Comm Eye Health Vol. 13 No. 33 2000 pp 13-14. Published online 01 March 2000.

An introduction. Training: essential for effective eye health promotion

John Hubley BSc PhD

Health Promotion Consultant, Leeds, United Kingdom

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Our understanding of what must be done to prevent blindness and promote eye health has advanced considerably in recent years. The challenge ahead is to introduce these methods to the field as quickly as possible. Training is an essential activity in the spread of new knowledge and skills to eye health workers. Training can take place in a variety of ways: through initial training of field workers, as part of the continuing education of existing field staff. Training can involve attendance at short sessions, longer training through intensive workshops, on-the-job bupervised practice or by distance learning through newsletters, manuals and recorded cassettes.

The purpose of this series of articles in the Journal of Community Eye Health is to provide an introduction to planning and implementation of effective training. The diagram (top right) provides a summarised approach to training.

Developing effective training programmes

Developing Effective Training Programmes

Determining training needs

One of the first steps in planning training is to prepare a revised job description for the field worker incorporating the new skills you plan to introduce. This may be based on concerns of field staff, communities, or ideas that may come from outside, such as reports from journals describing successful approaches in other communities.

Planning a curriculum

The content of your training will depend on the needs of the participants and the length of time available for the training. If, for example, there is only half a day a decision should be made regarding the most important topic to cover. You may have longer – but even so you will need to concentrate on what is really essential. A common problem with many training programmes is that they give too much emphasis on learning facts and not enough to acquiring skills and exploring attitudes and values.

Examples are given in the Table (page 14) of the five main kinds of learning and the most appropriate teaching methods for achieving different kinds of learning:

  • factual knowledge
  • decision-making skills
  • communication skills
  • manual skills
  • attitudes/values.

It is important to provide opportunities for participants to share experiences. While factual learning can be taught through lectures/talks, most other methods require more active forms of learning such as group discussion, role plays, practical exercises. People tend to teach others the way they themselves are taught, so it is important to expose participants to teaching methods that they themselves will be expected to use afterwards. Studies have shown that people retain less than 10% of the factual information given in a formal lecture – not a very effective way of learning.

Most training programmes are designed for adults, who have a wealth of expertise, ideas and creativity. The trainees are themselves a valuable resource, and ideally a training programme should be designed to allow participants to learn from each other as much as from the trainer.

Participatory learning methods such as role plays, discussions and learning exercises take longer to do and you need to allow sufficient time. It is a mistake to include too many lecture sessions presenting facts and just leave a short time at the end for discussion. You may think that you are covering a great deal of content but you will not have given enough time to answer adequately people’s questions or confront attitudes and prejudices.

An essential component in all training programmes is personal agenda setting which involves decision-making skills involving the following questions:

  • What can I do?
  • What more do I need to know?

Correct attitudes, with the commitment and confidence to put into practice what has been learnt in training, are vital.

Logistics and organisation of the training

It is important to keep the number of participants small to allow discussion – especially when you are confronting sensitive issues and exploring attitudes. It is possible to hold group activities with 8-12 participants. With greater numbers you must form small groups for discussion activities. Once you have more than 40 participants it is difficult to engage in group activities, problem-solving exercises and role plays. Care is needed in the selection of participants, so that the persons who come are the persons who will actually be putting the training into practice. Trainers and other resource persons you plan to involve should be properly briefed – especially if they are unfamiliar with some of the methods you will be using. The location of the training should resemble as closely as possible the situation where they will be putting into practice their newly acquired skills.

Implementation of training

Your training should begin with an opportunity for participants to express their expectations. This will give you a chance to make any last minute changes to meet their needs. During a course you need to encourage questions and feedback and be responsive to requests and needs. At the end of the training there should be an opportunity for participants to reflect on the training and consider how they can put the lessons learnt into practice.


In the short-term you will need to find out if the participants have mastered the tasks and learning components in the course. Obtaining feedback during and immediately after the course can do this. In the long term you will need to find out if they are actually putting into practice the new ideas they have learnt and carrying out the activities in the job description previously developed. One way to do this is to make supervisory field visits to trainees, their employers and the community. At this time you can discuss the impact of the course. Depending on the objectives of the training it might be appropriate to look for any impact in the community using indicators such as increased utilisation of eye care services, support for prevention activities and changes in community behaviour.

Teaching and learning for the promotion of eye health

Type of Learning Examples of Learning Teaching Method
Factual Knowledge Facts and Information concerning the distribution, seriousness, cause and prevention of different blinding conditions. Example: the role of flies in trachoma transmission of trachoma or onchcerciasis. Facts may be difficult to accept because they are new or are in conflict with beliefs Teaching facts involves the following steps:

  • relating information to previous knowledge
  • presenting information logically
  • using visual aids to explain relationships
  • avoiding too much information in one session causing overload
Decision-making skills The application of knowledge to make decisions such as:

  • the best way to promote eye health in one’s own family
  • how to respond to a client’s needs during counselling
  • how to set up an eye health promotion programme in a workplace, school or community
Decision-making skills are taught by:

  • providing necessary basic information
  • demonstrating skills with worked out examples presented as case studies. This allows the students to practice making decisions in realistic situations such as case studies, role plays and field exercises
Communication skills Communication skills can involve:

  • explaining key health worker actions to one’s family and friends
  • skills for communicating effectively to patients, asking about feelings and needs and giving advice on preventive actions
  • giving a talk on eye health, leading a group discussion, using visual aids etc
Effective teaching of communication skills should:

  • demonstrate good communication to the learners
  • let all trainees practice the skills with each other in role plays
  • ask someone to give a talk to the others, who act as the audience
  • ask someone to give a counselling session
  • discuss how well the talk was done. It is helpful to video the session and let the person watch him/herself in action
Practical/manual skills These psychomotor skills involve:

  • manipulating and handling objects

Examples are:

  • examining the eye
  • cleaning spectacles
  • handling visual aids
  • making a pit latrine
Demonstration and opportunities to practise:

  • pretend and real life situations
  • demonstration of a procedure
Attitudes and values Attitudes (feelings) that we often seek to influence through training programmes include:

  • realising the importance of invention
  • increasing uptake of services
  • bringing services to communities
  • the need to develop sensitivity, compassion, tolerance and patience in counselling relationships
Trainees can discuss the importance of particular attitudes for prevention of blindness through:

  • role plays where participants act out particular situations, e.g., a woman receiving inappropriate advice at a clinic
  • trainers themselves showing consideration, concern, tolerance, commitment.