Trainer's Guide
Designing Effective Printed Educational Materials

Introduction 10 minutes

Discuss the purpose and rationale for the session. Point out:

• A wide variety of printed education materials are produced throughout the world. These include the clinical and pharmacy literature; drug bulletins and newsletters, pharmacy and therapeutic manuals, standard treatment guidelines, and illustrated brochures and posters.

• These materials are often much cheaper than alternative prescribing and consumer education strategies, and can reach many prescribers through the mail, on bulletin boards, visual display or in person. They are also often very popular with funding agencies and government departments because they represent something tangible, that can be seen and are demonstrative of activity.

(Ask participants who has any experience of producing printed materials. Probe for  constraints/successes encountered and how these were evaluated).

• These materials are usually relied on exclusively to change prescribing and consumer practices although it has been shown that they barely work at all unless combined with other more interactive approaches, such as face-to-face education.

• Many materials, even within these limits, are not designed in a way that increases their chances of increasing knowledge or changing practice. Few materials are pre-tested with the target audience, which is an essential step in effective communication.

• The purpose of this unit is to introduce participants to some important principles for increasing the effectiveness of printed educational materials.

Second component

30 minutes

VA 3

Make the following points:

• These are the main principles covered in the Participant Guide.
• Go over each principle very briefly – explain that you will give several examples of each in the next few minutes.
• Most of these are applicable to consumer and prescriber education and to many different types of educational materials as well.
• Effective printed materials don’t need to be extremely costly to be effective. Good black and  white line drawings can be substituted for multi colour photographs or designs. And where printing quality is low, for reasons of cost or equipment, it is better to use simple line drawings that will reproduce easily than complex illustrations, such as photographs, that will not reproduce well.

• Emphasise that it is extremely important to have an idea about prescribers’ or consumers’ motivations for "incorrect" drug use before designing educational materials.

• Remind participants about the use of focus group interviews and surveys to uncover these motivations as described in a previous unit

VA 5 Present overhead ("plain aspirin" education brochure)

• This is the front cover of a patient education pamphlet designed to be given to patients by their prescriber in a program to reduce propoxyphene use.

• The pamphlet was designed because prescribers stated that patient demand was one of the most important reasons for using propoxyphene (as a placebo drug) in focus group interviews.

VA 6 Present overhead (what is a generic name)

• This poster from the Philippines comes from research that consumers did not know the meaning of the term "generic name", and also that they were worried about high drug prices.

• The text explains the meaning of term "generic" and links this knowledge with how consumers can save money on drugs.

VA 7 Present overhead (nurses at bed of patient)

Read the headline of this illustration.

• The material makes the point that elderly patients in nursing homes wet their beds less when they are  not exposed to anticholinergic drugs.

• Previous focus group interviews with nurses had already identified that nurses and aides would be very receptive to therapeutic recommendations which would decrease their workload (in this case the  need for changing wet sheets).

VA 8 Transition to second principle of decisions and actions.

• Explain that if you wish to change behaviour an orientation to decisions and actions is critical. Yet many educational materials do not emphasize what prescribers or patients should do or not do for particular health problems, e.g. what should be stopped, what should be started, and why.

The following examples illustrate this action/decision oriented approach:

VA 9 Present overhead (talk about prescriptions)

• This poster gives an overall message, that patients need to talk to their doctor or other health worker  about the drug prescribed and explains why.

• It then gives some key questions to ask.

VA10 Present overhead (if you are ill these few words will help you get better)

• A striking consumer poster from Australia which encourages patients to read directions and labels carefully.

VA11 Present overhead (chloramphenicol contraindicated)

• This education monograph clearly defines one part of the behavioural recommendation to physicians to stop prescribing chloremphenicol in outpatient practice.

• Ask the group if there is anything important missing from this recommendation. The key issue to get across here is the failure of the message to include appropriate alternative behaviors.

VA12 Present principle of emphasizing and repeating a few key messages

• Point out that this is one of the most fundamental principles of communication in all kinds of promotion.

