Principles of Face to Face Education

Principles of Face to Face Education: Objectives Recognize the advantages of persuasive face-to-face education Identify the key principles and techniques Understand how to carry out persuasive face-to-face intervention Be able to train others how to conduct effective face-to-face education Explain the overall objectives Explain the components Advantages and strengths of persuasive education Studies and experience Principle of face to face education and managing Activity Conclusion Principles of Persuasive Face-to-Face Education

Diversity of Educational Strategies Styles didactic vs. problem-oriented lecture vs. multi-method training one shot vs. repeated encounters Targets health problem vs. prescribing focus varying resistance to change Audience & setting small group vs. large group on-site vs. district seminar \ Principles of Persuasive Face-to-Face Education

Advantages of Persuasive Face-to-Face Education Present both sides of controversies Target opinion leaders Two way communication Adapt message to prescriber's situation Able to reinforce improved behavior Both sides of controversy--counter message Two way communication--problem solving Principles of Persuasive Face-to-Face Education

Effect of Persuasive Education on Prescribing by Private MD’s in the US 0% -10% -20% -30% -40% % change in prescribing in target drugs (n = 140) (n = 132) (n = 141) (p < 0.0001) (NS) controls print only print & detail Example from developed country Key Point: print material alone not different from controls Principles of Persuasive Face-to-Face Education

Zambia Essential Drugs Program Education and Information Training in drug management and therapeutics Standard Treatment Guidelines Drug information newsletter System Supports PHC Essential Drugs List (34 drugs) Kit supply system Distribution and reporting system Example from developing country Innovative approach in EDP training Key Point: system supports facilitate and reinforce effects of training Principles of Persuasive Face-to-Face Education

Group Seminars to Improve Prescribing in Zambia Design 16 matched Lusaka health centers 8 randomly assigned to intervention (N=26 prescribers) and control (N=26) 30 new cases per prescriber per month before, during, and after intervention Intervention three 2-day workshops in 4 months topics: STGs for malaria, diarrhea, ARI self-audit, cases, lectures, group work Design of EDP Training Details of intervention on Malaria Diarrhoea ARI Key Points: multi-method educational approach and reinforcement through multiple sessions. Principles of Persuasive Face-to-Face Education

Impact of Group Seminars on Prescribing in Zambia Adequate Examination Correct Case Management 30% 40% 20% 20% 10% 0% 0% Before During After Before During After Correct Drug Correct Dose Results of EDP Training program Key Points: sustained improvement in examination and case management, with smaller improvements in choice of drug and dose. 80% 60% 60% 40% 40% 20% 20% 0% 0% Before During After Before During After Intervention Control Source: Bexell et al. Zambia Essential Drugs Program. 1994 Principles of Persuasive Face-to-Face Education

Effect of Small Group Training on ORS Sales in Kenyan and Indonesian Pharmacies Key Points: Target of intervention--Drug sellers Positive impact of Intervention Wave 1 (N=58) Wave 2 (N=24) Controls (N=25) Training (N=42) Controls (N=41) Principles of Persuasive Face-to-Face Education

Effect of Small Group Training on Antidiarrheal Sales in Kenyan and Indonesian Pharmacies Positive impact on sales of Antidiarrheals Training (N=42) Controls (N=41) Wave 1 (N=58) Wave 2 (N=24) Controls (N=25) Principles of Persuasive Face-to-Face Education

Size of Improvement by Intervention Type in 36 Well-designed PHC Interventions MINOR MODERATE LARGE Informational: Print Info / Guidelines 7 Training / Workshop 6 Community Case Management 5 4 Group Process Focus on the first two categories of interventions and evidence for their success. Key Points: distributing printed materials is virtually always ineffective in changing behaviors. Training can vary in it’s effects. 3 Administrative: Supervision / Audit 2 1 Essential Drugs Program 1 1 % Improvement in Key Outcome Principles of Persuasive Face-to-Face Education

Findings About Educational Strategies Large impact (>25% improvement) repeated problem-oriented groups Moderate impact (10-25% improvement) single health problem focus small problem-focused on-site training -or- large multi-method seminar gains from small group more sustained Small impact (<10% improvement) distributing print info or guidelines single didactic seminar or diffuse focus Training can be effective with groups of any size from one-on-one to large groups if targeted interactive approaches are used. Repeated contacts increase the size and sustainability of improvements in practice. Principles of Persuasive Face-to-Face Education

Sites for Face to Face Education Face to Face education can occur in many sites. Health centers Hospitals Pharmacies Continuing education seminars Key Points: various possibilities of undertaking face to face education Face to Face education can occur as part of: Training Supervision Regular support visits Clinical consultation Principles of Persuasive Face-to-Face Education

Motivations Reported by Prescribers 2. Use of Placebos "...I always give patients drugs with names they don't know..." "If the patient likes it, it's O.K." 3. Clinical Experience "...my own experience shows that these drugs work." Principles of Persuasive Face-to-Face Education

Motivations Reported by Prescribers 1. Patient Demand " Vitamins are virtually useless, but patients always ask for them...and will go elsewhere if they are not pleased". "...Not enough time to bother with changing people's minds." Principles of Persuasive Face-to-Face Education

Principles of Persuasive Education Relevant to actual therapeutic decisions and actions Understand the reasons for prescribing Be oriented toward decisions and actions Emphasize only a few key messages Capture attention with headlines Use appealing print materials Use brief, simple text Refer to the best research Have a respected sponsor Key Point: persuasive education should focus on actual decisions faced by prescribers rather than didactic content. Ask participants who are the credible sources of information in their settings. Principles of Persuasive Face-to-Face Education

Targeting Opinion Leaders , ! Jan Apr Jul Oct 84 85 86 0.1 0.2 0.3 0.4 0.5 0.6 0.7 Percent of all C-sections Discussion with Chief of Obstetrics -- Cefazolin recommended — Cefoxitin not recommended Key Points: Opinion leaders can be targeted in an intervention and they can be the agents for changing other practitioners. Principles of Persuasive Face-to-Face Education

Effect of Reinforcement on Reduction in Use of Targeted Drug 0% -5% -10% -15% -20% -25% -30% -35% Controls Number of Visits Completed 1 2 % CHANGE (PRE TO POST) Key Points: Multiple contact reinforces effects and makes them more sustainable. Principles of Persuasive Face-to-Face Education

Characteristics of Persuasive Educators Good with language Energetic Alert Good interpersonal skills Calm under pressure Some science background Principles of Persuasive Face-to-Face Education

Managing Face-to-Face Education Target high frequency users Inform the target prescribers in advance Explain sponsorship and purpose Schedule follow-up visits Monitor performance Principles of Persuasive Face-to-Face Education

Face-to-Face Visit with Prescribers at Centro Health Center Activity One Face-to-Face Visit with Prescribers at Centro Health Center Principles of Persuasive Face-to-Face Education

Face-to-Face Education Conclusion Face to face education can be an effective intervention if it is: Targeted Has a clear message Actively managed with monitoring Fits the institutional environment Principles of Persuasive Face-to-Face Education