PHA-Exch> New publication: How to improve the use of medicines by consumers

[Claudio Schuftan]

From: Vern Weitzel <vern at coombs.anu.edu.au>
crosposted from: "[health-vn discussion group]" <health-vn at cairo.anu.edu.au>

From: Neil Pakenham-Walsh, UK neil.pakenham-walsh at ghi-net.org

I'd like to draw your attention to an important publication by Andrew
Chetley (Healthlink Worldwide) and colleagues. Although it was published
in 2007 (by WHO, University of Amsterdam, and the Royal Tropical
Institute), I have only just learned about it today - thanks to Juan
Ramos, who collates and distributes the monthly ProCOR Resource Update
(www.procor.org).

The report, 'How to improve the use of medicines by consumers', is 255
pages long but is clear and easy to read, and can be downloaded free from
the WHO website (PDF, 5.6Mb) at:
http://www.who.int/medicines/publications/WHO_PSM_PAR_2007.2.pdf

The introduction sets the scene: "An estimated one third of the world's
population lack regular access to essential drugs, with this figure rising
to over half in the poorest parts of Africa and Asia. When available, the
medicines are often used incorrectly: around 50% of all medicines are
prescribed, dispensed or sold inappropriately, while 50% of patients fail
to take their medicines appropriately (WHO 2002)"

Here are some extracts:

"Although improved knowledge is essential for behaviour change to occur,
there is increasing evidence to show that knowledge by itself may not be
sufficient... Research around efforts to improve home-based management of
malaria in Ghana found that:
- 71% of mothers were able to accurately recall how to administer
antimalarial drugs correctly but at home only 15% give the correct drug,
at the correct dosage for the correct duration
- 63% of mothers knew that a child with fever should receive tepid
sponging (ill) and antipyretics but only 3% cent actually practiced this
treatment.
(Source: Ford N et al. (2003). Communication strategy for implementing
community IMCI. Nairobi, UNICEF
East and Southern Africa Regional Office.)"

"To reach rural women a change in philosophy is needed. Traditionally,
strategies to communicate health messages have been driven by the goals of
policy-makers and senior health professionals. A change in perspective is
required, starting from where the community is in its thinking and
experience."

"1. Health communication is more effective when it reaches people on an
emotional as well as a rational level.
2. Health communication is more effective when it relates to people's
social or 'life' contexts.
3. A combination of the effectiveness of interpersonal communication and
the reach of mass media communication is needed to change population
behaviour.
4. Tailored communication is more effective than general messages.
5. Interactive communication is more effective than one-way information
dissemination.
(Source: Neuhauser L, Kreps GL (2003). Rethinking communication in the
E-health era. Journal of Health Psychology, 8(1):7-23.)"

"Communication methods (sometimes called channels) usually fall into four
broad areas:
- face-to-face activities, sometimes called interpersonal communication
- drama and other folk media, sometimes called performance, popular or
traditional media
- mass media, including electronic media
- print materials and other support activities.
An effective strategy will usually involve a combination of two or more of
these approaches, such as face-to-face and print."

"By themselves, print materials do not change behaviour. However, they are
valuable tools to increase awareness and interest in a topic. When
materials are used together with other methods, such as face-to-face
communication, they can influence attitudes and behaviour."

"Patrick Luganda, is a science journalist in Uganda... 'Many times the
information we publish about a medical subject in our newspaper, the most
read in Uganda, can make the difference between life and death.' Source:
International Network on Public Communication of Science and Technology
http://www.pcst2004.org/ing/conclusion.html "

"There are no formal or informal guidelines to help journalists ensure
that they are not used to promote drugs and to help them maintain the
scientific quality and independence of their reporting... Some journalists
develop their own strategies for confirming the accuracy of claims or
trying to bring balance into their stories. These strategies include:
- being sceptical of claims in company press releases;
- checking information with doctors, patient or disease groups or other
sources;
- consulting rival drug companies;
- consulting medical reference books; and
- checking to see if a drug was included in a national or provincial
formulary."

To me, this last extract raises a major issue. We know that the
information published in a newspaper (or broadcast on television, or
radio) can mean the difference between life and death [not to mention the
difference between clarity and confusion, and the difference between
presence and absence of public trust in science] - and yet there are "no
formal or informal guidelines to help journalists... maintain the
scientific quality and independence of their reporting"? Can this be true?
I'm not entirely clear if this is in fact a misprint and the sentence
should say "there are now formal and informal guidelines to help
journalists" (can anyone help?). If there really are no formal or informal
guidelines, then surely there should be?

The chapter itself provides useful guidance for health journalists,
including the following recommendations presented at a conference in 2001:

"- First, try to do no harm.
- Get it right. Check your facts, even if deadlines are put at risk.
- Do not raise false hopes. Be especially careful when reporting on claims
for 'miracle cures'.
- Beware of vested interests. Ask yourself who benefits from this story.
- Never disclose a source of information imparted in confidence.
- When dealing with individuals who may be sick or handicapped, and
especially with children, be mindful of the consequences of your story.
They will have to live with it long after you are gone.
- Never intrude on private grief.
- Respect the privacy of the sick, the handicapped and their families at
all times.
- Respect the feelings of the bereaved, especially when dealing with
disasters. Close-up photography or television images of victims and their
families should be avoided wherever possible.
- It in doubt, leave it out.
(Source: Apfel F (2001). Reframing the lifestyle and health debate:
enhancing the impact of public health communications. Paper presented at
the XVIIth World Conference on Heath Promotion and Health Education,
Paris, France, 15–20 July 2001.)"

Journalists clearly have a hugely important role in influencing health
behaviour, and yet have the potential to cause widespread confusion and
harm. How can they be better supported to deliver quality and independence
in their reporting?
-------------- next part --------------
An HTML attachment was scrubbed...
URL: <http://phm.phmovement.org/pipermail/phm-exchange-phmovement.org/attachments/20080216/4b0710b5/attachment-0001.html>