AI Related Booklet Pretest

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AI Related Booklet Pretest Study (healthcare
workers)
Date February 2009 Prepared for Academy for
Educational Development Research Team SIAR
Research and Consulting Qualitative Team
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Objectives and Methodology
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Background info and purpose of the research

• Background information
• The U.S. Agency for International Development has
  awarded Academy for Educational Development
  (hereinafter, AED) a global Task Order to conduct
  behavior change communications activities on
  avian influenza prevention and containment and
  response to pandemic influenza. In Azerbaijan,
  target audiences for these communication
  activities include small rural backyard poultry
  farmers (Sector 4), small commercial farmers
  (Sector 3), first responders to public health or
  natural disasters, and human and animal health
  officials.
• Purpose of the research
• As a second step of the Azerbaijani part of the
  project, AED has concluded contract with SIAR
  Research and Consulting Group (hereinafter, SIAR)
  to conduct qualitative research aimed at
  pretesting the booklet among specific target
  groups, namely healthcare workers and
  administrative workers of health institutions.
  More specifically, the goal was to understand
• ..to what extent the text in the booklet is
  understandable and applicable
• ..the lucidity of the text
• ..to what extent the picture used in the booklet
  are relevant
• ..the weak sides of the booklet and define ways
  of its development

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Methodology
Method Qualitative Research
Technique Focus Group Discussions
Timing February, 2009
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Sample design
Target group Number of FGDs Number of FGDs Number of FGDs Number of FGDs Total
Target group Baku Salyan Berde Khachmaz Total
Target group Baku Salyan Berde Khachmaz
Medical workers 1 1 1 1 4
Administrative medical workers 1 1 1 1 4
Total 2 2 2 2 8
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Perception
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Perception General opinion about 1st paragraph
This paragraph is about H5N1 virus and symptoms
of AI disease. Regarding the first paragraph
group participants mentioned that symptoms (high
temperature, throat ache or cough and heavy
breathing) listed in the leaflet are too general
and do not characterize the disease
specifically. In Khachmaz it was also stressed
that during the epidemic these symptoms are
enough to suspect Avian Influenza (hereinafter,
AI), but not at ordinary time as they are common
for many other diseases. Some of respondents
(Salyan) have never heard about H5N1 virus,
rather they knew AI. It was also told that the
last part of the 1st paragraph was completely
right. No one can judge unless the results of
analysis are published.

• Suggested measures
• To provide more detailed information on symptoms,
  for proper diagnose these are not enough. Other
  observed symptoms should be added.
• Use Avian Influenza instead of H5N1 (or at
  least give the former in the parentheses).
• The part about the fact that one should wait
  until analysis are released should be left as it
  is and not be removed.

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Perception General opinion about 2nd paragraph
Second paragraph is about self-protection
(namely, hand washing, using personal protection
means (especially, masks and gloves),
etc.). Majority found the paragraph to be
uninteresting and unnecessary due to the fact
that doctors are aware of issues related to
wearing mask or gloves and are using them not
only during AI but during all infectious
diseases. Some participants (especially, in
Salyan) had questions about mask N95 (if it is
the ordinary mask they use constantly). In Baku
it was also emphasized that it could be written
briefly and concrete Wear gloves and mask.

• Suggested measure
• To shorten the text because doctors are mostly
  aware about the mentioned measures and use them
  regardless AI outbreak
• To mention if N95 mask is a special one for AI or
  just a mask doctors always use

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Perception General opinion about 3rd paragraph

• The part is about protection of other people
  within medical institutions wearing mask or
  closing mouth while sneezing or coughing, wards
  and artificial ventilation.
• This paragraph appeared to be quite interesting
  for doctors. They mentioned that it was necessary
  information.
• It was emphasized that 1 meter between the
  person, who caught AI, and other sick people is
  too small.
• Suggested measures
• Distance between person sick by AI and other sick
  people (1 meter) should be increased.

1 meter is too close. It is ordinary distance
between talking people Salyan
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Perception General opinion about 4th paragraph

• The paragraph is about cleaning and keeping work
  place in safety.
• Given actions and advices are always fulfilled
  (after most medical procedures, not only during
  AI outbreak).
• Suggested measures
• Special information regarding cleaning during AI
  should be provided.
• Information about autoclave is good to be added
  (Washing instruments with water and soap is not
  enough. Every time after usage of instruments we
  use autoclave for sterilization) and it can be
  advised to work with disposable instruments
  (Baku)
• Cleaning instruments before and after usage is
  to be removed or changed as it does not
  correspond to reality. There is no need to clean
  instruments before usage (after sterilization) if
  they are sterilized and can even get dirtier
  rather than cleaner. (Salyan)
• Advise to use disposable instruments.
• Information regarding cleaning wards is to be
  removed or changed. It is not necessary for
  doctors, it is for junior nurses. (Salyan)
• Advice to put caps back on the needles should be
  concretized as it is not true for all doctors
  (for instance, not for dentists). However, for
  doctors besides dentists the advice is proper as
  finger can be needled as they have mentioned.
  (Khachmaz)

