16. Miscellaneous health topics including primary health care, patient education/use of medicines
16.1 General health education programmes
16.2 Primary health care and use of lay workers
16.3 Patient education and the use of medicine
16.4 Safety education and injury prevention
16.5 Miscellaneous schools
lick on the link for details of the Leeds Health Education Database Project, a complete listing of papers included and a listing of papers on family planning reviewed but not included in the database
16.1 General health education programmes
Adamolekun, B. Seasonal ataxia in western Nigeria: Evaluation of the impact of health education on hospital prevalence. Journal of Epidemiology and Community Health 49:489-491, 1995. Ref ID : 3501 (Borderline for inclusion in database)
Target Group/Country Hospital patients and their relatives in rural Nigeria
Intervention Methodology Focused health education on the hospital prevalence of a seasonal ataxic syndrome that occurs after eating the larvae of Anaphe venata Butler (Lepidoptera, Notodontidae). Hospital workers in western Nigeria were informed of prevalence of seasonal ataxia and were encouraged to educate hospital patients and their relatives and neighbors.
Evaluation Method The number of admissions for seasonal ataxia in the pre-intervention years (1990 and 1991) and the intervention years (1992 and 1993) were extracted from records, and prevalence rates were calculated and compared. There were no controls
Impact Achieved The pre-intervention prevalence rates were 1.27% and 1.59% for 1990 and 1991, respectively. The prevalence rates in the intervention years of 1992 and 1993 were .58% and .006%, representing a 65.5% reduction between 1991 and 1992, and a 99% reduction between 1992 and 1993. This study is limited by the absence of significance tests or controls.
Akram, D.S. and Agboatwalla, M. A model for health intervention. Journal of Tropical Paediatrics 38(2):85-87, 1992. Ref ID : 2507 (Borderline for inclusion in database)
Target Group/Country Women in squatter settlements in Karachi, Pakistan
Intervention Methodology 4 physicians taught 10 community health workers (CHW) certain health messages concerning reduction of the incidence of diarrhea, respiratory infection, and fever. Using the same messages, each CHW then informed 10 women living in a squatter settlement of Karachi, Pakistan how to improve health practices using the simple health messages. Topics included breast feeding, child nutrition, immunization, household sanitation, and personal hygiene.
Evaluation Method Researchers evaluated the project with pre and post intervention surveys and using a control group. Details of the survey including sampling and respondents are not provided. It is stated that results are based on 1551 children but it is not indicated how these were divided between intervention or controls.
Impact Achieved The snow balling effect reached 700 people. The health messages significantly improved
management of diarrhoea, respiratory infection, and fever in the intervention group (p<.05). 6 months after hearing the health messages, >60% of mothers used oral rehydration solution (ORS) to treat diarrhoea and only 20% needed the advice of a physician. Literacy had a positive effect on home treatment for diarrhoea, but not on treatment for respiratory infection or fever. Further the incidence of all 3 conditions was considerably lower in the intervention group than the control group (p<.05). A weakness with this report is the lack of clarity on data collection and sampling.
Bertrand, J.T. and Bertrand, W.E. Health education among the economically deprived of a Colombian city. International Journal of Health Education 22(2):102-112, 1979. Ref ID : 369 (Borderline for inclusion in database)
Target Group/Country Low income community in Colombia
Intervention Methodology Vivamos Mejor (Let's Live Better) is a health education program conducted in Colombia for low-income people who needed knowledge about nutrition, preventive medicine, family planning, sex education, and child raising. A 3-3 1/2 hour lecture and slide presentation (discussion, movies, puppet shows) is held at 6 p.m. in a local school. Attendance is encouraged by nurse-auxiliary extension workers who extend written invitations in a given neighborhood. A 40-page color booklet recapping the lecture information is given to those who attend.
Evaluation Method 128 women 15-49 yrs persons interviewed in the target community and 100 in a control community. There was no baseline. The interview schedule contained questions that were designed to create a health knowledge and a health hazards index. (note it is not clear from the report the sample size. It is stated that 100 exposed and 100-non-exposed were required for the Silo community but the report goes on to say that there were 128 respondents.
Impact Achieved Of the 128 respondents to the questionnaire, 38.3% (49) had received an invitation to come to the education sessions but only 21.9% (28) had attended. The initial goal of 80% coverage was not achieved. Women who had been to the lecture scored higher on all topics than nonattendants from Siloe or the control group from Terron Colorado (p<0.01). A greater percentage of the exposed population displayed desirable health practices. Women were more likely to have had their children vaccinated, prepare fresh vegetables, use meat, if they had attended the program than the non-exposed groups . 39% of those exposed to the program were using birth control compared to 33% of the non-exposed (significance tests for behaviour change not reported). The lack of baseline means that it is not possible to exclude the possibility that the persons attending the educational sessions were a self-selecting sample of women with higher motivation and interest in health topics.
Brown ,J. and Cody,M.J. (1991) Effects of a prosocial television soap opera in promoting women's status. Human Communication Research 18, 114-142. Ref ID: 8945
Target Group/Country General population in India
Intervention Methodology "Hum Log," India's
first long-running television soap opera. The soap opera is intended to promote
prosocial beliefs about the role of women in India.The proucers created positive
and negative role models to demonstrate the prosocial behaviours. At he end
of ech episode a famous Indian film actor gave a 30 to 50 second epilogue in
which he summarised the main points.
Evaluation Method a survey of 1170 respondents from three
geographic areas. A structural equation model was developed to measure the impact
of awareness, involvement, and television dependency on personal beliefs.
