Learning about a Drug Use Problem

Trainer’s Guide

Learning about a Drug Use Problem

TRAINER'S GUIDE

OBJECTIVES

1. Describe a model for developing interventions.2. Identify and evaluate sources of quantitative data.3. Understand the importance of studying provider and patient motivations.4. Introduce qualitative research methods.5. Develop instruments for field visits.

PREPARATION

1. Read the Session Notes.2. Read Chapter 29, in Managing Drug Supply on investigating drug use (p. 430).3. Complete Activity 1: Strengths and Weaknesses of Different Data Sources.4. Select a specific problem or issue to be addressed in Activity 2: Designing

Qualitative Instruments.

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Total Time Required: 5 hours, 45 minutes

TRAINER’S GUIDE LEARNING ABOUT A DRUG USE PROBLEM

VISUAL AIDS

1. Title Slide2. Objectives3. Components of the Drug Use

System4. An Overview of the Process of

Changing Drug Use5. Changing Drug Use Problems:

1. Examine6. Changing Drug Use Problems:

2. Diagnosis7. Changing Drug Use Problems:

3. Treat8. Changing Drug Use Problems:

4. Follow up9. Drug Use Encounter

10. Who Is a Prescriber?11. How to Collect Data12. Selecting Methods to Study

Drug Use13. Quantitative Methods14. Types of Quantitative Data15. Where Can We Find Useful

Quantitative Data?16. Data Available at District Level17. Data Available at Health

Facilities18. Data from Drug Encounters19. Activity 1: Strengths and

Weaknesses of Different Data Sources

20. Qualitative Methods21. In-Depth Interviews22. In-Depth Interview: Key Points23. In-Depth Interview: Strengths

and Weaknesses24. Focus Group Discussions 25. Focus Groups Key Points26. Focus Groups: Strengths and

Weaknesses27. Structured Observations28. Observations: Key Points29. Observations: Strengths and

Weaknesses30. Structured Questionnaires

31. Questionnaires: Key Points32. Questionnaires: Strengths and

Weaknesses33. Simulated Purchase Visits34. Simulated Visits: Key Points35. Simulated Visits: Strengths and

Weaknesses36. Conclusion: Which Method to Use?37. Activity 2: Designing Qualitative

Instruments38. Activity 3: Preparing for a Field Visit

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TRAINER’S GUIDE LEARNING ABOUT A DRUG USE PROBLEM

ORGANIZATION AND KEY POINTS OF SESSION

First Component 45 minutes VAs 1-12

Overview of the Process of Changing Drug UseThis session introduces participants to an important model underlying the entire course—the cycle of changing behavior. After discussing the four steps of the cycle of changing use, emphasize the importance of the first two steps in designing effective interventions. Use an analogy to clinical medicine to describe these two steps. Step One, measuring drug use, is like taking a patient history, signs, and symptoms. Step Two, diagnosing the problem, is like determining etiology and the range of possible therapies. After these two steps, it is possible to make an informed choice about an intervention (therapy) that is likely to be effective.

Second Component 45 minutes VAs 13-18

Sources of Quantitative Data about Drug UseParticipants receive a broad overview of the many kinds of quantitative data that is possible to collect at various locations in the drug use system: central and district administrative offices, health facilities, private pharmacies, and in the community. Encourage participants to think broadly about the range of data available and how different kinds of data can be used.

Narrow focus at the end of the session to the drug use encounter, and the types of information it is possible to collect about patients, providers, their interaction, and the drugs that are prescribe. Explain that the drug use indicator methodology taught in the course captures only a small part of the possible variety of data about the drug use encounter.

Third Component 60 minutes VA 19

Activity 1: Strengths and Weaknesses of Different Data SourcesThis activity will help participants think in more detail about the different types of data available for studying a specific problem. Use of antibiotics is the problem used in the activity, although this problem can be changed to make the activity fit better in a particular setting.

Time usually allows for each group to complete only one of the four pages of the activity in detail. Assign groups to think about specific pages.

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In reporting, emphasize differences in reliability, in the ease of data collection, and in the cost of obtaining the various types of data.

Fourth Component 45 minutes VAs 20-26

Overview of In-Depth Qualitative MethodsParticipants are introduced to two methods for in-depth qualitative assessment: in-depth interviews and focus group discussions. Emphasize that the purpose of these techniques is to stimulate respondents to talk at length about a set of issues, rather than to answer specific questions.

In-depth interviews and focus group guides should be structured to encourage logical, open discussions of a limited number of ideas, starting with a general question about an idea then narrowing to specific issues through a series of problems.

Fifth Component 45 minutes VAs 27-36

Overview of Semi-Structured Qualitative MethodsThe semi-structured methods described are specific variations of more general observation and questionnaire methods. These specific methods have been chosen because they are especially useful in drug use studies.

Questionnaires are familiar to most participants. Focus attention on how questionnaire can be used to measure attitudes and opinions, especially through the use of rating scales and open-ended questions. Use the session evaluation form as an example of an attitude questionnaire.

