Principles of Persuasive Face-To-Face Education

Principles of Persuasive Face-To-Face Education

Trainer's Guide

Principles of

Face-to-Face Education


Principles of Persuasive Face-to-Face Education



1.Recognize the unique advantages of facetoface education in comparison to other approaches.

2.Identify the most important principles and techniques of facetoface educational programs.

3.Understand how to carry out persuasive face to face education.

4.Gain expertise in the training of other health care workers to conduct effective face-to-face educational programs in their countries.


Read the Session Notes.

If Activity One: A Teaching Script for a Face-to-Face Visit with Prescribers at Centro Health Center will be used, arrange for one team to prepare the script in advance. During the activity, they can present the script and have their interaction critiqued. This saves considerable time in carrying out the activity.




  1. Objectives
  2. Diversity of Educational Interventions
  3. Advantages of Persuasive Face to Face Education
  4. Sites for Face to Face Education
  5. Effect of Persuasive Education on Prescribing by Private MDs in the US
  6. Zambia Essential Drugs Program
  7. Group Seminars to Improve Prescribing in Zambia
  8. Impact of Group Seminars on Prescribing in Zambia
  9. Effect of Small Group Training on ORS Sales in Kenya and Indonesia Pharmacies
  10. Effect of Small Group Training on Antidiarrheal Sales in Kenya and Indonesia Pharmacies
  11. Sizes of Improvement by Intervention Type
  12. Findings About Educational Strategies
  13. Principles of Persuasive Education
  14. Motivations Reported by Prescribers
  15. Motivations Reported by Prescribers
  16. Targeting Opinion Leaders
  17. Effect of Reinforcement on Reduction in Use of Targeted Drug
  18. Characteristics of Persuasive Educators
  19. Managing Face to Face Education
  20. Activity One
  21. Face to Face Education Conclusion






First Component

 (30 minutes)  VA 's 1-4

Overview of Persuasive Education

This component provides participants with an overview of the different types of educational interventions, and introduces them to the advantages of persuasive face-to-face education. Many participants will be unfamiliar with the concept of persuasive education, with what features make educational interactions persuasive, and with why persuasive education is the best for stimulating behavior change.

Spend time discussing the strengths and weaknesses of different styles of education that participants have experienced. Ask what types of in-service training programs are usually conducted in their environments. Use the example of the PRDU course structure to illustrate an interactive educational process using small groups, and the importance of two-way communication for learning.

Introduce the idea of the pharmaceutical marketing visit as a one-on-one persuasive educational interaction, and ask participants to describe some of the characteristics of these visits that make them effective.

Second Component

 (30 minutes)  VA 's 5-12

Examples of Successful Strategies

This component begins with a few examples of successful persuasive educational programs aimed at improving drug use in different settings.

Point out that early work with this method was referred to as “academic detailing” and emphasized brief (15 minute), one-on-one educational outreach visits by trained pharmacists to private physicians. The example from the US illustrates that this intervention resulted in significant reductions in outpatient use of targeted drugs (cephalosporins, propoxyphene, cerebral vasodilators), while simply distributing printed educational material about these drugs had no effect.

The Zambia study applied similar concepts of interactive targeted education to small groups of primary health care workers. The educational program involved repeated small group sessions, multiple training methodologies, and a small number of target health problems. System supports in the essential drugs program like an EDL and drug supply improvements facilitated the effects of training. The most notable improvements were in diagnosis and appropriate case management. The example of the drug sellers intervention from Kenya and Indonesia illustrates that a similar small group method can also be used to improve practices in private pharmacies.

Several review papers were commissioned for the International Conference on Improving the Use of Medicines, which was held in Chiang Mai, Thailand, in April 1997. The review of primary care interventions identified 59 studies from Africa, Asia, and Latin America, of which 36 had adequate methodological designs. In the overhead presenting the results of this review, focus on the first two categories: dissemination of printed materials, and training strategies. Reinforce the point that print materials alone are not effective in changing behavior. In the review of findings of educational strategies, emphasize the elements that have been shown to improve the effectiveness of training, including problem orientation, single health problem focus, interactive format, and multiple contacts with participants.

Third Component

 (45 minutes)  VA 's 13-19

Principles of Persuasive Education

Some principles of persuasive education are examined in more depth in this component. In the introductory overhead, give two points additional emphasis. First, persuasive education should focus on actual decisions and behaviors rather than on didactic content; always determine which decisions or behaviors must change, and focus the educational messages on those points. Second, credibility of the source of information is a key element in persuasiveness, and one way to differentiate unbiased educational programs from the marketing activities of industry.

