Final Thesis With CV (For Bookbind)

PRACTICES OF COMMUNITY RESIDENTS ON SELF MEDICATION WITH ANTIBIOTICS
A Thesis Presented to the Faculty of the COLLEGE OF NURSING Pamantasan ng Lungsod ng Maynila Intramuros, Manila
In Partial Fulfillment of the Requirement for the Course NURSING RESEARCH
ECLEVIA, BEA MARIE E. LLANTINO, COLETTE III S. MEDIDAS, ELAIZA MAE V. RAMOS, ART CHRISTIAN M. SANCHEZ, ALEXANDRA AGNES A. TINAYA, RENZ NICOLE ROSS C.
October 5, 2013
Pamantasan ng Lungsod ng Maynila University of the City of Manila Intramuros, Manila COLLEGE OF NURSING
RECOMMENDATION
This,
X Thesis _____ Research Project _____ Feasibility study
_____ Dissertation
entitled: "PRACTICES OF COMMUNITY RESIDENTS ON SELF MEDICATION WITH ANTIBIOTIC". was prepared and submitted by ECLEVIA, BEA MARIE E.; LLANTINO, COLETTE III S.; MEDIDAS, ELAIZA MAE V.; RAMOS, ART CHRISTIAN M.; SANCHEZ, ALEXANDRA AGNES A.; TINAYA, RENZ NICOLE ROSS C. in partial fulfillment of the requirements for the degree of Bachelor of Science in Nursing has been examined and hereby recommend for ORAL EXAMINATION.
____________________________ Maria Andrea L. Endeno, M.A.N. Nursing Research Adviser
________________________ Ma. Teresa S. Abila, M.A.N. Nursing Research Professor
Pamantasan ng Lungsod ng Maynila University of the City of Manila Intramuros, Manila COLLEGE OF NURSING APPROVAL SHEET This,
X Thesis _____ Research Project _____ Feasibility study
_____ Dissertation
entitled: "PRACTICES OF COMMUNITY RESIDENTS ON SELF MEDICATION WITH ANTIBIOTIC" was prepared and submitted by ECLEVIA, BEA MARIE E.; LLANTINO, COLETTE III S.; MEDIDAS, ELAIZA MAE V.; RAMOS, ART CHRISTIAN M.; SANCHEZ, ALEXANDRA AGNES A.; TINAYA, RENZ NICOLE ROSS C. in partial fulfillment of the requirements for the degree of Bachelor of Science in Nursing has been examined and hereby recommend for ORAL EXAMINATION. Approved by the committee on Oral Examination on OCTOBER 5, 2013 with a grade of: ____Excellent ____Highly satisfactory ____Satisfactory ____Needs Improvement
_________________________ Marilyn S. Agravante, M.A.N. Panel Member
___________________________ Dr. Raymond M. Fernandez Panel Member
_____________________________ Ma. Teresa S. Abila, M.A.N. Nursing Research Professor
ACKNOWLEDGEMENT
The success of this study will not be achieved without the help of the following individuals. Without them, the researchers might not be able to meet their desired goals in doing this undertaking. The researchers want to give their outmost gratitude for your invaluable help and support. To Prof. Maria Andrea L. Endeno, our research adviser, for sharing her knowledge for the improvement of this study. Thank you for your patience, understanding and encouragement throughout this endeavour despite of the shortcomings of the group. Your cheerfulness always boosts our confidence to strive harder and meet our objectives. To our research professor, Prof. Ma. Teresa S. Abila, for diligently moulding our group in the process of conceptualizing, writing , validating and even correcting the errors within our paper. We are very honoured to have you as our research professor. We are thankful for imparting your expertise not only on our group but to the whole class as well. To our dear panel, Prof. Marilyn S. Agravante, Prof. Sonny A. Pura and Dr. Raymond M. Fernandez, for your vital inputs and tremendous comments and suggestions for the improvement of our work. This will not be a commendable paper without your help. To Prof. Marilyn S. Agravante, our class adviser, for guiding, counselling, and believing that our block can overcome the challenges and hindrances that
we might face. Your motherly love has been always touching our hearts to become a better person than who we are today. To Prof. Ronald L. Singson, thank you for assisting us in translating our research questionnaire. Your proficiency has helped us lessen our work load. To Brgy. Chairman Armando C. Enaje Sr., for allowing us to conduct our study in their baranggay. Thank you for sharing with us information and statistics necessary to our study. We are also thankful for ensuring our safety during our ocular survey and the day of our survey proper. Your cooperation is very much appreciated. ` To BSN 4-3, our loving and hardworking classmates, for the unity and cooperation despite of the obstacles that we have faced. Thank you for the shared laughters, tears and experiences. We may not be the best, but still we are the happiest! To our ever supportive families, for sheltering us during our overnight sessions. You have always been our inspiration in fulfilling and reaching our dreams. Thank you for your patience, trust, love and support. And most especially, to our Almighty God for giving us the daily strength, wisdom and knowledge. Your provisions are unfailing and Your guiding hands are overwhelming. Thank you for allowing this undertaking to be done. Your presence during difficult times is more than enough for us to persevere for our future. Thank You Lord, everything is being lifted to Your name. With much appreciation, SMA Group
ABSTRACT TITLE: Practices of Community Residents on Self Medication with Antibiotics. RESEARCHERS: Eclevia, Bea Marie E. Llantino, ColetteIII S. Medidas, Elaiza Mae V. Ramos, Art Christian M. Sanchez, Alexandra Agnes A. Tinaya, Renz Nicole Ross C. SCHOOL: DEGREE: ADVISER: Pamantasan ng Lungsod ng Maynila Bachelor of Science in Nursing Maria Andrea L. Endeno, MAN
NUMBER OF PAGES: 132
Self medication with antibiotics is the human behavior in which an individual uses non-prescribed antibiotics to treat untreated and often undiagnosed medical ailments. It can also be the intermittent or continued use of prescribed antibiotics for chronic or recurrent symptoms or diagnosed diseases. People who practice this greatly vary from race to race, age to age, and economic status. In an effort to assess the current trend with regards to self medication with antibiotics, this research study was undertaken. This research endeavor entitled as Practices of Community Residents on Self Medication with Antibiotics aimed to assess the practices of community residents regarding self medication with antibiotics. This research study was
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conducted by means of a survey which made use of a pre made questionnaire form. The conclusions reached by this study were the following, reasons for practicing self medication with antibiotic was to improve condition. The condition most treated with antibiotics was respiratory infections. Dosages of antibiotics were known by means of experience, and changes in the dosage were done to improve ones condition. The very highly practiced duration of taking antibiotics was after the recovery. These findings may be of use for future researchers to develop a health educational material addressing and modifying the misconceptions and misguided expectations of community residents regarding self medication with antibiotics.
TABLE OF CONTENTS Page Preliminaries Title Page Recommendation Approval Sheet Acknowledgement Abstract Table of Contents List of Appendices List of Figures List of Tables CHAPTER I INTRODUCTION Background of the Study Statement of the problem Hypothesis Significance of the Study 1 3 4 4 i ii iii iv vi viii x xi xii
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Scope and Limitation CHAPTER II THEORETICAL FRAMEWORK Review of Related Literature and Studies Synthesis Conceptual Framework Conceptual Paradigm Definition of Terms CHAPTER III METHODOLOGY Research Design Research Locale Samples and Sampling Technique Instrumentation Data Gathering Procedure Statistical Analysis of Data CHAPTER IV Results and Discussion CHAPTER V Summary, Conclusion, and Recommendations Summary
7 23 27 28 29
32 33 33 34 37 38
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Findings Conclusions Recommendation Bibliography Appendices A. Email Correspondence B. Letters of Consent C. Research Tool D. National Statistics Office Survey Population E. Curriculum Vitae
86 89 91 93
101 103 106 122 123
LIST OF FIGURES
Figure 1 2 3 Conceptual Paradigm
Title
Page 28 39 40
Highest Educational Attainments of the Respondents Monthly Family Income of the Respondents
LIST OF TABLES Tables 1 Titles Extent of Self-Medication of Antibiotics Practices in Terms of Reasons 2 Extent of Self-Medication of Antibiotics Practices in Terms Of Conditions 3 Extent of Self-Medication of Antibiotics Practices in Terms Of Dosage 4 Extent of Self-Medication of Antibiotics Practices in Terms Of Dosage Change 5 Extent of Self-Medication of Antibiotics Practices in Terms Of Duration 6 Anova Results on the Significant Difference on SMA Practices on Reasons When grouped According to Highest Educational Attainment 7 Post Hoc Tukey Experience vs Education 8 Anova Results on the Significant Difference on SMA Practices on Reasons When grouped According to Monthly Family Income 9 Anova Results on the Significant Difference on SMA Practices on Conditions When grouped According to Highest Educational Attainment 10 Post Hoc Tukey HSD Respiratory Infections vs Education 57 56 54 53 52 50 48 46 44 Page 42
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Anova Results on the Significant Difference on SMA Practices on Conditions When grouped According to Monthly Family Income
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Post Hoc Tukey Respiratory Infections vs Monthly Family Income
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Post Hoc Tukey Gastrointesinal Problems vs Monthly Family Income
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Anova Results on the Significant Difference on SMA Practices on Dosage When grouped According to Highest Educational Attainment
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Post Hoc Tukey Package Checking vs Highest Educational Attainment
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Post Hoc Tukey Community Health Practitioners vs Highes Educational Attainment
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Post Hoc Tukey Family and Friends vs Highest Educational Attainment
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Post Hoc Tukey Internet vs Highest Educational Attainment
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Post Hoc Tukey Advertisements vs Highest Educational Attainment
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Anova Results on the Significant Difference on SMA Practices on Dosage When grouped According to Monthly Family Income
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Post Hoc Tukey Package Checking vs Monthly Family Income
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Post Hoc Tukey Community Health Practitioners vs Monthly Family Income
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Post Hoc Tukey Internet vs Monthly Family Income
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Anova Results on the Significant Difference on SMA Practices on Dosage Changes When grouped According to Highest Educational Attainment
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Post Hoc Tukey Insufficient Supply vs Education
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Anova Results on the Significant Difference on SMA Practices on Dosage Changes When grouped According to Monthly Family Income
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Post Hoc Tukey Insufficient Supply vs Income
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Anova Results on the Significant Difference on SMA Practices on Duration When grouped According to Highest Educational Attainment
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Post Hoc Tukey Consumed Supply vs Education
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Post Hoc Tukey Completion of Treatment vs Education
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Anova Results on the Significant Difference on SMA Practices on Duration When grouped According to Monthly Family Income Post Hoc Tukey 32 After a Few Days vs Monthly Family Income Table 33 Post Hoc Tukey Completion of Treatment vs Monthly Family Income
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Chapter I Introduction Background of the Study The irrational use of antibiotics has been documented all over the world. World Health Organization (WHO) estimates that more than half of all medicines are prescribed, dispensed or sold inappropriately, and that half of all patients fail to take them correctly. Incorrect use may take the form of overuse, underuse, and misuse of prescription or non prescription medicines. Self-medication has always been a part of normal practice in human life since the ancient times. It is a practice where an individual treats certain conditions and ailments with medicines usually available even without presenting prescriptions. But the question is, do people really know the proper usage of these medications? Are they able to apply appropriate management when adverse effects arise? Are these people competent enough in complying with the proper course of treatment regimen? Education is an important aspect in ones life. The level of education of an individual directly affects his decisions, choices, lifestyle, and behaviors. With a greater emphasis on health, people with higher level of education are more conscious and aware about health, health seeking behaviors and health maintenance. Insufficient knowledge may lead to inappropriate actions addressing health problems. This is true especially in practicing self-medication of antibiotics. One might have experienced the efficacy of a drug on a certain
symptom. Thus, this phenomenon becomes remarkable and habitual once the experienced symptom occurs again. Multi-drug resistance may follow since the bacteria either adapts to the ability of the antibiotic or die in a phenomenon known as selective pressure. Students taking health related courses have a great responsibility in influencing the choices and actions that their clients may take. Self-medication assumes a special significance among these students as they are the future health practitioners and have a potential role in counseling the patients about the advantages and disadvantages of self-medication. During one of the researchers related learning experience in a community health center in Manila, a patient directly asked one of them which and what type of antibiotic is best to take for treating an ailment that is being experienced instead of consulting a physician. The researchers, being a level two nursing students back then were not in the proper position and had limited knowledge to answer prior patients queries. Given this fact, the researchers were prompted to select community residents as the respondents of this study. Honestly, even health care professionals practice self-medication to improve and prevent acquiring diseases since they are more vulnerable considering the stressful environment they are into. Families and friends of the researchers have also practiced self-medication, and this fact has further encouraged the researchers to choose and conduct this study. As a future member of the health care team, the researchers aim to make an improvement
with this problem realizing that even the lives of their own loved ones may be placed in jeopardy. The researchers would like to emphasize the importance of providing the appropriate health education rendered by medical related practitioners and students regarding antibiotic usage, treatment and adverse effects. Ultimately, the researchers of this study hopes to modify and improve the practices of community residents concerning Self-Medication of Antibiotics (SMA). Statement of the Problem The aim of the study was to determine the practices of community residents towards Self-Medication of Antibiotics. Specifically, this study sought to answer the following questions: 1. What is the profile of the respondents according to: 1.1 highest educational attainment; and 1.2 monthly family income? 2. To what extent do the respondents manifest the following SelfMedication of Antibiotics practices: 2.1 reasons; 2.2 conditions; 2.3 dosage; and
2.4 duration? 3. Is there a significant difference in the manifested Self-Medication of Antibiotics (SMA) practices among community residents when they are grouped according to profile? Hypothesis The null hypothesis was tested at 0.05 level of significance. Ho: There is no significant difference in the manifested Self-medication of Antibiotics (SMA) practices of the community residents when they are grouped according to profile. Significance of the Study The research study was both relevant and significant in a number of ways to a group of people like the following: Community Residents. The study may increase community residents awareness about the inappropriate practices regarding self-medication of antibiotics. Ultimately, the researchers aim to modify and improve their practices with regards to antibiotic treatment and usage. Community Health Workers. This study may help the community health workers to identify the common practices of community residents towards selfmedication of antibiotics. The results of this undertaking may serve as a guide in developing community programs addressing and correcting self-medication of antibiotics practices of the community residents.
Nursing Students. As a health care provider for the patients well-being and safety, this study may emphasize improvement in the health teachings among patients regarding antibiotic usage, treatment compliance as well as its adverse effects. Barangay Officials. In partnership with the health officers of the community, programs regarding antibiotic treatment, usage and adverse effects may be developed in cooperation with the health care workers in their barangay. Future Researchers. This study may be utilized as a guide for future researchers with similar undertakings. The results that would be presented in this study may contribute in establishing further researches with regards to SMA practices focusing on a different locale and respondents. Scope and Limitation This research study is a descriptive correlational type of research which made use of survey method. This investigation was done to define the difference of community residents SMA practices when grouped according to demographic profile such as educational attainment and monthly family income. The instrument was adapted from a structured questionnaire and data were collected in a course of a week. This research investigation covered respondents residing in Barangay 598 of District VI. This research which has laid out a parameter was strictly defined by the following qualifications. First, the respondents must be at least 18 years of age and above; have self medicated with antibiotics; and were willing to
participate in this study. Second, respondents should have at least resided for two years in the barangay. The study focused on community residents practices towards self medication of antibiotics; other factors related to self-medication were not emphasized in this study and is to be of another future endeavor. In connection with this, an output of a health educational material correcting the
misconceptions about self medication of antibiotics practices will be of another future undertaking.
Chapter II Theoretical Framework Antibiotics and usage of antibiotics The invention of antibiotics to cure diseases especially infections are the most innovated medicine in the history of medicine, but as time goes by, sudden decrease of effectiveness has been to account because of misuse and overuse of antibiotics. Due to this unusual event, bacteria have been able to adapt to this antibiotics and able to withstand the effectiveness of the antibiotic and still it is an ongoing process of the bacteria to be able to resist and develop so called drug resistance to some of the antibiotics (Gangle, 2005). Antibiotic resistance is a world wide problem, and several studies have reported remarkably high prevalence of antibiotic resistant in low and middle income countries (Okeke, Laxminaryan, Bhutta, Duse, Jenkins, OBrien, Pablos Mendez, Klugman, 2005). This becomes especially important when high resistance coincides with high burden of infectious illness. Thus, resistance undermines the access to effective antibiotic treatment, because in many settings the inexpensive, first line antibiotics are no longer effective (Bhutta, 2008). This means that the cost increases, both for the patient and the health system. For the individual patient, the cost of second line treatments can be impossible to meet, thereby limiting access to effective treatment for vulnerable groups (Whitehead, Dahlgren, Evans, 2001). The emerging antibiotic resistance threatens to turn
back time to a situation where treatable infections once again become incurable (Cars, Hogberg, Murray, Nordberg, Sivaraman, Lundborg, So, Tamson, 2008). The underlying cause of this increasing development of multi resistance of some bacteria to antibiotics are associated with non prescription use thus adverse drug reactions take place, masking of underlying infectious processes, development of multiple drug resistance (Morgan, 2011). The irrational use of antibiotics has been documented all over the world. World Health Organization (WHO) estimates that more than half of all medicines are prescribed, dispensed or sold inappropriately, and that half of all patients fail to take them correctly. Incorrect use may take the form of overuse, underuse, and misuse of prescription or non prescription medicines (World Health Organization, 2010). Rational use of medicines means that patients receive medication appropriate to their clinical needs, in doses that meet their own individual requirements, for an adequate period of time, and at the lowest cost to them and their community. Irrational use includes use of antibiotics for non bacterial illnesses and non-adherence to recommended dosing regimens, hence preventing desired therapeutic outcomes from being achieved and potentially increasing antimicrobial resistance. It also includes use of expensive and frequently unsafe formulation such as injections when less expensive oral formulations would be more appropriate. When antibiotics are indicated, the prescriber should choose the appropriate drug, dose, and duration of effective agent, preferably with the narrowest spectrum and few side effects. Access to affordable health care is limited in many low and middle income countries; hence
people practice on self medication of antibiotics and get them directly from pharmacies, or markets (WHO, 2010). The usage of antibiotics has been the most emergence factor of the development of drug resistance. The use of any antibiotics for treatment of infection, in any dose, time of use, forces the bacteria to either adapt to the ability of the antibiotic or die in a phenomenon known as selective pressure. If the bacteria are able to adapt to the drug, it carries a gene or DNA which will be passed on and multiplied rapidly (Tenover, as cited by Hoa, 2006). For this reason, improving the use of antibiotics thereby reduce the selective pressure of antibiotics and increase the effectiveness of the antibiotics throughout the treatment of any infection. Self Medication of Antibiotics Practices Self Medication of Antibiotics Self-medication is common among countries whose
prescription is not that too strict and the drugs are available over the counter. It is well established that antibiotics are used indiscriminately throughout our society. This has led to antibiotic resistance and has disturbed the microbial ecosystem and diseases like water-borne and other infectious diseases developed from bacterial resistant drugs. Infections have become severer, resistant to treatment and prolonged. As treatment fails, the infectivity from an ill individual is prolonged and there is
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a chance of increased drug resistant of some bacteria and if worst not benn able to be treated (Zdziarski, 2003). Self medication antibiotics can be defined as the use of antibiotics to without any consultation of a professional, with or without prescription to treat self-diagnosed disorders, or recurrent symptom of disease. (Awad, Eltayeb, Matowe, Thalib, 2005). The rates of self-medication of antibiotics conducted in Jordan (23%) were relatively high (Al-Azzam, 2007). The self-use of antibiotics is also very common in Sudan (48%) while it is not very high in the said neighborhood in India where it has been quoted as 18% (Saradamma, 2000).Zafar, Syed, Waqar, Zubairi, Vaqar, Shaikh, Yousaf, Shahid, Saleem (2008) identified in their study, Self Medication amongst university students of Karachi: prevalence, knowledge, and attitudes., the prevalence of self medication of any drugs among university students in Karachi, Pakistan were 76%. Based on the study of Zafar et al., (2008), the most common symptoms for the practice of self medication of any drugs were headache (72.4%), flu (63.5%), and fever (55.2%). Similar study was also conducted witch special focus on self medication of antibiotics. Khan (2011) identified in his study, Self Medication of Antibiotics: Practices among Pakistan students in Sweden and Finland, that the self medication of antibiotics was primarily practiced for headache (0%), flu (8%), and fever (70%). The difference between the result of the symptoms were probably due to the fact that the study
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conducted by Khan (2011) was exclusively for the practice of self medication of antibiotic while in the study of Zafar et. al., (2008) was primarily conducted on self medication of any drugs. Khan (2011) identified that the most commonly used drugs were analgesics (74%) and antibiotics (100%) against Zafar et al (2008) 88.3% and 35.2% respectively. Furthermore, Khan et al., (2011) identified that the only legitimate reason for the practice of self medication of antibiotics were emergence of situation (18%), cost effectiveness (88%), and trivial nature of the illness (82%) which has similar notions to the study conducted by Zafar et al., (2008) in which quotes prior experience (50.3%) and trivial nature of illness (48.2%) as the most important factors for the practice of self medication of antibiotics. Prior knowledge of antibiotics, older age, and higher allowance are risk factors for self medication of antibiotics. Furthermore, they identified that the prior knowledge of antibiotics probably has led to a false sense of confidence in self diagnosis and self medication of antibiotics, also they identified that their prior knowledge of antibiotic plus easy access to purchasing antibiotics without prescription under the loose regulatory system might have encourage the respondents to self medicate antibiotics. They also added that self medication of antibiotics rate in older students could be cumulative illness episodes and prior experience of self medication of antibiotics contributes to practicing self
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medication of antibiotics. Lower allowance indicative of lower self medication antibiotics rate (Pan et al., 2012). Age of respondents does not affect their level of knowledge towards antibiotics usage. This implies that the age groups have the same quantity of health information regarding antibiotics usage. In Filipino culture, the older generations are usually the source of beliefs; as they were considered as primary care giver of a family. Thus if they have misconceptions such as pertaining to antibiotics usage, this will be passed on from one generation to another generation. Hence, the level of understanding of the young population remains to be the same with that of the old age (Avenir, 2013). This observation can be attributed to the theory proposed by Granovetter (as cited by Avenir, 2013) which explains the impact of ties in a relationship between an individual and a network member. Having strong ties with an individual may have a tendency to share same information and knowledge about health issues. Schillinger et al., (as cited in Avenir, 2013) indicated that an individual capacity to obtain, process, and understand basic health information has a direct relationship with educational attainment. Delschlegel et al., (as cited in Avenir 2013) identified that the population level of comprehensiveness may have difficulty in reading
