Organizations working with medicines programmes need to pay more attention to educating consumers on the appropriate use of medicines. Interventions directed towards consumers are most relevant if they focus on common patterns of irrational medicines use, and examine medicines use problems that consumers consider to be important.
Policy-makers need to be involved in research into drug use interventions to facilitate the process of translating evidence into action. Drug use studies should be an integral part of the process by which we develop interventions to enhance more appropriate drug use by consumers. An overview of the process is given in figure 1.
Figure 1. Steps in developing an effective intervention aimed at enhancing rational drug use by consumers
Research is an integral part of this intervention cycle. It is the main activity in all steps, except 4 and 6 that concern the actual selection and implementation of interventions.
Step 1: Identify medicines use problems. To identify drug use problems you first need to describe common drug use practices and assess to what extent these are rational, and to describe what people in the communities and health workers consider to be drug use problems. In this step you aim to get an overview of community drug use problems. You can use existing (secondary) data, and if resources are available new data on drug use by consumers can be collected. In this phase drug use studies should focus on what people do with drugs and what they consider to be problems in drug use, not on why they take drugs the way they do.
Step 2: Prioritize medicines use problems. The overview of problems identified in step 1 forms the basis for step 2, in which problems are prioritized and selected as the focus of your intervention.
Step 3: Analyse medicines use problems and identify possible solutions. In this step you analyse the factors that contribute to and cause the selected problem and identify possible solutions. Research in this step aims to describe the core-problem(s) in more detail and analyse why the problems occur. In conducting such an analysis you need to consider the various layers of influence, as discussed in Chapter 2 of this manual. These layers include the family, the community, the health institution, the state, and the global environment. Such analysis helps you develop an appropriate intervention aimed at changing the inappropriate medicines use practices. The analysis is done in consultation with key stakeholders. They also help to identify possible solutions.
Step 4: Select and develop interventions. How to select and develop rational drug use interventions is dealt with in the forthcoming companion manual, How to Improve the Use of Medicines in Communities. This guide will provide information on how to develop and use printed materials, folk and mass media, and video, as well as giving information on how to work with journalists, and advocate for better health and medicines policies. The intervention methods presented in the manual can be used to change individual behaviour and to convince health policy-makers and politicians that they need to change health and medicines policies.
Step 5: Pretest interventions. Once an intervention has been developed you will need to pretest it. Pretesting involves trying out the intervention and/or educational materials to be used in the intervention with a small group of the target audience. The group’s feedback and the results are used to fine-tune the intervention and the evaluation and monitoring activities.
Step 6: Implement interventions. Pretesting can lead to changes in the way the selected intervention is implemented. Once the intervention has been optimized, it can be implemented.
Step 7: Monitor and evaluate interventions. Research plays a role in monitoring and evaluating interventions. Evaluation results serve to improve an intervention, and help in sharing successes and failures with others.
Boonmongkon P, Pylpa J, Nichter M (1999). Emerging fears of cervical cancer in the Northeast of Thailand. Anthropology and Medicine, 6(3):359-380.
Hardon A (1991). Confronting ill health: medicines, self-care and the poor in Manila. Quezon City, Health Action Information Network.
Hardon A, Le Grand A (1993). Pharmaceuticals in communities. Practices, public health consequences and intervention strategies. Bulletin 330. Amsterdam, Royal Tropical Institute.
Homedes N, Ugalde A (1993). Patients’ compliance with medical treatments in the Third World. What do we know? Health Policy and Planning, 8(4):291-314.
Lansang MA et al. (1990). Purchase of antibiotics without prescription in Manila, the Philippines. Inappropriate choices and doses. Journal of Clinical Epidemiology, 43(1):61-67.
Lansang, MA et al. (1991). A drugstore survey of antibiotic use in a rural community in the Philippines. Philippine Journal of Microbiology and Infectious Diseases, 20(2):54-58.
Sringernyuang L (2000). Availability and use of medicines in rural Thailand. Amsterdam, Academisch Proefschrift, University of Amsterdam.
Ugalde A, Homedes N, Collado J (1986). Do patients understand their physicians? Prescription compliance in a rural area in the Dominican Republic. Health Policy and Planning, 1(3): 250-259.
Van Staa A, Hardon A (1996). Injection practices in the developing world: a comparative review of field studies in Uganda and Indonesia. Geneva, World Health Organization. WHO/DAP/96.4.
WHO (2002). Promoting rational use of medicines: core components. WHO Policy Perspectives on Medicines, No.5. Geneva, World Health Organization.