Transcript FINALFacetoFaceAdjusted304

Promoting Rational Drug Use
in the Community
Face to Face Education
Session objectives
1) Understanding of:
 What is good F2F education
 Advantages and disadvantages of F2F
 Why F2F is important/what it can achieve
 How people change behavior with F2F
 How and when to use F2F
 How to plan a F2F education project
2) Develop skills to understand problems and
encourage the person to try a new practice
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Face to Face in HIV/AIDS education
What characterizes good F2F?
Observations from field work?
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Good face to face education
 Relevant to personal and cultural needs
 Shows respect for people’s ideas and
practices
 Builds a bridge between old and new ideas
and practices
 Skills and credibility of educator
 Accessibility of key information
 Room for discussion and negotiation
 Includes check for understanding
 Others ???
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How and where to use F2F education?
 To discuss
drugs with
customers
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How and where to use F2F education?
 In training
courses
 In supportive
supervision
 Use + other
methods and
materials
 One-to-one
and small
groups
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How and where to use F2F education?
In
groups
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How and where to use F2F education?
 Convince
managers of
need for
programme
 To change
practices
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The reality: >50% of youth have sex
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Behavior change examples: Participants
 What did
you change?
 What or
who inspired
you to
change?
 How long
time did it
take?
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Children sent to buy drugs in
Kilifi: Reduced after training
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Behavior change in the community
What will make
her change?
Can you
change others?
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Behavior change basics
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You can only change yourself
To change behavior, you need a good reason
No one has ”a wrong idea”
Help people see need for change by expanding their view
Never push someone to change
To change, you require time and energy to think and
reflect
When people are in a stressed situation, they will not
consider change
We often judge people as being stubborn or ignorant if
they don’t want to change
Information only does not make people change
Create an enabling environment to help people change
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Emotions and Behavior Change
Emotions:
 Trigger BC
 Stop BC
”Fog” your view
Common problem UNCERTAINTY:
Not sure of anything
Stomach feeling,
Antennae down
Hear what you want to
hear
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Can you read reactions correctly?
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From Awareness to Change
Observations:
Role in group?
Any behavior or
practice you want to
change?
Ask group members to
support you to achieve
what you want
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What makes an educator credible?
 Status or “right to talk and be listened to”
 Experience with HIV/AIDS
 Knowledge
– of the problem and the treatment (biomedical)
– of the community: Perceptions, practices and
reasons for these
 Attitude:
– Respects people and reasons why it might feel
impossible to follow advice to change
 Communication skills (see next slide)
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Educator: Essential communication skills
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Educator: Essential communication skills
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Empathy
Approachable, and makes people welcome and at ease
Respectful of others
Curious - willing to learn
Good communicator - good listener: Active listening
Inspires dialogue and views
Can identify problems/constructive solutions
Knowledgeable about the subject
Can say “I don’t know - I’ll find out”
Can accept criticism
Non-judgemental
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Educating patient to use ARV
Demonstration role-play:
Lethiwe and Robert
 Observe: What skills is she using?
 What is she doing well?
 What could be improved?
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Six skills for effective education
The first set of 3 skills:
Understanding the problem by:
 observing the mood of the
client/customer and responding
appropriately
 asking open questions
 listening carefully and trying to
understand
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Six skills for effective education
The second set of 3 skills:
Responding to the problem/needs by:
 giving accurate and clear advice and
explaining why
 discussion to reach agreement
 checking for understanding
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How to
give
advice
effectively?
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How to
give
advice
effectively?
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How to give advice effectively
 Make it clear and simple.
– how the drug works, how often to take it,
for how long.
