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CBIA-PREGNANCY TO IMPROVE SKILLS OF PREGNANT MOTHERS IN SELECTING OTC COMMON COLD PREPARATION

CBIA-PREGNANCY TO IMPROVE SKILLS OF PREGNANT MOTHERS IN SELECTING OTC COMMON COLD PREPARATION. Hidayati , S. 1 , Hartayu , TS. 2 , Munawaroh S. 3 , Suryawati S. 1 1 Centre for Clinical Pharmacology and Medicine Policy Studies, Gadjah Mada University, Yogyakarta, Indonesia

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CBIA-PREGNANCY TO IMPROVE SKILLS OF PREGNANT MOTHERS IN SELECTING OTC COMMON COLD PREPARATION

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  1. CBIA-PREGNANCY TO IMPROVE SKILLS OF PREGNANT MOTHERS IN SELECTING OTC COMMON COLD PREPARATION Hidayati, S.1, Hartayu, TS.2, Munawaroh S.3, Suryawati S.1 1Centre for Clinical Pharmacology and Medicine Policy Studies, GadjahMada University, Yogyakarta, Indonesia 2School of Pharmacy, SanataDarma University, Yogyakarta, Indonesia 3Agency for Women and Community Empowerment, Yogyakarta province, Indonesia

  2. ABSTRACT CBIA-PREGNANCY TO IMPROVE SKILLS OF PREGNANT MOTHERS IN SELECTING OTC COMMON COLD PREPARATION  Hidayati, S.1, Hartayu, TS.2, Munawaroh S.3, Suryawati S.1 1Centre for Clinical Pharmacology and Medicine Policy Studies, GadjahMada University, Yogyakarta, Indonesia 2School of Pharmacy, SanataDarma University, Yogyakarta, Indonesia 3Agency for Women and Community Empowerment, Yogyakarta province, Indonesia Problem Statement: Pregnant women may have common cold episodes during pregnancy and need medicine to soothe the symptoms. Skills in selecting medicines for common cold in pregnancy are important. Mother’s active learning method (known as CBIA) is one of the strategies which is not only improving knowledge but also changes behavior (EDM No.32,pp 22-23, 2003). Since information on the use of medicine in pregnancy also available in the medicines’ package, it is expected that CBIA-Pregnancy be focused on the medicines use in pregnancy. Objective: To pilot test CBIA-Pregnancy in improving knowledge and skills of pregnant women to select common cold medicines Design: An intervention study with pre and post quasi experimental design. Data were collected at baseline, one-day (Post I), 2 weeks (Post II), and 4 weeks (Post III) after intervention Setting: The study was conducted in 2 hospitals in Yogyakarta, Indonesia., i.e., SakinaIdaman and PantiRapih. Women visiting ANC in SakinaIdaman were assigned as intervention group and those visiting PantiRapih were assigned as control. Study Population: Pregnant women who visited ANC program in SakinaIdaman and PantiRapih hospital on regular basis. Intervention: CBIA-Pregnancy is a 2-hour small group discussion using information in the medicines’ package as training material and CBIA-Pregnancymodule as activity guide. There were 5 groups of 5–6 participants with midwives in the study hospital as facilitators. Participants searched information on active compound, indication, dosage, side effects, and contra-indications and also specific information on the use of the medicine during pregnancy. Policies: This strategy will provide hospitals with tools for hospital-based community empowerment and promoting self-learning behavior among the community Outcome Measures: score of knowledge on the most familiar medicine, % of subjects who could select the correct medicine, and feasibility assessment. Results: Score of knowledge increased significantly (p<0.05) from 4.08 + SD 2.42 at baseline to 6.88 + SD 2.41 at post I, to 6.92 + SD 2.31 at Post II, and to 6.65 + SD 1.72 at Post III in the intervention group. % of subjects who could select the correct medicine increased significantly after CBIA-Pregnancy training from 46% at baseline to 92% at post I (x2 test p<0.05), to 85% at post II, and to 90% at post III. (x2- test, p<0.05 compared to baseline). Feasibility assessment showed that CBIA–Pregnancy needed less time to conduct and cost less than seminar, was supported by legal statements on medicine and law of consumers’ protection. Conclusions: CBIA-Pregnancy improved knowledge and skills of pregnant women on selecting OTC common cold preparations. This strategy is considered easy to follow and feasible to implement in hospitals. Keywords:CBIA-pregnancy, common cold, Ante Natal Care, pregnancy, hospital-based community, self-medication Funding source:: WHO-SEARO

  3. BACKGROUND In Indonesia.. Common cold is the most prominent illness in the community Pregnant women may also experience common cold and need medicine to soothe the symptoms. However, many OTC medicines are not safe for pregnancy Can we train pregnant women on how to select OTC medicines which are safe for them? More than 200 brand names of OTC medicines for common cold are available in the market

