Date: February 2009

Prepared for: Academy for Educational DevelopmentResearch Team: SIAR Research and Consulting Qualitative Team

AI Related Booklet Pretest Study

(healthcare workers)

Objectives and Methodology

Background info and purpose of the research

Background information

The U.S. Agency for International Development has awarded Academy for Educational Development (hereinafter, AED) a global Task Order to conduct behavior change communications activities on avian influenza prevention and containment and response to pandemic influenza. In Azerbaijan, target audiences for these communication activities include: small rural backyard poultry farmers (Sector 4), small commercial farmers (Sector 3), first responders to public health or natural disasters, and human and animal health officials.

Purpose of the research

As a second step of the Azerbaijani part of the project, AED has concluded contract with SIAR Research and Consulting Group (hereinafter, SIAR) to conduct qualitative research aimed at pretesting the booklet among specific target groups, namely healthcare workers and administrative workers of health institutions. More specifically, the goal was to understand:

..to what extent the text in the booklet is understandable and applicable

..the lucidity of the text

..to what extent the picture used in the booklet are relevant

..the weak sides of the booklet and define ways of its development

Methodology

MethodQualitative Research

Technique

Focus Group Discussions

Timing

February, 2009

Sample design

Target group

Number of FGDsTotal

Baku Salyan Berde Khachmaz

Medical workers 1 1 1 1 4

Administrative medical workers 1 1 1 1 4

Total 2 2 2 2 8

Perception

This paragraph is about H5N1 virus and symptoms of AI disease.

Regarding the first paragraph group participants mentioned that symptoms (high temperature, throat ache or cough and heavy breathing) listed in the leaflet are too general and do not characterize the disease specifically.

In Khachmaz it was also stressed that during the epidemic these symptoms are enough to suspect Avian Influenza (hereinafter, AI), but not at ordinary time as they are common for many other diseases.

Some of respondents (Salyan) have never heard about H5N1 virus, rather they knew AI.

It was also told that the last part of the 1st paragraph was completely right. “No one can judge unless the results of analysis are published”.

Perception: General opinion about 1st paragraph

Suggested measures:

To provide more detailed information on symptoms, for proper diagnose these are not enough. Other observed symptoms should be added.

Use “Avian Influenza” instead of “H5N1” (or at least give the former in the parentheses).

The part about the fact that one should wait until analysis are released should be left as it is and not be removed.

Second paragraph is about self-protection (namely, hand washing, using personal protection means (especially, masks and gloves), etc.).

Majority found the paragraph to be uninteresting and unnecessary due to the fact that doctors are aware of issues related to wearing mask or gloves and are using them not only during AI but during all infectious diseases.

Some participants (especially, in Salyan) had questions about mask N95 (if it is the ordinary mask they use constantly).

In Baku it was also emphasized that it could be written briefly and concrete: “Wear gloves and mask”.

Perception: General opinion about 2nd paragraph

Suggested measure:

To shorten the text because doctors are mostly aware about the mentioned measures and use them regardless AI outbreak

To mention if N95 mask is a special one for AI or just a mask doctors always use

The part is about protection of other people within medical institutions: wearing mask or closing mouth while sneezing or coughing, wards and artificial ventilation.

This paragraph appeared to be quite interesting for doctors. They mentioned that it was necessary information.

It was emphasized that 1 meter between the person, who caught AI, and other sick people is too small.

Suggested measures:

Distance between person sick by AI and other sick people (1 meter) should be increased.

Perception: General opinion about 3rd paragraph

” 1 meter is too close. It is ordinary distance between talking people”Salyan

Perception: General opinion about 4th paragraph

The paragraph is about cleaning and keeping work place in safety.

Given actions and advices are always fulfilled (after most medical procedures, not only during AI outbreak).

Suggested measures:

Special information regarding cleaning during AI should be provided.

Information about autoclave is good to be added (“Washing instruments with water and soap is not enough. Every time after usage of instruments we use autoclave for sterilization”) and it can be advised to work with disposable instruments (Baku)

“Cleaning” instruments before and after usage is to be removed or changed as it does not correspond to reality. There is no need to clean instruments before usage (after sterilization) if they are sterilized and can even get dirtier rather than cleaner. (Salyan)

Advise to use disposable instruments.