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Perception additional measures

• Avoid repetition (symptoms). Repetition raises
  negative attitude.
• Given time of prevention (7 days) at the end of
  the leaflet is not real (there is no need to
  mention concrete time as it can influence
  psychologically) (Baku)
• The text under the final statement (i.e. link to
  web-site and name of additional materials) given
  in booklet for administrative workers is absent
  in the one for healthcare workers.

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Lucidity of text
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Lucidity of text

• Participants of FGDs found nothing difficult in
  the text everything was quite understandable
  (even people without medical education can
  understand these sentences). Most of respondents
  stated that they were aware of the given
  information. Almost all respondents considered
  that the leaflet is for all people (for instance,
  schools, universities, kindergartens, etc.) but
  not for doctors. Majority of respondents did not
  learn anything new from the leaflet, and many of
  mentioned procedures and advices are followed
  daily regardless of AI outbreak. Respondents in
  Baku were more disappointed by the leaflet (we
  see much more advanced leaflets).
• Suggested measures
• Translation of leaflet into Russian language as
  well (Salyan, Baku) may appear to be expedient.

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Perception of pictures and its fitting to the
text. Effectiveness of explanation of some ideas
by pictures
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Perception of pictures and its fitting to the
text. Effectiveness of explanation of some ideas
by pictures.

• Majority of respondents stated that it would be
  much better if pictures are commented / named.
  Pictures and text were mentioned to be important
  equally, mutually complementary. Pictures appear
  to make people get interested and attract.
• Suggested measures
• 1st picture Running water, tap and soap should
  be reflected. It seems that he/she is washing
  hands in a bath which is not hygienic at all
  (All groups besides Berde). Berde soap should be
  reflected on the picture to make it more
  understandable.
• Next 4 pictures reflecting person wearing mask
  is not necessary for doctors who use mask
  regardless of AI outbreak. Berde as the picture
  is very detailed, the text can be shortened or
  vice versa.
• Picture of person in yellow glasses unfitting
  near the text. Baku yellow color of glasses
  should be transparent, not yellow. Salyan the
  picture should be placed near the hand washing,
  personal protection means.
• 1st picture on the 3rd page reflecting lying ill
  person is to be changed or replaced a) from the
  picture it is not seen that the person is alone
  in the room, and b) the colour of the persons
  clothes appears to be the colour of usual clothes
  rather than of the patient. Baku it does not
  reflect the reality. Berde comment is
  necessary. Mostly respondents did not like it.

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Perception of pictures and its fitting to the
text. Effectiveness of explanation of some ideas
by pictures.

• Suggested measures
• 2nd picture, which fits text, turned to be better
  than others and necessary one. However the
  picture should be changed as the rescue breathing
  in reality is not as it is shown (Salyan)
• Picture reflecting washing instruments Autoclave
  and cleaning agents should be added (Baku).
• Picture reflecting floor cleaning should be
  supplemented with raincoat as it easier to clean
  it up (Berde). Furthermore, the English word
  detergent can be translated.
• Medical garbage box The picture fits text.
  Regions the box should be on the floor, the
  doctor throwing it away should wear doctor's
  smock. Information regarding throwing the bag
  away or burning it should be given by pictures as
  well as text. Baku the box should be more
  oblong.
• Both last 2 pictures fit text. Picture reflecting
  man is unintelligible. Should be changed, idea
  should be reflected more concrete (Baku). Also it
  is not well depicted whether the person is lying,
  standing or sitting.

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Whether the leaflet can be better
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Whether the leaflet can be better

• Suggested measure
• The leaflet should be done for doctors, it seems
  to be for ordinary people.
• More concrete symptoms should be provided.
• More thorough information should be provided.
  The information
• may appear to be not enough during AI outbreak.
• Avoid repetition (symptoms)
• The leaflet should be for doctors, not for all
  people (for instance, schools, universities,
  kindergartens, etc.)
• There should be specific procedures and advices
  which are followed during AI outbreak
• Following points should be added
• First aid (Baku)
• Causation
• Pathogenesis
• Symptoms (All groups)
• Risk group, for instance, hunters, farmers
  (Salyan).

It is not bad for population, but is absolutely
unnecessary for doctors. Baku
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Thank you for attention!