1 Principles of Face to Face Education. Principles of Persuasive Face-to-Face Education 2 Principles...

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Principles of Face to Face Principles of Face to Face EducationEducation

Principles of Persuasive Face-to-Face Education

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Principles of Face to Face Principles of Face to Face Education: ObjectivesEducation: Objectives

• Recognize the advantages of persuasive Recognize the advantages of persuasive face-to-face educationface-to-face education

• Identify the key principles and techniquesIdentify the key principles and techniques

• Understand how to carry out persuasive Understand how to carry out persuasive face-to-face interventionface-to-face intervention

• Be able to train others how to conduct Be able to train others how to conduct effective face-to-face educationeffective face-to-face education


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Diversity of Educational StrategiesDiversity of Educational Strategies

StylesStyles• didactic vs. problem-orienteddidactic vs. problem-oriented• lecture vs. multi-method traininglecture vs. multi-method training• one shot vs. repeated encountersone shot vs. repeated encounters

TargetsTargets• health problem vs. prescribing focushealth problem vs. prescribing focus• varying resistance to changevarying resistance to change

Audience & settingAudience & setting• small group vs. large groupsmall group vs. large group• on-site vs. district seminaron-site vs. district seminar


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Advantages of PersuasiveAdvantages of PersuasiveFace-to-Face EducationFace-to-Face Education

• Present both sides of controversiesPresent both sides of controversies

• Target opinion leadersTarget opinion leaders

• Two way communicationTwo way communication

• Adapt message to prescriber's situationAdapt message to prescriber's situation

• Able to reinforce improved behaviorAble to reinforce improved behavior


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Effect of Persuasive Education on Effect of Persuasive Education on Prescribing by Private MD’s in the Prescribing by Private MD’s in the USUS

0%0%

-10%-10%

-20%-20%

-30%-30%

-40%-40%

% change in prescribing in target drugs% change in prescribing in target drugs

(n = 140)(n = 140) (n = 132)(n = 132) (n = 141)(n = 141)

(p < 0.0001)(p < 0.0001)

(NS)(NS)

controls

print only

print & detail


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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


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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 interventionIntervention

• three 2-day workshops in 4 months• topics: STGs for malaria, diarrhea, ARI• self-audit, cases, lectures, group work


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Impact of Group Seminars on Impact of Group Seminars on Prescribing in ZambiaPrescribing in Zambia

Intervention Control

Source: Bexell et al. Zambia Essential Drugs Program. 1994Source: Bexell et al. Zambia Essential Drugs Program. 1994

Adequate Examination

0%

10%

20%

30%

Before During After

Correct Case Management

0%

20%

40%

Before During After

Correct Drug

0%20%40%60%80%

Before During After

Correct Dose

0%

20%

40%

60%

Before During After


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Effect of Small Group Training on Effect of Small Group Training on ORS Sales in Kenyan and ORS Sales in Kenyan and Indonesian PharmaciesIndonesian Pharmacies

0%

20%

40%

60%

80%

Pre

Post 1

Post 2

Wave 1(N=58)

Wave 2(N=24)

Controls(N=25)

% ORS Sales

Kenya

0%

20%

40%

60%

80%

Pre

Post

Training(N=42)

Controls(N=41)

% ORS Sales

Indonesia


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Effect of Small Group Training on Effect of Small Group Training on Antidiarrheal Sales in Kenyan and Antidiarrheal Sales in Kenyan and Indonesian PharmaciesIndonesian Pharmacies

0%

10%

20%

30%

40%

50%

60%

70%

Pre

Post 1

Post 2

Wave 1(N=58)

Wave 2(N=24)

Controls(N=25)

% Antidiarrheal Sales

Kenya

0%

50%

100%

Pre

Post

Training(N=42)

Controls(N=41)

% Antidiarrheal Sales

Indonesia


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Size of Improvement by Intervention Type in 36 Well-designed PHC Interventions

0

1

2

3

4

5

6

7

0 0 0 1 1

% Improvement in Key Outcome

Training / Workshop

Community Case Management

Group Process

Informational:Print Info / Guidelines

Administrative:Supervision / Audit

Essential Drugs Program

MODERATEMINOR LARGE


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Findings About Educational Strategies

Large impact (>25% improvement)Large impact (>25% improvement)• repeated problem-oriented groupsrepeated problem-oriented groups