Impact Achieved The programme became the most popular
television programme in the history of Indian television with audience ratings
of 90% in North India and 40% in the non-Hindi speaking South India. The programme
was financially successful for its sponsors. Viewers who were most exposed to
"Hum Log" were more involved with its characters and more dependent
on Indian television for education and entertainment, but were no more aware
than their less exposed counterparts of the prosocial beliefs promoted by the
soap opera. There was no significant association between viewers' involvement
with the characters and their beliefs about women's equality, freedom of choice,
or family planning. Moreover, viewers who were more dependent on television
did not exhibit significantly stronger beliefs about these issues. There was
a significant association between awareness of the prosocial messages promoted
in "Hum Log" and viewer beliefs in freedom of choice and family planning
(p<0.05). Overall, it appears that, while "Hum Log" enjoys a large
and dedicated audience, its messages regarding women's equality are not being
assimilated on a large scale. An analysis of the female characters in the soap
opera reveals that, in many cases, the self-sufficient, career-oriented women
experienced negative social consequences, while characters who pursued more
traditional female roles were rewarded. This evaluation provides an important
lesson on the limitations of mass media soap opera for changing deeply entrenched
norms in a society. It is a remarkable but salutory lesson that a programme
can be entertaining yet at the same time not able to fulfil its (admittedly
Clark, N.M. and Gakuru, O.N. The effect on health and self-confidence of participation in collaborative learning activities. Hygie 1(2):47-56, 1982. . Ref ID: 3140. (Borderline for inclusion in database)
Target Group/Country Residents in 6 rural villages in the coastal region of Kenya
Intervention Methodology The programme sought to increase feelings of competence, develop adult skills through collaborative activity and thereby promote health. Women listed on the rosters of village women's club were invited to participate in the learning program. Following an intensive 14 day workshop facilitators were trained to use simple materials such as discussion starters, to engage group participants in dialogue and problem solving, to draw on participants' experience and abilities, to introduced related health nutrition and other information and to provide or help learners obtain resources or technical assistance. The education inputs consisted of a series of learning activities over a 12 month period (that are not described).
Evaluation Method 130 female participants were interviewed at the outset and following program activities. 50 non participants were interviewed only at the end. Women were invited to express their levels of confidence in their own ability to contribute time, money and labour to self help activities. Questions were asked of the extent of involvement in community activities as well as health practices. In addition the facilitators kept a log of their sessions. And this was used to derive a measure of group confidence( willingness to take a risk, confront a problem, raise a question or discuss a difficult issue).
Impact Achieved By the end of the programme five of the six learning groups had implemented at least one on-going collaborative activity. Changes in behaviour noted in post scores at p<0.05 level included eating chicken twice or more times a week,, engaging in income activity on a group basis, participating in community activities and expressing confidence in own abilities. There was a marginal trend for children to eat eggs at least twice a week or more. There no changes related to eating other protein rich foods such as fish, meant or legumes and no statistically ignificant changes related to other health behaviours e.e. building a latrine and securing safe water. Four groups increased in confidence behaviour and two decreased. . Limitations to the report are the minimal descriptions of eaducational activities used, lack of raw data and details of the measurement scales - however it does represent an early pioneering attempt to measure process changes that later might be called empowerment or self efficacy
Nwuga, V.C.B. (1988) Evaluation of an education programme as a prophylactic strategy for low back pain in a Nigerian community. In: Carlaw, R.W. and Ward, W.B. (Eds.) Primary health care: the African Experience Volume two in a series of case studies in community health education, pp. 401-407. Oakland, California: Third Party Publishing Company] Ref ID : 6649
Target Group/Country Staff from 4 hospitals that make up Ife University Teaching Hospital in Nigeria.
Intervention Methodology An education program consisting of self-instruction/lecture as a prophylactic strategy towards low back pain. Instructional sessions lasting one and a half hours were held once a week on Mondays for four consecutive weeks. This was supported by provision of reading materials. Content included description of the vertebral spine, degenerative changes taking place with age, proper back posture in day-to-day activities and lifting.
Evaluation Method There were 50 experimental subjects with 50 matched controls who were fellow staff members from the participating hospitals matched for age and sex. A questionnaire including a 50 item multiple choice test to assess knowledge was given before the educational sessions, at the end of the educational session and 12 months later to the experimental group. Details are not provided how experiences of back pain were measured.
Impact Achieved The results indicated that the educational program succeeded in importing knowledge of back pain, importance of good posture and back care to the experimental subjects over the course of the instruction (p<0.001) and the knowledge was durable for 12 months (p<0.01) as shown by a retest exercise. The experimental subjects suffered significantly less (p<0.01) back pain episodes over the 12 months period than did their control counterparts who did nor have an instructional exposure however details are not provided of how this was measured and baseline comparison of the control and experimental group are not provided for back-pain experience. It is disappointing that no information is provided of influence of the educational sessions on lifting behaviour. This is an interesting intervention in a neglected area for developing countries however lack of information on knowledge status of controls and measurement/baseline status of pain experience limit the value of this study.
Ottong, J.G., Asuquo, E.E., Olaniran, N.S., Duke, F.D. and Abia, R.P. (1997) Community mobilization for blood donation, Cross River State, Nigeria. The Calabar PMM Team. Int. J. Gynaecol. Obstet. 59 Suppl 2:S119-25, S119-25. Ref ID : 8028
River State, Nigeria. The Calabar PMM Team. Int. J. Gynaecol. Obstet. 59 Suppl 2:S119-25, S119-25.Ref ID : 8028
Target Group/Country Urban and rural communities in Calabar State, Nigeria
Intervention Methodology Focus group discussions highlighted people's fears and misconceptions about blood donations as important factors contributing to the shortage of blood donors. Fifteen community mobilization sessions to improve attitudes and stimulate voluntary blood donation were conducted over three months in 1994. Non-cash incentives were offered, including certificates of honor, free blood screening and assurance of priority if a family member needed blood.
Evaluation Method Monitoring blood donations.
