CBIA-PREGNANCY TO IMPROVE SKILLS OF PREGNANT MOTHERS IN SELECTING OTC COMMON COLD PREPARATION

ABSTRACT CBIA -PREGNANCY TO IMPROVE SKILLS OF PREGNANT MOTHERS IN SELECTING OTC COMMON COLD PREPARATION Hidayati, S. 1, Hartayu, TS. 2, Munawaroh S. 3, Suryawati S. 1 1 Centre for Clinical Pharmacology and Medicine Policy Studies, Gadjah Mada University, Yogyakarta, Indonesia 2 School of Pharmacy, Sanata Darma University, Yogyakarta, Indonesia 3 Agency for Women and Community Empowerment, Yogyakarta province, Indonesia Problem Statement: Pregnant women may have common cold episodes during pregnancy and need medicine to soothe the symptoms. Skills in selecting medicines for common cold in pregnancy are important. Mother’s active learning method (known as CBIA ) is one of the strategies which is not only improving knowledge but also changes behavior (EDM No.32,pp 22-23, 2003). Since information on the use of medicine in pregnancy also available in the medicines’ package, it is expected that CBIA -Pregnancy be focused on the medicines use in pregnancy. Objective : To pilot test CBIA -Pregnancy in improving knowledge and skills of pregnant women to select common cold medicines Design: An intervention study with pre and post quasi experimental design. Data were collected at baseline, one-day (Post I), 2 weeks (Post II), and 4 weeks (Post III) after intervention Setting: The study was conducted in 2 hospitals in Yogyakarta, Indonesia., i.e., Sakina Idaman and Panti Rapih. Women visiting ANC in Sakina Idaman were assigned as intervention group and those visiting Panti Rapih were assigned as control. Study Population: Pregnant women who visited ANC program in Sakina Idaman and Panti Rapih hospital on regular basis. Intervention: CBIA -Pregnancy is a 2-hour small group discussion using information in the medicines’ package as training material and CBIA- Pregnancy module as activity guide. There were 5 groups of 5–6 participants with midwives in the study hospital as facilitators. Participants searched information on active compound, indication, dosage, side effects, and contra-indications and also specific information on the use of the medicine during pregnancy. Policies: This strategy will provide hospitals with tools for hospital-based community empowerment and promoting self-learning behavior among the community Outcome Measures : score of knowledge on the most familiar medicine, % of subjects who could select the correct medicine, and feasibility assessment. Results: Score of knowledge increased significantly ( p <0.05) from SD 2.42 at baseline to SD 2.41 at post I, to SD 2.31 at Post II, and to SD 1.72 at Post III in the intervention group. % of subjects who could select the correct medicine increased significantly after CBIA -Pregnancy training from 46% at baseline to 92% at post I (x 2 test p <0.05), to 85% at post II, and to 90% at post III. (x 2 - test, p <0.05 compared to baseline). Feasibility assessment showed that CBIA –Pregnancy needed less time to conduct and cost less than seminar, was supported by legal statements on medicine and law of consumers’ protection. Conclusions: CBIA -Pregnancy improved knowledge and skills of pregnant women on selecting OTC common cold preparations. This strategy is considered easy to follow and feasible to implement in hospitals. Keywords: CBIA -pregnancy, common cold, Ante Natal Care, pregnancy, hospital-based community, self-medication Funding source: : WHO-SEARO

BACKGROUND In Indonesia.. More than 200 brand names of OTC medicines for common cold are available in the market Common cold is the most prominent illness in the community Pregnant women may also experience common cold and need medicine to soothe the symptoms. However, many OTC medicines are not safe for pregnancy

Community based Interactive Approach (CBIA) is effective in improving skills in selecting OTC medicines CBIA uses medicine complete package as training material Including information for use during pregnancy CBIA - Pregnancy A good strategy to improve medicine use in the community should have: Specific purpose specific target audience Replicable, feasible An adaptation from the original CBIA strategy, focused on how to select OTC medicine which is safe for pregnancy was then developed and named:

STUDY OBJECTIVES General Objective – To pilot test CBIA-Pregnancy in improving knowledge and skills of pregnant women to select OTC medicines for common cold Specific Objectives – To measure the score of knowledge of pregnant mothers in how to select OTC medicine for common cold in pregnancy before and after CBIA - pregnancy training. – To measure practice of pregnant mothers in how to select OTC medicine for common cold in pregnancy before and after CBIA – pregnancy training – To evaluate in general, the effectiveness of an educational module targeted to hospital based community in improving skill to select OTC medicine for common cold in pregnancy.