Moderate impact (10-25% improvement)Moderate impact (10-25% improvement)• single health problem focussingle health problem focus• small problem-focused on-site training -or- large multi-small problem-focused on-site training -or- large multi-

method seminarmethod seminar• gains from small group more sustainedgains from small group more sustained

Small impact (<10% improvement)Small impact (<10% improvement)• distributing print info or guidelinesdistributing print info or guidelines• single didactic seminar or diffuse focussingle didactic seminar or diffuse focus


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Sites for Face to Face EducationSites for Face to Face Education

• Health centersHealth centers• HospitalsHospitals• PharmaciesPharmacies

• Continuing education seminarsContinuing education seminars

Face to Face education can occur in many sitesFace to Face education can occur in many sites.

Face to Face education can occur as part of:Face to Face education can occur as part of:• TrainingTraining• SupervisionSupervision• Regular support visitsRegular support visits• Clinical consultationClinical consultation


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2. Use of Placebos2. Use of Placebos

• "...I always give patients drugs with "...I always give patients drugs with names they don't know..."names they don't know..."

• "If the patient likes it, it's O.K.""If the patient likes it, it's O.K."

3. Clinical Experience3. Clinical Experience

• "...my own experience shows that these "...my own experience shows that these drugs work."drugs work."

Motivations ReportedMotivations Reportedby Prescribersby Prescribers


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Motivations ReportedMotivations Reportedby Prescribersby Prescribers

1. Patient Demand1. Patient Demand

• " Vitamins are virtually useless, but " Vitamins are virtually useless, but patients always ask for them...and will patients always ask for them...and will go elsewhere if they are not pleased".go elsewhere if they are not pleased".

• "...Not enough time to bother with "...Not enough time to bother with changing people's minds."changing people's minds."


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Principles of PersuasivePrinciples of PersuasiveEducationEducation

• Relevant to actual therapeutic decisions and actionsRelevant to actual therapeutic decisions and actions• Understand the reasons for prescribingUnderstand the reasons for prescribing• Be oriented toward decisions and actionsBe oriented toward decisions and actions• Emphasize only a few key messagesEmphasize only a few key messages• Capture attention with headlinesCapture attention with headlines• Use appealing print materialsUse appealing print materials• Use brief, simple textUse brief, simple text• Refer to the best researchRefer to the best research• Have a respected sponsorHave a respected sponsor


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Targeting Opinion LeadersTargeting Opinion Leaders

JanJan AprApr JulJul OctOct JanJan AprApr JulJul OctOct JanJan AprApr JulJul OctOct8484 8585 8686

00

0.10.1

0.20.2

0.30.3

0.40.4

0.50.5

0.60.6

0.70.7Percent of all C-sectionsPercent of all C-sections Discussion Discussion

withwithChief of Chief of ObstetricsObstetrics

-- Cefazolinrecommended

— Cefoxitinnot recommended


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Effect of Reinforcement on Reduction in Effect of Reinforcement on Reduction in Use of Targeted DrugUse of Targeted Drug

0%0%

-5%-5%

-10%-10%

-15%-15%

-20%-20%

-25%-25%

-30%-30%

-35%-35%

ControlControlss

Number of Visits CompletedNumber of Visits Completed

00

11

22

% CHANGE (PRE TO POST)% CHANGE (PRE TO POST)


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Characteristics of Persuasive Characteristics of Persuasive EducatorsEducators

• Good with languageGood with language

• EnergeticEnergetic

• AlertAlert

• Good interpersonal skillsGood interpersonal skills

• Calm under pressureCalm under pressure

• Some science backgroundSome science background


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Managing Face-to-Face Managing Face-to-Face EducationEducation

• Target high frequency usersTarget high frequency users

• Inform the target prescribers in advanceInform the target prescribers in advance

• Explain sponsorship and purposeExplain sponsorship and purpose

• Schedule follow-up visitsSchedule follow-up visits

• Monitor performanceMonitor performance


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Activity OneActivity One

Face-to-Face Visit with Face-to-Face Visit with Prescribers at Centro Health Prescribers at Centro Health

CenterCenter


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Face-to-Face EducationFace-to-Face EducationConclusionConclusion

• TargetedTargeted

• Has a clear messageHas a clear message

• Actively managed with monitoringActively managed with monitoring

• Fits the institutional environmentFits the institutional environment

Face to face education can be an Face to face education can be an effective intervention if it iseffective intervention if it is::

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