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medical terminologies, prescription instructions, and other patient education material having lower educational attainment. According to Hansen (as cited by Avenir 2013) individuals who had higher education level were expected to think and learn beyond the facts from developed complex understanding of information and theories formulated from multiple sources. David Cuttler (Harvard University) noted that there is a well-known, large, and persistent association between education and health. The level of awareness of better educated individuals is higher. Also, they are more able to comprehend and comply to different instructions on different environmental setting. Thus, education greatly affects the health-seeking behaviors of an individual. Having a higher income means having exposed to multimedia widespread of health information. They have the ability to access internet resources; acquire books, and journals through health maintenance organization. Conversely, very low income earners that not to prioritize health information because this group tends to focus on their daily needs (Avernir, 2013). Furthermore, low income families have limited access to resource. They have greater risk of lower achievements in education and have poorer developmental health outcomes, compared to higher income families (Taylor and Fraser, as cited by Avenir, 2013).
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Avenir (2013) stated that very low income earners have the highest mean in terms of perceived appropriateness of self medication antibiotics, in which very low income earners do not want to compromise work or income earning activities so they have a habit of using available and affordable alternative antibiotics to prevent the development of illness. They have a judgment that consultation perse is very expensive Many economists have attributed these correlations to the effects of education, arguing that more educated people are better able to understand and use health information, and are better placed to benefit from the healthcare system
(http://www.nber.org/reporter/spring03/health.html) Maarten Wolbers suggested that it is a known fact that less welleducated people have higher unemployment rates than better educated people. A possible explanation of this finding is job competition: employers prefer higher over lower educated workers for jobs that were previously occupied by lower-educated employees. As a consequence, the lowest educated became unemployed. G. Scott Thomas revealed that there is a clear correlation between a person's educational attainment and his or her earning power. He stated that adults with bachelor's degrees in the late 1970s earned 55 percent more than adults who had not advanced beyond high school. That gap grew to 75 percent by 1990 and is now at 85 percent. Moreover,
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Education Voters of Pennsylvania suggested that over a lifetime, an 18 year old who does not complete high school earns approximately $260,000 less than an individual with a high school diploma and contributes about $60,000 less in lifetime federal and state income taxes. Angus Deaton of National Bureau of Economic Research found out that lower mortality and morbidity is associated with almost any positive indicator of socioeconomic status, a relationship that has come to be known as "the gradient". Socioeconomic status is a fundamental cause of health. Studies frequently endorse measures to improve health through manipulating socioeconomic status, not only by improving education but also by increasing or redistributing incomes. Ecob R. Smith stated that the effect of income on the health measures is comparable to that of the other socio-economic variables in combination. The shape of the relationship found between income and health is compatible with worse health in countries with greater income inequality, without the need to postulate any direct effect of income inequality itself Reasons for Self Medication with Antibiotics Self medication with antibiotics is a worldwide problem as it contributes to the rise of Multi Drug Resistant Organisms (MDRO). Reasons behind self medication with antibiotics varies in case to case basis. Agyeman, Donkor, Nartey, and Tetteh Quarcoo in their study
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entitled Self Medication Practices with Antibiotics Among Tertiary Level Students in Accra, Ghana: A Cross Sectional Study (2012), observed that reasons for self medication with antibiotics were, it was less expensive compared to medical care in the hospital and medical care in hospitals were associated with long delays. On the other hand, in the study Evaluation of Antibiotic Self Medication Pattern Amongst Undergraduate Students of Ahmadu Bello University (Main Campus), Zaria by Mus a, Olayeni, and Olayinka (2010), they reported that reasons given for practice of self medication with antibiotics included assumed knowledge on antibiotics, prior experience on use, and lack of time to go for consultation. However, as suggested by Al-Azzam, Al-Horani, Al-Husein, Alzoubi, and Masadeh in their study Self Medication with Antibiotics in Jordanian Population (2007), the main reason for self -medication with antibiotics as reported by the participants was their previous experience on the efficacy of treatment. Moreover, Misatis study Prevalence and Factors Influencing Self Medication with Antibiotics Among Adult Outpatients Attending Kenyatta National Hospital (2012) observed that the common reasons for self medication with antibiotics were to avoid a more serious infection, avoidance to pay for the physician/tests and lack of time to visit a physician. Furthermore, Ahmed, Angamo and Wabeds Self Medication with Antibiotics and Antimalarials in the Community of Silte
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Zone, South Ethiopia (2012) found out that majority of the respondents practiced self medication to avoid waiting time at health facilities. In addition, reasons for self medication with antibiotic includes previous successful experience, saving time and money, and information obtained from health professionals, lay people, and printed materials as proposed by de Crespigny, Hiller, Suryawati and Widayatis Self Medication with Antibiotics in Yogyakarta City Indonesia: A Cross Sectional Population-Based Survey (2011). Conditions for Practicing Self-Medication of Antibiotics There are many different health conditions that contribute and affect the behavior of an individual to self-medicate using antibiotics.In the study of Mohanna (2010), the minor ailments reported as the most common reasons for SMA were respiratory tract infections (e.g. common cold, sore throat, and sinusitis) as well as gastrointestinal infections which are often managed with antibiotics but requires no antibiotic treatment for the reason that those conditions are known to be viral of origin. This increases the prevalence of SMA in children in Yemen as well as in other countries like Jordan, Palestine, Turkey and Europe, as cited in study of Al-Azzam (2007) entitled as Self -medication with antibiotics in Jordanian population. As a result, the incidence of drug-resistance worldwide is alarmingly high. Thus, SMA has the potential to harm society at large, as well as the individual patient.
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Nalini (2010), identified factors that lead to SMA among respondents in Karnataka, India which were perceived as respiratory infections (66.7%), gastrointestinal diseases (23.4%), and systemic diseases (7.7%) and skin diseases (2.6%). In the study, researchers found out that inadequate knowledge regarding those health conditions prompted the respondents to self-medicate using antibiotics. Thus, they have agreed that proper health education regarding those diseases can lessen the occurrence of SMA not only in their locale but also globally. Also, Fadare and Tamuno (2011, Antibiotic self-medication among university medical undergraduates in Northern Nigeria) recognized other health situations such as diarrhea (24.6%), sore throat (20.3%), fever (17.4%), cough (8.7%), catarrhal (5.8%), toothache (5.8%), and body aches (2.9%). These diseases are perceived as mild clinical conditions which prompted respondents to resort to SMA.The dilemma with this practice is that fever and other similar symptoms which could be due to viral conditions are usually mismanaged with antibiotics creating a possibility for the development of drug-resistanceamong respondents in Northern Nigeria. A study in Rural Africa entitled Self Medication in Rural Africa: The Nigerian Experience regarding self-medication of antibiotics identified 16 common ailments for SMA in the four rural communities they studied, namely: spots and pimples, eczema, conjunctivitis, stomachaches, toothache, earache, diarrhea, body aches, sore throat, wounds and cuts,
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sores and ulcers, boils, common colds, ringworm, and whitlow. The treatment habits of the respondents through consultation of a medical doctor were compared to the treatment habit of community members through SMA. In this study, they found out that a total of 736 individuals who were given with questionnaires and a total of 552 individuals, representing 75% responded. Only,0.6% said they that the often consulted the doctor, while 99.4% were always resorting to self-medication(Arikpo, G.E., Eja, M.E., K.H. Enyi-Idoh, K.H., 2010). In addition, Oh AL, Hassali MA, Al-Haddad MS, Sulaiman SA, Shafie AA, Awaisu AA. (2011) cited in his study entitled Public Knowledge and Attitudes towards Antibiotic Usage: A cross-sectional study among the general public in the state of Penang, Malaysia that most of the respondents practice self-medication of antibiotics due to fever (40.7%) and respiratory infections (22.9%). Half of the respondents in Penang, Malaysia expect a prescription of antibiotics for common colds and cough, and that they believe that taking antibiotics when having cough or colds can give them a quick relief from their illness or symptom. Moreover, the study of Kumar N, Kanchan T, Unnikrishnan B, Rekha T, Mithra P. (2013) entitled Perceptions and Practices of SelfMedication among Medical Students in Coastal South Indiahighlighted that the various indications for self-medication of antibiotics reported are fever (75.1%), followed by headache (64.7) and cough/cold (58.7). The author identified that sore throat (31.6%) is the most common indication
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for self-medication with antibiotics. Even though majority of the individuals have a higher level of education they tend to practice self-medication of antibiotics for the above identified illnesses because the illnesses are too trivial for consultation followed by their confidence to self-medicate using antibiotics. Moreover, it was also found out that 35.3% of the participants reported not to have completed the entire course of antibiotic regimen and stopped medication when the symptom subsided and they use old prescriptions for the same illness as the source of information about the drug. Lastly, according to Becker (2003) health in the Filipino culture was based on the principle of balance and harmony whereas Filipinos view health as a result of being in balance, while illness was the result of an imbalance. Filipinos also believed in controlling their ailment by treating the symptoms that they are experiencing or more on a symptomatic approach in treating illnesses. It was also found out that Filipinos believed in keeping the body strong by being clean, orderly and appropriate in social situations to maintain balance, and therefore health. Filipinos also do many things to maintain and restore health among those are treatment with the use of medicines but using home remedies as treatment is also common in the Filipino culture.
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Dosage One of the most important factors that affect the effectivity of an antibiotic treatment is the dosage. It determines the prescribed amount to be administered and at the prescribed time in order to attain optimal therapeutic effect of a drug. According to Dr. Laurence Knott (2013), appropriate dosage of antibiotics is based on the patients age, weight, hepatic and renal function, and severity of infection because they affect the absorption of the drug. Under-dosing may lead to bacterial resistance in serious infection while over-dosing may result in toxicity and adverse effects. Thus, the exact or prescribed dosage should be taken into consideration to avoid undesirable effects. Samaniego (2011) reported in her news article entitled Its a fact: The Use of Antibiotics is often Abused that Dr. Rontgene M. Solante, President of the Philippine Society of Microbiology and Infectious Disease (PSMID) said that misuse of antibiotics has been a major problem in the Philippines. It is the number one cause of the emergence of superbugs or the antibiotic-resistant bacteria that is detrimental to humanity and is now becoming a global threat. Common inappropriate practices in the Philippines with regards to antibiotic usage are self-medication, skipping a dose of antibiotic, sudden cessation from the treatment and using of overthe-counter antibiotics. According to Dr. Solante, instead of consulting for the doctor to obtain prescription, some people use previous prescription of
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past experience, or ask for advice and suggestions from their relatives and friends in buying antibiotics (Samaniego, 2011). Pan et al. (2012) suggested in their study that information about antibiotic like the dosage is obtained from package insert only that the group without prior knowledge about antibiotics has low understanding about the instruction in the package insert. Also, majority from this group decided the type of antibiotics they will and the dosage by themselves. Moreover, Bakr stated in his study in 2012 entitled Antibiotic Purchasers International Network for the Rational Use of Drugs (INRUD), people who purchase antibiotics intend to read the package inserts. Furthermore, mDhil Editorial Team stated in their article Perils of Self Medication! that information about health and medicines like antibiotics are now readily accessible on the internet, and also in magazines and editorials. However, in the study of Kalyango, Rutebemberwa, Karamagi, Mworozi, Ssali, Alfven, and Peterson (2013), Community Health Workers (CHW) were allowed to prescribe medications like antimalarial and antibiotics and the dosage. Nevertheless, CHW needs to assure that the caregivers or the significant others understand the dosing regimens. Some people who are self-medicating with antibiotics tend to change the dosage for some reasons. In fact, in the study of Pan et al.
(2012), 55% participants of the study engaged in the alteration of antibiotics and dosage during the course of treatment. University students who participated in the study belong to ages 18 to 36. Some of the
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students believed that higher doses result in faster recovery and 274 of the students believe that lower doses result in adverse reaction. Also, Bakr (2012) reported that the people taking antibiotics believe that if they minimize the dosage, side effects could be avoided. The study of Esimone, Nworu, and Udeogaranya in 2007 entitled Utilization of antimicrobial agents with and without prescription by outpatients in selected pharmacies in South-eastern Nigeria was conducted to assess the dosing errors associated with self-medication of antibiotics among patients by getting their orders with or without prescription in the out-patient pharmacies. From 4,128 outpatients who were involved in the study, 42.2% came with prescription from qualified medical personnel and 57.8% came without prescription. High level of under-dosing is observed in regimen filled without prescription. Duration of Use According to Dr. Solante, one of the common practices of the improper use of antibiotics is the cessation of taking antibiotics even before the course of treatment is completed. Individuals who are selfmedicating with antibiotics stop the treatment once they feel betters. Another reason for why people fail to complete the treatment is that others cant afford to buy all the antibiotics prescribed due to financial constraints. Eventually, they will stop medicating when there is no antibiotics left (Samaniego, 2011).
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In the global survey on non-compliance with antibiotic therapy for acute community infections, 10% to 44% of the people reported that they do not finish taking antibiotics in required duration because they already feel better even before the course of treatment was completed (Avenir as cited from Kadas, 2012). Moreover, it was found in a study in the study of Buke, Ciceklioglu, Emertcan, Eren, and Hosgor-Limoncu in 2003 entitled Rational Antibiotic Use and Academic Staff that 15.6% of the educated group of people, excluding the population from the Medicine department, use antibiotics until the symptoms disappeared regardless of the prescribed duration for taking the drug. However, in the study of Pan et al. conducted in Southern China about the self-medication of antibiotic practices of university students, the rise of adverse reactions towards antibiotics use is the reason why people stop taking antibiotics. Furthermore, it was found in the study of Bakr that some individuals treating with antibiotics believe that it is necessary to discontinue using antibiotics as soon as possible to avoid side effects. Also, some believe that adults can stop the treatment with antibiotics anytime but children cannot. Likewise, in the study of Dixon in 2009 entitled Cultural Traditions and Healthcare Beliefs of Some Older Adults, Filipino elders who have spent the majority of their lives in Canada may be more accepting of Western biomedical views. More traditional Filipino approaches integrate concepts of illness as being a humoral imbalance between hot and cold in
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the body system, divine retribution for sins of omission or commission, the role of evil spirits or witches exacting punishment for wrongful deeds and the consequences of such natural events as cold drafts, thunder, lightning or typhoons. Filipino concept of health is based on the principle of balance (timbang). Specific disorders are perceived to be caused by an excess intake of one type of food. Hot foods such as meat are thought to cause arthritis and hypertension. Cold foods such as many fruits and vegetables may bring about cancer and anemia. Synthesis The researchers believe that each and every literature discussed in this research was relevant on the present study. The researchers related and differentiated these researches based on the problem and design of this study. The most parallel and related studies used were from China written by Pan H et al. in 2012 entitled Prior Knowledge, Older Age, and Higher Allowance Are Risk Factors for Self-Medication with Antibiotics among University Students in Southern China which the research tool was adapted and modified and from Philippines written by Avenir in 2013 entitled Knowledge towards Antibiotic Usage vis a vis Perceived Appropriateness of Self Medication among Patients. The two studies were similar with this current study in terms of the following: (1) both studies measured the reasons for self-medication of antibiotics as with the present study. Meanwhile, these studies differ with the current study observing the following parameters: (1) The current study focused on defining the
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practices of the respondents on self-medication of antibiotics, and did not concentrate on the factors and level of awareness towards antibiotic usage. (2) Ready-made survey questionnaires were personally distributed to the community residents of Barangay 598, District VI Metro Manila, whose age is at least eighteen years and was able to self-medicate using antibiotics . (3) The respondents of Avenirs research were out patients who consulted in selected doctors clinic (4) while the respondents of the online survey conducted by Pan were the students of Shantou University (STU) in Eastern Guangdong, China. (5) In addition to this, the respondents of the study from Pan were both users and non-users of antibiotics for self-medication purposes. The studies from South Carolina written by Mainous et al. in 2009 entitled Availability of Antibiotics for Purchase Without a Prescription on the Internet and from Nigeria written by Esimone et al. in 2007 entitled Utilization of Antimicrobial Agents With and Without Prescription by Out-Patients in Selected Pharmacies in South-eastern Nigeria are the least related. They are related with the current study in terms of the sources and non-prescribed use of antibiotics for self-medication purposes. Mainous et al., conducted an internet search using 2 major search engines (Google and Yahoo) to gather the data needed in their study while the study from Esimone et al. conducted a survey that was carried out daily in selected community pharmacies for a period of 90 days. One of the uniqueness of this study is the assessment of practices of community residents on Self-Medication of Antibiotics (SMA). Extent of practices
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on SMA were later grouped according to the respondents profile to define the significant differences among each category. Conceptual Framework Figure 1 illustrates the relationship of the variables of the study. The box on the left represents the profile of the community residents classified according to educational attainment and monthly family income. The box in the right corresponds to the practices of the community residents regarding SMA, which is consisted of reasons, conditions, dosage and duration of antibiotics. The difference in the manifested practices in relation to self-medication of antibiotics of community residents when they were grouped according to profile is represented by a straight line connecting the profile box and the SMA practices box.
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Conceptual Paradigm
Community Residents
Educational Attainment Monthly Family Income
Self-Medication Antibiotics Practices Reasons Conditions Dosage Duration
Figure 1 Practices of Community Residents on Self-Medication of Antibiotics
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Definition of Terms The following terms were used in the research study and were defined operationally in the context of the study. Community Residents: It refers to a population residing in Barangay 598 Zone 59, Old Sta. Mesa, Manila; 18 years old and above; practicing selfmedication of antibiotics; and has a willingness to participate in the conduct of the study. Highest Educational Attainment: It refers to the highest degree of education of an individual. This includes the following categories: Elementary Graduate/Undergraduate: It refers to community residents who are either graduate or undergraduate in elementary. High School Graduate/Undergraduate: It refers to community residents who are either graduate or undergraduate in high school. College Graduate/Undergraduate: It refers to community
residents who are either graduates or undergraduate in college. Self-Medication of Antibiotics: It is the human behavior in which an individual uses non-prescribed antibiotics to treat untreated and often undiagnosed medical ailments. It can also be the intermittent or continued use of prescribed antibiotics for chronic or recurrent symptoms or diagnosed diseases. Self-Medication of Antibiotics Practices: It is the practices of community residents towards SMA, in terms of:
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Reasons: It is the explanation or cause why community residents resorted in SMA practices (e.g. high cost of hospital consultation). Conditions: It refers to the health conditions that prompted community residents to self-medicate using antibiotics. (e.g. respiratory infections). Dosage: It refers to a specific quantity of a therapeutic drug or agent, in this case antibiotics, taken at any one time or at specified intervals. Duration: It is the course of or the period of continuous treatment using antibiotics. The following terms were used in the research study and were defined lexically in the context of the study. Monthly Family Income: It refers to the total family income (e.g. salaries and wages, commissions, retirement income and other forms of compensation) for a period of one month. According to the Family Income and Expenditure Survey (FIES) conducted by the National Statistics Office (NSO) last 2009, the standard ABCDE socioeconomic classification of monthly family incomes in the Philippines is categorized into the following ranges; 100,000/month and above (Families belong to Class A and B, or high income earners), 20, 000 - 100,000/month (Families belong to Class C or middle income earners), 10,000 -
20,000/month (Families belong to Class D which are the working poor or low
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income earners), and 10,000/month and below (Families belong to Class E or very low income earners).
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Chapter III Methodology Research Design Practices of community residents towards self-medication of antibiotics were discussed in this study and as a result, descriptive-correlational research design was utilized. Descriptive research helps provide answers to the questions of who, what, when, where, and how associated with a particular research problem; it cannot conclusively ascertain answers to why. According to Labaree in 2013, descriptive research is used to obtain information concerning the current status of the phenomena and to describe "what exists" with respect to variables or conditions in a certain situation. The Association for Educational Communications and Technology (2001) stated that descriptive research utilizes data collection and analysis techniques that yield reports concerning the measures of central tendency, variation, and correlation. The combination of its characteristic summary and correlational statistics, along with its focus on specific types of research questions, methods, and outcomes is what distinguishes descriptive research from other research types. Meanwhile, descriptive correlational research as proposed by James Key in 1997 aims to determine the extent of the relationship between two or more variables. This study determined the extent of the community residents practices on self-medication of antibiotics. Differences in the respondents SMA practices
