AI Related Booklet Pretest Study (administrative medical workers)

1. AI Related Booklet Pretest Study (administrative medical workers) Date:February 2009 Prepared for:Academy for Educational Development Research Team:SIAR Research and Consulting Qualitative Team

2. Objectives and Methodology

3. Background info and purpose of the research • Background information • The U.S. Agency for International Development has awarded Academy for Educational Development (hereinafter, AED) a global Task Order to conduct behavior change communications activities on avian influenza prevention and containment and response to pandemic influenza. In Azerbaijan, target audiences for these communication activities include: small rural backyard poultry farmers (Sector 4), small commercial farmers (Sector 3), first responders to public health or natural disasters, and human and animal health officials. • Purpose of the research • As a second step of the Azerbaijani part of the project, AED has concluded contract with SIAR Research and Consulting Group (hereinafter, SIAR) to conduct qualitative research aimed at pretesting the booklet among specific target groups, namely healthcare workers and administrative workers of health institutions. More specifically, the goal was to understand: • ..to what extent the text in the booklet is understandable and applicable • ..the lucidity of the text • ..to what extent the picture used in the booklet are relevant • ..the weak sides of the booklet and define ways of its development

4. Methodology Method Qualitative Research Technique Focus Group Discussions Timing February, 2009

5. Sample design

6. Perception

7. Perception: General opinion about 1st paragraph This part is about H5N1 virus, symptoms of AI disease, measures which should be taken to protect patients, employees and people around us. Majority of respondents in Baku and regions perceive symptoms listed in the leaflet to negatively (or from negative to neutral in regions), because they were too general and do not characterize the disease. • Suggested measures: • To provide more detailed information on both mentioned and other symptoms and ways of transmission. ” Information on being transmitted by droplet, it should be explained in details” Baku

8. Perception: General opinion about 2nd paragraph Second paragraph is about self-protection (namely, hand washing, using personal protection means (especially, masks and gloves), etc.). AI suspected people should wear masks or close mouth with clean piece of material and should not be in same wards with others or should be in 1 meter distance from others. Information about hand washing for 15-20 seconds seems to be unreal. • Suggested measures: • The part should be shortened (written more concrete). For instance, “wear gloves and mask” or “keep up cleanness”. It would be remembered better. • Information really necessary for administrative medical workers should be provided. E.g. it was mentioned that all medical workers knew given information and in department of infectious diseases it is ordinary procedure, regardless of whether it is AI or not. ” If washing hands helps in killing infections people would not use gloves ” Baku ” It is for people who are going on transport” Baku

9. Perception: General opinion about 3rd paragraph Part named “Main points” is related to providing information to patients and visitors about ways of preventing spread of AI (or other diseases). It was considered to be important, but information in this part related to notices about not spitting on the floor after cough or sneezing as it is naturally enough. Some sentences appear to be long and complicated. • Suggested measures: • First point should be divided to sub points. • Sentences should be shorter and easier. ” Very long and complicated sentences” Baku

10. Perception: General opinion about 4th paragraph • This paragraph consists of: • Napkins, soap, water, towels and dustbins for patients and their family members • Enough reserve of personal protection means for all medical workers, visitors and patients • Commemorative booklets of proper hand washing, usage of personal protection means for workers • Suggested measures: • Antiseptic napkins should be mentioned in the text, because water and soap is not available everywhere, and these napkins are also more effective than water and soap. • Repetition is better to be avoided “Partially 2nd point is repeated, it is not necessary.” It would be good to explain what “FMV” include. • This part should also provide information on any other special cleaning means. • Last point is unnecessary as hand washing was already mentioned before and as they are aware of how to wash hands. 1st point is the most important.

11. Perception: General opinion about 5th paragraph • 5th paragraph is about system that every medical institution should work out to identify possible AI cases and respective information provision. • Suggested measures: • The sentence “For instance, it is important to:..” is not grammatically linked to the text given in the bullet points’ form. • Long sentences should be divided into small ones • Information should be properly divided into points: 3rd point should be divided into two parts as there is information of different types. • The part should be generally shorter and more concrete. It is important part. • Some information (second sentence in the third point) is mentioned to be intended for medical workers.

12. Perception: General opinion about 6th paragraph • 6th paragraph was about Instructions of Ministry of Health. • Suggested measures: • Advices should be more concrete • Measures to be taken during outbreak should be mentioned • There should be no repetition (symptoms) • Tests are very necessary and description of them should be inserted

13. Lucidity of text

14. Lucidity of text • Text of the leaflet was quite understandable (“it is understandable for everybody”). Most of respondents stated that they were aware of the given information. Mostly respondents did not learn anything new from the leaflet (besides N-95 mask and H5N1 virus in some cases). Cleaning wards, wearing masks and other procedures and advices are followed daily regardless of AI outbreak. Respondents in Baku were much more irritated by the leaflet than respondents in the regions. In general, the booklet is credible. Given advices should be followed. • Suggested measures: • Divide long sentences into small ones • Different type of Information should be divided into points

15. Perception of pictures and its fitting to the text. Effectiveness of explanation ofsome ideas by pictures

16. Perception of pictures and its fitting to the text. Effectiveness of explanation ofsome ideas by pictures. • Pictures and text were mentioned to be important equally, mutually complementary. Because pictures make people get interested and attract. Majority of respondents stated that it would be much better if pictures are commented / named. All pictures fit text (for Baku respondents besides 1st picture on the last page). Photos are better than pictures. Pictures should not be repeated along the leaflet (1st and 2nd ones). • Suggested measures • First 2 pictures are quite understandable for respondents in regions • 2nd scene should be reflected better, it is quite primitive. Several times respondents mentioned that it seems that the patient is standing, but he should lie. • 3rd picture: Person should wash hands under running water. There should be tap in the picture and a soap pictured near the tap / the soap reflected in hands is not understandable. Liquid soap should be used instead of bar soap. • Next 2 pictures reflecting person wearing mask were considered to be necessary, but the shoe covers should be added.

17. Perception of pictures and its fitting to the text. Effectiveness of explanation ofsome ideas by pictures. • Suggested measures • Picture reflecting lying person should be more interesting. Box should be pictured better, his being isolated should be noted better, the picture needs a comment. If it is a dropper near him, it should be reflected better. • Picture reflecting medical garbage box: The box should be on the floor, the doctor throwing it away should wear doctor's smock (Regions). The box looks like postal box. Syringe in hand is not credible, should be shown opened. Information regarding throwing the bag away or burning it should be given. • Picture with napkins should also reflect dustbin / garbage box. Reflected bottle should be somehow named (Baku ), it is not understandable what it is (majority guessed that it is liquid soap). • Last picture does not fit the text because it reflects people, none of which looks like medical worker or representative of healthcare institutions.

18. Whether the leaflet can be better

19. Whether the leaflet can be better • Suggested measure • More information regarding actions during AI outbreak • More concrete symptoms • More thorough information should be provided • Not to give repetitious information. • Main points should be stressed via “bold” or “underline”. • The leaflet should be changed as it seems to be for ordinary people, but not for medical workers. • Any number (hot line), place to address when there is an AI outbreak; information on specialized clinics should be added. • The text should be more concrete and shorter. • There should be information on which concrete tests to pass and which measures to take. • Pictures should be replaced by photos (suggested in Baku) which should be commented. • More concrete information should be added in the last part regarding tests and laboratory.

20. Thank you for attention!