Lilia Manangan, Elvin Magee, Cheryl Tryon Division of Tuberculosis Elimination

1. The National Tuberculosis Surveillance System Training Program to Ensure Accuracy of Tuberculosis Data2010 USPHS Public Health Conference Lilia Manangan, Elvin Magee, Cheryl Tryon Division of Tuberculosis Elimination Centers for Disease Control and Prevention (CDC)

2. Presentation Overview • National Tuberculosis Surveillance System Training Program • Process for Developing, Implementing, and Evaluating the Training Program • Systematic Approach to Health Education • Lessons Learned • Next Steps

3. National Tuberculosis Surveillance System • Report of Verified Case of TB (RVCT) - standardized data collection form for TB disease surveillance • Web-based reporting • Data used to create annual TB surveillance report, monitor TB trends, and program planning

4. Revised Report of Verified Case of Tuberculosis (RVCT)

5. RVCT Revision Timeline 2007 1993 2001 2005 2008 2009 Requested comments from TB partners RVCT implement-ed RVCT revision work group conducted compre-hensive review of RVCT Last major RVCT revision Continued collabor-ation with experts on specific variables Received CDC and OMB clearance Conducted RVCT trainings Developed RVCT training materials Developed software

6. RVCT Training Program • Purpose • Train health care workers to accurately complete the revised RVCT • Target audience Health care workers from state and local healthdepartments, territories, and Pacific Islands who • Collect data from patients • Complete RVCT form • Enter data from RVCT into data system • Monitor accuracy of TB program data collection • Analyze data from RVCT

7. Provide a detailed description of the project Share with team members Revise throughout project Create a Training Plan Training Plan

8. Systematic Approach toHealth Education 1 Conduct Needs Assessment Develop & Pretest Concepts, Messages, & Materials 4 2 Assess Effectiveness & Make Refinements Implement the Program 3

9. Following these essential steps leads to Why Use the Systematic Process? Effective and successful health education materials and trainings

10. Improveskills Improveattitudes Increase knowledge Change behavior so that performance will improve Goal of Any Training Program Our goal: To increase accuracy of TB surveillance data

11. Systematic Approach toHealth Education 1 Develop & Pretest Concepts, Messages, & Materials Conduct Needs Assessment 4 2 Assess Effectiveness & Make Refinements Implement the Program 3

12. Conduct a Needs Assessment Alwaysdo this A needs assessment is a systematic process for obtaining and analyzinginformation to determine the gaps between The way things “are” The way things “ought to be”

13. Needs Assessment • Identified target audience(s) characteristics • Job positions • Knowledge level about the content • Skill level needed to perform the tasks • Determined what was needed to perform the job • Content (e.g., information, facts, statistics) • Tasks (skills such as complete registers/forms, analyze data) • Resources (e.g., materials, supplies, equipment, space)

14. Information Gathering • Reviewed surveillance data • Conducted expert reviews • Conducted focus groups • Reviewed surveillance training methods • Determined budget • Developed justification for training

15. Systematic Approach toHealth Education 1 Conduct Needs Assessment Develop & Pretest Concepts, Messages, & Materials 4 2 Assess Effectiveness & Make Refinements Implement the Program 3

16. Process for Developing Materials • Chose Project Team • Selected Type(s) of Training • Selected Training Methods • Selected Media • Determined Resources • Developed Content • Designed and Produced Materials • Pretested Materials

17. Selection of Types of RVCT Trainings and Training Activities • Based on adult learning principles • Best methods for gaining the skills • Needed flexible types of trainings to meet various situations

18. 3 Basic Learning Styles Visual Auditory Tactile

19. What Adults Remember Moreparticipationequalsmoreremembered Read Hear See Hear & See Say Say & Do % of What Adults Remember For people to learn something, they sometimes have to hear it 7 times.