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when they were grouped according to profile such as highest educational attainment and monthly family income were also discussed. Research Locale The study was conducted in Barangay 598, Zone 59 of District VI Metro Manila. It has a population of 11, 788 and is reported as the largest barangay in District VI (Census of Population and Housing, 2010; see Appendix D). It is headed by Chairman Armando E. Enaje Senior, together with seven barangay kagawads. Pamana Health Center (PHC) is located within Barangay 598, where the researchers were exposed for their related learning experience as second year students. Barangay 598 is one of the 8 barangays (barangays 598-605) that receives the services rendered by PHC. The livelihood of community residents in the said barangay were mostly computer rental shops, karinderya, sari-sari stores, and mini dry and wet markets. Commonly used modes of transportation were jeepneys and tricycles. Bystanders of all ages were very common in that area. Nearby prominent landmarks include San Juan River, San Juan City Hall, Kingdom Hall of Jehovahs Witnesses and Ramon Magsaysay Memorial Medical Center. Sample and Sampling Technique There are a total of 11, 788 community residents living in Barangay 598 Zone 59, Old Sta. Mesa, Manila. The researchers interviewed a total of 120 respondents which are chosen through a purposive sampling technique. It is selected based on the knowledge of a population and the purpose of the study.
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In this case the samples should be a resident of Barangay 598 Zone 59, Old Sta. Mesa, Manila, at least 18 years old and above, they should be practicing selfmedication of antibiotic and willing to participate in the conduct of the study. The sampling technique automatically catered all community residents who satisfied the criteria on the one-week period. This allowed the researchers to have an adequate number of samples which represents the entire population. Instrumentation
The questionnaire was adapted from the study of Pan et al., in 2012 entitled Prior Knowledge, Older Age, and Higher Allowance are Risk Factors for Self-Medication with Antibiotics among University Students in Southern China, however only certain items which are applicable in the present study will be used. This includes items number 4, 5, 11, 12, 13, and 19 in the original questionnaire. Instead of frequency checklist, the present endeavor was modified into a Likert Scale. Permission for adaptation of the questionnaire from the author was secured through email correspondence (Please see Appendix A). It was developed in English language and translated in Filipino by a PLM graduate of education major in Filipino and now a professor of Holy Trinity College Quezon City to make it more appropriate to the community setting. It consisted of six parts.
Part I of the questionnaire obtains the demographic profile of the community residents. It includes the educational attainment and monthly family income. Educational attainment was classified as elementary graduate or
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undergraduate, high school graduate or undergraduate and college graduate or undergraduate.
Educational Attainment Elementary Graduate / Undergraduate High School Graduate / Undergraduate College Graduate / Undergraduate
Interpretation Low level of understanding
Middle level of understanding
High level of understanding
While family income every month is categorized as class A and B (100,000/month and above), class C (20, 000 - 100,000/month), class D (10,000 - 20,000/month) and class E (10,000/month and below).
Class A and B C D E
Family Income Every Month 100,000/month and above 20, 000 - 100,000/month 10,000 - 20,000/month 10,000/month and below
Interpretation High income earner Middle income earner Low income earner Very low income earner
Part II consists of one item concerning the reasons for self-medication with antibiotics. It comprises of six choices that will help them identify their rationale for antibiotic usage. It was item number four in the original questionnaire.
Part III includes one item regarding the conditions for self-medication with antibiotics. It consists of five conditions they had that motivated them to use antibiotics. It was item number five in the original questionnaire.
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Part IV contains two items about the dosage for self-medication with antibiotics. It comprises of seven sources from where they found out the desired amount of the antibiotic they are going to take and a follow-up question to those respondents who changed the dosage of their antibiotic consumption. The three choices are the reasons for their antibiotic dosage changes. It was item numbers 11, 12 and 13 in the original questionnaire.
Part V includes one item pertaining to the duration for self-medication with antibiotics. It consists of five choices that identify the length of time of their antibiotic usage. It was item number 19 in the original questionnaire.
Parts II to V assessed the extent of self-medication of antibiotic practices of the respondents using the following rating scale:
Scale
Response
Range
Interpretation
4 Practice
Always
3.25-4.00
Very
Highly
Often
2.50-3.24
Highly Practice
Sometimes
1.75-2.49
Low Practice
Never
1.00-1.74
Very Low Practice
It is interpreted that the higher the score, the higher the extent of the selfmedication of antibiotics practices.
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Data Gathering Procedure
The researchers first visited the chosen research for formalities that includes the letter asking permission for their community to be the locale of the study. The researchers wrote a letter to the Barangay Chairman asking permission to conduct a survey among community residents in Barangay 598 Zone 59, Old Sta. Mesa Manila, particularly, those who are at least 18 years old and above, and practicing self-medication of antibiotics. Proper permit and letter was sought to conform to the standards and procedures of the research undertaking. An introductory letter was also attached to the questionnaire to discuss the purpose of the study and to ensure the respondents confidentiality. Aside from the introductory letter, the researchers conducted the survey themselves via house-to-house to be able to explain, clarify the queries of the respondents regarding the study and to make sure that each respondents is really self-medicating using antibiotics. After a one-week period of survey, the researchers gathered 120 respondents. Then, after valid questionnaire forms were gathered, the data was tabulated and organized after. Then, statistical treatment was applied for facilitation of analysis and interpretation of data results.
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Statistical Analysis The study utilized Statistical Package for Social Sciences version 20.0 for data analysis and processing. Specifically the software was used for the following purposes: For Problem Number 1, frequency and percentage distribution was utilized to identify the profile of the respondents. For Problem Number 2, weighted mean was utilized to identify the respondents practices towards self medication of antibiotics. For Problem Number 3, One Analysis of Variance (ANOVA) was utilized to measure the difference between the respondents practices towards self medication of antibiotics when grouped according to profile variables
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Chapter IV Results and Discussions Problem No. 1 What is the profile of the respondents according to:
1.1 Highest Educational Attainment
Figure 2 Highest Educational Attainment of the Respondents Figure 2 illustrates the highest educational attainment of the respondents. It describes that the majority (50%, n=60) of the respondents reached high school (secondary) level of education. Thirty five percent (n=42) reached college (tertiary) level while 15% (n=18) of the respondents reached elementary (primary) level.
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The result conveyed that most of the respondents were able to reach high school due to the fact that the age included in this study was 18 years old and above. The Census of Population and Housing (2010) indicated in their study that of the total household population aged five years and over, 19.1% had finished at most high school level, 11.7% attained elementary education, and 10.1% were able to attain college level.
1.2 Monthly Family Income
Figure 3 Monthly Family Income of the Respondents Figure 3 shows the distribution of the respondents in terms of their monthly family income. Most of the respondents (60%, n=72) falls in Category E interpreted as the very low income earners producing Php 10, 000/month and
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below. This is followed by the Category D or the low income earners (25%, n=30), followed by Category C or the middle income earners (13%, n=15), and lastly Category A/B or the high income earners (4%, n=3). The more probable cause of low family income is unemployment and unavailability of jobs provided. Moreover, most of the jobs (e.g., pedicab driver, store owners) available within this barangay have low wages. To support this, Brooks (2002) stated in his study that high rate of population growth, lack of access to land, insufficient job creation in industry, and a history of inappropriate economic policies contributed to high unemployment and underemployment. Real wages were low, having declined at about 3 percent per year since 1960, and relatively weak labor unions were unable to substantially affect the deterioration of workers' earning power. Problem No. 2 - To what extent do the respondents manifest the following Self-Medication of Antibiotics practices: 2.1 Reasons Table 1 represents the extent of self - medication of antibiotics practices in terms of reason. The table reveals that the respondents reason for SMA was to improve the condition or the prognosis of the symptoms being experienced and has a weighted mean score of 3.43 with a verbal interpretation of very highly practiced which ranked first. Experiences on the efficacy of antibiotics based on previous encounter ranked second and have a verbal interpretation of very highly practiced accounting for 3.34 weighted mean score. Economy or being able to
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save money ranked third and has a verbal interpretation as highly practiced with a weighted mean score of 2.96. Lack of time in consulting a doctor ranked fourth and is interpreted as highly practiced with a weighted mean score of 2.9. Knowledge about antibiotics ranked as the fifth reason for practicing SMA with a weighted mean of 2.60 and has a verbal interpretation of highly practiced.
Table 1 Extent of Self-Medication of Antibiotics Practices in Terms of Reasons Items 1.Economy 2. Knowledge 3. Experience 4. Prognosis 5. Time
*Legend: 1.00-1.74= Very Low Practiced 1.75-2.49= Low Practiced
Weighted Mean 2.96 2.60 3.34 3.43 2.91
Interpretation Highly Practiced Highly Practiced Very Highly Practiced Very Highly Practiced Highly Practiced
Rank 3 5 2 1 4
2.50-3.24= Highly Practiced 3.25-4.00= Very Highly Practiced
Table 1 represents the extent of self - medication of antibiotics practices in terms of reason. The table reveals that the respondents reason for SMA was to improve the condition or the prognosis of the symptoms being experienced and has a weighted mean score of 3.43 with a verbal interpretation of very highly practiced which ranked first. Experiences on the efficacy of antibiotics based on previous encounter ranked second and has a verbal interpretation of very highly
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practiced accounting for 3.34 weighted mean score. Economy or being able to save money ranked third and has a verbal interpretation as highly practiced with a weighted mean score of 2.96. Lack of time in consulting a doctor ranked fourth and is interpreted as highly practiced with a weighted mean score of 2.91. Knowledge about antibiotics ranked as the fifth reason for practicing SMA with a weighted mean of 2.60 and has a verbal interpretation of highly practiced. It can be seen from this table that the respondents most frequent reason for practicing SMA was because they want an improvement in the symptoms or conditions that they have experienced. This is mainly a preventive technique to avoid the occurrence of more serious infections and diseases. The respondents may have assumed that through SMA, further complications can be treated and prevented hence lesser money will be consumed. Previous encounters ranked as the second most practiced reason for SMA. Prior experiences on the efficacy of certain treatment or medications have caused these respondents to settle or apply the same drug regimen. These practices also enable the respondents to save money instead of paying physicians, laboratory tests and other hospital expenses. People have had limited time for consulting physicians and this reason has led them to practice SMA. Knowledge on antibiotics ranked as the least practiced reason for performing SMA. It may be suggested that since these respondents were mostly high school graduates, theyre understanding, awareness and level of knowledge on antibiotics and SMA were also limited.
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Similarly, Misati (2012) observed that the common reasons for selfmedication of antibiotics were to avoid a more serious infection, avoidance to pay for the physician/tests and lack of time to visit a physician. Also, in 2012, Agyeman observed that reasons for self-medication of antibiotics were, it was less expensive compared to medical care in the hospital and medical care in hospitals were associated with long delays. On the other hand Musa (2010) reported that reasons given for practice of self-medication using antibiotics included assumed knowledge on antibiotics, prior experience on use, and lack of time to go for consultation.
2.2 Conditions Table 2 Extent of Self-Medication of Antibiotics Practices in Terms Of Conditions Items 1. Respiratory Infections 2. Systemic Manifestations 3. Gastrointestinal Problems 4. Skin Wounds
Weighted Mean 3.20 2.71 2.05 2.98
Interpretation Highly Practiced Highly Practiced Low Practiced Highly Practiced
Rank 1 3 4 2
Based on the findings on Table 2, respiratory infections with a weighted mean of 3.20, skin wounds with a weighted mean of 2.98, and systemic manifestations with a weighted mean of 2.71 have a verbal interpretation of highly practice and ranked 1st, 2nd, and 3rd respectively. Whereas, gastrointestinal
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problems with a weighted mean of 2.05 has a verbal interpretation of low practice and ranked 4th. The above results signifies that majority of the respondents self-medicates with antibiotics when they suffer from respiratory infections (runny nose, nasal congestion, cough, sore throat), systemic infections (fever, aches and pains), and skin wounds rather than when they are suffering from gastrointestinal problems (vomiting, diarrhea, stomach ache). The Filipino culture approached their health symptomatically which means that they view their self as healthy individuals if they are not experiencing any symptoms of any illness. Filipinos also believe in eradicating their illness or symptoms completely as soon as possible. In addition to that, they usually treat their conditions specifically respiratory infections, systemic manifestations and skin wounds with antibiotics rather than
gastrointestinal problems which are frequently treated by home remedies like herbal medicines. This is supported by the study of Nalini (2010) in India, where respiratory infections, systemic manifestations and skin wounds are identified as the most common factors that driven community residents in practicing self-medication of antibiotics as their treatment for the said conditions. This is also similar with the study of Mohanna (2010), where he reported respiratory infections such as cough, common cold, sore throat, nasal congestion, runny nose and the like as the most common minor ailments which provoke community residents to resort in self-medication using antibiotics.
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Moreover, according to Becker (2003) health in the Filipino culture was based on the principle of balance and harmony. Health was a result of being in balance, while illness was the result of an imbalance. Aside from that, Filipinos believed in controlling their illness by treating the symptoms that they are experiencing or more on a symptomatic approach in treating illnesses. Filipino people also believed in keeping the body strong by being clean, orderly and appropriate in social situations to maintain balance, and therefore health. Pan et al. (2012) believed that prior knowledge regarding drug and regimen lead to a false sense of confidence in self-diagnosis and self-management resorting in using the similar treatment that was effective to them, thus, resorting in selfmedication of antibiotics.
2.3 Dosage Table 3 Extent of Self-Medication of Antibiotics Practices in Terms of Dosage Items 1. Package Checking 2. Community Health Practitioners 3. Family and Friends 4. Internet 5. Experience 6. Estimating Dosage 7. Advertisements Weighted Mean 2.46 2.84 3.06 1.28 3.18 2.00 2.23 Interpretation Low Practiced Highly Practiced Highly Practiced Very Low Practiced Highly Practiced Low Practiced Low Practiced
Rank 4 3 2 7 1 6 5
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The weighted mean describing the extent of self-medication of antibiotics practices in terms of dosage is shown in table 3. The above table reveals that experience, with the weighted mean of 3.18 and a verbal interpretation of highly practiced ranked first to which the respondents obtain or base the dosage they would take. It was followed by family and friends, with the weighted mean of 3.06 and a verbal interpretation of highly practice which ranked second. Community health practitioners, with a weighted mean of 2.84 and a verbal interpretation of highly practiced ranked third. This was followed by package checking, with a weighted mean of 2.46 and a verbal interpretation of low practice which ranked forth. Moreover, advertisements with a weighted mean of 2.23 and a verbal interpretation of low practice ranked fifth. Furthermore, estimating dosage, with a weighted mean of 2.00 and a verbal interpretation of low practice ranked sixth. Lastly, internet, with a weighted mean of 1.28 and a verbal interpretation of very low practice ranked seventh. Experience being the first rank to which the residents obtain or base the dosage they are going to take signifies that they have already experienced taking specific dosage of antibiotic for their previous condition that is similar to their recent or present encounter. Family and friends got the second rank as the source of dosage information which suggests that the respondents obtain or ask the dosage that they would take from the people they trust. This implication was supported by the study of Pan et. al. in 2012 stating that self medication of antibiotics rate in older students could be cumulative
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illness episodes and prior experience of self medication of antibiotics contributes to practicing self medication of antibiotics. Furthermore, Samaniego reported in his article in 2011 that according to Dr. Solante, instead of consulting for the doctor to obtain prescription, some people use previous prescriptions of past experience, or ask for advice and suggestions from their relatives and friends in buying antibiotics.
2.4 Dosage Change Table 4 Extent of Self-Medication of Antibiotics Practices in Terms of Dosage Changes Items 1. Improve Conditions 2. Reduce Side Effects 3. Insufficient Supply Weighted Mean 3.60 2.45 2.40 Interpretation Very High Practiced Low Practiced Low Practiced
Rank 1 2 3
The weighted mean showing the extent of self-medication of antibiotics practices in terms of dosage change is shown in table 4. It was found out that to improve conditions with a weighted mean of 3.60 and a verbal interpretation of very high practice ranked first as their reason for changing dosage. This was followed by reduce side effects, with the weighted mean of 2.45 and a verbal interpretation of low practice ranked second. Furthermore, insufficient supply, with a weighted mean of 2.40 and a verbal interpretation of low practice ranked third.
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Improvement of condition is the main reason why most of the respondents change doses to become free from the underlying symptoms they are experiencing. Filipino culture health is regarded to be symptomatic. The respondents of this study perceived that they are healthy if they dont experience symptoms. Consequently, this results to the development of multi drug resistance to antibiotic among the respondents. According to WHO in 2010, incorrect use may take the form of overuse, underuse, and misuse of prescription or non prescription medicines. Rational use of medicines means that patients receive medication appropriate to their clinical needs, in doses that meet their own individual requirements, for an adequate period of time, and at the lowest cost to them and their community. Irrational use includes use of antibiotics for non bacterial illnesses and non-adherence to recommended dosing regimens, hence preventing desired therapeutic outcomes from being achieved and potentially increasing antimicrobial resistance.
2.5 Duration of Use The assessment of the extent of self - medication of antibiotics practices with regards to duration is represented in this table. It was observed that the course of after the recovery with a weighted mean of 3.54, and symptoms disappeared with a weighted mean of 3.32 have a verbal interpretation of very highly practiced and was ranked as 1st, and 2nd in that order. On the other hand, consumed supply with a weighted mean of 2.59 has a verbal interpretation of highly practiced and was ordered as 3rd. Meanwhile, completion of treatment with
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Table 5 Extent of Self-Medication of Antibiotics Practices in Terms of Duration Items 1. After a few days 2. Symptoms disappeared 3. After the recovery 4. Consumed supply 5. Completion of treatment
Weighted Mean 2.25 3.32 3.54 2.59 2.33
Interpretation Low Practiced Very Highly Practiced Very Highly Practiced Highly Practiced Low Practiced
Rank 5 2 1 3 4
a weighted mean of 2.33, and after a few days with a weighted mean of 2.25 have a verbal interpretation of low practice and was ranked as 4 th, and 5th accordingly. Based on the findings stated above, it could be interpreted that majority of the community residents take antibiotic for only a short period of time, specifically after they feel better which could also be interpreted as the absence of symptoms or the return of balance. This could be attributed to the Filipino culture wherein health is equated with symptoms. In view of this fact, Filipinos consider themselves well or healthy if they are not experiencing any symptoms and vice versa. This is why the highest practised length of duration regarding self medication with antibiotics is a few days after the recovery which is equated to being symptoms free.
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According to Samaniego (2011), as cited in the collated article of Barbara Dixon entitled as Cultural Traditions and Health Care Beliefs of some Older Adults (2009), Filipinos concept of health is based on the principle of balance. Specific disorders are perceived to be caused by an excess intake of one type of food. Hot foods such as meat are thought to cause arthritis and hypertension. Cold foods such as many fruits and vegetables may bring about cancer and anemia. Moreover, as mentioned by Dr. Solante, one of the common practices of the improper use of antibiotics is the cessation of treatment even before the course is completed. The reasons for stopping the medication are financial constraints and that the patient taking the antibiotic is feeling better. Furthermore, in the global survey on non-compliance with antibiotic therapy for acute community infections, 10% to 44% of the people reported that they do not finish taking antibiotics in required duration because they already feel better even before the course of treatment was completed (Avenir as cited from Kadas, 2012). Likewise, it was found in a study in the study of Buke, et al in 2003 entitled Rational Antibiotic Use and Academic Staff that 15.6% of the educated group of people, excluding the population from the Medicine department, use antibiotics until the symptoms disappeared regardless of the prescribed duration for taking the drug. Problem No. 3 Is there a significant difference in the respondents practices on Self-Medication of Antibiotics practices when they are grouped according to profile?
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3.1 Reasons Table 6 Anova Results on the Significant Difference on SMA Practices on Reasons When grouped According to Highest Educational Attainment Educational Attainment 1. Economy f-Value 2.37 p-Value 0.09 Decision Accept Interpretation There is no significant difference There is no significant difference There is a significant difference There is no significant difference There is no significant difference
2. Knowledge 3. Experience 4. Prognosis
1.00
0.37
Accept
3.42
0.04
Reject
0.42
0.41
Accept
5. Time
0.11
0.11
Accept
*Legend: p-value < 0.05 significant; p-value > 0.05 not significant
Based on the findings on Table 6, experience with an f-Value of 3.42 and an equivalent p-Value of 0.04 led to the decision to reject the null hypothesis, thus a significant difference was found. Conversely, economy with an f-Value of 2.37 and an equivalent p-Value of 0.09, knowledge with an f-Value of 1.00 and an equivalent p-Value of 0.37, prognosis with an f-Value 0.42 and an equivalent p-Value of 0.41 and time with an f-Value of 0.11 and an equivalent p-Value of 0.11 have all led to the decision to accept the null hypothesis thus no significant difference was found.
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Table 7 Post Hoc Tukey Experience vs Education Experience High School Level College Level Mean 3.22 3.59 p- Value 0.03 Interpretation There is a significant difference
Tukey test was used for each mean comparison since they are proven to be significant in the previous computation of variance. Tukeys score was tested for statistical significance with Tukeys probability between High School Level with a mean value of 3.22 and College Level with a mean value of 3.59, both having an equivalent p-Value of 0.03. People who were able to reach college have an increased level of knowledge and understanding on the uses, side effects, and compliance of antibiotic treatment. This circumstance predisposes these individuals to risk on self-medicating assuming they have a well foundation of information on antibiotics and SMA. They tend to be independent on the actions that they will perform to address their health. Lesser educated people are more likely to consult family members, friends, know medical professionals since they know that they lack understanding and knowledge on proper drug regimen and its compliance. Furthermore, as more knowledgeable individuals risk on practicing SMA, their experiences on the efficacy of certain drugs become remarkable and is repeated on the time that the symptoms that theyve experienced occurs again.
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To support this, David Cutler (2007) of The National Bureau of Economic Research proposed that the better educated are substantially less likely to report that they are in poor health, and less likely to report anxiety or depression for they have the initiative to address their health problems even on their own. Finally, better educated people report spending fewer days in bed or not at work because of disease, and they have fewer functional limitations.
Table 8 Anova Results on the Significant Difference on SMA Practices on Reasons When grouped According to Monthly Family Income Monthly Family Income 1. Economy f-Value 2.12 p-Value 0.10 Decision Accept Interpretation There is no Significant difference There is no Significant difference There is no Significant difference There is no Significant difference There is no Significant difference
