Survival Pending Revolution: An Arts-Based Public Health Campaign to Promote COVID-19 Vaccination Among Young People of Color

The paper examines whether a youth-generated, arts-based public health communication campaign aligned with critical communication theory can more effectively engage young people of color (YOC) around COVID-19 vaccination than traditional approaches. In partnership with Youth Speaks, UCSF supported the creation of spoken-word video-poems by YOC under the campaign Survival Pending Revolution, aiming to shift discourse from solely individual behavior change to action for health justice by acknowledging social, environmental, and structural determinants of health. The study explores how this campaign aligns with critical communication principles and compares audience responses to it versus a traditional, expert-led campaign (Kaiser Family Foundation’s The Conversation/La Conversación).

The manuscript situates the work within critical health communication, public health literacy, and socioecological frameworks, contrasting them with traditional, individually focused models (e.g., health belief model, theory of reasoned action). It highlights Freire’s Pedagogy of the Oppressed and Boal’s Theater/Aesthetics of the Oppressed as pedagogical foundations for participatory, bottom-up communication. Prior work with The Bigger Picture (youth-generated health literacy campaigns) demonstrated feasibility and conceptual grounding for arts-based messaging around chronic disease prevention. Literature on vaccine communication indicates that knowledge-based, fear-based, and expert-driven messages may be insufficient or counterproductive, especially for marginalized populations, and underscores the importance of messenger credibility, contextualization, and inclusion. Scholarship calls for integrating socioecology and critical pedagogy, and adopting critical approaches centering inclusion, equity, and intersectionality, though empirical evaluations of such campaigns remain scarce, particularly in COVID-19 contexts disproportionately affecting marginalized communities.

Design: Two-phase qualitative evaluation. Phase 1 (poetry-based data analysis): The team analyzed nine spoken-word video-poems (out of 15 pieces created by 14 poets; nine filmed, each 4–6 minutes) from the Survival Pending Revolution campaign, disseminated via social media (June–August 2022). Two coders (a spoken-word poet and a public health communication specialist) independently viewed each video and reviewed transcripts. Using a directed, consensus-based approach, they characterized each poem across critical communication domains (e.g., messenger, strategy, form, perspective/positionality, setting, genre). They then coded arguments for COVID-19 vaccination rationales and contextual contributors to COVID-19 suffering and inequities. Discrepancies were resolved by consensus. Phase 2 (comparative focus group): A 90-minute online focus group (Sept 1, 2022) involved 13 California residents aged 18–30 (mean 25.5; identities included Black/non-Hispanic [3], Black/Latinx [1], White/Latinx [4], Asian/Pacific Islander [4], First Nations/Indigenous [1]; 10 women, 3 gender non-conforming). Recruitment used Youth Speaks networks, with $50 compensation. Participants viewed two sets of videos: (1) targeting Black audiences—KFF’s The Conversation segment featuring W. Kamau Bell with Black physicians (3:27) vs Survival Pending Revolution’s “A Walk Through the Valley” by Nia Lundkvist (6:19); (2) targeting Latinx audiences—KFF’s La Conversación “Why the COVID-19 Vaccines Matter For Us” (3:53) vs “Cuantificando Lo Esencial” by Sandra Vázquez (4:26). Standardized prompts elicited reactions on content, messaging, messenger credibility, tone, engagement, and perceived effectiveness. Analysis: Two coders conducted reflexive thematic analysis of the transcript two weeks later, coding responses linked to prompts, iteratively developing and organizing themes via consensus.

Phase 1 (content analysis of poems): Nearly all video-poems strongly aligned with critical communication attributes across multiple domains:

• Messenger: “Regular,” everyday people mirroring target audiences.
• Strategy: Contextualization of problems, calling out structural injustice; minimal reliance on facts/fear.
• Form: Narrative, emotionally compelling storytelling, often centered on family/community.
• Perspective/Positionality: Non-authoritative, critical, bottom-up, questioning dominant structures.
• Setting: Everyday, naturalistic environments.
• Genre: Artistic (poetry/film), avoiding didactic tone. Rationales for vaccination (counts across nine poems): survive to fight larger social justice battles (N=3); desire for safety/protection (N=2); return to community/celebrate life (N=2); preserve a way of life (N=1); necessary compromise/trade-off (N=1). Contextual themes (descending prevalence):