20. Types of RVCT TrainingRVCT Self-Study Modules • Participants worked at their own pace using the print-based modules • Training activities • Read instructions on how to complete each item • Worked through study questions and case studies

21. Types of RVCT Training (cont.)Facilitated Training Sessions • Facilitators led training sessions • Conducted with large and small • groups • Introduced the content and led discussions (not a lecture-based training) • Training activities • Worked through the Self-Study Modules • Discussed content, study questions, and case studies

22. Types of Training Activities (cont.)Training-of-Trainers Teachback Methodology was used to teach participants how to teach the facilitated training session to others • Training activities • Facilitators used interactive lectures and exercises on training basics • Participants • Observed training demonstrations • Practiced teaching the course • Received feedback

23. Conducted 5 Curriculum Pretests with Target Audience This is important • Analyzed results • Reviewed comments from participants • Remained objective and open to suggestions • Incorporated appropriate ideas • Conducted item analysis on all questions • Determined how each question was answered (by entire group and specific individuals) • Determined which items had problems and what was causing the problems • Revised materials as necessary

24. Course Manuals RVCT Self-Study Modules Participant Manual RVCT Self-Study Modules Facilitator Manual

25. Materials on CD ROM or download from FTP site • RVCT Self-Study Modules – Participant Manual • RVCT Self-Study Modules – Facilitator Manual and other training materials • RVCT Instruction Manual (instructions only) • RVCT Self-Study Modules Exercises (exercises only) • RVCT Materials Description ftp://ftp.cdc.gov/pub/Software/TIMS/2009 RVCT Documentation/RVCT Training Materials/

26. Systematic Approach toHealth Education 1 Conduct Needs Assessment Develop & Pretest Concepts, Messages, & Materials 4 2 Assess Effectiveness & Make Refinements Implement the Program 3

27. Implementation • Collaborated with health departments • Trained volunteer trainers • Developed a distribution and marketing plan for the materials • Reviewed a sample production copy before mass copies were duplicated • Logistics • Determined number of trainings and course materials needed • Monitored travel and budget

28. D.C. Received training No training States/Jurisdictions that Have Received RVCT Training

29. Number of Health Care Workers Trained on the RVCT as of 9/30/2009

30. Systematic Approach toHealth Education 1 Conduct Needs Assessment Develop & Pretest Concepts, Messages, & Materials 4 2 Assess Effectiveness & Make Refinements Implement the Program 3

31. Types of Evaluations

32. Participant Comments about the RVCT Training Courses • I learned a lot. Very informative.I will now be able to apply the newest revisions to the RVCT. • It gives me complete information on how to fill out the RVCT form accurately and concise information to report on all TB cases in geographic, treatments, adverse effects on any medications, and the drug susceptibility and completion of therapy.

33. Participant Comments about the RVCT Training Courses (cont.) • The course was good because it has interactive sessions and all participants had input andcomments. It is very good to see the revised/new variables. • The Instructors are motivating as trainers and ask questions if we need to clarify all that is discussed. • There were some items that I thought I was filling in correctly, but now I know that I need to change some things.

34. Lessons Learned • Input from the field staff (reviews, field tests, trainings) • Enhanced our training materials • Motivated people to collect more accurate data • Established strong and valuable relationships with field staff • Communication opened-up with groups that have been distant in the past • Encouraged more collaboration and questions to submit accurate data

35. Lessons Learned (cont.) • Use of case studies help apply content • Participants said it was “fun” • Use of visuals (e.g., tables, diagrams) to make content easy to grasp and refer to • Designed manual to be • User -friendly, easy to locate things for reference • Flexible for use in various types of trainings (self-study, facilitator-led training sessions)

36. Lessons Learned (cont.) • Best as facilitator-led training with discussions • Not appropriate for computer-based course • Not appropriate for webinar (good for update or reviewing a small number of items)

37. Next Steps Provide updates at national and regional meetings Conduct additional RVCT trainings Evaluate training effectiveness and data accuracy Develop and implement new training course on quality assurance

38. Thank you