• Usually only four or five education points or recommendations should be attempted in any one printed material. In a poster go for just one key idea.

• Most health workers and consumers are busy people with little time to read long texts unless it is part of a formal course.

• Instead, communications theory suggests that only a few critical knowledge gaps, or behaviors you wish to promote or change be emphasized and repeated.

Examples follow:

VA 13 Present overhead (clindamyacin)

• Read the headline.

• Point out that the sub-headline explains that unlike other the antibiotics clindamyacin only needs to be used three times per day instead of four.

• EmphasIze how the graph reinforces the message showing the half life of the drug.

VA 14 Present overhead (El exito depende)

• Read out the translated text: The outcome depends on the prescription being filled. Make sure that your patient can afford the drugs you prescribe.

• Point out how the bar chart shows the different prices for various products with the same active ingredient.

• Ask the group what they think are the strengths and weaknesses of the design of this poster.

• The principal strength is that it has a strong headline backed up by visual material (the graph).

• The weakness is that because all the text is the same size you don’t get pulled into the "story".

VA 15 Present principle of headlines

• Review the reasons for major headlines

• They should capture the interest of the reader.

• They should make the reader want to read the rest of the text. They can be provocative questions as well as recommended actions.

• If two headlines are needed one is usually less important than the other and is considered a "minor"  headline. This should be in smaller size and can be used to visually "pull" the reader’s eye down into the main part of material.

Examples follow:

VA 16 (If you want to save on medicines)

• Read the headline and point out that this is a strong enticement to the viewer to read further, one of the main purposes of a headline. After all, everyone want to save money.

• Point out how the design of the poster pulls the reader’s eye down and onwards.

VA l7 (Sometimes the best medicine is no medicine)

• Here is an example of a poster which is almost all headline.

• It seemingly breaks some of the rules but it works because original it is brightly coloured and the message is sufficiently provocative to attract attention.

• It was also, in real life, part of a campaign that included consumer education leaflets.

VA 18 Present principle of visually appealing illustrations

• Many of the materials already shown have included visually appealing illustrations. These illustrations can be used to:

• Awaken interest;

• Tell a story;

• Show a behavior which is being promoted or discouraged;

Examples follow:

VA 19 (Open wide)

• This a very appealing illustration with a pun on what is said by the dentist "open wide".

• See also how the bright picture of the clown which is intended to attract attention is reinforced further down by the bar chart which shows how to cut costs through oral administration of antibiotics

VA 20 (page from Bangladesh flipchart)

• Point out how this page from a flipchart has attractive illustrations which tell a story (when to take a prescribed drug)

• The time is shown not only by the sun and the moon through the window but also by the lamp illustrated in the third picture.

• Patients were also given a simple black and white paper reproduction of the same illustration as a line drawing to take away with their medicines.

VA 21 (Gardez le sens de la mesure)

• Read the translated text of the Swiss poster.  "Keep a sense of proportion don't insist on a prescription at every consultation."

• This is an example of the use of humour in printed materials. Point out that humour can be fun and can be very  effective but it is also culturally specific (place and socio- economic level). In other words, what  makes people laugh in one social group may be meaningless or even offend another group. So be quite sure that your material is culturally acceptable and understood before you print it.

VA 22 Present principle of brief, simple text

• Emphasize the need to pilot test all educational materials to be sure that the text is easy to understand by the target audience. This also applies to illustrations which will be discussed in more depth later in the session.

• Also, it goes without saying that the material must be culturally acceptable.

• What ever you do, avoid "medicalese". For example, remind participants about the example in the Participant Guide recommending use of words like "stomach pain" instead of "gastrointestinal disturbances".

VA 23 (organizing medicines at home)

• Explain that this is a text from a booklet for older citizens.

• The advice is straightforward and in simple language.

• The text is a good size – an important point for older people who may have poor eyesight.

• The type of font used is informal – it helps to make the text look friendly and inviting.

