Section 5 Education, training and awareness-raising
5.1 In Scotland, it has been estimated that only around one-third of individuals who are infected with Hepatitis C have been diagnosed (Hutchison et al, 2006). Because Hepatitis C is a slowly progressing illness, many people live with the virus for years without symptoms. The proportion of people with undiagnosed infections will only continue to grow so long as the general awareness of Hepatitis C remains low. However, the Scottish Executive recognises that a large-scale public awareness campaign would be counter-productive without new resources being made available for testing and treatment.
5.2 Therefore, in the two-year period of this Action Plan, the priority will be to consider options for a possible future campaign should new resources become available beyond 2008.
5.3 One aspect of this will involve undertaking a review of the nature and impact of public campaigns in other countries, including England, France and Australia. Such a review might answer questions such as: what has been the outcome of these campaigns in terms of encouraging people to come forward for testing? Which have been most successful at reducing the stigma of Hepatitis C infection? How have these campaigns sought to educate the public about Hepatitis C? What has been the cost of the campaigns in other countries, and how has this cost been allocated over time?
5.4 A second aspect will involve looking at how information about Hepatitis C is communicated to school children in Scotland. In relation to this, NHS Health Scotland will ascertain the nature of current teaching on Hepatitis C in Scottish secondary schools and will review the need for guidance and resources for schools.
5.5 However, the main priority for communication in Phase I will focus on:
- Educating, informing and raising awareness of Hepatitis C among health, social care and criminal justice professionals
- Informing and supporting those who are living with Hepatitis C, including those who are newly diagnosed and their families
5.6 NHS Health Scotland and NHS Education Scotland will take the lead in this work, in collaboration with other stakeholders, including Health Protection Scotland, the UK Hepatitis C Resource Centre, STRADA, the Scottish Drugs Forum and the Scottish Association of Drug and Alcohol Action Teams.
Health and social care professionals
5.7 Comments received from stakeholders suggest that a lack of knowledge and awareness about Hepatitis C among health and social care professionals is, in itself, a significant barrier to people being tested and referred for treatment. This situation urgently needs to be addressed. Action in this area is crucial since it will provide the basis for the success or failure of all other actions and interventions described in this plan, as well as those that may be taken forward in Phase II. Action in this area will also ensure that consistent messages are communicated, not only to professionals, but also by professionals to their clients and patients. The aim will be:
- To improve the knowledge that professionals have about Hepatitis C - what Hepatitis C is, how it can be prevented, what the options are for treatment, and how to access local services for testing, treatment and support, and
- To clearly describe the scale and implications of the Hepatitis C epidemic in Scotland, and lay out the benefits to service users, and to the NHS, of identifying people who have the virus and providing them with early treatment and support.
5.8 Action will be targeted at: GPs, primary care nursing staff including midwives and health visitors, hospital maternity staff, sexual health care providers, addiction staff, pharmacists, social workers, prison staff and staff in the voluntary sector who may have contact with high-risk groups. Health service managers and commissioners of services (those responsible for setting priorities and allocating resources) will also be a target for this work. The message from stakeholders around Scotland was that these groups often have an inadequate or even poor level of knowledge about Hepatitis C.
5.9 Staff in specialist (non-pharmacy) needle exchange and other harm reduction services are likely to have a very high level of knowledge about Hepatitis C. However, one of the main findings of the National Needle Exchange Survey in Scotland was that the lack of standardised training and education for needle exchange staff, especially in relation to safer injecting techniques, can lead to inconsistent messages being communicated to service users, and can act as a barrier to good practice in many areas. Action will be taken in Phase I to address this.
5.10 At the same time, the Scottish Executive has commissioned the Royal College of General Practitioners to deliver improved training and education on the management of substance misuse to GPs and other health professionals, including those who work in prisons and those who are involved in substitute prescribing programmes.
5.11 The information and awareness-raising campaign among professionals will be informed by the findings of research. NHS Education Scotland ( NES), the agency responsible for on-going training and education of NHS staff, is currently undertaking work to ascertain existing educational provision on Hepatitis C for pharmacists, doctors and nurses. This work will identify gaps in existing provision, and will indicate how these gaps can be addressed. Further work will be undertaken to address these gaps over the next two years during the period of this Action Plan.
5.12 In addition, the Scottish Executive will commission a series of depth interviews and focus groups with different groups of professionals to explore:
- their perceptions of Hepatitis C
- their attitudes towards people who have been diagnosed with the virus
- what messages would be relevant to them, and motivate them to take action
- what would constitute 'new news' for them
- how they would like to receive information on this subject.
Information for those who have been diagnosed with Hepatitis C
5.13 A positive diagnosis of Hepatitis C can result in fear, worry and confusion. Individuals who have been diagnosed with the virus will inevitably have a number of immediate questions and concerns such as: how it will affect them and their family; what the options are for treatment; how to access that treatment; what they can do to slow the progress of the illness and improve their quality of life; and how to limit onward transmission of the virus. Services have a duty to provide this information in a way which is clear and accessible to the individual, and action will be taken to produce materials and other resources to assist services in this.
5.14 In the first instance, the Scottish Executive will commission qualitative research among people who have the virus (including the newly diagnosed) to identify their specific needs for information and support. Again, the findings of this work will inform the content of the messages, and the way in which these messages are offered to service users.
Actions on education, training and awareness-raising
By Oct 2006
The Scottish Executive will commission qualitative research with professionals and with individuals recently diagnosed with Hepatitis to explore knowledge and attitudes towards Hepatitis C among these groups.
By Oct 2006
NHS Health Scotland will conduct a review of existing communications materials for Hepatitis C.
By Dec 2006
NHS Health Scotland will develop and distribute a range of information and educational materials and resources for professionals about Hepatitis C, consulting with key stakeholder groups as appropriate.
By Feb 2007
NHS Education Scotland, working together with the UK Hepatitis C Resource Centre will ascertain existing training and educational provision on Hepatitis C for NHS staff, identify gaps in existing provision and make recommendations for addressing the gaps.
By Apr 2007
The Scottish Prison Service will provide access to training on Hepatitis C to all prison staff as part of a larger training programme on harm reduction. Staff in HMP Aberdeen will be given special training on safe injecting techniques as part of a pilot needle exchange scheme in that prison.
By Apr 2007
The Scottish Executive will consider how to develop a module for training non-pharmacy needle exchange workers in Scotland.
By Jun 2007
The Scottish Executive will publish a review of the nature and impact of HIV and HCV public awareness-raising campaigns in other countries.
By Jul 2007
The Scottish Executive Health Department will consider how to develop a training strategy for substance misuse services in Scotland.
By Sep 2007
NHS Health Scotland will ascertain the nature of current teaching on Hepatitis C in Scottish secondary schools and will review the need for guidance and resources for schools. The findings will be reported to the Scottish Executive and the Action Plan Co-ordinating Group.
By Jun 2008
NHS Health Scotland will develop materials and resources that can be used to support individuals who have been received a positive diagnosis of Hepatitis C. These will be distributed to all relevant services throughout Scotland - in particular general practices, needle exchange and other harm reduction services, and prisons.