1. Social Determinants of Health (N=15): poverty (4), essential work/employment (4), housing insecurity (3), immigration (4).
2. Oppressive Systems/Structural Determinants (N=14): structural violence (6), capitalism (4), colonialism (2), individualism (1), misogyny (1).
3. Health and Social Inequities (N=10): unequal exposure to risks (6), health inequities (2), social inequities (2).
4. Trans-Generational Solidarity and Resilience (N=9): family (6), community (3).
5. Medical Discrimination (N=4): medical racism (2), unequal/discriminatory access to care (2).
6. Mistrust of Medicine and Government (N=3). Phase 2 (comparative focus group): Four dominant comparative themes emerged:

• Validating complexity in vaccine decision-making: Participants perceived The Conversation as oversimplifying concerns and solutions, sometimes flippant or tone-deaf, whereas Survival Pending Revolution validated ambivalence, trauma, and complexity faced by marginalized groups.
• Harnessing authentic vs. inauthentic emotion: SPR’s first-person narratives felt authentic and relatable, aiding retention and advocacy; some questioned emotional authenticity in The Conversation, undermining credibility for certain viewers.
• Historical and racialized context matters: Lack of acknowledgment of structural drivers in The Conversation reduced openness and credibility; SPR’s explicit framing of structural racism and determinants enhanced receptivity and perceived relevance.
• Questionable credibility and actionability: Credibility perceptions were mixed for both campaigns. Some viewed SPR’s artful approach as engaging but potentially less instructional; a few perceived cultural artforms as being co-opted. The Conversation was clearer and more directive for some but felt simplistic or aimed at already pro-vaccine audiences for others. Overall, neither campaign consistently increased behavioral activation or intent, though SPR was generally favored for authenticity, emotional resonance, and validation of lived experience.

Findings suggest that a critical communication approach—featuring relatable youth messengers, narrative and emotionally rich storytelling, acknowledgment of structural determinants, and use of art—can enhance engagement, authenticity, and openness among YOC relative to traditional, expert-led, fact-focused messaging. Positioning community members as messengers and validating medical mistrust and historical trauma created conditions for more genuine dialogue. While art-based communication may pose challenges for explicit instruction and some viewers questioned messenger credibility or perceived appropriation, the non-directive, bottom-up approach did not engender oppositional intentions and was no less effective in influencing behavioral intent than a more directive approach. Results align with calls to integrate socioecological and critical pedagogy principles in health communication and address limitations of traditional models that overlook context. This work contributes preliminary empirical evidence for critical, arts-based strategies in public health messaging for marginalized communities, with potential to counter misinformation by fostering trust and relevance.

An arts-based, youth-authored campaign aligned with critical communication theory organically situated COVID-19 vaccination within broader structural determinants of health and inequity, improving message salience, emotional engagement, and validation among YOC compared with a traditional, expert-driven campaign. Although neither approach consistently increased credibility or behavioral activation, the critical approach appears promising for enhancing engagement and openness to evidence-based content. Future research should rigorously compare critical vs. traditional approaches on reach, engagement, behavioral intentions, and uptake, and assess their roles in combating misinformation/disinformation in diverse marginalized populations.

• Phase 1’s qualitative analysis of poetic content may face threats to internal validity; interpretive bias is possible despite using both poet and non-poet coders and consensus processes.
• Phase 2’s small, qualitative focus group cannot determine causal efficacy; larger quantitative studies assessing behavioral intentions and actual vaccination are needed.
• In vitro exposure: participants viewed entire selected videos; naturalistic viewing may yield different results.
• Sampling limitations: small, non-representative convenience sample; absence of male participants; recruitment via Youth Speaks networks may bias toward art-accepting audiences, limiting generalizability.
• Limited stimulus set: only specific representative videos from each campaign were shown.
• Campaign reach not evaluated; traditional campaigns often have larger dissemination resources.
• Potential challenges in analyzing performative art via text transcripts and coder subjectivity.