1. Promoting Rational Drug Use in the Community Face to Face Education

2. WHO Face to face Promoting Rational Drug Use in the Community 2 Session objectives 1) 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

3. WHO Face to face Promoting Rational Drug Use in the Community 3 Face to Face in HIV/AIDS education What characterizes good F2F? Observations from field work?

4. WHO Face to face Promoting Rational Drug Use in the Community 4 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 ???

5. WHO Face to face Promoting Rational Drug Use in the Community 5 How and where to use F2F education?  To discuss drugs with customers

6. WHO Face to face Promoting Rational Drug Use in the Community 6 How and where to use F2F education?  In training courses  In supportive supervision  Use + other methods and materials  One-to-one and small groups

7. WHO Face to face Promoting Rational Drug Use in the Community 7 How and where to use F2F education? In groups

8. WHO Face to face Promoting Rational Drug Use in the Community 8 How and where to use F2F education?  Convince managers of need for programme  To change practices

9. WHO Face to face Promoting Rational Drug Use in the Community 9 The reality: >50% of youth have sex

10. WHO Face to face Promoting Rational Drug Use in the Community 10 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

11. WHO Face to face Promoting Rational Drug Use in the Community 11 Behavior change in the community What will make her change? Can you change others?

12. WHO Face to face Promoting Rational Drug Use in the Community 12 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

13. WHO Face to face Promoting Rational Drug Use in the Community 13 Emotions and Behavior Change Emotions:  Trigger BC  Stop BC  ”Fog” your view Common problem - UNCERTAINTY:  Not sure of anything  Stomach feeling, Antennae down  Hear what you want to hear

14. WHO Face to face Promoting Rational Drug Use in the Community 14 Can you read reactions correctly?

15. WHO Face to face Promoting Rational Drug Use in the Community 15 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

16. WHO Face to face Promoting Rational Drug Use in the Community 16 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)

17. WHO Face to face Promoting Rational Drug Use in the Community 17 Educator: Essential communication skills

18. WHO Face to face Promoting Rational Drug Use in the Community 18 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

19. WHO Face to face Promoting Rational Drug Use in the Community 19 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?

20. WHO Face to face Promoting Rational Drug Use in the Community 20 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

21. WHO Face to face Promoting Rational Drug Use in the Community 21 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

22. WHO Face to face Promoting Rational Drug Use in the Community 22 How to give advice effectively?

23. WHO Face to face Promoting Rational Drug Use in the Community 23 How to give advice effect- ively?

24. WHO Face to face Promoting Rational Drug Use in the Community 24 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

25. WHO Face to face Promoting Rational Drug Use in the Community 25 Communication barriers (1): Client

26. WHO Face to face Promoting Rational Drug Use in the Community 26 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

27. WHO Face to face Promoting Rational Drug Use in the Community 27 Communication Barriers (2): Educator

28. WHO Face to face Promoting Rational Drug Use in the Community 28 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

29. WHO Face to face Promoting Rational Drug Use in the Community 29 Communication barriers (3) The environment  too noisy  not safe  not private  not comfortable

30. WHO Face to face Promoting Rational Drug Use in the Community 30 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?

31. WHO Face to face Promoting Rational Drug Use in the Community 31 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

32. WHO Face to face Promoting Rational Drug Use in the Community 32 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

33. WHO Face to face Promoting Rational Drug Use in the Community 33 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

34. WHO Face to face Promoting Rational Drug Use in the Community 34 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

35. WHO Face to face Promoting Rational Drug Use in the Community 35 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

36. WHO Face to face Promoting Rational Drug Use in the Community 36 Evidence to support use of F-to-F Review 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

37. WHO Face to face Promoting Rational Drug Use in the Community 37 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

38. WHO Face to face Promoting Rational Drug Use in the Community 38 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

39. WHO Face to face Promoting Rational Drug Use in the Community 39 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

40. WHO Face to face Promoting Rational Drug Use in the Community 40 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