METHODS STUDY DESIGN: A pilot implementation study, applying a pre and post quasi- experimental design. STUDY SETTING: The study was conducted in Sakina Idaman Private Maternity Hospital and Panti Rapih Hospital. Both are in Yogyakarta province, Indonesia. Women visiting ANC in Sakina Idaman were assigned as intervention group and those visiting Panti Rapih were assigned as control.

 Focus Group Discussions (FGD) to reveal experiences in using medicines during pregnancy  Drafting the CBIA-Pregnancy module  Review by experts  Testing the clarity with a group of pregnant mothers  Revising and finalizing the module Final CBIA-Pregnancy Module

 26 subjects from Sakina Idaman maternity hospital underwent training  Subjects were grouped into 5 groups of 5 – 6  2-hour interactive discussion.  CBIA-Pregnancy module was used as guideline  Facilitator: trained midwives.  Various OTC medicines for common cold complete with their original packages were used as training material  Phase I: Participants searched information on active compound, indication, dosage, side effects, and contra indications.  Phase II: Participants searched information use during pregnancy and discussed if the medicine is safe

CBIA Pregnancy improves knowledge and skills 1.Knowledge on the Most Familiar Medicine 2. Correctness in Selecting Medicine *) (Wilcoxon test, p <0.05). **) (X 2 test, p <0.05) RESULTS CBIA-Pregnancy significantly improved score of knowledge of the most familiar medicine score *) % Percentage of subjects who could mention the correct OTC medicine increased significantly after CBIA -Pregnancy training **)

Time feasibility Time consumed to prepare and to conduct CBIA - Pregnancy training : One day facilitator training prior to the training Two hour intensive interactive training Acceptance/cultural feasibility In-depth interview revealed that CBIA-Pregnancy training activity was enjoyable and acceptable both for the patients and for the hospital staff. Legal feasibility CBIA-Pregnancy supports the implementation of the Law of Consumer Protection no. 8/ 1999 article 4: a - c on the rights of consumers, and article 5 on the obligation of consumers. Information on the OTC medicine package is strictly controlled by the National Agency of Drug and Food Control (NA-DFC), under Ministerial Decree of Ministry of Health, Republic Indonesia No.02823/A/SK/XI/90. Therefore, information on the package of OTC medicine is considered reliable and can be used as source of accurate information for consumers. Cost feasibility Unit cost for conducting CBIA-Pregnancy activity for 30 participants was RP 40,000,00/ participant (USD 3.47) and this figure was less than unit cost of conducting large group seminar, which was Rp (USD 11.55)/ participant

Hospital based community groups are available for educational purposes CBIA-Pregnancy showed significant result to improve knowledge and correctness in selecting OTC medicine for common cold which is safe for pregnancy. CBIA-Pregnancy is feasible to replicate on the setting where – There are groups of pregnant mothers who meet on regular basis such as in Ante Natal Care (ANC) clinic in hospitals – Information on the package of OTC medicine is considered reliable and strictly regulated and therefore, can be used as source of accurate information for consumers. CBIA-Pregnancy cost less to conduct than large group seminar, and considered as an enjoyable activity by the participants SUMMARY

This strategy will provide hospitals with tools for hospital-based community empowerment and for promoting self-learning behavior among the community CONCLUSION & POLICY IMPLICATION CBIA-Pregnancy is proven effective in improving knowledge and skills on selecting OTC medicine for common cold for pregnant women and is feasible to implement in hospital based community setting

The authors would like to thank to:  The WHO-SEARO for financial support.  Director and staff of the Sakina Idaman and Panti Rapih hospitals in Yogyakarta Indonesia, for their support and cooperation during the study  All study participants This study has been presented in  The Inter country meeting of WHO-SEARO in India, 13 – 15 July 2010,  Funded by: WHO-SEARO. ACKNOWLEDGEMENT

Thank You communication : Sri Hidayati