Advocacy and networkingTrainer's notes

INVESTIGATING DRUG USE

PATTERNS AND IDENTIFYING PROBLEMS

trainer’s notes

PURPOSE AND CONTENT

This module aims to give participants insight in how they can get a ‘helicopter’ overview of community drug use problems in their country. It also intends to give them insight in the limitations of existing data-sources. Doing a situation analysis of drug use problems is the first step in the development of effective drug use interventions.

Prior to coming to the course, participants should have identified three major drug use problems in their countries. In group activities the participants review the evidence for these problems; identifying where additional data-gathering is called for. And, they practise two specific data-collection tools: A drug inventory and a focus group discussion (FGD).

OBJECTIVES

This module will develop the participant’s ability to:

1.Understand when research is needed during development of drug use interventions, specifically gaining insight in the kind of research that can result in a good overview of drug use problems in the country.

2.Define what questions need to be asked to identify community drug use problems that can be a focus for interventions.

3.Identify appropriate quantitative and qualitative methods to answer the questions.

4.Appreciate how the methods can be used to collect the data needed to answer research questions.

PREPARATION

Participants should:

1.Read the Session Notes.

2.Have identified three major drug use problems in their countries, as well as supporting evidence. Prior to the course, they were asked to prepare a short description of three important consumer drug use problems in their country and to cite any studies or secondary (supporting) sources which provide data on the problems. In Activity 1 of this module, they are asked to review the data which they have on the selected problems.

3.After the session, participants should be encouraged to review the Session Notes again. The methods presented in this module are of use in all the stages in the development and implementation of interventions.

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Investigating drug use patterns and identifying problemsTrainer's Notes

The trainer should

1. Read the Session Notes thoroughly. These are rather dense and form the basis for this half-day session. It is important that during the session the trainer refers to relevant sections in the Session Notes to encourage the students to reread them after the session.

2. Prepare for Activity 1 by reminding the participantsat the end of the session What influences drug use by consumers if they have indeed described three major drug use problems in their country as they were instructed to do in the letter of invitation. Tell them that they need to take this information with them to the session on Investigating drug use patterns and identifying problem’. Also identify four FGD moderators and ask them to prepare for Activity 3, i.e. review the guide and adapt it, and review the role of the moderator (Session Notes D2).

3. Prior to the session, arrange the name cards on the tables, so that for the activity participants can work together in regional groups with around 5-6 participants per group. Each group needs a flip chart and pens.

4. Prepare for Activity 2 by making sure the inventory list is copied for all the participants to be distributed before lunch.

5. After the coffee break prepare for Activity 3 (the FGD), by asking participants to form new ‘table’ groups, by gender and ‘relative’ age, resulting in around four groups of around 6-7 participants:

  • women below 40
  • women 40+
  • men below 40
  • men 40+

6. Review the overheads.

7. Make sure that each group has a copy of the FGD guide, pieces of A5 paper for the drug use inventory part of the FGD and a soft-board on which these papers can be pinned in relevant groups.

8. Check that core library handouts are ready for distribution at the end of the day.

CORE LIBRARY

de Zoysa J et al. (1988) Research Steps in the Development and Evaluation of Public Health Interventions. Bulletin of the World Health Organization, 76(2):127-133.

additional READING

Hudelson PM (1994) Qualitative Research for Health Programmes. Division of Mental Health (WHO/MNH/PSF/94.3.Rev.l) Geneva, World Health Organization.

Debus M (1986) Methodological Review: A Handbook for Excellence in Focus Group Research. Washington DC, Academy for Educational Development, HEALTHCOM, (Write to: BASICS, Information Center, l600 Wilson Blvd., Suite 300, Arlington, VA 22209, e-mail to request a free copy).

Abramson JH, Abramson ZH (1999) Survey Methods in Community Medicine, 5th ed. Edinburgh, Churchill Livingstone.

organiSation of the session AND KEY POINTS

The session includes two activities for group work, one individual activity to be conducted in the lunch break and interactive lectures.

Structure and timing of the session

  1. Objectives and purpose - 5 minutes
  1. Why study drug use by consumers - 5 minutes
  1. Introducing the framework for the development of interventions and the step where research is needed - 10 minutes
  1. Activity 1: initial review of drug use problems - 20 minutes
  1. Studying drug use by consumers -20 minutes
  1. Activity 1: Step 2 - 30 minutes

Coffee/tea break - 20 minutes

  1. Studying drug use by consumers: key methods - 30 minutes
  1. Introduction on how to conduct an FGD - 30 minutes + 10 minutes for review
  1. Activity 3: FGD on everyday medicine use - 30 minutes
  1. Feedback : strengths and weaknesses of FGDs - 20 minutes