Highlight the importance of directly observing behavior during drug use encounters for in-depth understanding of quality of care. Structured observation protocols and simulated client visits are two useful observation methods. Encourage discussion about the issue of bias on the part of the observer and also how the observer's presence might affect normal behavior (Hawthorne Effect).

Sixth Component 75 minutes VA 37

Activity 2: Designing Qualitative InstrumentsThis is a long activity during which participants prepare three draft data collection instruments (in-depth interviews, observation form, patient exit interviews) to use during the second field visit. All groups should develop instruments related to a single clinical

TRAINER’S GUIDE LEARNING ABOUT A DRUG USE PROBLEM

issue that is important in the local environment. Groups can use the examples in the annexes (in the back of the Session Guide) as models for the instruments they develop.

Be sure that the groups adhere to the restrictions on length (one side of a sheet of paper for the questionnaire and observational form, and three or four issues for the in-depth interviews).

Support staff should enter the draft instruments in the computer and return the printed drafts to the groups for editing the following day. After revisions, instruments should be duplicated for use during the second field visit. Each team should use its own instrument, as well as instruments developed by other groups for the remaining two methods.

Seventh Component 30 minutes VA 38

Activity 3: Preparing for a Field VisitDescribe the field sites that participants will visit the following day, and discuss necessary logistics, such as assignment of teams to facilities and transportation arrangements. Remind participants to bring the pages from the activity for Field Visit 1, which they will need for debriefing.

The purpose of the field visit is to demonstrate to participants the wide variety of ways they can learn about drug use in a new setting. Ideally each team should visit at lest one public sector facility (hospital, health center, warehouse, district office) and at least one private pharmacy. Team members should be encouraged to interview staff and patients, examine different kinds of records and receipts, and observe the process of care in different settings. Plan to spend about two to three hours in the field visit.

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Slide 1

Slide 2

TRAINER’S GUIDE LEARNING ABOUT A DRUG USE PROBLEM

Slide 3

Emphasize that many types of data about drug use can be collected at any of the points in the drug use system

Slide 4

Move quickly around the cycle, and expand on details in the slides that follow. Make the analogy to the process of clinical care. Key points: Intervention orientation, interdisciplinary approach, and evidence-based recommendation

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TRAINER’S GUIDE LEARNING ABOUT A DRUG USE PROBLEM

Slide 5

Key point: Focus attention on a small number of issues, and use quantitative methods to examine patterns of drug use.

Slide 6

Key points: What are major causes of problems? What are key barriers to change?

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Slide 7

Key Points: Interventions depend on the causes refined during the diagnosis phase

Slide 8

Key Points: Follow-up completes the quality improvement cycle.

TRAINER’S GUIDE LEARNING ABOUT A DRUG USE PROBLEM

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Slide 9

Key Points: Drug use encounters are the main focus of attention for learning about therapeutic decisions made by a variety of health providers.

Slide 10

Key Points: Interventions can target many different decision makers

TRAINER’S GUIDE LEARNING ABOUT A DRUG USE PROBLEM

Slide 11

Key Points: Emphasize the primary objective of the quantitative method and qualitative method

Slide 12

Key Points: Availability of different methods for studying drug use depending on the situation.

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Slide 13

Key Points: Many sources for quantitative data

Slide 14

TRAINER’S GUIDE LEARNING ABOUT A DRUG USE PROBLEM

Slide 15

Slide 16

Key Points: The importance of district level as sources of data on public sector drug use.

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Slide 17

Key Point: Different workers in health facilities are aware of different sources of data.

Slide 18

Key Points: Level of detail will depend on where and how data are collected

TRAINER’S GUIDE LEARNING ABOUT A DRUG USE PROBLEM

Slide 19

Slide 20

Key Point: Different participants may be aware of or have experience in the use of qualitative methods.

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Slide 21

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TRAINER’S GUIDE LEARNING ABOUT A DRUG USE PROBLEM

Slide 23

Slide 24

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TRAINER’S GUIDE LEARNING ABOUT A DRUG USE PROBLEM

Slide 27

Slide 28

Key Points: Observations can introduce bias in the behaviors of the persons observed, and efforts must be made to desensitize the process before beginning to record data

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Slide 29

Slide 30

TRAINER’S GUIDE LEARNING ABOUT A DRUG USE PROBLEM

Slide 31

Key Points: Questionnaires are useful for many purposes. Here we emphasize using them to measure attitudes, opinions, and beliefs, especially with rating scales and open-ended questions

Slide 32

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Slide 33

Simulated purchases are a form of structured observations

Slide 34

Key Points: Because the scenario is standardized, the method only measures a limited range of behavior. Varying the scenario systematically can illustrate behavior in responses to a range of likely situations.

TRAINER’S GUIDE LEARNING ABOUT A DRUG USE PROBLEM

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