The development of a conceptual framework and model for Information, Education and Communication (IEC) to reduce antibiotic misuse among the Vietnamese population in Nam Dinh province

The development of a conceptual framework and model for Information, Education and Communication (IEC) to reduce antibiotic misuse among the Vietnamese population in Nam Dinh province The literature, Vietnamese health statistics reveal problems with the antibiotic use with misunderstanding leading to the irrational and inappropriate use of these drugs resulting in bacterial resistance together with its consequences. In Vietnam the public healthcare service is provided at community level based on a system of communes. Here it is accepted that health centres are located in each rural area but that, public health workers are disadvantaged especially with regard to their educated/training, but are still mainly responsible for provision of healthcare including administration of antibiotics. The main aim of this study was to develop a conceptual framework for an education and training model for public health workers to reduce antibiotic misuse. It was piloted among the population in Myloc district, Nam Dinh province Vietnam but could be transferable to other rural areas in Vietnam. Thus, as a starting point baseline measures were taken using method triangulation in order to evaluate the current situation of antibiotic use in this study location. This survey revealed a very high rate of antibiotic administration (79.8%) of which more than half (54%) were incorrectly prescribed for non-infectious conditions. It also revealed misunderstandings and limited knowledge and perceptions regarding the use of antibiotics, and that staff had received little post basic training and education. These findings provided baseline data for the development of the training programme. Through reviewing theories of learning, principles of adult learning and teaching, the basic philosophies of experiential learning from the western world were taken into account then adapted to the Vietnamese context, especially to the situation of the commune health workers. The model was developed, based on Kolb’s (1984) experiential learning cycle, with modifications to fit with Vietnamese condition. The model named the ‘Modified Kolb’s Model for Vietnam’ (MKMVN) then was used to design and implement the training programme, taken place in each commune health centre. The programme, assessed through a time-series questionnaire, using participant observation and focus groups, was found to have led to positive changes in the health workers’ knowledge and practical ability regarding the use and administration of antibiotics. The health workers’ enthusiasm for ongoing learning was evident in the focus groups held as part of the final evaluation. The overall mean score for correct responses to the questionnaire elevated significantly from 58.43± 8.77 points before the programme to 99.25 ± 1.00 points after the completion of the programme and remained comparatively high at 79.76 ± 9.02 points after three months. Considerable improvements were seen in solving patients problems, providing appropriate treatment and administration of medicines and antibiotics in particular. Instructions to patients regarding courses of antibiotics contained greater detail. The most significant finding from this study is that the model and training programme were accessible, acceptable and appropriate for the commune health workers, and required minimal resourcing.There are clear the possibilities for applying this model (MKMVN) and programme on a larger scale and for applying this approach to other key health issues.