Impact Achieved Blood donations to the teaching hospital maternity increased from 40 pints per month in 1991 to 81 in 1994. However, national strikes interrupted service and the increase was not sustained. At the secondary facility, blood transfusions increased from 14 in 1991 to 35 in 1995, with 100% of donations from volunteers. COSTS: The cost of community mobilization for blood donation was US $17,531. Increasing voluntary blood donations through non-cash incentives and community mobilization is therefore possible. No conclusions may be drawn regarding sustainability, however
16.2 Primary health care and the use of lay health workers
Agboatwalla, M. and Akram, D.S. An Experiment in Primary Health Care in Karachi, Pakistan. Community Development Journal 30(4):384-391, 1995. . Ref ID : 5506
Agboatwalla, M. and Akram, D.S. (1997) Impact of health education on mother's knowledge of preventive health practices. Trop. Doct. 27, 199-202. Ref ID : 7249
Target Group/Country Women in Neelam Colony, an urban slum of population 10,000 in Karachi, Pakistan
Intervention Methodology The intervention group was given health education by female community health workers were selected and trained as an adult literacy teacher and also as a home school teacher. The 'home school' system involved informal education to children who cannot afford to go to school.. Each CHW teaches 20-25 pupils. The CHW also runs adult literacy classes to the mothers. The CHWs gave group lectures to mothers in the form of lane meetings held weekly, each lasting for about 2 hrs using flip charts, slides and videos. In addition, the provided immunization services, dispensed oral rehydration (ORS) packets for diarrhoea and weighed children giving nutritional advice. Health education was carried on for a minimum of six months. Each CHW runs a health centre in her own home providing mainly preventive services.
Evaluation Method A prospective community-based intervention study with control group. One hundred and fifty households were studied in the intervention and the same in the non-intervention group. The surveys were carried out as one to one interviews in the respondent's homes. In addition to questions, observation for hygienic health practices was also carried out. Details of the survey are not provided.
Impact Achieved In the intervention sample there was a higher (p<0.05) level of hygiene practices - garbage covered, garbage disposal in the garbage drum, hands washed before feeding, washing hands and child after defaecation. More than 65% of women in the intervention group 'knew' how to make up ORS at home as compared to only 15% in the control group (significance data not provided and it is not stated how this knowledge of preparation was measured).The post intervention knowledge scores of the mothers showed a significant difference of P< 0.05. Nearly 50.7% mothers in the intervention group knew of at least four diseases against which vaccination is given as compared to the non-intervention group (P < 0.05). Similarly, mothers in the intervention group were more aware about the advantages of breast feeding, signs of dehydration, measures for prevention of measles and tuberculosis as compared to the non-intervention group (P<0.05). Finally, a comparison was made between the pre- and post-intervention scores between the two groups. The score in the non-intervention group changed from 11.5 to 16.1 (P> 0.05) as compared to the intervention group in which it changed from 10.2 to 32.2 (P<0.05). A disappointing feature of this study is the lack of information on the data collection methodology and hence the reliability of self-reported data.
Bentley, C. Primary health care in northwestern Somalia: a case study. Social Science & Medicine 28(10):1019-1030, 1989. Ref ID : 1965 (Borderline for inclusion in database)
Target Group/Country Semi-nomadic communities in Northwest and Awdal regions of Somalia
Intervention Methodology A primary health care approach in which village health committees were set up in communities who selected and supported community health workers (CHWs) who were trained by project staff. The duties of CHWs in order or importance included: treatment of common illness, care of children and mothers, sanitation activities and health education talks. Details of the health education talks including methods and content are not provided in the report.
Evaluation Method A household survey of 24 participating villages and 16 control villages. A total of 872 children under 5 years of age were surveyed for diarrhoea incidence and "273 1-year-olds were posed a series of questions pertaining to child care and environment. " No information is provided on the data collection methodology and the distribution of samples among intervention and control communities. The claimed respondents for the questions are obviously incorrect and are presumably not the infants but parents (mothers or fathers?). Data on latrines, garbage disposal and availability of safe water is reported but it is not stated how this data was obtained. There was no baseline.
Impact Achieved 74% of the respondents had been visited by a CHW during the last two months. ORS was used by 58% of the mothers of children with diarrhoeal in PHC villages and 15% of mothers in control villages. The PHC mothers are more included to give the child extra fluids(47% vs. 33%) and know signs of dehydration (45% vs. 20%) but the % who stopped regular feeding of a child width diarrhoea was similar for both groups at about 60%. 66% of the women in the PHC villages mentioned at least one way of preventing diarrhoea (most commonly clean food) compared to only 37% in the control sample. Although latrines were found slightly more often in PHC villages (32% vs 14% p<0.01) there were no differences in availability of safe water or disposal of garbage. % of immunization cover was higher in the PHC villages. This report contains a very good description of the process of setting up a programme of CHWs but is limited by poor description of data collection methods, lack of base line and the lack of significance testing for most of the reported changes.
Matomora, M.K. (1989) A people-centered approach to primary health care implementation in Mvumi, Tanzania. Social Science & Medicine 28, 1031-1037.. Ref ID : 1979
Target Group/Country Communities in 9 villages (18,000 population) within catchment of Mvumi Hospital, Dodoma District, Tanzania
Intervention Methodology Two one week long awareness seminars were conducted during the first year for village leaders and local extension workers. Health development committees were set up and 50 Village Health Workers (VHWs) were selected and provided 4 weeks training . 100 Traditional birth attendants were trained and supplied with kits. Educational activities were supplemented with monthly mobile MCH teams - the schedule for which was agreed with village representatives. Communication skills were given high priority in project activities - amounting to one third of VHW training time. The overall educational approach drew on the LePSA methodology (Learner-centred, Problem posing, Self-discovery and Action -oriented). Details of how this methodology was actually used with the community are not provided.
