Principles of Face to Face
Education
1
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
2
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
3
Advantages of Persuasive
Face-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
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Effect of Persuasive Education on
Prescribing by Private MD’s in the
US
% change in prescribing in target drugs
0%
controls
print only
print & detail
-10%
(NS)
-20%
(p < 0.0001)
-30%
(n = 140)
(n = 132)
(n = 141)
-40%
Principles of Persuasive Face-to-Face
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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
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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
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Impact of Group Seminars on
Prescribing in Zambia
Adequate Examination
Correct Case Management
30%
20%
10%
0%
40%
20%
0%
Before
During
After
Before
Correct Drug
During
After
Correct Dose
80%
60%
40%
20%
0%
60%
40%
20%
0%
Before
During
After
Intervention
Before
During
After
Control
Source: Bexell et al. Zambia Essential Drugs Program. 1994
Principles of Persuasive Face-to-Face
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Effect of Small Group Training on
ORS Sales in Kenyan and
Indonesian Pharmacies
Kenya
Indonesia
% ORS Sales
% ORS Sales
80%
80%
60%
Pre
Post 1
Post 2
40%
20%
60%
Pre
40%
Post
20%
0%
0%
Wave 1
(N=58)
Wave 2
(N=24)
Controls
(N=25)
Training
(N=42)
Controls
(N=41)
Principles of Persuasive Face-to-Face
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Effect of Small Group Training on
Antidiarrheal Sales in Kenyan and
Indonesian Pharmacies
Kenya
Indonesia
% Antidiarrheal Sales
% Antidiarrheal Sales
70%
100%
60%
50%
40%
Pre
Post 1
Post 2
30%
20%
Post
0%
10%
0%
Pre
50%
Wave 1
(N=58)
Wave 2
(N=24)
Controls
(N=25)
Training
(N=42)
Controls
(N=41)
Principles of Persuasive Face-to-Face
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Size of Improvement by Intervention
Type in 36 Well-designed PHC
Interventions
MINOR
Informational:
Print Info / Guidelines
7
Training / Workshop
6
Community Case
Management
5
Group Process
Administrative:
Supervision / Audit
Essential Drugs Program
MODERATE
LARGE
4
3
2
1
0
0
0
0
1
1
% Improvement in Key Outcome
Principles of Persuasive Face-to-Face
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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
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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
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Motivations Reported
by 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."
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Motivations Reported
by 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
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Principles of Persuasive
Education
•
•
•
•
•
•
•
•
•
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
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Targeting Opinion Leaders
0.7
Percent of all C-sections
0.6
0.4
,
,
0.5
Discussion
with
Chief of
Obstetrics
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recommended
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— Cefoxitin
not recommended
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0.3
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Jan
Apr
Jul
84
Oct
Jan
Apr
Jul
85
Oct
Jan
Apr
Jul
Oct
86
Principles of Persuasive Face-to-Face
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Effect of Reinforcement on Reduction in
Use of Targeted Drug
Controls
0%
Number of Visits Completed
0
-5%
-10%
-15%
-20%
1
-25%
-30%
2
-35%
% CHANGE (PRE TO POST)
Principles of Persuasive Face-to-Face
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Characteristics of Persuasive
Educators
•
•
•
•
•
•
Good with language
Energetic
Alert
Good interpersonal skills
Calm under pressure
Some science background
Principles of Persuasive Face-to-Face
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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
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Activity One
Face-to-Face Visit with
Prescribers at Centro Health
Center
Principles of Persuasive Face-to-Face
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Face-to-Face Education
Conclusion
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
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