promoting rational drug use in the community face to face education

Promoting Rational Drug Use in the Community

Face to Face Education

Face to face Promoting Rational Drug Use in the Community

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Session objectives1) Understanding of: What is good F2F education Advantages and disadvantages of F2F Why F2F is important/what it can achieve How people change behavior with F2F How and when to use F2F How to plan a F2F education project

2) Develop skills to understand problems and encourage the person to try a new practice


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Face to Face in HIV/AIDS education

What characterizes good F2F?

Observations from field work?


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Good face to face education

Relevant to personal and cultural needs Shows respect for people’s ideas and

practices Builds a bridge between old and new ideas

and practices Skills and credibility of educator Accessibility of key information Room for discussion and negotiation Includes check for understanding Others ???


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How and where to use F2F education?

To discuss drugs with customers


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In training courses

In supportive supervision

Use + other methods and materials

One-to-one and small groups


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In group

s


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Convince managers of need for programme

To change practices


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The reality: >50% of youth have sex


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Behavior change examples: Participants What did

you change?

What or who inspired you to change?

How long time did it take?

Children sent to buy drugs in Kilifi: Reduced after training


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Behavior change in the community

What will make her change?

Can you change others?


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Behavior change basics

You can only change yourself To change behavior, you need a good reason No one has ”a wrong idea” Help people see need for change by expanding

their view Never push someone to change To change, you require time and energy to think

and reflect When people are in a stressed situation, they will

not consider change We often judge people as being stubborn or

ignorant if they don’t want to change Information only does not make people change Create an enabling environment to help people

change


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Emotions and Behavior Change

Emotions: Trigger BC Stop BC”Fog” your view

Common problem -UNCERTAINTY: Not sure of anythingStomach feeling, Antennae downHear what you want to hear


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Can you read reactions correctly?


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From Awareness to Change

Observations:

Role in group?

Any behavior or practice you want to change?

Ask group members to support you to achieve what you want


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What makes an educator credible? Status or “right to talk and be listened to” Experience with HIV/AIDS Knowledge

– of the problem and the treatment (biomedical)

– of the community: Perceptions, practices and reasons for these

Attitude: – Respects people and reasons why it might

feel impossible to follow advice to change Communication skills (see next slide)


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Educator: Essential communication skills


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Educator: Essential communication skills Empathy Approachable, and makes people welcome and at

ease Respectful of others Curious - willing to learn Good communicator - good listener: Active listening Inspires dialogue and views Can identify problems/constructive solutions Knowledgeable about the subject Can say “I don’t know - I’ll find out” Can accept criticism Non-judgemental


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Educating patient to use ARV

Demonstration role-play: Lethiwe and Robert

Observe: What skills is she using? What is she doing well? What could be improved?


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Six skills for effective education

The first set of 3 skills:

Understanding the problem by:

observing the mood of the client/customer and responding appropriately

asking open questions listening carefully and trying to

understand


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Six skills for effective education

The second set of 3 skills:

Responding to the problem/needs by:

giving accurate and clear advice and explaining why

discussion to reach agreement checking for understanding


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How togive advice effectively?


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How togive advice

effect-ively?


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How to give advice effectively

Make it clear and simple. – how the drug works, how often to take it,

for how long. Explain WHY this treatment Explain importance of finishing the

treatment and what can happen if you don’t

Be confident, friendly and non-judgemental Be practical - if possible demonstrate how

to measure and administer dose


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Communication barriers (1): Client


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Communication barriers (1): Client

The client or customer feels uncomfortable does not trust the educator does not have money to follow advice feels worried/judged/patronised does not dare to ask questions gets too much - or too complicated

information does not have the time


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Communication Barriers (2): Educator


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Communication Barriers (2)

The educator Unfriendly, judgemental or patronising lacking respect for patient’s perceptions,

practices and concerns Does not listen - interrupts - argues Uses technical language Lacks the appropriate knowledge and

expertise Does not follow-up


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Communication barriers (3)

The environment

too noisy not safe not private not comfortable


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Using F2F in projects

Aim: What do you want to communicate? To whom? Through which channels? Is F2F needed for some of it? Why - to achieve what, with whom?

What personnel is needed to do F2F? Do you have this personnel? Do they need further training?

What support materials do you need for the trainers to use in their education?

What is your budget? How are you going to monitor and

evaluate the effect?


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Support F-to-F with other methods Continuing community education - use

simple materials and health workers or informal providers as resource people

Training for community leaders - encourage them to take a lead role

Encourage activities in schools Give information through community

meeting, local radio, community drama, etc

NB good supporting educational materials will improve the impact of F to F interventions


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Summary F-to-F

effective method to change practices useful in a mix of methods best supported by educational materials content should be based on (participatory)

research educator must understand and respect

community views and practices educator must be respected and skilled in

participatory methods supportive supervision essential


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Additional slides and handouts for F to F

Slides … to … can be used to teach content of session notes

Slides used in session today are new, and introduces material (behavior change) which is not included in session notes

Additional handouts provided gives this background


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Requirements for success Analyse the problem - early research needed Assess perceptions and practices and reasons

for these, and perception of need for change Respect people and develop solutions with

them Build bridges between old practices and new Focus on sustainability Use credible and skilled communicators Involve and inform opinion leaders Be available over time Support with a variety of educational methods


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Pros and cons of F-to-F education Improves rational use and compliance Reduces morbidity and mortality Empowers people Encourages good communication Changes behaviour Allows immediate feedback Can include practical demonstration Promotes general awareness Encourages neighbours to discuss with each other Expensive (financial and human resources) Requires skilled and motivated educators


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Evidence to support use of F-to-FReview of 37 studies investigating

compliance/adherence concluded: Teaching patients resulted in improved

compliance Poor communication with health workers

most common cause of non-compliance Lack of continuity in patient-physician

interaction contributed to non adherence In Kenya ORS sales increased 30% and in

Indonesia 21% after pharmacy workers received F to F training


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Lessons from ORS study in Nepal Gain the confidence of opinion leaders and

traditional healers - explain problem and plan - invite their ideas and participation

Keep them involved and informed throughout Use successes and positive experiences to

motivate others Create (or use existing) forum for exchange of

experiences Successful use of new practice by neighbours

inspires imitation importance of using educators with local

knowledge and language as facilitators


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Team building: Characteristics of team

There must be Awareness of unity Interpersonal relationship

Members must have the ability to

Act together toward a common goal


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10 Characteristics of well-functioning teams

Purpose: Share why team exist Priorities: What needs to be done, by whom, when Roles: Must know own roles, and when to ask others Decision: Authority and decision-making lines clearly

understood Conflict: Dealt with openly. Considered important to

decision-making and personal growth Personal traits: Members feel appreciated and

utilized Norms: Group norms are set. Seen as standard for

everyone Effectiveness: Members find team meetings efficient.

Look forward to this time together Success: Know when team is successful, share it

equally and proudly Training: Opportunities for feedback and updating

skills given, and used


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Guidelines: effective team membership

Contribute ideas and solutions Recognize and respect differences in others Value the idea and contributions of others Listen and share information Ask questions and get clarification Participate fully and keep your

commitments Be flexible and respect the partnership

created by the team - strive for the “win – win”

Have fun and care about the team and the outcomes

promoting rational drug use in the community face to face education

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