Evaluation Method Evaluation was based on the on-going monitoring system over four years. Surveys were conducted every year between June and August. In 1982 three villages were selected randomly from the nine programme villages and a house-to-house survey was conducted and children under 5 yrs were weighed and immunization status recorded. All mothers were interviewed and their households assessed for sanitation. In 1983 the survey was repeated for all 9 programme villages but only children aged 12-23 were assessed for immunization status. In 1983, 1984 and 1985 village section clusters were used as the basis for sampling. Details of the questionnaires and other data-collection instruments are not provided. Data from unserved control villages (unserved and those only receiving government PHC) is presented but no information is presented on the selection of these controls.
Impact Achieved The Mvumi comprehensive PHC programme rapidly increased its coverage population from 20,000 to 100,000 during the 4 year period. There was an increase in full immunization (p<0.001). Moderate malnutrition did not change but severe malnutrition was reduced (p<0.001). Greater knowledge of immunizable diseases was shown by mothers in mobile clinic and health facility villages than in un-served villages. Knowledge of the content of oral rehydration solution was hither in mobile clinic villages compared to health facility and unserved villages (p<0.05) but the differentials in preparation and use of home made ORS were insignificant. Among factors which led to malnutrition, only feeding the child three or more times a day showed significant difference (p<0.001). The evaluation is of interest in demonstrating that PHC is more likely to influence immunization than malnutrition. However, a limitation of this study is the lack of information on sample size, data-collection instruments and of the control communities. It would also have been of interest to have had more information on how the LePSA methodology was actually used
16.3 Patient education and the use of medicines
Chalker,J. (1998) Improving quality of care
in Hai Phong Province. Essential Drugs Monitor 15-17. Ref ID 8691 Ref
Target Group/Country 1.6 million people in twelve districts of Vietnam
Intervention methodology Following workshops with community members and health workers an IEC programme was developed which included the following messages: 1) Never use injections if tablets will do. Injections can be dangerous and are usually not necessary.2) If you need antibiotics, you must use a full dose. Not finishing the dose means that the next time you need them they may be less effective.3) When you are ill do not self-prescribe, ask your local expert. Use your commune health station. 4)The media used included: two posters - --five distributed to every Community Health Stations (CHS); four radio programmemes (short, five-minute p plays of five minutes) and four 30 -second radio spots broadcast on district and regional radio and also distributed as cassettes to be broadcast through commune loudspeaker systems; four 5-minuteTV programmesmes each 5 minutes long and one -minute TV spots were broadcast on provincial TV; newspaper advertisements; a leaflet was given to every householder in five communes. The content of the educational programmemes was closely matched to the messages above.
Evaluation Method Two hundred 200 households were randomly selected from each of five 5 communes and interviewed. Forty 40 CHSs were randomly chosen and data obtained from the outpatients book, the drug cabinet, the accounting books and some interviews were carried out. The last thirty 30 treatments in the outpatient books of for each CHS wereas examined.
Impact Achieved 89% of households could repeat some IEC message, 75% claimed to have had a change in knowledge or practice. Respondents claimed to have heard messages from the following sources: commune public address system (67%); TV (52%, note TV ownership is 51%), CHS staff (53%), newspapers (7.5%), posters (15%), leaflet (37%). The following improvements were noted between August 1994 and December 1995: patients given vitamins (75% à8%); percentage% of patients given injections (33%à7%); patients given antibiotics (69%à46%); patients given correct doses of antibiotics (29%à91%). Follow-up data in September 1`996 showed that improvements were sustained. By using local resources the additional costs came to a total of $2,200. This case study was included because it is one of the rare examples showing from developing countries of use of mass media for public education on drugs in a developing country. Its evaluation data have limitations in In showing an impact for the educational component, their evaluation data has limitations. While they demonstrated that their campaign was received, their impact data highlighted was health worker practices. From the data, iIt is difficult to establish from the data whether or not the improvements are a result of the training of of health workers iin improved prescribing or the educational component. However, even if the change is mainly due to improved prescribing, it is important that this is acceptable to patients. It is possible, but not proven by their data, that the educational campaign also contributed although there is but no evidence is available to support this.. While cost data is welcome, it should be noted that this is the additional costs but routine operational costs, research and supervision do not seem have been factored into the costing.
Edem, C.U., Brieger, W. and Jegede, R.O. (1985) A Nigerian experiment in presurgical patient counseling: a pilot study. Patient Education and Counseling 7, 167-179. Ref ID : 6646
Target Group/Country Patients in hospital in Nigeria
Intervention Methodology Preoperative counselling and relation training was provided to patients over 18 yrs undergoing between December 1982 and January 1983 the following operations: laparotomy, colporrhaphy, herniorrhaphy and hemorrhoidectomy. A total of 42 male and female patients were assigned to experimental and control groups.
Evaluation Method Measurement were made at five points in time for each patient - the evening before surgery, the evening after surge and the mornings of the next 3 days following surgery. Zung's anxiery Status Inventory Scale was adapted to the Nigerian context for diagnosis of situational anxiety. Note this was not a blind study.
Impact Achieved An experimental group showed reduced analgesic intake (p<0.01) and reduction in anxiety levels. This simple study would be worth repeating with a larger sample and with further development of the anxiety scale.
Hadiyono, J.E., Suryawati, S., Danu, S.S., Sunartono, and Santoso, B. Interactional group discussion: results of a controlled trial using a behavioral intervention to reduce the use of injections in public health facilities. Social Science & Medicine 42(8):1177-1183, 1996. , Ref ID : 6058
Target Group/Country Patients attending health facilities in a hilly area 45 km from Yogyakarta, Indonesia
Intervention Methodology Interactional Group Discussion (IGD), for reducing the overuse of injections. The groups, , were facilitated by a behavioural scientist and a clinician.. Each group consisted of 6 prescribers (both physicians and paramedics) and 6 patients (who were from a different health centre catchment). The single session lasted 90-120 minutes and was held in a relaxed informal setting of a restaurant with a free meal provided. The session included an exploration of feelings of members about being included in the group, discussions of the discrepancies between the prescribers’ and patient’s beliefs and motivations for injection use, the presentation of scientific materials and a conclusion
Evaluation Method 24 of 29 public health in a single district were chosen because records showed that at least 20% of presecriptions were injections. These were randomized to 12 intervention and 12 control groups. 24 IGDs were held in a 4-week period, and all invited prescribers participated. Outcomes were measured by a retrospective prescribing survey covering the periods 3 months before and 3 months after the intervention, with samples of 100 prescriptions per center per month. 6900 cases were collected before intervention and 7200 afterwards. Rates of injection and average number of drugs per prescription were computed separately for each centre, and t-tests were used to compare pre-post changes in outcomes in both groups.