  4. Which strategy to use? • A good strategy to improve medicine use in the community should have: • Specific purpose • specific target audience • Replicable, feasible CBIA uses medicine complete package as training material Including information for use during pregnancy Community based Interactive Approach (CBIA) is effective in improving skills in selecting OTC medicines An adaptation from the original CBIA strategy, focused on how to select OTC medicine which is safe for pregnancy was then developed and named: CBIA - Pregnancy

  5. STUDY OBJECTIVES • General Objective • To pilot test CBIA-Pregnancy in improving knowledge and skills of pregnant women to select OTC medicines for common cold • Specific Objectives • To measure the score of knowledge of pregnant mothers in how to select OTC medicine for common cold in pregnancy before and after CBIA - pregnancy training. • To measure practice of pregnant mothers in how to select OTC medicine for common cold in pregnancy before and after CBIA – pregnancy training • To evaluate in general, the effectiveness of an educational module targeted to hospital based community in improving skill to select OTC medicine for common cold in pregnancy.

  6. METHODS STUDY DESIGN: A pilot implementation study, applying a pre and post quasi-experimental design. The study was conducted in SakinaIdaman Private Maternity Hospital and PantiRapih Hospital. Both are in Yogyakarta province, Indonesia.Women visiting ANC in SakinaIdaman were assigned as intervention group and those visiting PantiRapih were assigned as control. STUDY SETTING:

  7. Final CBIA-Pregnancy Module Development of training module • Focus Group Discussions (FGD) to reveal experiences in using medicines during pregnancy • Drafting the CBIA-Pregnancy module • Review by experts • Testing the clarity with a group of pregnant mothers • Revising and finalizing the module

  8. CBIA-Pregnancy Training • 26 subjects from SakinaIdaman maternity hospital underwent training • Subjects were grouped into 5 groups of 5 – 6 • 2-hour interactive discussion. • CBIA-Pregnancy module was used as guideline • Facilitator: trained midwives . • Various OTC medicines for common cold complete with their original packages were used as training material • Phase I: Participants searched information on active compound, indication, dosage, side effects, and contra indications. • Phase II: Participants searched information use during pregnancy and discussed if the medicine is safe

  9. RESULTS CBIA Pregnancy improves knowledge and skills 1.Knowledge on the Most Familiar Medicine 2. Correctness in Selecting Medicine % score **) *) CBIA-Pregnancy significantly improved score of knowledge of the most familiar medicine Percentage of subjects who could mention the correct OTC medicine increased significantly after CBIA-Pregnancy training *) (Wilcoxon test, p<0.05). **) (X2 test, p<0.05)

  10. Is CBIA-Pregnancy feasible to replicate? • Time feasibility • Time consumed to prepare and to conduct CBIA - Pregnancy training : • One day facilitator training prior to the training • Two hour intensive interactive training • Acceptance/cultural feasibility • In-depth interview revealed that CBIA-Pregnancy trainingactivity was enjoyable and acceptable both for the patients and for the hospital staff. • Legal feasibility • CBIA-Pregnancy supports the implementation of the Law of Consumer Protection no. 8/ 1999 article 4: a - c on the rights of consumers, and article 5 on the obligation of consumers. • Information on the OTC medicine package is strictly controlled by the National Agency of Drug and Food Control (NA-DFC), under Ministerial Decree of Ministry of Health, Republic Indonesia No.02823/A/SK/XI/90. Therefore, information on the package of OTC medicine is considered reliable and can be used as source of accurate information for consumers. • Cost feasibility • Unit cost for conducting CBIA-Pregnancy activity for 30 participants was RP 40,000,00/ participant (USD 3.47) and this figure was less than unit cost of conducting large group seminar, which was Rp 133.333 (USD 11.55)/ participant

  11. SUMMARY • Hospital based community groups are available for educational purposes • CBIA-Pregnancy showed significant result to improve knowledge and correctness in selecting OTC medicine for common cold which is safe for pregnancy. • CBIA-Pregnancy is feasible to replicate on the setting where • There are groups of pregnant mothers who meet on regular basis such as in Ante Natal Care (ANC) clinic in hospitals • Information on the package of OTC medicine is considered reliable and strictly regulated and therefore, can be used as source of accurate information for consumers. • CBIA-Pregnancy cost less to conduct than large group seminar, and considered as an enjoyable activity by the participants

  12. CONCLUSION & POLICY IMPLICATION conclusion This strategy will provide hospitals with tools for hospital-based community empowerment and for promoting self-learning behavior among the community CBIA-Pregnancy is proven effective in improving knowledge and skills on selecting OTC medicine for common cold for pregnant women and is feasible to implement in hospital based community setting Policy implication

  13. ACKNOWLEDGEMENT The authors would like to thank to: • The WHO-SEARO for financial support. • Director and staff of the SakinaIdaman and PantiRapihhospitals in Yogyakarta Indonesia, for their support and cooperation during the study • All study participants • This study has been presented in • The Intercountry meeting of WHO-SEARO in India, 13 – 15 July 2010, • Funded by: WHO-SEARO.

  14. Thank You communication: Sri Hidayati srhida@yahoo.com

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