Information regarding cleaning wards is to be removed or changed. “It is not necessary for doctors, it is for junior nurses.” (Salyan)

Advice to put caps back on the needles should be concretized as it is not true for all doctors (for instance, not for dentists). However, for doctors besides dentists the advice is proper as finger can be needled as they have mentioned. (Khachmaz)

Perception: additional measures

Avoid repetition (symptoms). Repetition raises negative attitude.

Given time of prevention (7 days) at the end of the leaflet is not real (“there is no need to mention concrete time as it can influence psychologically”) (Baku)

The text under the final statement (i.e. link to web-site and name of additional materials) given in booklet for administrative workers is absent in the one for healthcare workers.

Lucidity of text

Lucidity of text

Participants of FGDs found nothing difficult in the text; everything was quite understandable (“even people without medical education can understand these sentences”). Most of respondents stated that they were aware of the given information. Almost all respondents considered that the leaflet is for all people (for instance, schools, universities, kindergartens, etc.) but not for doctors. Majority of respondents did not learn anything new from the leaflet, and many of mentioned procedures and advices are followed daily regardless of AI outbreak. Respondents in Baku were more disappointed by the leaflet (“we see much more advanced leaflets”).

Suggested measures:

Translation of leaflet into Russian language as well (Salyan, Baku) may appear to be expedient.

Perception of pictures and its fitting to the text.

Effectiveness of explanation of some ideas by pictures

Perception of pictures and its fitting to the text. Effectiveness of explanation of some ideas by pictures.

Majority of respondents stated that it would be much better if pictures are commented / named. Pictures and text were mentioned to be important equally, mutually complementary. Pictures appear to make people get interested and attract.

Suggested measures:

1st picture: Running water, tap and soap should be reflected. “It seems that he/she is washing hands in a bath which is not hygienic at all” (All groups besides Berde). Berde: soap should be reflected on the picture to make it more understandable.

Next 4 pictures reflecting person wearing mask: is not necessary for doctors who use mask regardless of AI outbreak. Berde: as the picture is very detailed, the text can be shortened or vice versa.

Picture of person in yellow glasses: unfitting near the text. Baku: yellow color of glasses should be transparent, not yellow. Salyan: the picture should be placed near the hand washing, personal protection means.

1st picture on the 3rd page reflecting lying ill person is to be changed or replaced: a) from the picture it is not seen that the person is alone in the room, and b) the colour of the person’s clothes appears to be the colour of usual clothes rather than of the patient. Baku: “it does not reflect the reality”. Berde: comment is necessary. Mostly respondents did not like it.

Perception of pictures and its fitting to the text. Effectiveness of explanation of some ideas by pictures.Suggested measures:

2nd picture, which fits text, turned to be better than others and necessary one. However: the picture should be changed as the rescue breathing in reality is not as it is shown (Salyan)

Picture reflecting washing instruments: Autoclave and cleaning agents should be added (Baku).

Picture reflecting floor cleaning: should be supplemented with raincoat as it easier to clean it up (Berde). Furthermore, the English word “detergent” can be translated.

Medical garbage box: The picture fits text. Regions: the box should be on the floor, the doctor throwing it away should wear doctor's smock. Information regarding throwing the bag away or burning it should be given by pictures as well as text. Baku: the box should be more oblong.

Both last 2 pictures fit text. Picture reflecting man is unintelligible. Should be changed, idea should be reflected more concrete (Baku). Also it is not well depicted whether the person is lying, standing or sitting.

Whether the leaflet can be better

Whether the leaflet can be better

Suggested measure:

The leaflet should be done for doctors, it seems to be for ordinary people.

More concrete symptoms should be provided.

More thorough information should be provided. “The information

may appear to be not enough during AI outbreak”.

Avoid repetition (symptoms)

The leaflet should be for doctors, not for all people (for instance, schools, universities, kindergartens, etc.)

There should be specific procedures and advices which are followed during AI outbreak

Following points should be added:

First aid (Baku)CausationPathogenesisSymptoms (All groups)Risk group, for instance, hunters, farmers (Salyan).

” It is not bad for population, but is absolutely unnecessary for doctors.”Baku

Thank you for attention!