Principles of Face to Face Education

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 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 PersuasiveFace-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 Principles of Persuasive Face-to-Face Education

5. % change in prescribing in target drugs 0% -10% (NS) -20% (p < 0.0001) controls print only print & detail -30% (n = 140) (n = 141) (n = 132) -40% Effect of Persuasive Education on Prescribing by Private MD’s in the US 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 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 Principles of Persuasive Face-to-Face Education

8. Intervention Control 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 80% 60% 60% 40% 40% 20% 20% 0% 0% Before During After Before During After Source: Bexell et al. Zambia Essential Drugs Program. 1994 Principles of Persuasive Face-to-Face Education

9. Effect of Small Group Training on ORS Sales in Kenyan and Indonesian Pharmacies Kenya Indonesia % ORS Sales % ORS Sales 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 Kenya Indonesia % Antidiarrheal Sales % Antidiarrheal Sales 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 3 Administrative:Supervision / Audit 2 1 Essential Drugs Program 0 0 0 0 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 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 • 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 Reportedby 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 Reportedby 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 PersuasiveEducation • 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 Principles of Persuasive Face-to-Face Education

17. Discussion with Chief of Obstetrics Percent of all C-sections 0.7 ! ! ! ! 0.6 ! -- Cefazolin recommended , ! , 0.5 ! ! ! ! ! ! , ! , ! , ! ! , 0.4 , , ! ! — Cefoxitin not recommended , ! ! , 0.3 ! , ! ! , , 0.2 , ! ! , , 0.1 , , , ! , , , ! , , , , , ! ! ! ! ! ! ! , , , , , , , 0 Jan Apr Jul Oct Jan Apr Jul Oct Jan Apr Jul Oct 84 85 86 Targeting Opinion Leaders Principles of Persuasive Face-to-Face Education

18. Controls Number of Visits Completed 0% 0 -5% -10% -15% 1 -20% -25% -30% 2 -35% % CHANGE (PRE TO POST) Effect of Reinforcement on Reduction in Use of Targeted Drug 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. Activity One Face-to-Face Visit with Prescribers at Centro Health Center Principles of Persuasive Face-to-Face Education

22. Face-to-Face EducationConclusion 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