VA 24 Repetition increases memory and learning

VA 25 Present principle of referencing respected research and sponsors

• Point out how in the most effective prescribing education interventions in the United States the  sponsorship of a respected medical institution (in one case a medical school, and in the other a local medical society) were obtained to increase credibility).

• The respected sponsor of the educational materials should be very visible in order to be certain that  the reader understands where the material comes from (otherwise they may think it is simply a drug  company advertisement).

• Another way of establishing credibility is to emphasise quotes from respected medical reference books which support your prescribing recommendations. For consumer information you may choose a well known public figure.

Examples of these principles in action follow:

VA 26 (50% savings on essential drugs)

• This is an example of where the then Minister of Health of the Philippines, Dr Bengzon, appeared in a  poster which promoted l5 government outlets for essential drugs at half price.

VA 27 (another edition older)

VA 28 Relevance and involvement

VA 29 Principles of printed educational materials (1)

VA 29 Principles of printed educational materials (2)

GROUP CRITIQUE OF MORE OVERHEADS

1. Tell the participants that they have been exposed to important principles of persuasive print materials, they will have a chance to evaluate a number of different educational materials which have been used in different countries. Ask them to volunteer their opinions on the strengths and weaknesses of each of the following materials.

VA31 (Prescribir en Generico)

VA 39 & 40

Principles of public educational materials

Fifteen minutes

• Present VA and review the underlying reasons for each principle. These are summarised in the session notes. Don’t spend too long on this because there is some overlap with the earlier material.

• If possible, involve participants in the review, particularly when discussing pre-testing.,. Ask participants if any of them have been involved in pre-testing materials; if so what they had to change as a result of the test. .

ACTIVITY ONE: EVALUATION OF EXISTING PRINT MATERIALS

Present rationale for the unit (5 minutes)

- this activity will enable participants to critique two sample educational materials

Facilitate conducting the activity (30 minutes)

1. Ask participants to break up into small groups
2. Pass out the sample print materials. If there is a poster collection displayed participants can choose a posters as one of their two materials.
3. Read the instructions on both sides of the worksheet. Emphasise that they should not try to read the entire text but rather "skim" the material to get a quick feel and impression of its target audience (e.g. prescribers, press, patients) and what are its objectives (behavioral change, general advocacy, knowledge change).
4. Ask participants to rate the materials one at a time on the first side of the worksheet. Also have them briefly jot down answers to the questions on the back of the worksheet.
5. Allow 5-10 minutes for three of the groups to report their evaluation on one of the samples and respond to questions from other participants. Ask the groups not report point by point because this takes too long. They should rather summarise what the material aims to do and whether it is effective (main strengths and weaknesses).

ACTIVITY TWO: SKETCHING OUT A PRINTED EDUCATIONAL BROCHURE OR POSTER FOR PRESCRIBERS OR CONSUMERS (ONE HOUR AND FIFTEEN MINUTES)

Present rationale for the unit (five minutes)

This activity will give participants a chance to begin to develop a printed education brochure or poster, using the principles discussed in the session, which demonstrates that the design of effective materials is a skill that can be developed with practice.

Tell participants that the materials will go on display and at the end of the afternoon ballot papers will be distributed so that each person can vote for their favorite brochure or poster. Count the votes overnight and award the groups who come first, second and third with a small prize, such as a bag of sweets.

Facilitate conducting the activity (45 minutes)

Ask participants to:

1. Break up into small groups
2. Read the rationale and instructions
3. Make sure that the materials reflect the principles discussed in the session

Make sure participants understand that they don’t need to write the text of the brochure (if that is what they choose to do) in detail. They just need to put blocks or lines in to show where the text would go and what would be covered. Equally, if there are no "artists" in the group, they can simply use a minimalist line drawing or even write what the illustration would be. Tell them to spend a maximum of ten minutes deciding what topic to cover.

After completing the activity, each group will present its material to other participants for comments and recommendations.

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