2. Knowledge
0.36
0.77
Accept
3. Experience
1.48
0.22
Accept
4. Prognosis
0.49
0.68
Accept
5. Time
1.69
0.17
Accept
Table 8 reveals that, economy with an f-Value of 2.12 and an equivalent pValue of 0.10, knowledge with an f-Value of 0.36 and an equivalent p-Value of
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0.77, experience with an f-Value of 1.48 and an equivalent p-Value of 0.22, prognosis with an f-Value 0.49 and an equivalent p-Value of 0.68 and time with an f-Value of 1.69 and an equivalent p-Value of 0.17 have all led to the decision to accept the null hypothesis thus no significant difference was found. There is no significant difference between the respondents monthly fami ly income and their reasons for practicing SMA. The respondents reasons for committing SMA were not affected by their ability to produce either high or low income on a monthly basis. Socio-economic status is considered as an indicator of heath. On the other hand, there are respondents that receive a low monthly income but ensure that their health would not be compromised. Likewise, there are individuals that receive adequate, even high monthly income but do not prioritize health and its maintenance but rather on lifes basic necessities (food, water, clothing etc).Same goes for Knowledge, Experience, Prognosis and Time. A persons reasons for practicing SMA are minimally affected by his monthly income and are dependent on his determination and realization on the need to participate in such act. In line with this, Michaela Benzeval (2005) stated in her study that while it is widely recognized that poverty, or low income, is associated with poor health, even in rich societies, the nature of the relationship between income and health status is not clearly understood. Moreover, Laaksonen (2003), in his study on Income and Health Behaviors concluded that adjusting for education and occupation largely removed income differences in health behaviors. The results suggest that income
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does not only reflect the available material resources, but works as a general socioeconomic indicator that is associated with health behaviors in much the same way as other socioeconomic indicators.
3.2 Conditions Table 9 Anova Results on the Significant Difference on SMA Practices on Conditions When grouped According to Highest Educational Attainment Educational Attainment 1.Respiratory Infections 2.Systemic Manifestations 3.Gastrointestinal Problems 4.Skin Wounds F-Value 4.83 p-Value 0.01 Decision Reject Interpretation There is a significant difference There is no significant difference There is no significant difference There is no significant difference
0.41
0.66
Accept
2.53
0.08
Accept
1.26
0.28
Accept
Based on the above table, respiratory infections with an f-Value of 4.83 and an equivalent p-Value of 0.01 lead to the decision to reject the null hypothesis thus a significant difference was found. However, systemic manifestations with an f-Value of 0.41 and an equivalent p-Value of 0.66, gastrointestinal problems with an f-Value of 2.53 and an equivalent p-Value of 0.08, and skin wounds with an f-Value of 1.26 and an equivalent p-Value of 0.28 all lead to the decision to accept the null hypothesis thus no significant difference was found.
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Table 10 Post Hoc Tukey Respiratory Infections vs Highest Educational Attainment Respiratory Infections High School Level Mean 2.90 3.49 p-Value 0.02 Interpretation There is a significant difference.
College Level
Tukey test was used for each mean comparison since they are proven to be significant in the previous computation of variance. Tukeys score was tested for statistical significance with Tukeys probability between high school level with a mean value of 2.90 and college level with a mean value of 3.49 and both have an equivalent p-Value of 0.02. This result signifies that the respondents who have reached college level have a very high practice in self-medication of antibiotics with regards to respiratory infections compared to respondents who have reached high school level. Since college level individuals have sufficient knowledge regarding their condition and the medication they should take, with regards to this an increased knowledge means increased confidence to self-medicate unlike in high school level respondents. College level respondents feel knowledgeable enough to take antibiotics without consulting a medical health professional. Higher level of education results in a false sense of confidence to self-diagnose and selfmedicate using antibiotics. Moreover, college students become very busy in their school where there is no room for sick days and that one absent has a great impact and they feel that there is a need to treat respiratory infections such as
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runny nose, nasal congestion, cough and sore throat with antibiotics for faster relief. Contradictory, high school students they treat respiratory infections by having enough rest. This is another factor that prompted college level respondents to self-medicate more rather than high school level respondents. The results are similar to the study of Kumar (2013), where he states that majority of individuals who have a higher level of education tend to selfmedicated because of the illness being too trivial for consultation followed by their confidence to self-medicate using antibiotics. Also, they use old prescriptions for the same illness as the source of information about the drug. In addition, Oh, et al (2011) cited in his study that half of the respondents expected a prescription of antibiotics for common colds and cough, and that they believe that taking antibiotics when having cough or colds can help them recover faster.
Table 11 Anova Results on the Significant Difference on SMA Practices on Conditions When grouped According to Monthly Family Income Monthly Family Income 1.Respiratory Infections 2.Systemic Manifestations 3.Gastrointestinal Problems f-Value 4.37 p-Value 0.01 Decision Reject Interpretation There is a significant difference There is no significant difference There is a significant difference
1.51
0.21
Accept
2.89
0.03
Reject
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Based on the findings on Table 11, respiratory infections with an f-Value of 4.37 and an equivalent p-Value of 0.01 and gastrointestinal problems with an fValue of 2.89 and an equivalent p-Value of 0.03 both lead to the decision to reject the null hypothesis thus a significant difference was found. Conversely, systemic manifestations with an f-Value of 1.51 and an equivalent p-Value of 0.21 and skin wounds with an f-Value of 0.83 and an equivalent p-Value of 0.47 both lead to the decision to accept the null hypothesis thus no significant difference was found.
Table 12 Post Hoc Tukey Respiratory Infections vs Monthly Family Income Respiratory Infections Category D Mean 2.92 3.67 p-Value 0.01 Interpretation There is a significant difference.
Category E
Tukey test was used for each mean comparison since they are proven to be significant in the previous computation of variance. Tukeys score was tested for statistical significance with Tukeys probability between Category D with a mean value of 2.92 and Category E with a mean value of 3.67 and both have an equivalent p-Value of 0.01. It can be gleaned in the monthly family income that the highest mean came from Category E or very low income earners ( = 3.67) who only earns
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10,000/month and below while the lowest mean came from Category D or low income earners ( = 3.67) who have a monthly income of 10,000 20,000/month. The reason for this is that families with small monthly family income have a greater tendency to self-medicate using antibiotics to prevent further development of a more serious illness. They wanted a quick relief from symptoms or illness because they do not want their work to be compromised given the fact that they already are only earning a small amount of money every month. Aside from that, respondents from Category E are prompted to selfmedicate using antibiotics to avoid expensive consultation fees. Category D respondents earn a higher income than the respondents in Category E which gives them a better access to healthcare. Also, they often associate illness with medicines which led them to self-medicate using antibiotics for respiratory infections. The above findings are supported by Avenir (2012) who states that the lower the monthly family income, the higher the tendency to self-medicate using antibiotics for the reason of preventing the worsening of the health condition and avoiding expensive consultation fees since respondents in Category E are only earning a small amount every month compared to respondents in Category D.
Tukey test was used for each mean comparison since they are proven to be significant in the previous computation of variance. Tukeys score was tested for statistical significance with Tukeys probability between Category D with a
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Table 13 Post Hoc Tukey Gastrointesinal Problems vs Monthly Family Income Gastrointestinal Problems Category D Category E Mean 1.83 2.40 p-Value 0.05 Interpretation There is a significant difference
mean value of 1.83 and Category E with a mean value of 2.40 and both having an equivalent p-Value of 0.01. The result exemplifies that Category E respondents resort from selfmedication of antibiotics when they are experiencing gastrointestinal problems than Category D respondents. Their difference in their monthly family income can be the reason for this. Category E are very low income earners, they only earn 10,000/month and below, while Category D earns 10,000 - 20,000/month. The above result is parallel to the study of Kumar (2013), where he stated that individuals or families with a low monthly income tend to practice selfmedication of antibiotics more often than that of those families with a sufficient of high enough income. In the above result, it can be inferred that Category E practice self-medication frequently due to the amount of monthly family income and the amount of consultation fee.
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3.3 Dosage Table 14 presents the significant differences regarding the respondents SMA practices on dosage when grouped according to highest educational attainment. Package checking with an f-value of 11.84 and p-value of 0.00 lead
Table 14 Anova Results on the Significant Difference on SMA Practices on Dosage When grouped According to Highest Educational Attainment Educational Attainment 1. Package Checking 2. Community Health Practitioners 3. Family and Friends 4. Internet 5. Experience 6. f-Value 11.84 3.99 p-Value 0.00 0.02 Decision Reject Reject Interpretation There is a significant difference There is a significant difference There is a significant difference There is a significant difference There is no significant difference There is no significant difference There is a significant difference
3.44 9.28 2.27
0.04 0.00 0.11 0.14 0.00
Reject Reject Accept Accept Reject
Estimating 2.00 Dosage 7. Advertisements 8.50
to the decision to reject the null hypothesis, thus a significant difference was interpreted. Community health practitioner with an f-value of 3.99 and a p-value of 0.02 lead to the decision to reject the null hypothesis, hence a significant difference was found out. Moreover, family and friends with an f-value of 3.44 and a p-value of 0.04 proceed to the decision to reject the null hypothesis therefore, a significant difference was identified. Furthermore, internet with an f-
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value of 9.28 and a p-value of 0.00 directed to the decision to reject the null hypothesis, as a result a significant difference existed. Also, advertisement with an f-value of 8.50 and a p-value of 0.00 fronted to the decision to reject the null hypothesis consequently, a significant difference was determined. On the other hand, experience with an f-value of 2.27 and a p-value of 0.11 lead to the decision to accept the null hypothesis so no significant difference was established. Likewise, estimating dosage with an f-value of 2.00 and a p-value of 0.14 resulted to the decision to accept the null hypothesis that is why no significant difference observed. Table 15 Post Hoc Tukey Package Checking vs Highest Educational Attainment Package Checking Elementary level High School level Elementary level College level Mean 1.39 2.46 1.39 2.93 p-Value 0.00 Interpretation There is a significant difference There is a significant difference
0.00
Tukey test was used for each mean comparison since they are proven to have significant difference in the previous computation. Tukeys score was tested for statistical significance with Tukeys probability between elementary level with a mean value of 1.39 and high school level with a mean of 2.46 has an equivalent p-value of 0.00. Also, elementary level with a mean of 1.39 and college level with a mean of 2.93 has a p-value of 0.00.
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The above table conveys that the respondents who attained only at elementary level has a very low practice of package checking. This signifies that they may have limited knowledge about reading and understanding the content of the package. On the other hand, there is a very high practice on package checking of the respondents who attained high school and college level because of the fact they have enough knowledge and understanding on the content of the package. Pan et al. in 2012 suggested in their study, information about antibiotic like the dosage is obtained from package insert. Only that the group without prior knowledge about antibiotics has low understanding about the instruction in the package insert. Schillinger et al., (as cited in Avenir, 2013) indicated in their study that an individual capacity to obtain, process, and understand basic health information has a direct relationship with educational attainment.
Table 16 Post Hoc Tukey Community Health Practitioners vs Highest Educational Attainment Community Health Practitioners Elementary level College level Mean 2.28 3.05 P Value 0.02 Interpretation There is a significant difference
Tukey test was used for each mean comparison since they are proven to be significant in the previous computation of variance. Tukeys score was tested for statistical significance with Tukeys probability between elementary level with
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a mean value of 2.28 and college level with a mean value of 3.05 and both have an equivalent p-value of 0.02. The above result exemplifies that respondents who attained college level of education have high practice on obtaining the dosage to take by asking health practitioners while respondents who attained elementary level of education has low practice of asking health practitioners about the dosage to take. This indicates that respondents who attained education at the college level have knowledge and understanding that there is a need to ask a health practitioner about the dosage that they would take. While those who attained elementary level of education has limited knowledge that is why they disregard consulting health practitioner about the dosage to take. Schillinger et al., (as cited in Avenir, 2013) indicated in their study that an individual capacity to obtain, process, and understand basic health information has a direct relationship with educational attainment.
Table 17 Post Hoc Tukey Family and Friends vs Highest Educational Attainment Family and Friends Elementary Level High School Level Mean 3.56 2.85 p Value 0.03 Interpretation There is a significant difference
Using Tukey as Post Hoc Test, findings showed that there is a distinction between elementary graduate and high school graduate (p=0.3) in terms of
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asking family and friends opinions and recommendations about dosing information. Results that were reflected in the above table signify that elementary graduates are not well informed that they need to consult a physician for the proper quantity of antibiotics to take. This is why they would just ask the people whom they trust and that is, their family and friends. In Filipino culture, the older generations are usually the source of beliefs; as they were considered as primary care giver of a family. Thus if they have misconceptions such as pertaining to antibiotics usage, this will be passed on from one generation to another generation. Hence, the level of understanding of the young population remains to be the same with that of the old age (Avenir, 2013). This observation can be attributed to the theory proposed by Granovetter (as cited by Avenir, 2013) which explains the impact of ties in a relationship between an individual and a network member. Having strong ties with an individual may have a tendency to share same information and knowledge about health issues.
Table 18 Post Hoc Tukey Internet vs Highest Educational Attainment Internet Elementary Level College Level High School Level College Level Mean 1.00 1.66 1.10 1.66 p Value 0.00 0.00 Interpretation There is a significant difference
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Results from the Post Hoc Test using Tukey have shown that there is a discrepancy between elementary graduate and college graduate (p=0.00) in terms of using internet as source of dosing information. Likewise, distinction between high school graduate and college graduate (p=0.00) has also been found out. The above table conveys those elementary graduates and high school graduates are not well educated with the usage of internet for checking the dosage of any antibiotic compared to college graduates since the trust they have for their families and friends opinions and recommendations are more reliable. WHO (2010) suggested that patients receive medication appropriate to their clinical needs, in doses that meet their own individual requirements, for an adequate period of time, and at the lowest cost to them and their community.
Table 19 Post Hoc Tukey Advertisements vs Highest Educational Attainment Advertisements Elementary Level High School Level Elementary Level College Level Mean 3.28 2.08 3.28 2.00 0.00 p Value 0.00 Interpretation There is a significant difference
In the Post Hoc Test using Tukey, findings showed that there is a distinction between elementary graduate and high school graduate (p= 0.00). Likewise, elementary graduate was significantly different from the college graduate (p= 0.00).
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This table illustrates that respondents who attained elementary education level has a high practice on relying dosage from advertisements probably because they were not aware that dosage of the antibiotics should be consulted with a physician. On the other hand, respondents who attainted college level education were well aware that not all recommendations in the advertisements were reliable. Bhutta (2008) indicated in his study that since advertisements show influence to the respondents in terms of what effective and inexpensive antibiotics can be bought, some people are not aware that dosage of antibiotics should be consulted with a physician.
Table 20 presents the significant differences regarding the respondents SMA practices on dosage when grouped according to monthly family income. Package checking with an f-value of 4.64 and p-value of 0.00 lead to the decision to reject the null hypothesis, consequently, a significant difference was interpreted. Community health practitioner with an f-value of 2.99 and a p-value of 0.03 lead to the decision to reject the null hypothesis, hence a significant difference was found out. Moreover, internet with an f-value of 12.86 and a pvalue of 0.00 proceed to the decision to reject the null hypothesis therefore, a significant difference was identified. However, family and friends with an f-value of 1.54 and a p-value of 0.21 directed to the decision to accept the null hypothesis, as a result, no significant difference existed. Also, experience with an
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f-value of 2.23 and a p-value of 0.09 fronted to the decision to accept the null hypothesis, thus, Table 20 Anova Results on the Significant Difference on SMA Practices on Dosage When grouped According to Monthly Family Income Monthly Income 1. Package Checking 2. Community Health Practitioners 3. Family and Friends 4. Internet F-Value 4.64 p-Value 0.00 Decision Reject Interpretation There is a significant difference There is a significant difference There is no significant difference There is a significant difference There is no significant difference There is no significant difference There is no significant difference
2.99
0.03
Reject
1.54
0.21
Accept
12.86
0.00
Reject
5. Experience
2.23
0.09
Accept
6. Estimating Dosage 7. Advertisements
2.22
0.09
Accept
1.23
0.30
Accept
a significant difference was observed. Likewise, estimating dosage, with an fvalue of 2.22 and a p-value of 0.09 lead to the decision to accept the null hypothesis so, no significant difference was established. Furthermore,
advertisements, with an f-value of 1.23 and a p-value of 0.30 resulted to the decision to accept the null hypothesis thus difference determined.
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Table 21 Post Hoc Tukey Package Checking vs Monthly Family Income Package Checking Class A and B Class E Class C Class E Mean 4.00 2.21 3.13 2.21 p - Value 0.05 0.03 Interpretation There is a significant difference
Results from the Post Hoc Test using Tukey have shown that there is a significant difference between class A and B and class E (p=0.05). Likewise, findings showed that there is a distinction between class A and B and class E (p= 0.03). This result exemplifies that there is a very high practice on package checking of the respondents who belong to the class A and B because of the fact that they earn high income. Individuals and families who are under class A and B are more particular when it comes to checking the dosage of their bought antibiotics for the reason that they want to make sure that the antibiotic they bought with their own money is already containing the information they need to self-medicate. On the other hand, those who belong in the class E, does not practice the need to check the dosage in the package given that for as long they can buy an antibiotic, they will drink it. Whitehead et al., (2001) indicated in their study that the cost of second-line treatments can be impossible to meet, thereby limiting access to effective treatment for vulnerable groups.
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Table 22 Post Hoc Tukey Community Health Practitioners vs Monthly Family Income Community Health Practitioners Class C Class E Mean 3.47 2.68 p - Value 0.03 Interpretation There is a significant difference
Using Tukey as Post Hoc Test, findings showed that there is a discrepancy between class C and class E (p=0.03) in terms of asking community health practitioners opinions and recommendations about dosing information. Results that were reflected in the above table signify that there is a very high practice on consulting community health practitioners on the dosage of antibiotics of the respondents who belongs to class C because they think that the most reliable source of information are community health practitioners. They want to make sure that the dosage they were taking is accurate since they earn enough income for themselves and their family compared to those who belong to class E. They think that even the cheapest antibiotic can nurse them back to health since it is the only available antibiotic they can afford. WHO (2010) suggested that when antibiotics are indicated, the prescriber chooses the most appropriate drug, dose and duration of an effective agent, preferably with the narrowest spectrum and few side effects they think the most effective since they are said to be reliable.
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Table 23 Post Hoc Tukey Internet vs Monthly Family Income Internet Class A and B Class D Class A and B Class E Class C Class D Class C Class E Mean 2.33 1.10 2.33 1.13 2.13 1.10 2.13 1.13 p-Value 0.01 Interpretation There is a significant difference There is a significant difference There is a significant difference There is a significant difference
0.01
0.00
0.00
In the Post Hoc Test using Tukey, class A and B was significantly different from class D (p= 0.01). Inconsistency was also found out between class A and B and class E (p=0.01), class C and class D (p= 0.00) and between class C and class E (p= 0.00) in terms of using internet as source of dosing information. The table above conveys that class E has a very low practice on checking the dosage of an antibiotic on the internet since they are not well educated with the usage of internet for checking the dosage of any antibiotic compared to class A and B given that they think that the most reliable source of information are community health practitioners. WHO (2010) suggested that since access to health care is limited in many low and middle income countries, many people just trust their families and friends opinions and recommendations because it is viewed as reliable as community health practitioners.
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3.3 Dosage Changes Table 24 Anova Results on the Significant Difference on SMA Practices on Dosage Changes When grouped According to Highest Educational Attainment Educational Attainment 1. Improve Condition 2. Reduce Side Effects 3. Insufficient Supply F-value 0.19 0.25 9.19 p-Value 0.82 0.78 0.00 Decision Accept Accept Reject Interpretation There is no significant difference There is no significant difference There is a significant difference
Table 24 shows that the significant difference in the respondents SMA practices in terms on dosage changes in terms of educational attainment. Improve condition with an f-value of 0.19 and a p-value of 0.82 lead to the decision to accept the null hypothesis, thus, no significant difference was determined. Moreover, reduce side effects with an f-value of 0.25 and p-value of 0.78 fronted to the decision to accept the null hypothesis, therefore, no significant difference observed. On the other hand, insufficient supply with an f-value of 9.19 and a p-value of 0.00 directed to the decision to reject the null hypothesis, consequently, significant difference existed. Table 25 Post Hoc Tukey Insufficient Supply vs Education Insufficient Supply Elementary level High School level Elementary level College level Mean 3.43 2.39 3.43 1.81 P - Value 0.02 Interpretation There is a significant difference There is a significant difference
0.00
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Tukey test was used for each mean comparison since they are proven to have significant differences in the previous computation. Tukeys score was tested for statistical significance with Tukeys probability between elementary level with a mean value of 3.43 and high school level with a mean of 2.439 has an equivalent p-value of 0.02. Also, elementary level with a mean of 3.43 and college level with a mean of 1.81 has a p-value of 0.00. The discrepancy was possibly because of the distinction of the level of understanding of each group. Elementary level tends to have less knowledge and information about the proper use, dose, and effects of the antibiotics. According to Angus Deaton in 2003, many economists have attributed these correlations to the effects of education, arguing that more educated people are better able to understand and use health information, and are better placed to benefit from the healthcare system.
