|
1. Recognize the unique advantages of face-to-face education in comparison to other approaches. 2. Identify the most important principles and techniques of face-to-face educational programs. 3. Understand how to carry out persuasive face to face education. 4. Gain expertise in the training of other health care workers to conduct effective face-to-face educational programs in their countries. Read the Session Notes. If Activity One: A Teaching Script for a Face-to-Face Visit with Prescribers at Centro Health Center will be used, arrange for one team to prepare the script in advance. During the activity, they can present the script and have their interaction critiqued. This saves considerable time in carrying out the activity.
ORGANIZATION AND KEY POINTS OF SESSION
First Component
Overview of Persuasive Education This component provides participants with an overview of the different types of educational interventions, and introduces them to the advantages of persuasive face-to-face education. Many participants will be unfamiliar with the concept of persuasive education, with what features make educational interactions persuasive, and with why persuasive education is the best for stimulating behavior change. Spend time discussing the strengths and weaknesses of different styles of education that participants have experienced. Ask what types of in-service training programs are usually conducted in their environments. Use the example of the PRDU course structure to illustrate an interactive educational process using small groups, and the importance of two-way communication for learning. Introduce the idea of the pharmaceutical marketing visit as a one-on-one persuasive educational interaction, and ask participants to describe some of the characteristics of these visits that make them effective.
Second Component
Examples of Successful Strategies This component begins with a few examples of successful persuasive educational programs aimed at improving drug use in different settings. Point out that early work with this method was referred to as "academic detailing" and emphasized brief (15 minute), one-on-one educational outreach visits by trained pharmacists to private physicians. The example from the US illustrates that this intervention resulted in significant reductions in outpatient use of targeted drugs (cephalosporins, propoxyphene, cerebral vasodilators), while simply distributing printed educational material about these drugs had no effect. The Zambia study applied similar concepts of interactive targeted education to small groups of primary health care workers. The educational program involved repeated small group sessions, multiple training methodologies, and a small number of target health problems System supports in the essential drugs program like an EDL and drug supply improvements facilitated the effects of training. The most notable improvements were in diagnosis and appropriate case management. The example of the drug sellers intervention from Kenya and Indonesia illustrates that a similar small group method can also be used to improve practices in private pharmacies. Several review papers were commissioned for the International Conference on Improving the Use of Medicines, which was held in Chiang Mai, Thailand, in April, 1997. The review of primary care interventions identified 59 studies from Africa, Asia, and Latin America, of which 36 had adequate methodological designs. In the overhead presenting the results of this review, focus on the first two categories: dissemination of printed materials, and training strategies. Reinforce the point that print materials alone are not effective in changing behavior. In the review of findings of educational strategies, emphasize the elements that have been shown to improve the effectiveness of training, including problem orientation, single health problem focus, interactive format, and multiple contacts with participants.
Third Component
Principles of Persuasive Education Some principles of persuasive education are examined in more depth in this component. In the introductory overhead, give two points additional emphasis. First, persuasive education should focus on actual decisions and behaviors rather than on didactic content; always determine which decisions or behaviors must change, and focus the educational messages on those points. Second, credibility of the source of information is a key element in persuasiveness, and one way to differentiate unbiased educational programs from the marketing activities of industry. Major issues to be covered in the review of principles include: targeting educational messages to individual motivations reported by prescribers; identifying and using opinion leaders; and the importance of reinforcement for maximizing and sustaining effects. Spend time on the concept of choosing suitable individuals to be persuasive educators. Emphasize that the appropriate type of individual will vary according to the setting and the target audience. Discuss whether specially trained pharmacists would be appropriate outreach educators for private physicians in the participants’ countries. This component concludes with an overview of some key management issues for education programs. Persuasive education is most successful not as a one-step process, but rather as an ongoing activity. Establishing credibility, developing a relationship of trust over multiple encounters, and monitoring changes in practice are all aspects of successful programs.
Fourth Component (Option 1)
Activity One: A Teaching Script for a Face-to-Face Visit with Prescribers at Centro Health Center This activity is a role play of an education visit by Dr. Onyango, a trained educator, to a small staff group at a health center. Because the text for the encounter is somewhat long, it is best to have one group prepare the script in advance so they can act it out in front of the other participants. Ideally choose a group with a dynamic individual who can play Dr. Onyango. Alternatively you can give the whole class ten minutes in which they should read through the script and note the various principles being used. If you tell one group at the start of the reading that they will present it gives them ample time to select who will play which role. When introducing the activity, review briefly the material in the background section. Then explain that one group has prepared the role play, and that other participants are to observe the encounter and be prepared to critique the performance of the educator according to the principles of effective persuasive education. One option for this activity is to have the group prepare to act out the role play once in a way that violates the principles of effective persuasive education. For example, Dr. Onyango could be abrupt in his/her manner, fail to establish credibility, be critical of previous practice by the staff, give unclear messages, fail to set up a return encounter, etc. Alternately, the group could try to act out the role play in the reasonably positive way that it is written. After the role play is complete, elicit comments from participants about the good and bad points of the encounter. When the major issues have been covered, ask the same or a different group to act out the role play again, with Dr. Onyango taking into account what he/she has learned about ways to improve the persuasiveness of the encounter. Complete the activity with a discussion about whether it is realistic to expect these types of educational sessions in different countries. Ask participants to comment about how the sessions would be different if the outreach educator was a district medical officer responsible for supervision of the health center, or if the educator was a district pharmacist responsible for pharmaceutical quality improvement. The use of the bad and then the good role play has been criticized by some trainers who have suggested that it is better to allow one group to present as well as they can and to break up the action at a number of points. The text of the role play is reproduced below with the suggested comments by the trainer included in italics.