Impact Achieved Results showed a significant decrease in injection use from 69.5 to 42.3% in the intervention group, compared to a decrease from 75.6 to 67.1% among controls [-18.7.0% intervention vs control, 95% CI = (-31.1%, -6.4%), P < 0.025]. The largest proportional decline in injection use occurred for analgesics and vitamins with baseline rates nearly halved in the experimental groups. There was also a significant reduction in average number of drugs per prescription [-0.37 drugs prescribed per patient, 95% CI = (-0.04, -0.52), P < 0.05], indicating that injections were not substituted with other drugs. The authors concluded that the IGD significantly reduces the overuse of injections. Note the decline in the control health centres was probably a result of cross communication and also illustrates that the reduction in injections in the intervention health centres could not be explained by patients going elsewhere. This study is also of interest because it revealed considerable misperceptions by health workers of the wishes of their patients.
Kara, M. and Asti, T. Effect of education on self-efficacy of Turkish patients with chronic obstructive pulmonary disease. Patient Educ Coun 55, 114-120. 2013. Ref ID: 9296
Target Group/Country Patients with chronic obstructive pulmonary disease (COPD in Turkey
Intervention Methodology The patients were asked to visit the outpatient pulmonary clinic with family member or caregiver three or four times per week. The researcher met the referred patients. Initially, for one patient, the structured education program consisted of 60-70 min by enabling the patient and his or her family to take part. Then, the classes were designed by the researcher, lasting 35-40 min and three or four times per week. In addition, education was tailored to the needs and environment of the patient, interactive, directed at improving quality of life, simple to follow, practical and appropriate to the intellectual and social skills of the patient and caregiver.. The classes of were consisted of a didactic component that focused on pathphysiology and management of COPD, self-care instruction, and social support. The education component was also followed by training and workout sessions that focused on respiratory muscle training, breathing retraining, aerobic and anaerobic exercises, and relaxations training. The class size for each program ranged from three to five participants. A small class size helped to ensure that there would be time to meet individual needs. Four components were incorporated to influence efficacy mastery experiences, modelling, verbal persuasive, and decreasing emotional/physical. Mastery experiences were integrated into the structured education program by having the participants indicate in writing what their goals were for attending the program. Vicarious experiences involved allowing observation of other siwith comparable degrees of physical impairment successfully performing tasks. Verbal persuasion was achieved through praising participant's efforts . A patient education brochure was prepared to accompany the educational session. Note - details of the total number of classes is not provided.
Evaluation Method There were 30 patients in control and experimental group measurements were obtained on the COPD Self-Efficacy Scale (CSES). Self-efficacy, as it affects managing or avoiding breathing difficulty, was measured before and after the structured education program and the nursing care.
There was a significant difference between control group and experimental group
scores on the efficacy scores. Patients' self-efficacy scores significantly
improved after the structured education and remained significantly improved
1-month later (p<0.001). Standard nursing care alone was also effective in
significantly improving self-efficacy scores, but patients' scores 1-month later
were not significantly better than pre-program (p> 0.05). Note that details
of the total number of classes is not provided so it is not possible to estimate
the total effort required to achieve the results. Also information is not provided
on the specific contribution or the booklet compared to the counselling sessions.
Given that there was some improvement in the control group it would be interesting
to know if that improvement might have been sustained with the leaflet alone.
Krause, G., Benzler, J., Heinmüller, R., Borchert, M., Koob, E., Oattara, K., and Diesfeld, H.J. Performance of village pharmacies and patient compliance after implementation of an essential drug programme in rural Burkina Faso. Health Policy and Planning 13(2):159-166, 1998. Ref ID : 7378
Target Group/Country Patients using village pharmacies in Burkina Faso
Intervention Methodology A nation-wide essential drug programme. Village pharmacies were been installed in all villages with health centres, an essential drug list and treatment guidelines have been published, nurses received refresher courses on essential drugs and drug vendors have been trained on selling the drugs within the new village pharmacies. A village committee is in charge of the new village pharmacy. Details are not provided of the training and it is not stated whether it included patient communication skills.
Evaluation Method Structured non-participant observation for two week periods was carried simultaneously from June 25 to July 26, 1995 in 9 health centres in 3 districts and in the 8 corresponding village pharmacies and was combined with household interviews of the corresponding patients in 2 of the districts. All general consultations (except wound treatment) were observed (313 patients) and 498 client-vendor contacts (12 vendors distributing a total of 908 drugs). 170 out of 190 patients from the two districts were located and interviewed in the middle of their treatment period. The number of remaining pills were counted and the patient asked how he/she was supposed to take it.
Impact Achieved For only 32.9% of the prescribed drugs did the prescriber specify to the patient how long the drug had to be taken. Patients could recall the correct dosage for 68.3 % of the drugs. From the pills remaining in the household it was shown that children under 5 yrs received correct dosage in only 40.3% of cases while patients of 5 years or more were compliant for 64.7 of the drugs (chi2 =11.91, p<0.001). 11.5% of the drugs had obviously been taken incorrectly to such an extent that the occurrence of undesired drug effects was likely. The evaluation indicates that essential drugs programme had been successful as far as performance of the pharmacies and drug purchasing behaviour, but not as far as utilization of medicines.