Table 26 Anova Results on the Significant Difference on SMA Practices on Dosage Changes When grouped According to Monthly Family Income Monthly Family Income 1. Improve Condition 2. Reduce Side Effects 3. Insufficient Supply F-Value 3.13 0.21 4.67 p-Value 0.06 0.81 0.02 Decision Accept Accept Reject Interpretation There is no significant difference There is no significant difference There is a significant difference
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Table 26 shows that the significant difference in the respondents SMA practices in terms on dosage changes when they are grouped according to monthly family income. Improve condition with an f-value of 3.13 and a p-value of 0.06 resulted to the decision to accept the null hypothesis, therefore, no significant difference was observed. Moreover, reduce side effects with an fvalue of 0.21 and p-value of 0.81 fronted to the decision to accept the null hypothesis, thus, no significant difference existed. On the other hand, insufficient supply with an f-value of 4.67 and a p-value of 0.02 directed to the decision to reject the null hypothesis, so, significant difference was identified.
Table 27 Post Hoc Tukey Insufficient Supply vs Income Insufficient Supply Category C Category E Mean 1.43 2.65 p - Value 0.01 Interpretation There is a significant difference
Tukey test was used for each mean comparison since they are proven to be significant in the previous computation of variance. Tukeys score was tested for statistical significance with Tukeys probability between category C with a mean value of 21.43 and category E with a mean value of 2.65 which has an equivalent p-value of 0.01. This signifies that families whose incomes are in Category E change the type of antibiotic being used and replacing them with available leftover of
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antibiotics because of insufficient supply to cover the needed supply intended for the curing of the symptom manifesting the clients. Low income earners tend to hesitate in buying more supply of the antibiotics because they tend to prioritize their basic needs. Similar to the study of Avenir (2013) that very low income earners have the highest mean in terms of perceived appropriateness of self medication antibiotics, in which very low income earners do not want to compromise work or income earning activities so they have a habit of using available and affordable alternative antibiotics to prevent the development of illness. They have a judgment that consultation per se is very expensive.
3.4 Duration Table 28 Anova Results on the Significant Difference on SMA Practices on Duration When grouped According to Highest Educational Attainment Highest educational Attainment 1. After a Few Days 2. Symptoms Disappear 3. After Recovery F - value 1.88 p-Value 0.16 Decision Accept Interpretation There is no significant difference There is no significant difference There is no significant difference There is a significant difference There is a significant difference
1.40
0.25
Accept
1.32
0.27
Accept
4. Consumed Supply 5. Completion of Treatment
4.70
0.01
Reject
7.90
0.00
Reject
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Table 28 presents that the respondents SMA practices in terms of duration concerning, After a few days (F=1.88, p-value= 0.16), Symptoms disappear (F=1.40, p-value= 0.25), and After recovery (F=1.32, p-value= 0.27) leads to the decision to accept the null hypothesis, interpreted as having no significant difference. However, a p-value = 0.01 and F value = 4.70 for the course of after consuming supply as well as a p-value = 0.00 and F value = 7.90 for the choice, completion of treatment leads to the decision to reject the null hypothesis and interpreted as to having a significant difference.
Table 29 Post Hoc Tukey Consumed Supply vs Education Consumed Supply Elementary Level High School Level Elementary Level College Level Mean 3.39 2.44 3.39 2.46 0.02 P - Value 0.01 Interpretation There is a significant difference There is a significant difference
Tukey test was used for each mean comparison since they are proven to be significant in the previous computation of variance. Tukeys score was tested for statistical significance with Tukeys probability between elementary level with a mean value of 3.39 and high school level with a mean value of 2.44 and both have an equivalent p value of 0.01. Moreover, Tukeys was also tested between elementary level with a mean value of 3.39 and college level with a mean value of 2.46 and both have an equivalent p value of 0.02.
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Based on the table presented above, it could be gleaned that elementary graduates practices self-medication with antibiotics until they have consumed their supply. This may be because of the level of education they had achieved, since in elementary completing the course of medication is not emphasized in classes. Furthermore, elementary graduates have lower incomes and less stable jobs compared to high school and college graduates that is why they tend to self medicate with antibiotics until their supply lasts regardless if they are well or not. However this practice is in direct contrast with those of the high school and college graduates, since the least practiced span of time for them is this one. These practices are symptoms of a health care context in which drug distribution is uncontrolled and in which people use drugs according to their own ideas concerning efficacy (Vander Geest & Hardon, 2009). Schillinger et al., (as cited in Avenir, 2013) indicated that an individuals capacity to obtain, process, and understand basic health information has a direct relationship with educational attainment. In this research study, the researchers observed that most respondents whos highest educational attainment is being on an elementary level, falls in category E or those with a family income of ( 10,000/month and below). Furthermore, low income families have limited access to resources. They have greater risk of lower achievements in education and have poorer developmental health outcomes, compared to families with higher income (Taylor and Fraser, as cited by Avenir, 2013).
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Table 30 Post Hoc Tukey Completion of Treatment vs Education Completion of Treatment Elementary Level High School level Elementary Level College Level Mean 1.44 2.39 1.44 2.63 p Value 0.00 Interpretation There is a significant difference There is a significant difference
0.00
Tukey test was used for each mean comparison since they are proven to be significant in the previous computation of variance. Tukeys score was tested for statistical significance with Tukeys probability between elementary level with a mean value of 1.44 and high school level with a mean value of 2.39 and both have an equivalent p value of 0.00. Moreover, Tukeys was also tested between elementary level with a mean value of 1.44 and college level with a mean value of 2.63 and both have an equivalent p value of 0.00. Based on the table presented above, it can be observed that those who were able to finish college were the individuals who finish the allotted seven days with regards to taking of antibiotics. This is because of the educational attainment they were able to achieve. Generally, college students are taught a lot of things and one of them is application of scientific processes to everyday life just like self medication with antibiotics. Due to this, they know the importance of finishing the allotted duration for taking antibiotics. Moreover, those who belong to the college level have higher incomes and more stable jobs than those who just finished high school or elementary. These higher incomes and stable jobs enable
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them to have a higher purchasing power; therefore granting them the privilege of being able to buy the prescribed amount of antibiotics to take. According to Hansen (as cited by Avenir 2013) individuals who had higher educational level were expected to think and learn beyond the facts from developed complex understanding of information and theories formulated from multiple sources. Moreover, having a higher income means being exposed to multimedia widespread of health information. They have the ability to access internet sources; acquire books, and journals through health maintenance organization. Equally, very low income earners tend not to prioritize health information because this group tends to focus on their daily needs (Avernir, 2013). Table 31 Anova Results on the Significant Difference on SMA Practices on Duration When grouped According to Monthly Family Income Monthly Family Income 1. After a Few Days 2. Symptoms Disappear 3. After Recovery 4. Consumed Supply 5. Completion of Treatment F value 4.80 p-Value 0.00 Decision Reject Interpretation There is a significant difference There is no significant difference There is no significant difference There is no significant difference There is a significant difference
1.42
0.24
Accept
0.63
0.60
Accept
0.31
0.82
Accept
5.00
0.00
Reject
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Table 31 presents that the respondents SMA practices in terms of duration concerning, Symptoms disappear (F value = 1.40, p value = 0.25), After recovery (F value = 1.32, p value = 0.27), and Consumed supply (F value = 0.31, p value = 0.82) leads to the decision to accept the null hypothesis, interpreted as having no significant difference. However, F value = 4.80 and p value = 0.00 for After a few days and a F value = 5.00, p value = 0.00 for the choice, completion of treatment leads to the decision to reject the null hypothesis and interpreted as to having a significant difference.
Table 32 Post Hoc Tukey After a Few Days vs Monthly Family Income After a Few Days Class C Class D Class C Class E Mean 2.30 2.44 2.30 2.44 0.00 P - Value 0.04 Interpretation There is a significant difference There is a significant difference
Tukey test was used for each mean comparison since they are proven to be significant in the previous computation of variance. Tukeys score was tested for statistical significance with Tukeys probability between Class C with a mean value of 2.30 and Class D with a mean value of 2.44 and both have an equivalent p value of 0.04. Moreover, Tukeys was also tested between Class C with a mean value of 2.30 and Class E with a mean value of 2.44 and both have an equivalent p value of 0.00.
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It could be gathered from the tables presented above that because of the wide difference of the monthly incomes of classes A and E, a significant difference arose. It could be remembered that the monthly family income of Class A ranges from 100, 000/month and above and class E was 10, 000/month and below. This is where the gulf emerges between these two extreme classes. One is very high and the other one is very low. This now would lead us to the premise and conclusion that those who belong to class E have limited spending power thereby buying only limited quantity of antibiotic. Since, they only bought limited quantity it is therefore not suffice for the complete course of the treatment; hence they will cease taking antibiotic if there is no more to be taken. As shared by one of the respondents, they wont buy more antibiotics to complete the course of treatment and instead allocate it to their daily expenses such as food and utilities. As reported by Van der Geest et al. (2009), a young man suffering from a venereal disease bought only two tablets of penicillin because he did not have more money and for that man two is better than one. This was also sadly the scenario in the community wherein families make do with what they have and let their health take the back seat. According to National Economic and Development Authority (NEDA), if a family of 5 wants to get out and stay out of poverty they should have at least an estimated amount of P258.96 per day. This is equivalent to an average income of around P7,768.80 per month or P93,225.60 per year. This supports as to why the respondents categorized under Class E, abruptly ends their antibiotic therapy and the money saved from this will be budgeted into the basic needs of each and
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everyone in the family. Furthermore, the poverty incidence stood at 27.9 percent in the first semester of 2012practically unchanged according to the inquirer newspaper. This establishes as to why the respondents choose their basic needs over the complete set of antibiotics they should take, because for them an empty stomach is worse than an aching body induced by a sickness.
Table 33 Post Hoc Tukey Completion of Treatment vs Monthly Family Income Completion of Treatment Class A Class E Class C Class E Mean 4.00 2.15 2.27 2.15 0.03 P Value 0.02 Interpretation There is a significant difference There is a significant difference
Tukey test was used for each mean comparison since they are proven to be significant in the previous computation of variance. Tukeys score was tested for statistical significance with Tukeys probability between Class A with a mean value of 4.00 and Class E with a mean value of 2.15 and both have an equivalent p value of 0.02. Moreover, Tukeys was also tested between Class C with a mean value of 2.27 and Class E with a mean value of 2.15 and both have an equivalent p value of 0.03. From the table presented above it could be surmised that the income differences between the two classes are greatly apart thereby producing a significant difference upon the selection of the course of treatment. Class As
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income ranges from 100, 000/month and above and classified as high income earners. While Class Es income ranges only from 10, 000/month and below, thus categorized as very low income earners. Seventy two out of 120 respondents surveyed belong to category E translated into having a minimal purchasing power, thus a limited supply of antibiotics to take. This is why majority of them thus not complete the course of time in taking antibiotics, since additional antibiotics mean a decrease in their meager income which is mostly budgeted for their daily expenses and basic needs such as food and utility. This is supported in the study conducted by Awab et al.(2005), which says that lower income and higher level of education was found to be significantly associated with the increase risk of self-medicating with antibiotic. It is also attributed to the fact that having a higher income means having exposed to multimedia widespread of health information. They have the ability to access internet sources; acquire books, and journals through health maintenance organization. In contrast, very low income earners that do not prioritize health information because this group tends to focus their income into their daily need (Avernir, 2013). Furthermore, low income families have limited access to resource. They have greater risk of lower achievements in education and have poorer developmental health outcomes, compared to higher income families (Taylor and Fraser, as cited by Avenir, 2013).
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Chapter V SUMMARY, CONCLUSIONS, RECOMMENDATIONS
Summary For this undertaking, the main purpose was to determine the practices of the community residents towards self medication of antibiotics. Specifically it depicted the profile of the respondents in terms of highest educational attainment and monthly family income. It also established the self medication of antibiotics practices of the community residents in terms of reasons, conditions, influencing factors, dosage and duration. Furthermore, significant differences were also measured with regards to the respondents manifested self medication of antibiotics practices when grouped according to their profile. This study is a descriptive, correlational type of research which was accomplished quantitatively by means of a survey method. Through the use of purposive sampling, 120 residents of Barangay 598 Zone 59, Old Sta. Mesa, Manila became the respondents of this study. The questionnaire utilized was adapted from a previous study and was modified in order for it to fit into the research objectives. The adapted questionnaire was consisted of 3 parts namely the background, attitude and knowledge. Data gathering was conducted from September 8 to 15, 2013. The data collected were collated and statistically processed through the application of Statistical Package for Social Sciences (SPSS) version 20.0 for data analysis.
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Findings The following are the results of the study: Out of 120 respondents, (50%, n=60) of the respondents reached high school (secondary) level of education. Thirty five percent (n=42) reached college (tertiary) level while 15% (n=18) of the respondents reached elementary (primary) level. The distribution of the respondents in terms of their monthly family income falls in Category E (60%, n=72) interpreted as the very low income earners producing Php 10, 000/month and below. This is followed by the Category D or the low income earners (25%, n=30), followed by Category C or the middle income earners (13%, n=15), and lastly Category A/B or the high income earners (4%, n=3). In the extent of self - medication of antibiotics practices in terms of Reason, the weighted mean of Economy is 2.96; Knowledge is 2.60;
Experience is 3.34; Prognosis is 3.43; and Time is 2.91 In the extent of self - medication of antibiotics practices in terms of Conditions, the weighted mean of Respiratory Infections is 3.20; Systemic Manifestations is 2.71; Gastrointestinal Problems is 2.05; and Skin Wounds is 2.98 In the extent of self - medication of antibiotics practices in terms of Dosage, the weighted mean of Package Checking is 2.46; Community Health practitioners is 2.84; Family and Friends is 3.06; Internet is 1.28;
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Experience is 3.18; Estimating Dosage is 2.00; and Advertisements falls in 2.23 The weighted mean showing the extent of self-medication of antibiotics practices in terms of dosage change was for changing dosage (weighted mean 3.60). While the reasons as to reduce side effects and insufficient supply ranked second (weighted mean 2.45) and third (weighted mean 2.40). The weighted mean showing the extent of self-medication of antibiotics in terms of duration were: After a few days was 2.25; Symptoms disappeared was 3.32; After the Recovery was 3.54; Consumed supply was 2.59; and the completion of treatment was 2.33. The p value of the respondents on Self Medication of Antibiotics Practice on Reasons when grouped according to Highest Educational Attainment in terms of Economy is 0.09 (F=2.37); Knowledge is 1.00 (F=3.42); Experience is 0.04 (F=0.42); Prognosis is 0.41 (F=0.42); and Time is 0.11 (F=0.11) The p value of the respondents on Self Medication of Antibiotics Practice on Reasons when grouped according to Monthly Family Income in terms of Economy is 0.10 (F=2.12); Knowledge is 0.77 (F=0.36); Experience is 0.22 (F=1.48); Prognosis is 0.68 (F=0.49); and Time is 0.17 (F=1.69) The p value of the respondents on Self Medication of Antibiotics Practice on Conditions when grouped according to Highest Educational
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Attainment in terms of Respiratory Infections is 0.01 (F=4.83); Systemic Manifestations is 0.66 (F=0.41); Gastrointestinal Problems is 0.08 (F=2.53); and Skin Wounds is 0.28 (F=1.26) The p value of the respondents on Self Medication of Antibiotics Practice on Conditions when grouped according to Monthly Family Income in terms of Respiratory Infections is 0.06 (F=4.37); Systemic Manifestations is 0.21 (F=1.51); Gastrointestinal Problems is 0.03 (F=2.89); and Skin wounds is 0.47 (F=0.833) The p value of the respondents on Self Medication of Antibiotics Practice on Dosage when grouped according to Highest Educational
Attainment in terms of Package Checking is 0.00 (F=11.84); Community Health Practitioners is 0.02 (F=3.99); Family and Friends is 0.04 (F=3.44); Internet is 0.00 (F=9.28); Experience is 0.11 (F=2.27); Estimating Dosage is 0.14 (F=2.00); and Advertisement is 0.00 (F=8.50) The p value of the respondents on Self Medication of Antibiotics Practice on Dosage when grouped according to Monthly Family Income in terms of Package Checking is 0.00 (F=4.64); Community Health Practitioners is 0.03 (F=2.99); Family and Friends is 0.21 (F=1.54); Internet is 0.00 (F=12.86); Experience is 0.09 (F=2.23); Estimating Dosage is 0.09 (F=2.22); and Advertisement is 0.30 (F=1.23) The p value of the respondents on Self Medication of Antibiotics Practice on Dosage Change when grouped according to Highest
Educational Attainment in terms of Improve Condition is 0.82 (F=0.19);
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Reduce Side Effects is 0.78 (F=0.25); and Insufficient Supply is 0.001 (F=9.19) The p value of the respondents on Self Medication of Antibiotics Practice on Dosage Change when grouped according to Monthly Family Income in terms of Improve Condition is 0.55 (F=3.13); Reduce Side Effects is 0.806 (F=0.21); and Insufficient Supply is 0.015 (F=4.67). The p value of the respondents on Self Medication of Antibiotics Practice on Duration when grouped according to Highest Educational Attainment in terms of After a few days is 0.16 (F=1.88); Symptoms Disappear is 0.25 (F=1.40); After Recovery is 0.27 (F=1.32); Consumed Supply is 0.01 (F=4.70); and Completion of Treatment is 0.00 (F=7.90) The p value of the respondents on Self Medication of Antibiotics Practice on Duration when grouped according to Highest Monthly Family Income in terms of After a few days is 0.00 (F=4.80); Symptoms Disappear is 0.24 (F=1.42); After Recovery is 0.60 (F=0.63); Consumed Supply is 0.82 (F=0.31); and Completion of Treatment is 0.00 (F=5.00) Conclusions Based on the findings of this study, the researchers concluded the following: There is a significant difference in the respondents Self -Medication of Antibiotics Practices on reason when grouped according to highest educational attainment particularly in Item number 3 or Experience. It was found out that there is a significant difference in the Experience of high
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school level respondents to elementary level respondents and college level respondents. However, no significant differences were found when they are grouped according to monthly family income. There is a significant difference in the respondents Self -Medication of Antibiotics Practices on conditions when grouped according to highest educational attainment specifically in Item number 1 or Respiratory Infections. It was found out that there is a significant difference between high school level respondents and college level respondents. Still, there is a significant difference when they are grouped according to monthly family income specifically in Items number 1 and 3 which are Respiratory Infections and Gastrointestinal Problems respectively. It was found out that there is a significant difference between Category D and Category E respondents. There is a significant difference in the respondents Self -Medication of Antibiotics Practices on dosage except on Items number 5 (Experience) and 6 (Estimating Dosage) which shows no significant difference when grouped according to highest educational attainment. Also, there is a significant difference when group according to monthly family income particularly in Items number 1, 2, and 4 which are Package Checking, Community Health Practitioners, and Internet respectively. There is a significant difference in the respondents Self -Medication of Antibiotics Practices on dosage changes when grouped according to highest
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educational attainment and monthly family income. Both differences was found out on Item number 3 or Insufficient supply. Recommendations In the light of the findings and conclusion of the study, the following recommendations are devised. Community Residents: A well planned, systematic, and ordered educational campaign geared towards those who have low family incomes and those with low educational attainment. This is to correct and modify their misconceptions and misguided expectations which contribute to the practices of self medication of antibiotics. Medical Practitioners/Students: The members of the health care team especially the doctors and nurses should make an effort to perform health teachings when prescribing and giving antibiotics to their patients. These health teachings and shared knowledge could greatly influence their patient not to practice self medication of antibiotics. Community Health Workers: In conducting health educational campaigns, lessons should be conveyed on the simplest way and term possible so that common patients could understand. Future Researchers: The Future Researchers shall develop this study and produce a health educational material output targeting the common
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misconceptions about practices of self medication of antibiotics aiming to modify and hopefully correct it.
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Appendix A E-mail Correspondence
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Appendix B Letters of Consent 19 June 2013 Maria Andrea L. Endeno, R.N., M.A.N. Clinical Instructor This University Dear Madam Endeno, Greetings of Peace We, the nursing students from BSN IV 3, Group 3, would like to request you to be our adviser in our Research Subject this 1 st semester, Academic Year 2013 2014 under Ms. Maria Teresa S. Abila Your Expertise in research will be valuable for us to be guided in this undertaking. Hoping for your kind consideration Thank you and God Speed. Respectfully yours,
Ramos, Art Christian M. Group leader
Noted by:
Ma. Teresa S. Abila, MAN Research Instructor
Conforme:
Maria Andrea L. Endeno, R.N., M.A.N.
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September 5, 2013 Professor Ronald D.P. Singson Trinity University of Asia Major in Filipino
Dear Professor Singson: Greetings! We the Nursing research group of BSN IV Block 3, would like to ask for your permission to translate the tool that will be used in our study entitled as: Practices of Community Residents on Self Medication of Antibiotics. We would like to request for your time, effort, and knowledge in translating the above mentioned tool that will be disseminated to our designated respondents. This term paper will serve as part of our Nursing study and practice in PLM College of Nursing. Attached with this letter is the sample tool. Thank you in anticipation of your most favorable response.
Sincerely yours,
Art Christian M. Ramos Group leader
Noted by:
Maria Andrea L. Endeno, MAN Research Adviser
Conforme:
Ronald D.P. Singson
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September 07, 2013 Armando E. Enaje Sr. Barangay Chairman Barangay 598 Zone 59 Thru: KagawadPaulito V. Linis Acting Chairman
Dear Sir Enaje: Greetings of Peace! We, fourth year students of PamantasanngLungsodngMaynila, taking up Bachelor of Science in Nursing, is presently creating our research entitled Practices of Community Residents on Self Medication of Antibiotics, in connection with this, may we humbly ask your office to grant us the permission to conduct the saidsurvey on your Barangay. Moreover, may we kindly request assistance in the collection of data.We earnestly hope for yourfavorable response. Thank you and God Bless! Sincerely yours,
Art Christian M. Ramos Group leader
Noted by:
Maria Andrea L. Endeno, MAN Research Adviser
Ronnie M. Tiamson RN, RM, MAN Chairman in Instructional Nursing
106
Appendix C Research Tool

