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TB Notes 1, 2003
Updates from the Communications and Education Branch
Duty Officer Assessment at the Division
of Tuberculosis Elimination
Each day, health care providers and concerned citizens telephone
the Division of Tuberculosis Elimination (DTBE) requesting TB information.
DTBE has a duty officer system, which each day designates a different
person within the division to answer these calls. During the months
of April through July 2001, the DTBE Communications and Education
Branch (CEB) conducted an assessment of the duty officer system
to identify target audiences and leading information needs of persons
contacting DTBE duty officers.
Approximately 450 calls were received during the assessment period,
with duty officers reporting 6 to 15 calls per day. Time spent on
each call ranged from 1 to 90 minutes, averaging 11.2 minutes. The
assessment results showed that the majority of callers to the duty
officer line were health care providers (53%), followed by the general
public (15%). A number of calls were also received from administrators
(11%), patients (6%), and students (2%).
The most common topic of duty officer calls was skin testing (41%).
Questions on skin testing covered the following areas (not mutually
- Skin testing in health care facilities
- Follow-up of skin test with chest x-ray
- Two-step testing
- Reading/interpreting skin test
- Skin testing in special populations
- Administering skin test
- Other disease/treatment complicating skin test
- Annual skin testing in health care facilities
- Specific materials request
- Frequency of skin tests
Other common topics of duty officer calls included infection control
(22%) and treatment guidelines (14%).
The DTBE will use the results of this needs assessment to ensure
that development and updates of educational materials address common
questions asked by callers. Assessment of information/education
services such as the duty officer system yields valuable information
and must be performed periodically to identify information needs
and gaps in educational materials.
-Reported by Betsy Carter, MPH, CHES
Div of TB Elimination
To the Point! Academic Detailing in Action
CDC’s Division of Tuberculosis Elimination is investigating
ways of increasing private health care providers’ use of targeted
testing and treatment of latent TB infection (LTBI) in their patients.
The goal of the project To the Point! Academic Detailing in Action
is to provide state and local TB control program personnel with
the tools to develop, implement, and evaluate academic detailing
strategies targeting private health care providers.
Modeled on the visits of pharmaceutical representatives to physicians’
offices, academic detailing has been demonstrated to be effective
in conveying concise, practical health information. In 15 minutes,
a detailer conveys no more than three points, while giving the health
care provider an opportunity to ask questions. Formative research
was conducted with providers and patients to test the content of
provider and patient educational materials on LTBI. These materials
are part of a step-by-step guide to TB academic detailing.
The pilot project trained 10 individuals in the use of academic
detailing methods during a 6-hour training session held on August
23, 2002, in Decatur, Georgia. These trained academic detailers
will contact physicians and other health care providers in their
regions and teach them to assess the risk and test patients for
Five of the participants were Georgia District TB Coordinators.
They coordinate TB activities in their districts, provide education,
and oversee case management. State TB nurses made up the other half
of the training group. These coordinators and nurses primarily oversee
other colleagues and programs. The districts for which these individuals
are responsible represent the whole state of Georgia, a mix of counties
that can be characterized as mostly rural.
Drs. Donna Richter and Donna Rhoades taught and cofacilitated the
training session. Dr. Richter is the Chair of the Department of
Health Promotion, Education, and Behavior in the Norman J. Arnold
School of Public Health at the University of South Carolina. Dr.
Rhoades is a private consultant. Both have advanced degrees in education
and are experienced in teaching techniques. Drs. Richter and Rhoades
employed an interactive, experiential style using slides, video,
printed materials, and flip charts in the training course.
Participants gave overall high scores to the training session. Breakdowns
of the specific areas that were evaluated are included below.
Training evaluation. Participants used a 7-point
Likert scale to rate the overall training, addressing such topics
as objectives, materials, content, methods, teaching style, and
learning environment. Higher scores indicated a more positive response.
Mean scores ranged from 5.5 to 6.4, with the total mean being 6.0,
Training self-confidence. Participants rated the
level of confidence they felt in their ability to use the training
materials effectively, using a four-item scale. All participants
except one were confident of their ability to handle the training
materials. The trainees’ scores ranged from 17 to 28, with
28 (the highest possible score) indicating that a person felt the
highest amount of confidence in handling the training materials
Receptivity to training. Participants’ receptivity
to the training was measured by a five-item scale. The highest possible
score was 35 and the lowest possible score was 5. Trainee scale
scores ranged from 20 to 35. Most participants appeared to be receptive
to the training, with only two trainees scoring 25 or less.
