This research explores the effectiveness of an innovative public health campaign, "Survival Pending Revolution," designed to promote COVID-19 vaccination among young people of color (YOC). The campaign, a collaboration between Youth Speaks, Inc., and the UCSF Health Communications Research Program, uses spoken-word poetry and film created by YOC artists to address vaccine hesitancy. The study's central research question is whether this arts-based, critical communication approach is more effective than traditional public health campaigns in engaging and persuading YOC, particularly within the context of historical and ongoing systemic inequities that contribute to health disparities. The importance of this research lies in the need to develop effective communication strategies that address vaccine hesitancy in marginalized communities, where mistrust in healthcare systems and historical trauma often play significant roles in shaping health decisions. Traditional campaigns frequently fail to resonate with these communities due to their often-simplistic messaging and neglect of the social determinants of health. This study aims to investigate whether a critical communication framework, which centers the voices and experiences of marginalized communities and acknowledges systemic inequalities, yields better results. The campaign draws inspiration from the work of Paulo Freire and Augusto Boal, emphasizing participatory pedagogy and the transformation of oppressive systems.

The literature review examines existing research on health communication strategies, particularly those targeting marginalized populations. It highlights the limitations of traditional approaches that often rely on deficit models of communication, assuming vaccine hesitancy stems from a lack of knowledge. Studies show that these traditional methods frequently fail to address the deeper social, cultural, and historical factors that shape health beliefs and behaviors in communities with experiences of structural oppression and historical trauma. The review also examines the theoretical underpinnings of critical health communication, including socioecological models and critical pedagogy. This emphasizes the importance of centering the voices of marginalized communities, challenging dominant power structures, and promoting social justice as essential components of effective health interventions. Existing studies on the use of arts-based approaches in health communication are reviewed, exploring their potential to foster engagement, build trust, and promote positive health behaviors among specific target populations. The review also touches on research focusing on the impact of historical trauma and systemic racism on healthcare decisions within marginalized communities, underscoring the need for culturally sensitive and contextually relevant communication strategies.

This study employs a two-phase mixed-methods approach. Phase 1 involved a qualitative content analysis of nine video poems from the "Survival Pending Revolution" campaign. Two coders, one a spoken-word poet and the other a public health communication specialist, independently analyzed each video poem and its transcript based on a coding scheme aligned with critical communication theory. The coding scheme assessed attributes such as messenger, strategy, form, perspective/positionality, setting, and genre. This analysis aimed to identify the themes present in the campaign materials and to assess the extent to which they reflect a critical communication approach. Phase 2 consisted of a qualitative focus group with 13 young adults (aged 18-30) representing diverse racial/ethnic backgrounds. Participants were shown video segments from both the "Survival Pending Revolution" campaign and the Kaiser Family Foundation's "The Conversation" campaign (used as a comparator). After viewing each set of videos, participants engaged in a semi-structured discussion guided by open-ended prompts exploring their reactions to the content, messaging, and presentation styles. A reflexive thematic analysis was conducted on the focus group transcripts to identify key themes and compare the perceived effectiveness of both campaigns in engaging the target audience. The focus group was moderated by an experienced program director from Youth Speaks, with the evaluator serving as an observer.

Phase 1's content analysis revealed that almost all video poems aligned with critical communication principles, exhibiting characteristics such as everyday messengers, strategies emphasizing structural injustice, emotionally compelling narratives, and an artistic genre. The dominant themes across the poems included the need for survival to fight for social justice, a desire for safety and community, and the acknowledgement of medical discrimination. Phase 2's focus group highlighted several key differences in audience perception between the two campaigns. Participants expressed a greater appreciation for the "Survival Pending Revolution" campaign's validation of complex decision-making processes surrounding vaccination, the authenticity of the messengers' emotions, and its inclusion of historical and racial context. The "Survival Pending Revolution" campaign was perceived as more effective in addressing concerns about medical mistrust and acknowledging systemic inequalities, offering a more nuanced understanding of the factors influencing vaccination decisions within marginalized communities. In contrast, "The Conversation" campaign was often criticized for its superficial treatment of concerns, tone-deaf approach, and oversimplification of solutions. While some participants found "Survival Pending Revolution's" artistic format engaging, others questioned its credibility and perceived it as a potentially manipulative tactic. However, neither campaign generated consistently high levels of credibility or behavioral intent, suggesting further research to optimize engagement and increase influence on behaviour change.

The findings support the hypothesis that a critical communication approach, as exemplified by "Survival Pending Revolution," can be more effective than traditional approaches in engaging marginalized communities around vaccination. The use of YOC artists as messengers fostered authenticity and relatability, leading to greater emotional resonance and engagement. The campaign's acknowledgment of systemic racism and other social determinants of health provided a crucial context that traditional approaches frequently lack, leading to better understanding. The focus group results highlight the limitations of traditional public health messaging that fails to address the historical and ongoing structural challenges faced by marginalized communities. The contrasting responses to the two campaigns underscore the importance of culturally sensitive and contextually relevant communication in building trust and overcoming vaccine hesitancy. While the study’s focus group did not directly measure behaviour change, it revealed important nuances in how the different approaches to communicating about vaccination were received, suggesting avenues for more effective campaigns.

This study provides preliminary evidence that critical communication approaches offer a promising alternative to traditional public health communication strategies in engaging marginalized communities around vaccination. The "Survival Pending Revolution" campaign's success in fostering engagement and emotional resonance highlights the need to move beyond simplistic, information-based approaches and to embrace inclusive, contextually relevant, and empowering strategies. Future research should focus on quantitative evaluations of larger-scale campaigns that employ critical communication principles and explore their impact on vaccination rates. Further research might also examine the effectiveness of similar strategies in addressing other public health issues, as well as the potential use of critical communication to counter misinformation and disinformation. The unique aspects of the arts-based approach provide an important platform for future health promotion strategies.

This study has several limitations. The qualitative nature of the evaluation, particularly Phase 1's content analysis of poetry, introduces potential subjective biases. While efforts were made to ensure coder reliability through consensus processes, there’s inherent limitations to capturing the depth of artistic expression through coding schemes. Phase 2's small focus group size and sampling strategy limit generalizability. The sample may not fully represent the target population, particularly lacking male perspectives. The controlled setting of the focus group, where participants were obliged to view the entirety of each video, might differ from the more naturalistic settings. Furthermore, the study did not assess the reach of the "Survival Pending Revolution" campaign relative to that of "The Conversation", which may differ because of differences in the investment of resources. Future research is needed to expand the findings through quantitative studies with larger samples, naturalistic settings, and a more thorough assessment of campaign reach.