Ngoh, L.N. and Shepherd, M.D. (1997) Design, development, and evaluation of visual aids for communicating prescription drug instructions to non-literate patients in rural Cameroon. Patient Education and Counseling 30, 257-270.. Ref ID : 6884
Target Group/Country Illiterate, female patients using health facilities in Cameroon
Intervention Methodology Culturally-sensitive, visual aids were designed to convey instructions for use of prescription antibiotics(ampicillin, sulfamethoxazole, trimethoprim, metronidazole, and tetracycline) to illiterate women. The education involved use of visual aids and an "advanced organiser." The advanced organiser (introductory information used to explain why the drug is needed) used the example of farming to explain antibiotic use - a body as a crop field, disease as weeds, and antibiotics as a farmer. Visual aids were subjected to a rigorous process of development and pre-testing. Drawings were based on photographs selected by the community as depicting local relevant scenes.
Evaluation Method The study, conducted in three health centres, gave initial and follow-up tests to three randomly selected groups of 26 illiterate female patients. After their consultation and purchase of medicines patients were given a test to measure comprehension of the medicines in their treatment regime. One group was treated as control, a second group received the visual aids and some explanation and the third group the control and advance organizer. A second comprehension test was given after these two educational sessions. The comprehension test consisted of 7 questions on name and purpose of the medication, amount of each single dose and route, timing, total number of daily doses, number of days. The follow-up repeated the comprehension test in the home and compliance was assessed with a pill count
Impact Achieved It was found that the experimental groups (1 with only visual aids, 1 with visual aids and the advanced organizer) scored significantly higher (p<0.05) than the controls in measures of comprehension and compliance and that use of the advanced organizer improved scores significantly (p<0.05%) over that of just visual aids. It is concluded that, to be effective, visual aids must be population-specific but that their preparation and use contributes significantly to achieving desired results in patients
Ponnusankar, S., Surulivelrajan, M., Anandamoorthy, N. and Suresh, B. (2013) Assessment of impact of medication counseling on patients' medication knowledge and compliance in an outpatient clinic in South India. Patient Educ Couns., 54, 55-60. Ref ID: 9293
Target Group/Country Patients with chronic conditions attending an outpatient clinic in a private hospital in South India
Intervention Methodology At the out patient clinic, counseling sessions were performed at a separate corner of the clinic to ensure privacy. One patient was counseled at a time. Counseling sessions were designed so that all patients were counseled according to their individual understanding and attitude of their medication. Pharmacist explained about their disease, the name of the medications, identification of the medications, dose, time of administration, purpose, duration of therapy of their medication, food and other medications that have to be avoided during their therapy, etc. Counseling sessions lasted 15-20 minutes.
Evaluation Method Ninety patients were randomized in the ratio of 1:2 into either counseled or usual care group. Their medication knowledge was assessed by a questionnaire and adherence was assessed by pill count method and self-assessment by the patients. Their medication knowledge was assessed at baseline and during their subsequent appointments. . Statistical analysis of medication knowledge was carried out and all the demographic characters and number of medication were individually correlated with medication knowledge score
Impact achieved The average medication knowledge score of the counseled group versus usual care group was 13.82+/-1.8064 and 11.78+/-3.5037 (p<0.001). Compliance score of the patients during their follow-up period was 92.29+/-4.5 and 84.71+/-11.80 for the counseled and control group, respectively and the difference observed was statistically significant (p values not provided)
See also studies in the malaria section on compliance with malaria prophylaxis, diabetes counselling in Chronic section and counselling in AIDS and Family Planning sections.
16. 4 Accident Prevention/Safety Education
Krug, A., Ellis, J.B., Hay, I.T., Mokgabudi, N.F., and Robertson, J. The impact of child-resistant containers on the incidence of paraffin (kerosene) ingestion in children. S.Afr.Med.J. 84:730-734, 1994. Ref ID : 4346
Target Group/Country Black children in South Africa
Intervention Methodology Health education on paraffin poisoning had been provided to all the communities at child health clinics, outpatient clinics and paediatric wards but had not been effective. A specifically designed child-resistant container (CRC) was introduced to evaluate whether its use would decrease the incidence of paraffin ingestion. Instructions on how to open the top and a health education messages was printed in English and local language. All mothers who brought their children to the child health clinic received a CRC and it was marked on their Road to Health Charts. Health workers made home visits to distribute the CRC to the remaining mothers with children. This was supported by health education to both intervention and control communities including poster competitions and distribution of leaflets.
Evaluation Method In this intervention study CRCs were distributed to 20,000 households in the study area (Gelukspan district). No CRCs were distributed in the control area (Lehurutshe district). Health education about paraffin poisoning prevention was given in both the control and the study areas. The monthly incidence rates of paraffin ingestion were monitored during the 14-month intervention period after the distribution and were compared with the pre-intervention incidence rates in the study and control areas. 6 months after distribution of CRCs a household survey was carried out in three villages of the intervention community (50 households per village) using a semi-structured questionnaire. Health workers were asked to complete a questionnaire for every case of paraffin poisoning encountered.
Impact Achieved During the intervention period 69 cases of poisoning (but no deaths) were reported in the control and intervention areas. The main finding was that the incidence of poisoning by paraffin ingestion dropped by 47% in the study area during the intervention period (p=0.022). There was no change in the control community. After distribution the incidence rates in the study area was lass than one-half of those in the control area (mean 4.54±3.46 v. 9.80±5.63 cases /100,000 population, p<0.015. The survey showed that only 67% of households received a CRC and only 52%had one at the time of the survey due to breakages and loss. This was because distribution had been targeted to families with very young children. 85% of households had a paraffin contain on floor, by stove, under bed where it could be easily reached by children. Questionnaires were returned from 43 of 69 poisoning cases . 13 children came from households with CRCs and 5 children had ingested paraffin from CRCs. In four of these cases the mothers said the CRC been left open or had not been properly closed. In only one case had a child opened a CRC. In the remaining cases of poisoning in households with CTCs the children had ingested paraffin from cold drink bottles (2), paraffin lamps or intermediate containers (3) , an unknown container or at a neighbours. This is a very good example of and evaluation directed at an intervention designed to influence situational factor rather than behaviour change.
