First Component
· (45 minutes) 2 VA 's 1-12
Overview of the Process of Changing Drug Use
This session introduces participants to an important model underlying the
entire course-the cycle of changing behavior. After discussing the four steps of the cycle
of changing use, emphasize the importance of the first two steps in designing effective
interventions. Use an analogy to clinical medicine to describe these two steps. Step One,
measuring drug use, is like taking a patient history, signs, and symptoms. Step Two,
diagnosing the problem, is like determining etiology and the range of possible therapies.
After these two steps, it is possible to make an informed choice about an intervention
(therapy) that is likely to be effective.
Second Component
· (45 minutes) 2 VA 's 13-18
Sources of Quantitative Data about Drug Use
Participants receive a broad overview of the many kinds of quantitative data
that is possible to collect at various locations in the drug use system: central and
district administrative offices, health facilities, private pharmacies, and in the
community. Encourage participants to think broadly about the range of data available and
how different kinds of data can be used.
Narrow focus at the end of the session to the drug use encounter, and the types of
information it is possible to collect about patients, providers, their interaction, and
the drugs that are prescribe. Explain that the drug use indicator methodology taught in
the course captures only a small part of the possible variety of data about the drug use
encounter.
Third Component
· (60 minutes) 2 VA 's 19
Strengths and Weaknesses of Different Data Sources
This activity will help participants think in more detail about the different types
of data available for studying a specific problem. Use of antibiotics is the problem used
in the activity, although this problem can be changed to make the activity fit better in a
particular setting.
Time usually allows for each group to complete only one of the four pages in the
activity in detail. Assign groups to think about specific pages.
In reporting, emphasize differences in reliability, in the ease of data collection, and
in the cost of obtaining the various types of data.
Fourth Component
· (45 minutes) 2 VA 's 20-26
Overview of In-Depth Qualitative Methods
Participants are introduced to two methods for in-depth qualitative assessment:
in-depth interviews and focus group discussions. Emphasize that the purpose of these
techniques is to stimulate respondents to talk at length about a set of issues, rather
than to answer specific questions.
In-depth interviews and focus group guides should be structured to encourage logical,
open discussions of a limited number of ideas, starting with a general question about an
idea then narrowing to specific issues through a series of problems.
Fifth Component
· (45 minutes) 2 VA 's 27-36
Overview of Semi-Structured Qualitative Methods
The semi-structured methods described are specific variations of more general
observation and questionnaire methods. These specific methods have been chosen because
they are especially useful in drug use studies.
Questionnaires are familiar to most participants. Focus attention on how questionnaire
can be used to measure attitudes and opinions, especially through the use of rating scales
and open-ended questions. Use the session evaluation form as an example of an attitude
questionnaire.
Highlight the importance of directly observing behavior during drug use encounters for
in-depth understanding of quality of care. Structured observation protocols and simulated
client visits are two useful observational methods. Encourage discussion about the issue
of bias, on the part of the observer and also how the observer's presence during normal
behavior.
Sixth Component
· (75 minutes) 2 VA 37
Designing Qualitative Instruments
This is a long activity during which participants prepare three draft data
collection instruments (in-depth interviews, observation form, patient exit interviews) to
use during the second field visit. All groups should develop instruments related to a
single clinical issue that is important in the local environment. Groups can use the
examples in the annexes as models for the instruments they develop.
Be sure that the groups adhere to the restrictions on length (1 side of a sheet of
paper for the questionnaire and observational form, and 3-4 issues for the in-depth
interviews).
Support staff should enter the draft instruments in the computer and return the printed
drafts to the groups for editing the following day. After revisions, instruments should be
duplicated for use during the second field visit. Each team should use its own instrument,
as well as instruments developed by other groups for the remaining two methods.
Seventh Component
· (30 minutes) 2 VA 38
Activity Three: Preparing for a Field Visit
Describe the field sites that participants will visit the following day, and
discuss necessary logistics, such as assignment of teams to facilities and transportation
arrangements. Remind participants to bring the pages from the activity for Field Visit 1,
which they will need for debriefing.
The purpose of the field visit is to demonstrate to participants the wide variety of
ways they can learn about drug use in a new setting. Ideally each team should visit at
lest one public sector facility (hospital, health center, warehouse, district office) and
at least one private pharmacy. Team members should be encouraged to interview staff and
patients, examine different kinds of records and receipts, and observe the process of care
in different settings. Plan to spend about 2-3 hours in the field visit.