Consent Form (Pagpapahintulot)
Ang pagpapahintulot na ito ay nagbibigay impormasyon upang maisakatuparan ang pananaliksik na Practices of Community Residents on Self-Medication of Antibiotics na isinasagawa nina Bea Marie Eclevia, Colette Llantino, Elaiza Mae Medidas, Art Christian Ramos, Alexandra Agnes Sachez, Renz Nicole Tinaya, mga mag-aaral ng Pamantasan ng Lungsod ng Maynila (University of the City of Manila) College of Nursing. Upang makapagpasya kung ako ay dapat sumang-ayon na maging bahagi ng pananaliksik na ito, dapat kong maunawaan ang mga kaakibat na panganib at mga benepisyo ng pag aaral na ito. Ang prosesong ito ay tinatawag na kaalamang pahintulot (informed consent). Ang pahintulot na ito ay nagbibigay ng impormasyon sa mga bagay na kaugnay ng pag aaral na ito, na kung saan ay tinatalakay sa akin. Sa sandaling naunawaan ko ang layunin ng pananaliksik na ito, ako ay lalagda sa liham na ito upang pruweba ng aking pagsang-ayon at partisipasyon. Sa aking pakikilahok sa pag aaral na ito, ako ay sasagot ng mga katanungan gamit ang isang palatanungan (survey questionnaire) na may kaugnayan sa mga layunin ng pag-aaral. Nauunawaan ko na ang pamamaraang ito ay walang bayad.Naiintindihan ko na ako ay maaaring mailantad sa mga bagay na maaring magdulot sa akin ng takot sa mga bagay na hindi ko alam (fear of the unknown), takot sa mga bagay na maaring maging epekto ng pag aaral na ito (fear of eventual repercussions) at paglalaan ng aking personal na oras. Nauunawaan ko na ang aking pakikilahok sa pag-aaral na ito ay maaaring magbigay ng ilang kapakinabangan sa akin tulad ng kaluwagan sa pag talakay ng ang aking sitwasyon o problema sa isang maayos at propesyunal na pamamaraan, karagdagang kaalaman tungkol sa aking kalagayan, at kasiyahan na ang mga inpormasyong aking maibibigay ay maaaring makatulong sa iba na may katulad na kalagayan. Hindi lingid sa aking kaalaman na ito ay mananatiling pribado at lahat ng aking kasagutan ay gagamitin lamang sa pag-aaral na ito. Gayunman, alam ko na maari kong bawiin ang aking partisipasyon sa pag-aaral na ito sa anumang oras na aking nanaisin nang walang anumang mga pagbabago sa pakikitungo at pagaalagang maari kong matanggap sa anumang health center o ospital. Nauunawaan ko na sa anumang pinsala na maaaring magresulta mula sa aking pakikilahok sa pag-aaral na ito ay walang compensation at walang libreng medikal na paggamot o reimbursement na iniaalok ang mga partido na kasangkot sa pag-aaral na ito. Sa pamamagitan ng pag-lagda sa dokumentong ito, ako ay nagsasabi na nabasa at sumasang-ayon ako na lumahok sa pag-aaral na ito.
Lagda sa itaas ng pangalan Petsa
107
I. DEMOGRAPHIC DATA Put a check () mark in the space provided for your response to provide the necessary information 1. Highest Educational Attainment Elementary Graduate / Undergraduate High School Graduate / Undergraduate College Graduate / Undergraduate 2. Family Income Class A and B (100,000/month and above) Class C ( 20, 000 - 100,000/month) Class D (10,000 - 20,000/month) Class E ( 10,000/month and below) 3. Do you take antibiotics without the doctors prescription or from previously utilized antibiotic found to be effective? II. PRACTICES FOR SELF MEDICATION WITH ANTIBIOTICS General Direction: Use the following scale to answer. Put a check () in the column provided. SCALE: 4 = Always 3 = Often 2 = Sometimes 1 = Never 4 3 2 1
REASONS Rate to what extent these reasons lead you to self medicate with antibiotics. 1. I can save money when I self medicate with antibiotics. 2. I have a prior knowledge about antibiotics. 3. I have previously experienced the efficacy of antibiotic in treating my condition. 4. I dont want my ailment/infection to get more serious 5. I dont have time to consult a doctor. 6. Others (please specify): ________________________
108
CONDITIONS Rate to what extent the conditions listed below prompted you to self medicate with antibiotics. 1. Respiratory infections (runny nose, nasal congestion, cough, sore throat) 2. Systemic manifestations (fever, aches and pains) 3. Gastrointestinal problems (vomiting, diarrhea, stomach ache) 4. Skin wounds 5. Others (please specify): ________________________
DOSAGE Rate to what extent these factors enabled you to know the dosage of your self medicated antibiotic. 1. By checking the package inserted 2. By consulting health care workers such as nurses 3. By consulting family members / friends 4. From the internet 5. From my previous experience 6. By guessing the dosage myself 7. From the newspapers, magazines, books or TV programs
109
Did you ever change the dosage of antibiotics deliberately during the course of self medication? Place a check () mark in the appropriate box. Yes, if yes proceed to next table No, if no proceed to the last table.
Rate to what extent these reasons lead you to change the dosage of antibiotic during course of self medication. 1. To improve my condition since it got worse 2. To reduce side effects 3. Drug is insufficient to complete the course of treatment, so I took the available antibiotic
DURATION Rate to what extent you normally stop taking self medicated antibiotics. 1. After a few days regardless of the outcome. 2. After symptoms disappeared. 3. A few days after the recovery. 4. After antibiotics ran out 5. At the completion of the course
110
I. DEMOGRAPIKONG DATOS 1. Pinakamataas na Edukasyong Narating Nagtapos / Nakapag-aral sa Mababang Paaralan Nagtapos / Nakapag-aral sa Mataas na Paaralan Nagtapos / Nakapag-aral sa Kolehiyo / Pamantasan 2. Kabuuang Kita ng Pamilya Kategorya A at B (00,000/ buwan o higit pa) Kategorya C (20, 000 - 100,000/ buwan) Kategorya D (10,000 - 20,000/ buwan) Kategorya E ( 10,000/ buwan pababa) 3. Umiinom ka ba ng antibayotiko nang hindi nagpapatingin / kumukunsulta sa doktor o napatunayan nang mabisa dahil dati na itong iniinom?
II. MGA NAKAGAWIANG SARILING PAGGAGAMOT GAMIT ANG ANTIBAYOTIKO PANUTO: Gamitin ang mga sumusunod na antas sa pagsagot. Lagyan ng tsek () sa nakalaang hanay. ANTAS: 4 = Palagi 3 = Madalas 2 = Minsanan 1 = Hindi kailanman
MGA DAHILAN Uriin kung hanggang saang antas ang sariling paggagamot gamit ang antibayotiko 1. Nakakatipid ako sa sariling paggagamot gamit ang antibayotiko 2. Mayroon akong kaalaman tungkol sa antibayotiko. 3. Mayroon akong karanasan sa bisa ng antibayotiko sa paggamot sa aking kondisyon 4. Hindi ko nais na lumala ang aking karamdaman 5. Wala akong oras upang kumunsulta sa doktor 6. Iba pang dahilan (ilahad): ________________________
111
MGA KONDISYON Uriin kung hanggang saang antas ng kondisyon nakatala sa ibaba ang nag-uudyok sa iyo upang maggamot sa sarili gamit ang anitbayotiko 1. Mga inpeksyon sa respiratory (sipon, baradong ilong, ubo, pananakit ng lalamunan) 2. Systemic manifestations (lagnat, sakit ng katawan) 3. Gastrointestinal problems (pagsusuka, labis na pagdumi, sakit ng tiyan) 4. Sugat sa balat 5. Iba pang dahila (ilahad): ________________________
DOSIS Uriin kung hanggang saang antas sa mga nakatala sa ibaba upang malaman mo ang dosis para sa sariling paggagamot 1. Sa pagsusuri sa pakete ng antibayotiko 2. Sa pagkokunsulta sa mga may alam sa kalusugan katulad ng nars 3. Sa pagkokunsulta samiyembro ng pamilya o sa kaibigan 4. Mula sa internet 5. Mula sa aking karanansan 6. Sa pagtatantya ng dosis 7. Mula sa pahayagan, magasin, aklat o mga programa sa TV
112
Binabago mo ba ang dosis ng antibayotiko sa panahon ng paggagamot sa sarili? Lagyan ng marka () ang mga kahon sa ibaba. Oo, kung oo pumunta sa susunod na talahanayan Hindi, kung hindi naman ay magtungo sa huling talahanayan.
Uriin kung hanggang saang antas sa mga nakatala sa ibaba ang nagdudulot sa na baguhin ang dosis ng antibayotiko para sa iyong sariling paggagamot 1. Upang mapabuti ang kondisyon dahil ang sakit ay lumala 2. Upang mabawasan ang masamang epekto 3. Kakulangan sa gamot upang matapos ang gamutan, kaya gumagamit ako kung ano lang ang meron.
TAGAL Uriin kung hanggang saang antas kadalasang humihinto sa sariling paggagamot gamit ang antibayotiko 1. Pagkalipas ng ilang araw kahit na ano pa man ang kinalabasan. 2. Matapos mawala ang sintomas. 3. Pgkalipas ng ilang araw matapos ang paggaling. 4. Kapag naubos na ang antibayotiko 5. Matapos ang nakasaad sa antibayotiko
113
File S1: Questionnaire for self-medication with antibiotics
Part A: Self-medication behaviors
Have you ever taken antibiotics? A. Yes B. No If NO, please go to Part B Question 1 Have you ever treated yourself (self-medicated) with antibiotics? A. Yes B. No If NO, please go to Part B Question 1 How many times did you treat yourself with antibiotics in the past one year? What was (were) your reason(s) of self-medication with antibiotics? (check more than one if applicable) A. Cost saving B. Convenience C. Lack of trust in prescribing doctor D. Others (specify)
For which of the following complaint(s) did you use antibiotics? (check more than one if applicable) A. Runny nose B. Nasal congestion C. Cough D. Sore throat E. Fever F. Aches and pains G. Vomiting H. Diarrhea I. Skin wounds J. Others (specify)
Your selection of antibiotics was based on (check more than one if applicable) A. Recommendation by community pharmacists B. Opinion of family members C. Opinion of friends D. My own experience E. Recommendation by net citizens F. Previous doctors prescription G. The advertisement
What did you consider when selecting antibiotics? (check more than one if applicable) A. Type of antibiotics B. Brand of antibiotics C. Price of antibiotics D. Indications for use E. Adverse reactions F. Others (specify) Where did you usually obtain antibiotics from for self-medication? (check more than one if applicable) A. Community pharmacies B. TCM practitioners
119
C. Leftover from previous prescription D. Online shopping/E-pharmacies E. Others (specify) Did you ever check the instructions come with the package insert of antibiotics for self-treatment? A. Yes, always B. Yes, sometimes C. Never If Never, please go to Question 11 How much did you understand the instructions? A. Fully understood B. Partly understood (percentage:) C. Did not understand at all
10
11
How did you know the dosage of antibiotics? (check more than one if applicable) A. By checking the package insert B. By consulting a doctor C. By consulting a pharmacist D. By consulting family members/friends E. From the newspapers, magazines, books, or TV programs F. From the Internet G. From my previous experience H. By guessing the dosage by myself
12
Did you ever change the dosage of antibiotics deliberately during the course of self-treatment? A. Yes, always B. Yes, sometimes C. Never If Never, please go to Question 14
13
Why did you change the dosage of antibiotics during the course of self-treatment? (check more than one if applicable) A. Improving conditions B. Worsening conditions C. To reduce adverse reactions D. Drug insufficient for complete treatment E. Others (specify)
14
Did you ever switch antibiotics during the course of self-treatment? A. Yes, always B. Yes, sometimes C. Never If Never, please go to Question 16
15
Why did you switch antibiotics during the course of self-treatment? (check more than one if applicable) A. The former antibiotics did not work B. The former antibiotics ran out C. The latter one was cheaper D. To reduce adverse reactions E. Others (specify) How many different antibiotics did you take maximally during a single illness? Are you concerned that you might have taken counterfeit antibiotics? A. Yes, very much B. Yes, somewhat
16
17
120
C. No Have you ever found out that you had taken the same antibiotics with different names at the same time? A. Yes B. No
18
19
When did you normally stop taking antibiotics? (check more than one if applicable) A. After a few days regardless of the outcome B. After symptoms disappeared C. A few days after the recovery D. After antibiotics ran out E. At the completion of the course F. After consulting a doctor/pharmacist G. Others (specify)
20
Have you ever had any adverse reaction when you took antibiotics for self-medication? A. Yes (specify) B. No If NO, please go to Question 22
21
What did you do for the adverse reactions? (check more than one if applicable) A. Stopped taking antibiotics B. Switched to another antibiotic C. Consulted pharmacy staff D. Consulted a doctor E. Consulted family members/friends F. Nothing G. Others (specify)
22
Please write down the names of antibiotics you have ever taken for SELF-MEDICATION: A .B. C. D .E. What do you think about self-medication with antibiotics for self health care? A. Good practice B. Acceptable practice C. Not acceptable practice
23
24
Do you think you can treat common infectious diseases with antibiotics successfully by yourself? A. Yes, I can B. Not sure C. No, I cannot
Part B: Knowledge
Do you know what are antibiotics? A. Yes B. No What are antibiotics used for? (check more than one if applicable) A. Virus infection B. Bacterial infection C. Others (specify) Which of the following statement(s) about antibiotics is (are) correct? (True/False) A. Broad-spectrum antibiotics are better than narrow-spectrum ones B. Higher doses result in faster recovery
National Capital Region National Capital Region

