Effective Public Education Trainers Guide

OBJECTIVES

1. Understand the role of public knowledge, attitudes and practice in the use of medicines

2. Identify the major drug utilization problems in your community

3. Identify the components of a comprehensive public education program for rational drug use

4. Identify the various channels that exist in the community to convey consumer education

PREPARATION

1. Study the module Principles of Face to Face Education.

Read Chapter 33 of Managing Drug Supply 2^nd edition

VISUAL AIDS LISTING

Title Slide

Objectives

Patient's Role

Patient's Role

Where do Patients get Medicines

Concept of Disease Etiology

Concept of Cure

Concept about Drugs

Effect of Promotion and Marketing on Use of Drugs

Social Marketing Component 4P's

Health Belief Model

Global Public Education Initiatives on Drug Use

Developing a Public Education Strategy

Six Steps toward Effective Communication

Developing a Public Education Strategy

Developing a Public Education Strategy

Developing a Public Education Strategy: Develop Communication Materials

Developing a Public Education Strategy: Test and Revise Materials

Developing a Public Education Strategy: Implementation

Developing a Public Education Strategy: Monitor, Evaluate and Revise

Activity 1

ORGANIZATION AND KEY POINTS OF SESSION

First Component: Why public education in RUD is needed

VA l to 8

Time 70 minutes

Briefly review the objectives.

Visual aids are available for the discussion of patients’ role, through to concepts about drugs. If you want to make the session very interactive - which is best - don’t use these visual aids at the beginning of the discussion because they will pre-empt active participation from the group. It is better to keep them as a back up or to show for a brief review at the end of each discussion.

Point out that health professionals tend to consider themselves at the prime force of decision-making about illness and treatment; in fact it is not the health professionals which take the key decisions it is the community itself as this session will show. The community will sometimes, but not always, choose to share this decision-making process with health professionals.

1. THE PATIENT’S ROLE

Highlight that in both developed and developing countries patients choose to use a variety of health providers. Patients go through a series of decisions before a treatment is chosen.

The first decision is whether they are ill or not, Explain that this is not a foolish question because illness is partly culturally defined. Ask the group for examples.

Second people decide whether they need help and third where to turn for help. Ask the group where people go for help in their own country. Then ask where people obtain medicines. Discuss the VA from the Philippines "Where do people get medicines" and point out that this study was undertaken by Anita Hardon in Manila over one year and highlights the many different sources of drugs

Ask what decisions people may make when they take their prescription to the pharmacy. Highlight that many prescriptions contain four or five drugs. Patients may not be able to afford them all and may not know which to choose.

Discuss patient adherence to treatment, which is the fifth decision. Research shows that 50% of patients do not take drugs as prescribed.

2. CONCEPTS OF DISEASE ETIOLOGY AND CURE

When discussing concepts of disease aetiology elicit suggestions from participants about cultural beliefs in their own society which don’t match the biomedical model, such as cancer being contagious or spirits being responsible for disease. Recognise that concepts of cure also vary greatly in different settings.

3. CONCEPTS OF THE THERAPEUTIC VALUE OF DRUGS

Elicit and discuss some of the common problems and highlight their public health and economic implications.

4. DRUG PROMOTION

Ask what problems – if any – exist in participants’ countries. Usually many hands will go up here.

When discussing the effect of promotion and marketing draw on some of the reported work that shows unethical promotion to be common in developed and developing countries, particularly the latter. A resolution of the 1999 World Health Assembly (Revised Drug Strategy WHA5219) had drawn attention to the problem as had two WHO recent roundtables, one on the WHO Ethical Criteria for Medicinal Drug Promotion, the other on collaboration with public interest non-governmental organizations.

Point out that everyone has a role to play in combating unethical promotion and promoting access to independent drug information. Ask participants for ideas of what they could do. Discuss some of the approaches currently being used:

educational modules for medical students to evaluate promotional materials (including videos)

consumer group campaigns

monitoring of drug advertising by professional groups, such as MaLAM

monitoring the claims of drug representatives, such as the monitoring network set up by La Revue Prescrire in France

promoting awareness and use of the WHO Ethical Criteria for Medicinal Drug Promotion

Second component: Approaches to public education

VA 9-11

15 minutes

Lead into a discussion about the need for consumer education. Begin by reviewing the history of health education, starting from the authoritarian approach of telling people what programme managers and policy makers think they need to know. This approach was unsuccessful. The 4PSs approach comes from commercial marketing sources not from health educators.

When discussing the health belief model stress that the different component neded to be present and that this makes change difficult. Point out that of the five factors that of "perceived barriers" is the most important in determining behaviour and that severity is the least important. The implication of these findings is that when planning a health education campaign it is crucial to identify possible barriers.

When discussing public education initiatives ask participants to describe what different experiences they have had. Point out that changing awareness, knowledge and practice may have to be phased and thsat behavior change is the most difficult. The global experience includes discussions of Australia (peer drug educators for the elderly), Bolivia (community networks) and the Philippines (posters related to the generics drug law).

Third Component

VA 12-29

Time 20 to 30 minutes

Start by reviewing the different steps on VA 13. When discussing preliminary research emphasize the importance of using qualitative methods. When discussing the plan, give examples for each component describing the different words e.g. facilitating factors, communication channels, media mix. Explain the more focused the campaign (target audience and behavior change) the morelikelihood of success. Point out the importance of making a realistic timetable. Things usually take longer than you think. Repeat the message of the printed materials session that all materials and campaigns should be pilot tested and that printed materials alone are unlikely to change behaviour although they may increase awareness. Warn the artist and fellow workers to expect modifications. Then discuss the importance of monitoring when implementing the work to avoid any nasty surprises. Conclude by emphasizing the importance of evaluation.

Fourth component

ACTIVITY ONE - DESIGNING A PUBLIC EDUCATION PROGRAM

45 minutes for discussion. 30 minutes for presentations

For this session circulate around the groups keeping them on track and giving warnings on the time available. Encourage them to focus on a very clearly defined target audience and problem. Help them to be realistic about what can be achieved within modest budgets.

Ask the groups to summarise their key elements rather than reporting every aspect of the worksheet