CBIA-PREGNANCY TO IMPROVE SKILLS OF
PREGNANT MOTHERS IN SELECTING OTC COMMON
COLD PREPARATION
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, Gadjah Mada University, Yogyakarta, Indonesia
2School of Pharmacy, Sanata Darma 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., Sakina Idaman and Panti Rapih. Women visiting ANC
in Sakina Idaman were assigned as intervention group and those visiting Panti Rapih were assigned as control.
Study Population: Pregnant women who visited ANC program in Sakina Idaman and Panti Rapih 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-Pregnancy module 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
BACKGROUND
In Indonesia..
Common cold is
the most
prominent illness
in the community
More than 200 brand names
of OTC medicines for
common cold are available in
the market
Pregnant women
may also experience
common cold and
need medicine to
soothe the symptoms.
However, many OTC
medicines are not
safe for pregnancy
• A good strategy to improve medicine use in the community should have:
 Specific purpose
 specific target audience
 Replicable, feasible
CBIA uses
Community based
medicine
Interactive Approach
complete
(CBIA) is effective in
package as
improving skills in
training material
selecting OTC
Including
medicines
information for
use during
pregnancy
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
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.
METHODS
STUDY DESIGN: A pilot implementation study, applying a pre and post quasiexperimental design.
STUDY SETTING: The study was conducted in Sakina Idaman Private Maternity Hospital and
Panti Rapih Hospital. Both are in Yogyakarta province, Indonesia. Women
visiting ANC in Sakina Idaman were assigned as intervention group and
those visiting Panti Rapih were assigned as control.





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
Final CBIA-Pregnancy
Module
 26 subjects from Sakina Idaman 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
RESULTS
CBIA Pregnancy improves knowledge and skills
1.Knowledge on the Most Familiar Medicine
score
%
2. Correctness in Selecting Medicine
**)
*)
CBIA-Pregnancy significantly improved
score of knowledge of the most familiar
medicine
*) (Wilcoxon test, p<0.05).
**) (X2 test, p<0.05)
Percentage of subjects who could mention the
correct OTC medicine increased significantly after
CBIA-Pregnancy training
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 training activity 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
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
CONCLUSION & POLICY IMPLICATION
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
This strategy will provide hospitals with tools for hospital-based
community empowerment and for promoting self-learning behavior
among the community
ACKNOWLEDGEMENT
The authors would like to thank to:
 The WHO-SEARO for financial support.
 Director and staff of the Sakina Idaman and Panti Rapih hospitals in Yogyakarta
Indonesia, for their support and cooperation during the study
 All study participants
This study has been presented in
 The Inter country meeting of WHO-SEARO in India, 13 – 15 July 2010,
 Funded by: WHO-SEARO.
Thank You
communication:
Sri Hidayati
srhida@yahoo.com