1. Decision Making for Rational Use Interventions

2. Decision Making for Rational Use Interventions: Objectives
To review intervention strategies
Choose between interventions
Develop a plan to undertake an intervention
Decision Making for RDU Interventions

3. Choosing Strategies Expected magnitude of impact Likelihood of success
Risk of unintended effect
Political and cultural feasibility
Technical feasibility
Cost (economic feasibility)
Potential for donor support
Decision Making for RDU Interventions

4. Framework for Intervention Studies
FORMATIVE
STUDIES
INTERVENTION
FOLLOW UP
1. Define Problems with Drug Use Patterns
2. Identify Motivating Factors/Underlying Causes
3. List Possible Interventions
4. Choose Intervention(s) to test
5. Conduct controlled study of Intervention(s)
REVISE & RESTUDY
partially effective or costly interventions
IMPLEMENT
cost effective interventions on a larger scale
DROP
ineffective, uneconomical interventions
prescribing
dispensing
patient use
informational
economic
social, cultural
supply logistics
educational
managerial
regulatory
cultural acceptance
likelihood of success
potential impact
feasibility
Source: Quick et al
Decision Making for RDU Interventions

5. Selecting an Intervention Stage 1: Choosing a Target
Characterize situation (indicator study)
Clarify problem (follow-up quantitative studies)
Investigate underlying factors (qualitative studies)
motivations of prescribers
patient expectations
constraints of system
Synthesize data to choose targets
key behaviors to change
target group
Decision Making for RDU Interventions

6. Selecting an Intervention Stage 2: Choosing an Intervention
List possible interventions
Consider available resources
financial
human
administrative structure
Choose an intervention (or interventions)
feasibility
likely to change target behaviors
no absolute constraints
Decision Making for RDU Interventions

7. Types of Study Design Post Only: Pre-Post Randomized Trial Time Series
after the event
Pre-Post
before and after
Randomized Trial
random assignment of study & control group
Time Series
multiple measures before and after
Not Recommended
Not Recommended
Recommended
Recommended
Decision Making for RDU Interventions

8. Principles of Good Intervention Testing
Use a relevant comparison group
randomly assigned if possible
data collected like study group
Measure outcomes at multiple time points
before and after intervention
time series?
Focus on key outcome measures
behaviors targeted by intervention
feasible to measure
Decision Making for RDU Interventions

9. Choosing Useful Outcome Measures
Focus on key behaviors to be changed
Consider likely substitute behaviors
Focus on several important outcomes, not all changes
Choose outcomes:
that can be clearly defined
that can be reliably measured
Measure more than one dimension, for example
changes in knowledge
changes in prescribing
changes in patient knowledge
Decision Making for RDU Interventions

10. Issues and Sampling Methods
Unit of analysis must be defined before sampling begins. Sample size must be enough to detect expected changes
Simple Random Sampling
Systematic Sampling
Stratified Sampling
Cluster Sampling
Multistage Sampling
Decision Making for RDU Interventions

11. Using Samples to Collect Data
A sample should be typical of the overall group of interest.
The accuracy of a study depends on the sample size.
If sample units are drawn in clusters, the size of the clusters should be small, and the number of clusters should be large.
Decision Making for RDU Interventions

12. Involving Decision Makers at Design Stage
By involving decision makers at design stage increases chances of implementation if the intervention is successful
Opportunities for involving decision maker should be actively sought
Asking for input at the design stage increases chances of cooperation and success
Decision Making for RDU Interventions

13. Planning an Intervention
Decide what kind of study to use to test the intervention
Define study and control groups
Define sampling process and size
Define outcome variables to measure success
Plan how to collect data
Decide who will analyze the data, how, and when*
Plan how to present the data, and to whom
Decide how to monitor the project
* Remember: if you can analyze by hand, a computer may help.
If you can't, a computer only makes things worse!
Decision Making for RDU Interventions

14. Gantt Chart
Decision Making for RDU Interventions

15. Budget Outline
Decision Making for RDU Interventions

16. Budget Outline (continued)
Decision Making for RDU Interventions

17. Conclusion Which Method to Use
Best method depends on:
nature of the problem
objectives of collecting data
available resources and time
local capacity and experience
Use multiple methods
quantitative + qualitative
“triangulate” findings
each method can look at different aspects of a problem
Decision Making for RDU Interventions

18. Conclusion 2 Points to Consider when Developing Strategy
Specific intended changes in behavior
Possible unintended outcomes due to the intervention
How both intended and unintended changes will be measured
Choice of intervention (or combination of interventions)
Why this is likely to achieve desired changes
Other information needed to design the intervention
Decision Making for RDU Interventions