed the first script during a brainstorming session at the Medical Library. The PI provided snack food, given the after-school schedule of the meetings.

Once the camera and sound equipment arrived, the Yale student coordinator was responsible for transporting the equipment to the High School for filming. The PI worked with the high school room scheduling secretary to have a classroom reserved for filming. During April and May 2010, the filming for the first video on “stress” proceeded. A small cohort of four Healthflicks students attended the after-school sessions consistently, even though more than 20 students expressed initial interest. At this point there was no connection between the Healthflicks project and a classroom teacher or existing student clubs. Healthflicks students also had additional competing after-school club and event commitments. The PI’s own budgeted grant time was only a few hours a week. In spite of obstacles, the small group of Healthflicks students and Yale student mentor had fun and completed the filming of the first video. However, the projected grant output of 8-10 videos began to seem overly ambitious as the school year came to a close in June and only one Healthflicks video was completed.

The Yale student coordinator, expected to continue during the summer of 2010, announced at the beginning of May that she had unexpectedly received a very competitive Teach for America (Anonymous2011) contract offer and would have to relocate out of New Haven right after her graduation. Losing an effective mentor for the high school students was a challenge.

A new Yale student was hired for summer Healthflicks activities. The high school’s summer program began at the end of June, and the project PI had received some signs of interest in collaboration with a summer class. Yet the Yale student missed the first meeting with the summer instruction coordinator, and from that inauspicious start, the summer collaboration never materialized. When the Yale student revealed her other simultaneous job commitments for the summer, her employment was terminated by mutual agreement. As the Healthflicks project was predicated on “organic” student creativity and productivity, most of the summer productivity was lost. Nearly eight months into the project, only one single Healthflicks video had been deposited (Healthflicks 2010a).

Seeking a way to engage the attention of Healthflicks students and regain some momentum from the spring, a week-long Medical Library-based workshop called the Healthflicks Academy was conducted in August, focusing on teaching the students health information literacy. Students were introduced to the American College of Physicians Foundation (ACP Foundation) definition of health literacy developed for the National Library of Medicine and used by Healthy People 2010 (American College of Physicians Foundation 2009), learned the techniques for evaluating health web sites, as well as developed themes for future Healthflicks videos. Specific students that had already expressed Healthflicks interest or had interviewed for CHILI library internships were invited. Seven students committed to attending. The Academy met on four consecutive summer afternoons from 2:30-5:00pm at the Cushing/Whitney Medical Library. Two sessions focused on defining “health information literacy” and techniques of evaluating health web sites, using the Health on the Net web site evaluation rubric (Health on the Net Foundation 2011). Two guest speakers presented on different days: a Yale Psychiatry resident shared her health career path from high school through medical school, and the NER-NNLM Consumer Health coordinator demonstrated NLM web resources. Students received a Healthflicks Academy Participation Certificate (figure 4):

Figure 4.

Figure 4

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Healthflicks Academy Class of 2010 (One male student could not attend on the final day)

The demonstrated commitment of students spending free summer afternoons in the Medical Library restored some momentum to the Healthflicks project as school started in the fall. At the end of August the student coordinator position was again posted, and a Yale graduate student who had already spent time with students in another New Haven high school became the student video coordinator and mentor. The PI and Yale student agreed to use September to develop contacts at the class level. The Yale student readily agreed to meet the teacher and class for the health careers elective at 8:00am, and the high school students in that class were encouraged to consider using video for an assignment to develop a public service announcement. Over several months, the Yale student helped the high school students in this class to create three Healthflicks public service announcements on asthma (Healthflicks 2010b), diabetes (Healthflicks 2010), and HIV awareness (Healthflicks 2010a).

The teacher in the medical careers class also recommended that we try to align Healthflicks with an existing after-school activity, rather than compete for the attention of the same students. The PI used his own time to meet with the student officers and faculty advisor for the Health Occupations Student Association (HOSA) after-school club. The HOSA student officers explained their need to create a video for their spring national HOSA convention. Students suggested a Healthflicks video promoting HOSA as a way to learn about health professions. The HOSA motivated student group created their own Healthflicks video, “A Place Where We All Belong.” (Healthflicks 2010b) The students’ faculty advisor was very happy that the students took responsibility for the video filming and editing.

