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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 exclusive):

  • 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 latent TB.

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.

Conference evaluations
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, “mostly agree.”

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 well.

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 message
  • 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.”

Next steps
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 and treatment.

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 Products Available

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 or ruler:

  • Place an order through the DTBE’s online ordering system:; or
  • 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


Released October 2008
Centers for Disease Control and Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Division of Tuberculosis Elimination -

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CDC/Division of Tuberculosis Elimination
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