Major issues to be covered in the review of principles include: targeting educational messages to individual motivations reported by prescribers; identifying and using opinion leaders; and the importance of reinforcement for maximizing and sustaining effects. Spend time on the concept of choosing suitable individuals to be persuasive educators. Emphasize that the appropriate type of individual will vary according to the setting and the target audience. Discuss whether specially trained pharmacists would be appropriate outreach educators for private physicians in the participants’ countries.

This component concludes with an overview of some key management issues for education programs. Persuasive education is most successful not as a one-step process, but rather as an ongoing activity. Establishing credibility, developing a relationship of trust over multiple encounters, and monitoring changes in practice are all aspects of successful programs.

Fourth Component (Option 1)

 (60 minutes)

Activity One: A Teaching Script for a Face-to-Face Visit with Prescribers at Centro Health Center

This activity is a role play of an education visit by Dr. Onyango, a trained educator, to a small staff group at a health center. Because the text for the encounter is somewhat long, it is best to have one group prepare the script in advance so they can act it out in front of the other participants. Ideally choose a group with a dynamic individual who can play Dr. Onyango. Alternatively you can give the whole class ten minutes in which they should read through the script and note the various principles being used. If you tell one group at the start of the reading that they will present it gives them ample time to select who will play which role.

When introducing the activity, review briefly the material in the background section. Then explain that one group has prepared the role play, and that other participants are to observe the encounter and be prepared to critique the performance of the educator according to the principles of effective persuasive education.

One option for this activity is to have the group prepare to act out the role play once in a way that violates the principles of effective persuasive education. For example, Dr. Onyango could be abrupt in his/her manner, fail to establish credibility, be critical of previous practice by the staff, give unclear messages, fail to set up a return encounter, etc. Alternately, the group could try to act out the role play in the reasonably positive way that it is written.

After the role play is complete, elicit comments from participants about the good and bad points of the encounter. When the major issues have been covered, ask the same or a different group to act out the role play again, with Dr. Onyango taking into account what he/she has learned about ways to improve the persuasiveness of the encounter.

Complete the activity with a discussion about whether it is realistic to expect these types of educational sessions in different countries. Ask participants to comment about how the sessions would be different if the outreach educator was a district medical officer responsible for supervision of the health center, or if the educator was a district pharmacist responsible for pharmaceutical quality improvement.

The use of the bad and then the good role play has been criticized by some trainers who have suggested that it is better to allow one group to present as well as they can and to break up the action at a number of points.

The text of the role play is reproduced below with the suggested comments by the trainer included in italics.

Introduce the setting to be as close as possible to the local situation.


Dr. Aziz sits with the facility staff in his office at the health center waiting for Dr. Onyango to enter. Dr. Aziz is looking at his watch as if he has very little time to spare.

Dr. Onyango enters the room and shakes hands with the staff before he sits as well.

Dr. Onyango:"Hello, I am a Drug Information Advisor from the Mashiriki Medical School's Drug Information Program.


Dr. Aziz:Drug Information Advisor, "What is that?" (Looking surprised and skeptical, as if he suspects that this is really a drug salesman in disguise).

Dr. Onyango:"I'm a Pharmacist working for the Drug Information Program at Mashiriki Medical School. We are trying to provide an information service to physicians and other prescribers who treat children in their practice. You will agree with me, Dr. Aziz, that children are very delicate, and there's an enormous amount of new information coming out every year on drugs to prescribe for them, and it's almost impossible to keep up with it. The main goal of our service is to provide important, uptodate information on drugs you may be prescribing so that your patients get appropriate treatment. The information and recommendations were prepared by pharmacology experts at the Medical School and consultants from the World Health Organization."

Point out that this first interaction was aimed at establishing credibility.

Dr. Aziz:"Thank you for coming, but I have very little time. I have 10 patients waiting in the other room."

Dr. Onyango:"I realize that, and I will try to be very brief. If necessary, I can finish up another day."

Dr. Aziz:"O.K., but please hurry."

Dr. Onyango:"I'm sure that a few of your ten patients waiting in other room are mothers with children suffering from diarrhea. At one time or another, you may have used many different mixtures, including the so-called antidiarrhea drugs..."

This sequence shows that Dr Onyango is aware of the problems seen by Dr. Aziz and is interested in his situation

Dr. Aziz:(Nods head, agreeing.)

Dr. Onyango:"Could any of you tell me which ones you commonly use?"

Mr. Bofu:"Well a few of them. Let me try to remember the ones I have used in last couple of days... Streptomagna, Dialin, Septrin. Why do you ask? "

By asking participants questions and then responding to these questions the to and from of two way communication is established.

