1. Principles of Face to Face Education

2. 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

3. 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

4. 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

5. Effect of Persuasive Education on Prescribing by Private MD’s in the US0%
-10%
-20%
-30%
-40%
% change in prescribing in target drugs
(n = 140)
(n = 132)
(n = 141)
(p < )
(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

6. 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

7. 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

8. 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
Principles of Persuasive Face-to-Face Education

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. Effect of Reinforcement on Reduction in Use of Targeted Drug0%
-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

19. 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

20. 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

21. 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

22. 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