The first stage of the project was a search of the published literature on public education in the rational use of drugs (RUD).31 This was completed in February 1995 and covered searches on material published from 1988 onwards.a
a Databases used: Medline; African Index Medicus; Lilacs (the index of the Pan American Health Organization). Journals used: American Journal of Hospital Pharmacy; American Journal of Pharmaceutical Education; American Pharmacy; Annals of Internal Medicine; British Journal of Clinical Pharmacology; British Journal of General Practice; British Journal of Prevention and Social Medicine; British Medical Journal; Drug Intelligence and Clinical Pharmacy; Health Education Reports; Health Education Research; Health Policy and Planning; Health Promotion International; Quarterly on Community Health Education; Lancet; Medical Journal of Australia; New England Journal of Medicine; Social Science and Medicine. WHO sources: Bulletin of the World Health Organization; Essential Drugs Monitor; World Health Forum; DAP’s reference collection. Keywords: Communication; drug use; medication use; public education; school health education.
The literature search confirmed the continued scarcity of accessible information. Although numerous descriptive studies (KAP-knowledge/attitude/practice) concerning RUD issues have been conducted, such as those reported in DAP's Research Series,32-37 there are very few documented descriptions of public education interventions in the rational use of drugs. Some of the sources included in the review - in particular articles from the Essential Drugs Monitor (EDM) and Health Action International (HAI) News - are short descriptive pieces or announcements of ongoing projects, and not detailed reports, and are not generally cited in standard databases.
In contrast to the lack of reported public educational studies, many of the interventions and intervention studies described in the literature are aimed at changing the drug utilization patterns of prescribers, or at influencing what is described as "patient compliance". It is important to make a distinction here between "compliance" and "RUD education". The former refers to the adherence of an individual to a prescribed treatment regimen, whereas the latter concerns the judicious, appropriate, and safe use of medications, whether prescribed or purchased over-the-counter. The substantial body of literature on compliance has been reviewed elsewhere38 and was not included in the literature review.
Furthermore, as though to underscore the small number of public education interventions on RUD, many descriptive studies of drug use in Africa, 3639-43 Asia, 44-47 Latin America,48-50 Europe51 and the Western Pacific,52 53 highlight and recommend the need for education of the population in the correct use of medicines and the dangers associated with their improper use.
The projects discussed in the literature can be classified into five categories, based on the type of interventions used. The principal interventions are:
- direct contact (patient counselling or home visits). This includes interpersonal communication training for pharmacists or health workers;
- leaflets or package inserts;
- mass-media campaigns;
- school education;
- publications to consumers and health workers.
Other approaches included audiotapes and street theatre, in combination with printed materials.
In strong contrast to the scanty body of published interventions, it was apparent from informal channels of communication and from the Action Programme's own country work that many activities were taking place that were not reported in any standard published outlets. It was therefore decided to seek additional information about ongoing or recently completed projects via questionnaire.