Arreola-Risa,C., Trevino-Perez,R., Almazan-Saavedra,V.Z.-P.J.E., Gonzalez-Solis,R.,
Simpson,K.R.-R.L. and Hernandez-Torre,M.H. (2013) Injury prevention counselling
to improve safety practices by parents in Mexico. Bulletin of the World
Health Organization 81, 591-598.
Reference ID: 9102 Borderline for inclusion
Target Group/Country Parents attending child health clinics in Monterrey, Mexico
Intervention Methodology Three different counselling programmes were designed to meet the needs of the upper, middle and lower socioeconomic strata.. For the upper and middle socioeconomic strata the upgrading involved lectures and demonstrations lasting six hours and utilizing audio-visual materials from several sources, including The Injury Prevention Program (TIPP) of the American Academy of Pediatrics (17) and a locally developed programme entitled Pal Ki (Healthy Child) in the Mayan language. The topics included motor car and pedestrian safety, burn prevention, home safety and recreational safety. Several such courses were organized in 2011-01. In addition, parts of the middle socioeconomic stratum group received clinic-based counselling, consisting of talks given in waiting rooms which lasted 15-20 minutes. Some of the above-mentioned audio-visual materials were used. TIPP information sheets in Spanish were given to the participants. Some parents received one-to-one counseling from a doctor. Injury prevention counselling in the lower socioeconomic stratum group was performed during half-hour household visits by nurses and health promoters attached to community health centres who had received training specifically for this project. The counselling covered the breadth of injury prevention topics appropriate to the ages of the children in each household. TIPP and Pal Ki audio-visual materials were used in paper format and occasionally in video format.
Evaluation involved the use of baseline questionnaires on parents' existing
safety-related practices for intervention and control groups and the administration
of corresponding questionnaires after the programmes had been carried out. Questionnaires
were self-administered for the middle/upper socioeconomic group and administered
verbally to the lower ses during household visits. Data were obtained on 1124
children before counselling took place and on 625 after it had been given.
Overall safety scores (% safe responses) increased from 54% and 65% for the
lower and upper socioeconomic strata, respectively, before counseling to 62%
and 73% after counselling ( P<0.001 for all groups). Improvements occurred
both for activities that required caution and for activities that required the
use of safety-related devices (e.g. helmets, car seats). However, scores for
the use of such devices remained suboptimal even after counselling and there
were wide discrepancies between the socioeconomic strata. The use of bicycle
helmets improved in the middle and lower socioeconomic stratum intervention
groups. All of the socioeconomic stratum groups reported usage rates in the
45-48% range after counselling. Minimal changes were seen in the relatively
subjective matter of children's knowledge on crossing roads safely. Two of the
most effective burn prevention strategies showed no improvement. Neither checking
the temperature of water heaters nor the use of smoke detectors improved
after counselling. The usage of smoke detectors remained negligible in all groups.The post-counselling scores for the use of safety-related devices were 55%, 38% and 19% for the upper, middle and lower socioeconomic strata, respectively.
The authors concluded that increased attention should be given to specific safety-related devices and to the safety of pedestrians and educational efforts should be combined with other strategies for injury prevention, such as the use of legislation and the improvement of environmental conditions. In discussion their results the authors pointed out that the evaluation depended on self-reported data with a different model of administration between the different groups. They also commented that controls had been exposed to some education on injury prevention through the mass media and at the clinics. A weakness of this study is that there is no information on how controls were selected
Swaddiwudhipong, W., Boonmak, C., Nguntra, P. and Mahasakpan, P. (1998) Effect of motorcycle rider education in changes in risk behaviours and motorcycle-related injuries in rural Thailand. Tropical Medicine and International Health 3, 767-770.Ref ID : 8557
Target Group/Country Motorcyclists in Mae Sot District of Tak Province in Northern Thailand
Intervention Methodology A community-based programme for motorcycle rider education was provided for motorcyclists in all villages of 3 randomly selected sub-districts, between January and March 1995. The target riders for the educational programme were identified by village health communicators (VHCS) and health centre workers. The education team comprised personnel from the hospital and the Department of Land Transport. The hospital gave health education on the epidemiology of motorcycle crash injury I the area, motorcycle related risk and the benefits of helmet use. The Department of Land Transport provided motorcycle rider education including traffic laws , vehicles regulations, traffic signs and written and skill tests for a driving licence. The VHCs provided copies of these to motorcyclists who did not attend sessions. Detailed or the length and number of educational sessions are not provided. Between 1994 and 1996 both the intervention and control communities were exposed to health education about injury prevention through radio and television.