 Explain WHY this treatment
 Explain importance of finishing the
treatment and what can happen if you don’t
 Be confident, friendly and non-judgemental
 Be practical - if possible demonstrate how
to measure and administer dose
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Communication barriers (1): Client
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Communication barriers (1): Client
The client or customer
 feels uncomfortable
 does not trust the educator
 does not have money to follow advice
 feels worried/judged/patronised
 does not dare to ask questions
 gets too much - or too complicated
information
 does not have the time
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Communication Barriers (2): Educator
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Communication Barriers (2)
The educator
 Unfriendly, judgemental or patronising
 lacking respect for patient’s perceptions,
practices and concerns
 Does not listen - interrupts - argues
 Uses technical language
 Lacks the appropriate knowledge and expertise
 Does not follow-up
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Communication barriers (3)
The environment
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too noisy
not safe
not private
not comfortable
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Using F2F in projects
 Aim: What do you want to communicate? To
whom? Through which channels? Is F2F needed
for some of it? Why - to achieve what, with
whom?
 What personnel is needed to do F2F? Do you
have this personnel? Do they need further
training?
 What support materials do you need for the
trainers to use in their education?
 What is your budget?
 How are you going to monitor and evaluate the
effect?
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Support F-to-F with other methods
 Continuing community education - use
simple materials and health workers or
informal providers as resource people
 Training for community leaders - encourage
them to take a lead role
 Encourage activities in schools
 Give information through community
meeting, local radio, community drama, etc
NB good supporting educational materials will
improve the impact of F to F interventions
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Summary F-to-F
effective method to change practices
useful in a mix of methods
best supported by educational materials
content should be based on (participatory)
research
 educator must understand and respect
community views and practices
 educator must be respected and skilled in
participatory methods
 supportive supervision essential
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Additional slides and handouts for F to F
 Slides … to … can be used to teach
content of session notes
 Slides used in session today are new, and
introduces material (behavior change)
which is not included in session notes
 Additional handouts provided gives this
background
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Requirements for success
 Analyse the problem - early research needed
 Assess perceptions and practices and reasons
for these, and perception of need for change
 Respect people and develop solutions with
them
 Build bridges between old practices and new
 Focus on sustainability
 Use credible and skilled communicators
 Involve and inform opinion leaders
 Be available over time
 Support with a variety of educational methods
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Pros and cons of F-to-F education
 Improves rational use and compliance
 Reduces morbidity and mortality
 Empowers people
 Encourages good communication
 Changes behaviour
 Allows immediate feedback
 Can include practical demonstration
 Promotes general awareness
 Encourages neighbours to discuss with each other
 Expensive (financial and human resources)
 Requires skilled and motivated educators
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Evidence to support use of F-to-F
Review of 37 studies investigating
compliance/adherence concluded:
 Teaching patients resulted in improved
compliance
 Poor communication with health workers
most common cause of non-compliance
 Lack of continuity in patient-physician
interaction contributed to non adherence
 In Kenya ORS sales increased 30% and in
Indonesia 21% after pharmacy workers
received F to F training
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Lessons from ORS study in Nepal
 Gain the confidence of opinion leaders and
traditional healers - explain problem and plan invite their ideas and participation
 Keep them involved and informed throughout
 Use successes and positive experiences to
motivate others
 Create (or use existing) forum for exchange of
experiences
 Successful use of new practice by neighbours
inspires imitation
 importance of using educators with local
knowledge and language as facilitators
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Team building: Characteristics of team
There must be
 Awareness of unity
 Interpersonal relationship
Members must have the ability to
 Act together toward a common goal
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10 Characteristics of well-functioning
teams
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Purpose: Share why team exist
Priorities: What needs to be done, by whom, when
Roles: Must know own roles, and when to ask others
Decision: Authority and decision-making lines clearly
understood
Conflict: Dealt with openly. Considered important to
decision-making and personal growth
Personal traits: Members feel appreciated and utilized
Norms: Group norms are set. Seen as standard for
everyone
Effectiveness: Members find team meetings efficient.
Look forward to this time together
Success: Know when team is successful, share it equally
and proudly
Training: Opportunities for feedback and updating skills
given, and used
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Guidelines: effective team membership
Contribute ideas and solutions
Recognize and respect differences in others
Value the idea and contributions of others
Listen and share information
Ask questions and get clarification
Participate fully and keep your commitments
Be flexible and respect the partnership created
by the team - strive for the “win – win”
 Have fun and care about the team and the
outcomes
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