C. Lower doses result in less adverse reactions D. Switching antibiotics enhances drug effects E. Switching antibiotics reduces adverse reactions F. Intravenous is better than oral medication What is (are) the common adverse reaction(s) of antibiotics? (check more than one if applicable) A. Nausea B. Vomiting C. Diarrhea D. Rash E. Vaginal thrush F. Drug resistance
121
Background Age (years) Gender A. Male B. Female
School/college: A. B. C. D. E. F. G. H. College of Science Medical College College of Liberal Arts College of Engineering Law School Business School Cheung Kong School of Art and Design Cheung Kong School of Journalism and Communication
Program: A. Undergraduate B. Masters C. Ph.D. Year of your study: (e.g., 2nd year)
Your monthly allowance: A. 500 RMB B. 500 to 1,000 RMB C. 1,001 to 2,000 RMB D. >2,000 RMB What kind(s) of health insurance(s) do you have this year? (check more than one if applicable) A. B. C. D. E. F. G. H. Free medical care College insurance Basic medical insurance for town staff Medical insurance for urban and town residents Commercial health insurance New rural co-operative medical insurance None Others Province City
Hometown
122
Appendix D Research Tool
National Capital Region
Total Population by Province, City, Municipality and Barangay: as of May 1, 2010 Province, City, Municipality and Barangay Barangay 581 Barangay 582 Barangay 583 Barangay 584 Barangay 585 Barangay 586 Barangay 587 Barangay 587-A Barangay 588 Barangay 589 Barangay 590 Barangay 591 Barangay 592 Barangay 593 Barangay 594 Barangay 595 Barangay 596 Barangay 597 Barangay 598 Barangay 599 Barangay 600 Barangay 601 Barangay 602 Barangay 603 Barangay 604 Barangay 605 Barangay 606 Barangay 607 Barangay 608 Barangay 609 Barangay 610 Barangay 611 Barangay 612 Barangay 613 Barangay 614 Barangay 615 Total Population 2,845 1,359 1,276 3,583 788 2,170 1,580 1,237 1,222 776 3,151 2,179 2,108 1,835 1,042 2,690 2,494 2,101 11,788 3,336 4,874 7,709 2,355 648 1,533 405 483 1,570 558 726 985 929 685 574 527 1,968
National Statistics Office
123
Appendix E Curriculum Vitae
124
BEA MARIE E. ECLEVIA Age: 20 Birthday: July 20, 1993 Civil Status: Single E-mail Address: ecleviabeamarie@yahoo.com Mobile: 09179407343 Educational Background: Elementary School: Project 6 Elementary School (2006) High School: Don Alejandro Roces Sr. Science Technology High School (2010) College: Pamantasan ng Lungsod ng Maynila Bachelor of Science in Nursing (2014) Hospital Affiliations: Gat Andres Bonifacio Memorial Medical Center Jose R. Reyes Memorial Medical Center Ospital ng Maynila Medical Center Ospital ng Sampaloc Philippine General Hospital Sta. Ana General Hospital
125
LLANTINO, COLETTE III S. Age: 19 Birthday: March 21, 1994 Civil Status: Single E-mail Address: itsmecolette@yahoo.com Mobile: 09178622324 Educational Background: Elementary School: Immaculate Heart of Mary College (2006) High School: Immaculate Heart of Mary College (2010) College: Pamantasan ng Lungsod ng Maynila Bachelor of Science in Nursing (2014) Hospital Affiliations: Gat Andres Bonifacio Memorial Medical Center Jose R. Reyes Memorial Medical Center Ospital ng Maynila Medical Center Ospital ng Sampaloc Philippine General Hospital Sta. Ana General Hospital Tondo Medical Center
126
ELAIZA MAE V. MEDIDAS Age: 18 Birthday: November 23, 1994 Civil Status: Single E-mail Address: elamaemedidas23@yahoo.com Mobile: 09161314008 Educational Background: Elementary School: Andres Bonifacio Elementary School (2006) High School: Ramon Magsaysay High Schoo Manila (2010) College: Pamantasan ng Lungsod ng Maynila Bachelor of Science in Nursing (2014) Hospital Affiliations: Gat Andres Bonifacio Memorial Medical Center Jose R. Reyes Memorial Medical Center Ospital ng Maynila Medical Center Ospital ng Sampaloc Philippine General Hospital Sta. Ana General Hospital Tondo Medical Center
127
ART CHRISTIAN M. RAMOS Age: 20 Birthday: November 14, 1992 Civil Status: Single E-mail Address: defender99_ramos@yahoo.com Mobile: 09054934928 Educational Background: Elementary School: Caloocan Bethel Chrisitan School (2006) High School: Manila Science High School (2010) College: Pamantasan ng Lungsod ng Maynila Bachelor of Science in Nursing (2014) Hospital Affiliations: Gat Andres Bonifacio Memorial Medical Center Jose R. Reyes Memorial Medical Center Ospital ng Maynila Medical Center Ospital ng Sampaloc Philippine General Hospital Sta. Ana General Hospital Tondo Medical Center
128
ALEXANDRA AGNES A. SANCHEZ Age: 19 Birthday: November 10, 1993 Civil Status: Single E-mail Address: agnes111093@yahoo.com Mobile: 09277158362 Educational Background: Elementary School: St. Marys Academy of Caloocan City (2006) High School: St. Marys Academy of Caloocan City (2010) College: Pamantasan ng Lungsod ng Maynila Bachelor of Science in Nursing (2014) Hospital Affiliations: Gat Andres Bonifacio Memorial Medical Center Jose R. Reyes Memorial Medical Center Ospital ng Maynila Medical Center Ospital ng Sampaloc Philippine General Hospital Sta. Ana General Hospital Tondo Medical Center
129
RENZ NICOLE ROSS C. TINAYA Age: 19 Birthday: October 12, 1993 Civil Status: Single E-mail Address: nikiki_tinaya@yahoo.com Mobile: 09167324771 Educational Background: Elementary School: Legarda Elementary School (2006) High School: Ramon Magsaysay High School (2010) College: Pamantasan ng Lungsod ng Maynila Bachelor of Science in Nursing (2014) Hospital Affiliations: Gat Andres Bonifacio Memorial Medical Center Jose R. Reyes Memorial Medical Center Ospital ng Maynila Medical Center Ospital ng Sampaloc Philippine General Hospital Sta. Ana General Hospital Tondo Medical Center