Readiness to transfer. Participants also rated
how likely they were to use the skills learned at the training workshop
by choosing the statement that best summarized his or her action
upon returning to their work setting, using a 5-stage scale. Of
those who answered the question, all were in the highest levels
of change: two thirds (66%) were in the “maintenance”
stage of change (stage 5) and one third (33%) were in the “action”
stage (stage 4).
Attitude toward training. Participants revealed
their reactions toward the application of academic detailer training
knowledge and skills. The highest possible score was a 42, with
high scores indicating a more positive reaction toward using the
detailer knowledge and skills. Participant scores ranged from 25
to 42, with the mean scale score being 37.2.
Autonomy. Participants rated themselves as having
a high level of autonomy at work. Possible scale scores could range
from 4 to 28 with the higher score indicating more autonomy. Their
scores ranged from 22 to 28, with a mean score of 25.3.
Academic detailer skills. Participants also rated
how frequently they performed skills related to academic detailing
with public and private health care providers and how confident
they were in their ability to perform each of these skills. Relevant
skills included the following:
- Travel to office of a health care provider
- Collaborate with a health care provider
- Identify a health care provider who would benefit from TB message
- Make an appointment with a health care provider to present TB
- Present a targeted TB message to the health care provider.
The following skills were also assessed for how frequently they
were performed and the participants’ confidence in their ability
to perform them:
- Goal setting and achievement
- Ability to deal with challenging and difficult healthcare providers
when presenting a TB message
The academic detailer training participants consistently reported
higher scores on both frequency and confidence with public health
care providers than with private providers, and “confidence”
scores generally were higher than “frequency” scores.
Although trainees were fairly confident in their ability to perform
Academic Detailer skills, their confidence levels were slightly
lower in relation to “identifying private providers,”
“traveling to the office of a private provider,” and
“making an appointment with a private provider.”
Overall, most of the participants agreed that the Academic Detailer
Training Conference was completed successfully. The consistently
high scores on all the subscales portray this group as confident
and empowered to carry out academic detailing tasks. Although as
a group they work more frequently with public health care providers
and are more confident with this group, they see themselves as up
to the challenge of completing a pilot project with private healthcare
providers. The goal is for each participant to now go out and present
the information in an academic detailing session to 3 to 5 physicians.
To reinforce the information that was relayed during the academic
detailing session, a follow-up session will be scheduled. Follow-up
helps ensure the provider’s retention of the primary messages
delivered during the academic detailing session as well as enhance
the provider’s awareness of the problems related to TB testing
An evaluation of the initial academic detailing session and the
follow-up session will be conducted. Both the TB control program
detailer and the provider will evaluate the session and materials.
These evaluations will be used to further refine the training course
and materials. The project should be completed by the end of June
2003. The To the Point! Academic Detailing in Action materials should
be available to TB control programs later in the fall of 2003.
-Reported by Scott McCoy
Div of TB Elimination
New Mantoux Tuberculin Skin Test (TST) Training
Requests from the field and information gathered through key informant
interviews identified the need for updating and revising current
TST materials. A project was started to develop new and revise current
Mantoux TST training materials. In February 2002, a calibrated Mantoux
TST ruler was produced and made available as part of this project.
A “Mantoux Tuberculin Skin Test Training Materials Kit”
is now available which includes a videotape and a facilitator guide.
The target audience is health care workers who administer and read
tuberculin skin tests. The goal of the videotape is to increase
and reinforce knowledge about and skills in administering and reading
the Mantoux tuberculin skin test. The videotape is approximately
30 minutes long. The facilitator guide includes a transcript of
the videotape, and notations for facilitators who use the videotape
for skin test training.
Using both internal and external working groups for formative evaluation,
these materials have been developed and reviewed by health care
staff with extensive TST experience. An external working group was
convened to provide practice related comments from the field. The
external working group consisted of health educators, nurses, public
health advisors, administrators, and others. The internal working
group made up of CDC staff was convened to review the products as
they were developed.
To order the Mantoux Tuberculin Skin Test Training Materials Kit
- Place an order through the DTBE’s online ordering system:
- Mail or fax the enclosed DTBE Educational and Training Materials
Order Form; or
- Call the CDC Voice and Fax Information System toll free: 1-888-232-3228,
then select 2, 5, 1, 2, 2 and request order #00-5457 for the materials
kit or #99-7047 for the ruler.
-Reported by Gaby Benenson, MPH
Div of TB Elimination