promoting rational drug use in the community conducting a rapid appraisal to analyse problems and...

Promoting Rational Drug Use in the Community

Conducting a rapid appraisal to analyse problems and

identify possible solutions

Conducting a rapid appraisal to analyse problems and identify possible solutionsPromoting Rational Drug Use in the Community

2WHO

Objectives:

Participants will be able to:

1. Describe the main methodological characteristics of rapid appraisals and their historical origins

2. Outline how rapid appraisals can be used to focus and analyse drug use problems and identify possible solutions

3. Develop a problem analysis diagram


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Step 1 Describedrug use and identify

problems

Step 4Select and

developintervention

Step 5 Pretest

intervention

I mprove intervention

I mprove int

erventi

on

Step 3 Analyseproblems and identify

solutions

I mpr

ove a

nalys

is

Step 7Monitor and

evaluateintervention

Step 2 Prioritiseproblems

Step 6 Implementintervention

Steps in an effective communication intervention


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Rapid appraisal

The Session:

Introduction: What is RAP?

What are the historical roots of RAP

How can RAP be use to focus and analyse drug use problems?

Activity: Develop a problem analysis diagram


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What is a rapid appraisal?

Quick way to get info:– How do people describe the problem?– What are reasons for the problem?– What are possible solutions?

Using mix of qualitative and quantitative methods

Often participatory approach Quick = 2 weeks - 3 months


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Characteristics of RAP

Efficient: essential information only Flexible: learn-as-you-go

Participatory:stakeholder participation in data gathering and analysis

Interactive: team members and disciplines work together

Triangulated: mix of methods


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History of RAP Early 1980s: RRA - Mainly used in agriculture

Mid 1980s: Increasingly used in health field/popular among NGOs

Late 1980s: PRA - more influence to target group, more attention for power

Early 1990s: PRA used by mainstream development agencies

Mid 1990s: more reflexive: attention for attitudes and behaviour of researchers and facilitators


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Objectives: RAP on a drug use problem

Describe problems and sub-problems see how different stakeholders see the problem

Focus on core problem (or a series of sub problems) for intervention;

Analyse the core problem(s), by– identifying stakeholders’

perception of main causes– collecting additional information

on these factors


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Objectives RAP continued

Identify stakeholders ideas for possible solutions:– target audiences– proposed messages– communication channels

Identify factors which:– can facilitate interventions– are likely constraints to change


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Steps (Manual: “Activities”)to conduct a RAP

1) Review literature, unpublished reports, secondary data

2) Key informant interviews: further describe problem and sub‑problems; gain insight into reasons for present practices

3) Multi-stakeholder workshop: focus on a core problem(s), further define causes;develop a problem analysis diagram

4)Fieldwork on a core problem as a basis for community health education interventions

5)Finding solutions


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Step 1 ‑ Review of available data: What do we know about problem in local settings? Have studies on problem been done elsewhere? What reasons for the problem were identified? What sub‑problems have been described? What population groups are affected? What can you learn from drug sales statistics in your

country? Have studies been done on community members'

perception of the problem in your country? What data are still lacking?


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Step 1 continuedSources of secondary data:

Computerised literature search, e.g. in Medline and Popline

INRUD Drug Use Bibliography (Over 4,200 entries)

IRENE: New website on intervention studies for RDU

Documentation centres, e.g. UNICEF

Ask key informant for unpublished reports

Review sales statistics


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Step 2 - Key Informant InterviewsKey informants are: people who are affected by the problem community leaders teachers community health workers pharmacists, other drug sellers staff of health programmes researchers specialised in community

health staff of consumer organisations and

health and development NGOs.


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Example of sub-problems: Key informant interviews on use of ABs

In self-care people tend to use antibiotics for non-severe conditions that could be treated with home remedies or less strong drugs. People use antibiotics because they fear conditions will worsen and become life threatening.

Antibiotics are sold illegally by informal providers, who may or may not know how to use these drugs correctly.

Consumers have "learnt" which antibiotics to take for which conditions from observing prescriptions given for former illness episodes.

Economic reality leads patients to buy a few "magic capsules" expecting instant cure from powerful drugs.


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Sub-problems continued:

Health workers over-prescribe antibiotics for self‑limiting conditions, because they fear criticism by clients if they fail to treat the illness adequately.

When prescribed: people don't comply with the advice to use a full course of antibiotics. They don't see why they should continue to buy medicines when condition has improved.

Neither health workers nor informal providers give people adequate advice on WHY they should take a full course of the medicines, and thus do not motivate the consumers to take the (biomedically) right action.


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Step 3: Multi-stakeholder workshop

Suggested objectives:

Review the list of problems identified in step 2 and identify core problem(s)

Develop a problem analysis diagram

Review factors contributing to the problem

Are there additional factors to be added to the diagram?


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Group Activity: developing a problem analysis diagram Review background information Define core problem and related sub-

problems Identify community/individual factors

related to core problem Identify health institution/national factors Play around with factors till they form a

coherent diagram Formulate a main objective and specific

questions for fieldwork


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Problem analysis

Lack ofcontrol/

regulation ofmedicines

supply

Inadequatedispensing

of ABs

ABsin

groceries

OTC-availabilityof ABs in

pharmaciesand shops

Beliefs: ABs are

essential Parents fear

conditionwill worsen

Pastexperience

Lack ofknowledge

andinformation

Weak implementation

of essentialdrugs

programme

Inadequateinformationprovision on

how to use ABs

Cost

Over-prescribing

of ABs

Core problem:

INAPPROPRIATEUSE

NATIONALLEVEL

HEALTHINSTITUTION

LEVEL

COMMUNITYLEVEL

INDIVIDUALLEVEL

Example of a problem analysis diagramof the inappropriate use of antibiotics

promoting rational drug use in the community conducting a rapid appraisal to analyse problems and...

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