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PRACTICES OF COMMUNITY RESIDENTS ON SELF MEDICATION WITH ANTIBIOTICS

In Partial Fulfillment of the Requirement for the Course NURSING RESEARCH

____________________________ Maria Andrea L. Endeno, M.A.N. Nursing Research Adviser

________________________ Ma. Teresa S. Abila, M.A.N. Nursing Research Professor

_________________________ Marilyn S. Agravante, M.A.N. Panel Member

___________________________ Dr. Raymond M. Fernandez Panel Member

_____________________________ Ma. Teresa S. Abila, M.A.N. Nursing Research Professor

NUMBER OF PAGES: 132

101 103 106 122 123

Figure 1 2 3 Conceptual Paradigm

Post Hoc Tukey Respiratory Infections vs Monthly Family Income

Post Hoc Tukey Gastrointesinal Problems vs Monthly Family Income

Post Hoc Tukey Package Checking vs Highest Educational Attainment

Post Hoc Tukey Community Health Practitioners vs Highes Educational Attainment

Post Hoc Tukey Family and Friends vs Highest Educational Attainment

Post Hoc Tukey Internet vs Highest Educational Attainment

Post Hoc Tukey Advertisements vs Highest Educational Attainment

Post Hoc Tukey Package Checking vs Monthly Family Income

Post Hoc Tukey Community Health Practitioners vs Monthly Family Income

Post Hoc Tukey Internet vs Monthly Family Income

Post Hoc Tukey Insufficient Supply vs Education

Post Hoc Tukey Insufficient Supply vs Income

Post Hoc Tukey Consumed Supply vs Education

Post Hoc Tukey Completion of Treatment vs Education

Educational Attainment Monthly Family Income

Self-Medication Antibiotics Practices Reasons Conditions Dosage Duration

Figure 1 Practices of Community Residents on Self-Medication of Antibiotics

undergraduate, high school graduate or undergraduate and college graduate or undergraduate.

Interpretation Low level of understanding

Middle level of understanding

High level of understanding

Very Low Practice

Data Gathering Procedure

1.1 Highest Educational Attainment

1.2 Monthly Family Income

Weighted Mean 2.96 2.60 3.34 3.43 2.91

2.50-3.24= Highly Practiced 3.25-4.00= Very Highly Practiced

Weighted Mean 3.20 2.71 2.05 2.98

Interpretation Highly Practiced Highly Practiced Low Practiced Highly Practiced

2.50-3.24= Highly Practiced 3.25-4.00= Very Highly Practiced

*Legend: 1.00-1.74= Very Low Practiced 1.75-2.49= Low Practiced

*Legend: 1.00-1.74= Very Low Practiced 1.75-2.49= Low Practiced

Weighted Mean 2.25 3.32 3.54 2.59 2.33

2.50-3.24= Highly Practiced 3.25-4.00= Very Highly Practiced

2. Knowledge 3. Experience 4. Prognosis

3.44 9.28 2.27

0.04 0.00 0.11 0.14 0.00

Reject Reject Accept Accept Reject

Estimating 2.00 Dosage 7. Advertisements 8.50

6. Estimating Dosage 7. Advertisements

4. Consumed Supply 5. Completion of Treatment

Chapter V SUMMARY, CONCLUSIONS, RECOMMENDATIONS

Educational Attainment in terms of Improve Condition is 0.82 (F=0.19);

BIBLIOGRAPHY Research Studies, Journals and Magazines

Computer Based Reference http://www.patient.co.uk/doctor/blind-treatment-of-bacterial-infection Date Retrieved: July 2013

https://en.wikipedia.org/wiki/Antibiotic_resistance Date Retrieved: August 2013

http://business.inquirer.net/34317/improper-use-of-antibiotics-may-lead-toevolution-of-infectious-superbugs Date Retrieved: August 2013

http://census.gov.ph/sites/default/files/attachments/hsd/pressrelease/National%2 0Capital%20Region.pdf Date Retrieved: August 2013

http://lynn-library.libguides.com/researchmethodsd6 Date Retrieved: August 2013

Appendix A E-mail Correspondence

Ramos, Art Christian M. Group leader

Ma. Teresa S. Abila, MAN Research Instructor

Maria Andrea L. Endeno, R.N., M.A.N.