CDC History of Tuberculosis Control - Medical and Public Health ...

and the distribution of print-based materials.
Educational films, then later videotapes, were
developed and distributed, but often these
materials had a very limited distribution
because of the costs of the films and tapes and
the limited availability of audiovisual
equipment for viewing.
Today, through the availability of technology
and reduced production costs, we have a vast
array of materials and courses that are
distributed through a wide variety of media.
Some of the media include print-based
curricula with slides (e.g., the Core
Curriculum on Tuberculosis); CD ROM (e.g.,
Tuberculosis: An Interactive CD ROM for
Clinicians); satellite-based courses (e.g., the
Satellite Primer on Tuberculosis); videotapes
(e.g., the Skin Testing Video); audiotapes (e.g.,
the TB voice information system); and
Internet-based courses (e.g., the Web-Based
Self-Study Modules). With the use of satellitebased
courses, instructors can simultaneously
reach thousands of health care providers in
every US state and territory with accurate, upto-date
information. Reduced costs for the
reproduction of videotapes and CD ROMs
allow for wide-spread distribution of
materials. In addition, the Internet allows for
distribution of materials and courses to
audiences we may have never reached before,
both professionally and geographically, at no
additional cost after initial production.
Print-based materials are also accessible in a
Notable Events in TB Control
55
variety of ways. Hard copies can be ordered
by mail, by telephone, by fax, or through the
Internet online ordering system. Materials can
also be downloaded and printed from the
Internet. The electronic files of the materials
available through the Internet can also be
utilized as the basis for adaptation and
development of site-specific or populationspecific
materials.
Another big change in TB training and
education is in the methodologies used to
influence health care providers’
implementation of TB recommendations. In
the past, the primary method utilized was
information dissemination to increase the
health care providers’ knowledge of the
recommendations. However, we know that
information alone is not sufficient to change
the practice of many health care providers. In
addition to knowledge or information, health
care providers must be persuaded to try the
new recommendations. This persuasion can
occur if the health care provider thinks that
the recommendations provide an advantage
(is it better than what it’s replacing?); is
compatible with the current system (no major
conflicts created in the current system to
implement); is not too complex (how hard is it
to do or use?); can be tried beforehand (can I
try it before I decide to really use it with
patients?); can be observed (can I actually see
the result of using this innovation?); and is
flexible to being adapted to the current system.
After being persuaded that there is an
advantage to the new recommendation, health
care providers must progress through a
decision process (adopt or reject), then to
implementation, then to continued, ongoing
use of the recommendations. Behavioral
theories and models can be utilized to guide
the development of educational and training
interventions to aid in this progress.
Interventions such as academic detailing and
the use of opinion leaders can be utilized to
facilitate the progress.
For current and future efforts, utilization of