Introduce the setting to be as close as possible to the local situation. SETTING
Point out that this first interaction was aimed at establishing credibility.
This sequence shows that Dr Onyango is aware of the problems seen by Dr. Aziz and is interested in his situation
Dr. Onyango: "Could any of you tell me which ones you commonly use?"
By asking participants questions and then responding to these questions the to and fro of two way communication is established.
This is the key point of the meeting. Dr Onyango is giving the key messages, using multiple different methods, print, graphic inputs and oral interactions ideally combined with body language.
Responding to difficult or challenging questions is an important part of a face to face interview. By pointing out difficulties Dr Onyango is likely to win Dr. Aziz over to his point of view.
Here Dr Onyango is using the questions to reinforce the key messages of the presentation.
With these final comments Dr. Onyango is summarizing again the key messages and involving his target audience by challenging them.
Dr Onyango is now setting up his next visit so that he will be welcome and that he can identify other issues that he could address in the next visit.
By showing an immediate response to Dr Aziz and thanking all of the staff Dr Onyango is emphasizing that he is responsive and respectful.
Fifth Component (Option 2)
Activity: Designing an Educational Intervention Depending on the time available, and on whether a group has been asked to prepare the role play in advance, an alternate activity is possible to bring together some of the lessons about managing a persuasive education program. This activity will not require prior preparation. The objective of this activity is for each group to design an educational intervention directed at a group of local health providers targeting an issue that was identified as a problem during field visits in the first week of the course. For example, lack of appropriate preventive education about worms and failure to periodically de-worm children may have been identified as problems. First identify the common problem to be addressed in consultation with participants. Groups should then design an intervention directed at a specific group of health providers (e.g., health post staff, or community pharmacists). The groups should address the following five questions:
Allow 30-45 minutes for groups to discuss their ideas. Have groups write up their interventions on flip charts, and then select 2 or more groups at random to present them.
Conclusion
Conclude by presenting the summary points on the final overhead. Ask participants for comments about what it means to have an intervention "fit" its institutional environment, and give examples of how educational interventions with a similar target problem (e.g., improving pneumonia case management) might differ in a teaching hospital setting, a health center setting, and a retail pharmacy setting.
Slide 1
Slide 2
Explain the overall objectives. Explain the components. Advantages and strengths of persuasive education. Studies and experience. Principle of face to face education and managing. Activity Conclusion
Slide 3
Slide 4
Both sides of controversy--counter message. Two way communication--problem solving.
Slide 5
Example from a developed country. Key Point: print material alone not different from controls.
Slide 6
Example from a developing country. Innovative approach in EDP training. Key Point: system supports facilitate and reinforce effects of training.
Slide 7
Design of EDP Training. Details of intervention on: Malaria Diarrhoea ARI Key Points: multi-method educational approach and reinforcement through multiple sessions.
Slide 8
Results of EDP Training program Key Points: sustained improvement in examination and case management, with smaller improvements in choice of drug and dose.
Slide 9
Key Points: Target of intervention--Drug sellers. Positive impact of Intervention.
Slide 10
Positive impact on sales of Antidiarrheals. Slide 11
Focus on the first two categories of interventions and evidence for their success. Key Points: distributing printed materials is virtually always ineffective in changing behaviors. Training can vary in it’s effects. Slide 12
Training can be effective with groups of any size from one-on-one to large groups if targeted interactive approaches are used. Repeated contacts increase the size and sustainability of improvements in practice. Slide 13
Key Points: various possibilities of undertaking face to face education. Slide 14
Slide 15
Slide 16
Key Point: persuasive education should focus on actual decisions faced by prescribers rather than didactic content. Ask participants who are the credible sources of information in their settings. Slide 17
Key Points: Opinion leaders can be targeted in an intervention and they can be the agents for changing other practitioners.
Slide 18
Key Points: Multiple contact reinforces effects and makes them more sustainable. Slide 19
Slide 20
Slide 21
Slide 22
Back to top | Back to Table of Contents
|