Evaluation Method An interview survey of motorcyclists was conducted in 3 villages selected by systematic sampling from the 3 intervention subdistricts (n=1141) and in 3 control (without intervention) villages (n=1297) for comparison in March 1997, 2 years after the programme. The questionnaire had two parts. The first contained questions on the characteristics of the motorcyclists, licence status, helmet use and alcohol intake, The second contained questions about the characteristics of the motorcycles including brakes, lights and mirrors. They also compared incidence rates of motorcycle-related injuries and deaths from hospital records taking care to include records from patients transferred out to other hospitals. They added police reports and post mortem examinations (who would not have appeared on hospital records)
Impact Achieved The proportion of motorcyclists who always or often wore helmets was significantly greater in the intervention sample (46.0% p<0.01) than in the control sample (20.5%) but there was no significant difference in alcohol use and the state of the motorcylces. In 1994, the annual incidence rate of motorcycle-related injuries was slightly higher in the intervention areas than in the control areas. Following the education programme, the injury rates for 1995 were significantly lower in the intervention than in the control population but the difference was less evident in 1996 (morbidity rates/100 registered motorcycles in 1994; intervention 13 CI10.6-13.6, control 12.2 CI 10.3-13.3, 1995: intervention 9.4 CI 9.2-12, control 14.7 CI15.2-18.5, 1996 intervention 10.9 CI 11.2-14.3., control 13.1 CI 13.5-16.7) The annual number and rate of fatal motorcycle injuries decreased after the intervention although there was no significant difference between the two populations. It is concluded that motorcycle rider education may be a promising intervention for prevention of motorcycle-related injuries in rural areas where road safety measures, particularly enforcement activities, are commonly limited. The study is limited by the lack of baseline data on helmet use and the minimal information provided on the methods used for the educational input.
16.5 Miscellaneous topics -schools
Lohsoonthorn,P., Bhamornsathit,S., Sukonthaman,U.,
Tattakorn,V., Kamolratanakul,P., Sresthabutra,M., Viputsiri,O. and Dhanamun,B.
(1983) The effect of health surveillance and health education on primary school
children. Public Health 97, 171-175.Ref. ID: 332
Target Group/Country Pupils at three primary schools in Cholburi Province, eastern region of Thailand
Intervention Methodology In one group of schools health surveillance was provided by nurses, physicians and school health volunteers. School health volunteers were selected form the leaders of school children, one schoolboy and one schoolgirl for each class. The observed the cleanliness of school children, classroom and school environment. They reported the accidental injuries or abnormal symptoms in the school children to the schoolteacher and also filled in the absentee record. The nurses and physicians visited the school at monthly intervals measuring heights and weights and examining for throat infection. A second group also received health education given by medical students twice a month using group discussion, demonstrations, pictures, slides and movies.
Evaluation Method 363 children of grades 3-6 were given pre- and post-tests were carried out with a nine month interval with surveillance (School1), surveillance with health education (School 2) and control (School 3). Health knowledge was tested by multiple-choice examination with 55 questions. The measurement of health practice was concerned with personal cleanliness and measured by the school nurse.
Impact Achieved Increases in mean differences of pre-test and post-test scores of health practice were statistically significant for the school receiving surveillance and surveillance and health education and great than that of the control school (p<0.01). There as a significant increase in health knowledge scores for the school receiving surveillance and health education over that of the control (p<0.01). There was no correlation between gains in health knowledge and practice. No improvements in health status were found over the nine months (the main health problems were pediculosis (25.1%) pyodemrma (20.8%), tinea versicolor (8.8%) and enlarged tonsils (5.5%).
Nath, S. (1999) Health knowledge of rural Bangladeshi children: Does BRAC's non-formal schools programme have any impact? Health Education Journal 58, 26-38.Ref ID : 8454 (Borderline for inclusion in database)
Target Group/Country Rural primary school aged children aged 10-16 in Bangladesh
Intervention Methodology Children received the non-formal primary education programme of the Bangladeshi Rural Advancement Committee (BRAC) and also a magazine produced by BRAC. The programme was not a specific health education programme but health was included in the curriculum (details of the health component not provided).
Evaluation Method Three groups were randomly selected from five rural areas of 240 children - graduates of the BRAC non-formal primary school programme (mean age 12.7yrs), formal school learners who had completed at least 3 years of school (mean age 12.9 yrs) and children who never went to school (mean age 12.4 yrs) - were assessed with an instrument containing six health knowledge items. There was no baseline.
Impact Achieved The performance of BRAC graduates was significantly hither in four items compared with that of the formal school learners (p<0.001). These areas were treatment of diarrhoea, benefits from vaccination, prevention of night blindness and water purification. A limitation of this study is the lack of description of the health education content of the curriculum or wider context of the BRAC programme, lack of baseline and any information to see of knowledge gains were translated into behaviour change.
Paredes, S.S., Estrada, R., Alarcon, H., Chavez, G., Romero, M. and Hay, R. (1997) Can school teachers improve the management and prevention of skin disease? A pilot study based on head louse infestations in Guerrero, Mexico. Int. J. Dermatol. 36, 826-830.Ref ID : 8558
Target Group/Country School children in Mexico
Intervention Methodology Health education provided by teachers but details not provided of content and methods
Evaluation Method A rapid assessment by a team of dermatologists and epidemiologists was carried out in 3 primary schools in a single day. Nine hundred forty-four students and 33 teachers were interviewed; a focus group discussion with 6-8 mothers per school was performed. Children between 1st and 3rd grades were interviewed by an investigator and children in 4, 5th and 6th grades were given a self-completed questionnaire. Information was collected on the child's background, head hygiene behaviour, experience of symptoms of head lice infestation and knowledge of head lice. Each child was then given a physical examination for signs of head lice infestation. There was no baseline.
Impact Achieved In the self-diagnosis of pediculosis, the prevalence was 22% (range, 18%-33%) with a sensitivity of 68% and a specificity of 86%. In one school, 100% of the teachers applied a health program, whereas in the other two schools this percentage was only 20%. A child under 9 years of age who attended a school without information on health was 3.6 times more likely to have head louse infestation (OR = 3.6, CI 95% = 2.1-6) than a child of the same age who attended a school where information was given. In older children the effect and potential impact were lower. The difference between the two age groups is unlikely to be explained by chance (X2 het = 5.7, df = 1, p = 0.01). None of the other factors investigated other than presence or absence of health education could explain the differences between the schools. A limitation of this study is the lack of baseline and detail of the health education provided on head lice. It is unfortunate that no information is provided e.g. from qualitative studies to support the impact of school health education.
Leeds International Health Promotion Home PageHealth education