VISUAL AIDS

  1. Title slide
  2. Objectives
  3. Why study drug use
  4. Extent to which health worker advice is sought
  5. Trends in medicine use
  6. Community drug distribution
  7. Framework for developing interventions
  8. Steps in an effective communication intervention
  9. Step 1: describe
  10. Step 2 : prioritise
  11. Step 3: analyse and focus
  12. Research also needed for
  13. Activity 1
  14. Questions: individual/community
  15. Questions: individual/community continued
  16. Questions: health institution level
  17. Questions: national level
  18. Activity 1, Step 2: review of existing data sources
  19. Matrix for review of existing data sources
  20. Limitations of existing data sources
  21. Limitations continued
  22. Additional quantitative research needed
  23. Additional qualitative data needed
  24. Key quantitative methods
  25. Key qualitative methods
  26. Research methods: Individual level/community
  27. Research methods continued
  28. Research methods: health institutions
  29. Research methods: national level
  30. Focus groups
  31. Focus groups: how to
  32. Focus group content
  33. How to analyse FGDs
  34. Activity 3: FGD on everyday medicine use

1. Objectives and purpose (5 minutes)

Use OH 1, 2 to discuss the objectives of the session. Give more details on the overall purpose (see above)

2. Why study drug use by consumers? (5 minutes)

The session starts with a discussion on why research is needed to describe and analyse community drug use problems, referring back to some of the key insights in community drug use from the module What influences drug use by consumers.

Use OH 3-6.

3. Introducing the framework for the development of interventions: When is research needed? (10 minutes)

The session continues with a discussion of the framework for the development of interventions, which is a key framework for the entire course. Here, the trainer introduces the steps in which research is needed; and points to the sessions of the course in which these steps will be discussed.

Use OH 7-12

Stress that many of the methods discussed in this session are useful in the other steps in the development of interventions. During the various ‘research’ sessions there are practical exercises to give the groups hands-on experience with key research methods.

The trainer should also highlight that the framework involves a focusing process in which first an inventory is made of possible drug use problems; the problems are then prioritised, and further analysed as a basis for interventions. It is important to focus on specific problems as only with such a focus can one define specific communication objectives for interventions. In reality health planners often develop interventions without conducting a ‘rational’ prioritisation and focusing of problems; and without analysing the problems properly. As a result interventions are often not well-designed, nor effective.

4. Activity 1: Step 1: Initial review of drug use problems

(spend approximately 20 minutes on this step)

Refer participants to Activity 1 and ask them to do Step 1 in the regional groups which you have arranged. Use OH 13 to explain the exercise. Explain that this is just a preparatory step.

5. Studying drug use by consumers: (20 minutes)

The group discussion in activity one is a good starting point for an interactive lecture on key questions that one would want to answer in research on drug use by consumers. Ask participants to reflect back on the factors which influence drug use by consumers, and the layers of influence identified in the former session. Starting from the individual/community level ask them to propose relevant research questions.

One of the co-trainers writes the suggestions on a flipchart.

Continue in the same way with the health institution and the national level. There is probably no time to do the international level, which is also a bit ‘remote’ in terms of concrete drug use problems.

Review the questions raised. You can use OH 14-17 to summarise key questions. But, this is not essential. It is better if the group elicits the questions, as proposed above.

6. Activity 1: Step 2: reflection on evidence which justifies drug use problems (30 minutes)

The purpose of Step 2 in the group activity is for participants to reflect on the drug use problems which they identified prior to coming to the course, and the evidence which justifies the identification of the problem. This exercise helps them realise that additional research is needed to get a good overview (helicopter view) of the drug problems in their country/region. Participants also reflect on the strengths and weaknesses of existing data sources.

Use OH 18,19to explain the exercise. In identifying possible additional research refer the students to the Session Notes, which can give them ideas.

Coffee/tea break (20 minutes)

7. Studying drug use by consumers: key methods

(30 minutes)

Start with reviewing the limitations of existing data. OH 20-23.

In an interactive lecture following this exercise the trainer goes back to the layers of influence:

  • individual/community
  • health institution
  • national

and the key questions identified in the morning. (S)he discusses key methods which can be used to answer the questions.

Use OH 24-29.

8. Introduction on how to conduct an FGD (30 minutes)

In other sessions the participants will practise other research methods. In this session the method to be applied is a ‘focus group discussion’.

The trainer gives an introduction on how to conduct FGDs

Use OH 30-34, including introduction to Activity 3.

9. Activity 3: Focus group discussion on every day medicine use (40 minutes)

Help the participants to split into the required groups: women below 40, women 40+, men below 40, men 40+. Groups should not be larger than 8 participants so it may be necessary to form more than one group of each category.

The participants then review, and if desired modify, the FGD guidelines (10 minutes).

The participants select a facilitator and a rapporteur. They then conduct a focus group discussion on the medicines they commonly use, and their views on the safety and efficacy of these medicines (see Session Notes for full description of the activity and text of the FGD guidelines) (30 minutes).

Circulate among the groups while the FGDs are being conducted to answer any queries they may have. The rapporteurs in particular may need some additional help. Keep an eye on the time and move discussions along if a group is spending too long on one issue.

10. Feedback: strengths and weaknesses of FGDs

(20 minutes)

For the final 20 minutes of the session the trainer facilitates a group discussion on the lessons learnt, followed by a wrap up summarising the strengths and weakness of FGDs.

Follow-up

The results of the inventory (the forms which participants filled in during the lunchbreak) are analysed by the teacher. Fix a time the next day to meet with the FGD rapporteurs when they can give you an extended report on the discussions. The results of this exercise are presented in the session on Data analysis.

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