In spite of all the positive activities happening during the fall and winter of 2011, the greatest challenge was actually completing a Healthflicks video and posting it to the Healthflicks YouTube channel. The NER-NNLM advisors reminded the PI that the grant termination date of April 30th 2011 was firm. At the end of March, there were only two Healthflicks videos uploaded and available publicly, in spite of the fact that many more videos were still being created. The use of grant funds had been judicious, and in consultation with the Medical Library business office, the PI was given the green light to hire a second Yale student video coordinator for the final five weeks of the project. The hiring process was immediate, as one of the qualified candidates from the fall advertisement was still available and had a considerable amount of non-class time and availability. The new Yale student immediately began work to complete the rest of the Healthflicks videos.

Two other opportunities presented themselves to complete additional Healthflicks videos during the final few weeks of the grant. The PI decided to repeat the successful summer Healthflicks Academy during the April public school spring recess. While only two students responded to the invitations, one was the student vice president of the HOSA club, and these two students did not lack ideas or motivation. The Healthflicks video on ADHD (Healthflicks 2011a) and Skin Cancer (Healthflicks 2011b) were direct outcomes of the spring Healthflicks Academy. Another source of both student creativity and productivity was the CHILI (Anonymous) Intern program taking place in the Medical Library during the winter and spring. Both of the two CHILI interns were students from the same high school; they were asked to consider making a Healthflicks video. One intern created her own video on concussion prevention (Healthflicks 2011), while the other chose to work on a video with friends in the medical careers class. After the conclusion of the project, the tradition of the CHILI intern creating a video continues, and the summer 2011 CHILI intern created a Healthflicks video on Sickle Cell Disease (Healthflicks 2011).

With the encouragement and guidance of the two Yale student video coordinators, the project students reached the target of 10 Healthflicks videos uploaded to the YouTube channel by the conclusion of funding at the end of April. In May, the PI and Instructional Design Librarian presented the Project as a poster session at the Medical Library Association annual meeting. As was already noted, the collection of Healthflicks videos should expand with the efforts of each future CHILI intern.

What were the lessons learned from this project that would help plan and conduct a similar partnership activity between a school and a medical library in another community?

  1. A critical success factor in achieving the target of completing 10 Healthflicks was the gradual project adaptation to de-emphasize Healthflicks as an after-school club and instead work more closely with a classroom teacher and an existing student club, the Health Occupations Students of America (HOSA), even though classroom instructors and student-led clubs may have their own priorities and performance requirements.

  2. The Healthflicks Project was of relatively short duration (16 months), but the video outputs will have an audience for several years. There is an expectation that because the New Haven HOSA student club will bring the Healthflicks video to their national HOSA meeting later this spring, there will be significant publicity and perhaps interest in other locations to combine HOSA activities with a medical library’s expertise in identifying quality health information and teaching skills to students to recognize accurate health information on the internet.

  3. One disconcerting lesson learned was that the public high school participant uses filtering software on student and teacher computer that inhibits the ability to see www.youtube.com. This will undoubtedly present an obstacle when teachers want to feature a discussion activity in class. Of course, there can be a homework assignment to watch a particular Healthflick video at home. Perhaps computer system administrators can authorize teachers to override filtering software on their workstations for instructional reasons. The usage rights for material produced for this project also allow us to create an “offline” version for instructional use, such as the version that was exhibited at the MLA annual meeting.

  4. The first Healthflick video followed the target model of 5 minute length (including a 30 second introduction and 30 second credit at the end). Once the grant incorporated the classroom component for Healthflicks production, the public service announcement (PSA) assignment for the class became a necessary redefinition of appropriate length. The shorter PSA Healthflicks are good examples of shorter, more targeted content and message. The project actually benefited from not constraining ourselves to only one particular set of design principles, as all of the Healthflicks videos will serve as both practical teaching and learning tools and models for additional projects.

Figure 1.

Figure 1

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Healthflicks Administrative Support Concept Map

Figure 3.

Figure 3

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Healthflicks 01: Stress

Figure 5.

Figure 5

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The Healthflicks Library Exhibited Offline at the 2011 Medical Library Association Annual Meeting

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