Dr. Onyango:"I ask because conclusive evidence has now been found that all of the mixtures used in treating childhood diarrhea are really useless, and sometimes can even be dangerous. Let us just see how effective these drugs are. (Takes out the brochure on antidiarrheals, "Do antidiarrheals and other drugs have a role in the treatment of diarrhea in children of 0-5 years?"). According to WHO and UNICEF, and pharmacology experts at the medical school, these mixtures have no role in the management of childhood diarrhea which is self-limiting in 90 to 95% of cases. At the same time antidiarrhea drugs can be dangerous to your patients. (Turns to inside of front page). You see, Doctor, diarrhea is nature's way of eliminating harmful substances from the body. The antidiarrhea drugs may superficially stop the diarrhea, but the pathologic effects on the body of whatever caused the diarrhea in the first place will continue. On top of that, fluid loss from the body into the gut continues as well. Adding insult to injury, antidiarrhea drugs can also cause side-effects (points to list of side-effects) which you will agree can be quite dangerous for babies. That's why our program is recommending the modern scientific treatment of diarrhea (points to sign of hand on inside-back page): ORS+Fluids+Food. What do you think about this, Doctor? Does it make sense to you in your own practice?"

This is the key point of the meeting. Dr Onyango is giving the key messages, using multiple different methods, print, graphic inputs and oral interactions ideally combined with body language.

Ms. Clotilda:"You say these drugs are dangerous. But how come our government has approved their use in the first place?"

Dr. Onyango:"You see, Dr. Aziz, new knowledge about drugs comes every day, and the whole point of this drug information service is to periodically provide you with such information so that you can better treat your patients. There is agreement among the worldwide community of scientists that antidiarrhea mixtures are of no use, and could be even potentially dangerous in childhood diarrhea. We are working with the government to change regulations regarding these dangerous drugs. Such changes take time. Many countries have banned them already."

Responding to difficult or challenging questions is an important part of a face to face interview. By pointing out difficulties Dr Onyango is likely to win Dr. Aziz over to his point of view.

Mrs. Dhama:"Those scientists may be right. But many of my patients come expecting a fancy drug for their illness. In fact, their illness seems to be helped the most if I prescribe a drug with a name they can't pronounce. If they think it's more powerful, the effect on diarrhea seems to be greater! A plain packet of ORS will disappoint them as many of them think that ORS is just water, and not a drug."

Ms. Clotilda:"Yes, that happened to me yesterday when a patient demanded an injection but I convinced him that ORS was better."

Dr. Onyango:"I understand your objections. But we feel that if ORS is presented in the proper way, you can convince patients that ORS is truly the best drug for their children's diarrhea. (Takes out ORS pamphlet.) In fact, we have these patient information flyers that I'll leave with you. If you give these to the patient with a prescription for ORS, you are emphasizing the potency of ORS and creating your own "placebo effect." You canactually write a prescriptionforORS. Some other patients will still be unwilling to take "plain ORS" because of their strong beliefs in drugs that look different, or have fancy names. For these patients there are some flavored ORS brands such as Servidrat which may be more appealing."

Here Dr Onyango is using the questions to reinforce the key messages of the presentation.

"In summary, Doctor, ORS is the drug of choice for uncomplicated diarrhea in children. It is the only drug which is effective in correcting dehydration and restoring health in your patients, and free from the side-effects which antidiarrheals have."

"Will you try ORS for the next child you see with uncomplicated diarrhea?"

With these final comments Dr. Onyango is summarizing again the key messages and involving his target audience by challenging them.

Mr. Ephraim:"What you say makes sense, and may be worth trying."

Dr. Onyango:"I'll come by in a month to see if your new approach works. Our group will be very interested in hearing your results. Is there anything else I can help you with today?"

Dr Onyango is now setting up his next visit so that he will be welcome and that he can identify other issues that he could address in the next visit.

Dr. Aziz:"Well, you mentioned that WHO has done detailed research into the role of antidiarrheals. Quite frankly, the materials which you showed me are very basic. Do you have more detailed information which I could share with my junior colleagues?"

Dr. Onyango:"That's no problem. I'll leave with you few copies of what we call the "pink book". Do you think it would help if I spent few minutes with your colleagues as well?"

All Staff:Oh sure. Do let me know what they have to say.

Dr. Onyango:I will, Dr. Aziz. Thanks very much for your valuable time.

By showing an immediate response to Dr Aziz and thanking all of the staff Dr Onyango is emphasizing that he is responsive and respectful.

Fifth Component (Option 2)

 (60 minutes)

Activity: Designing an Educational Intervention