8/12/2019 Final Thesis With Cv (for Bookbind)
1/138
PRACTICES OF COMMUNITY RESIDENTS ONSELFMEDICATION WITH ANTIBIOTICS
A Thesis Presented to the Faculty of theCOLLEGE OF NURSING
Pamantasan ng Lungsod ng MaynilaIntramuros, Manila
In Partial Fulfillment of the Requirement for the CourseNURSING 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
8/12/2019 Final Thesis With Cv (for Bookbind)
2/138
Pamantasan ng Lungsod ng Maynila
University of the City of Manila
Intramuros, Manila
COLLEGE OF NURSING
RECOMMENDATION
This,
X Thesis _____ Research Project
_____ Dissertation _____ Feasibility study
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 ofBachelor of Science in
Nursing has been examined and hereby recommend forORAL EXAMINATION.
____________________________ ________________________
Maria Andrea L. Endeno, M.A.N. Ma. Teresa S. Abila, M.A.N.
Nursing Research Adviser Nursing Research Professor
8/12/2019 Final Thesis With Cv (for Bookbind)
3/138
Pamantasan ng Lungsod ng Maynila
University of the City of Manila
Intramuros, Manila
COLLEGE OF NURSING
APPROVAL SHEET
This,
X Thesis _____ Research Project
_____ Dissertation _____ Feasibility study
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. inpartial fulfillment of the requirements for the degree ofBachelor of Science inNursing has been examined and hereby recommend forORAL 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. Dr. Raymond M. FernandezPanel Member Panel Member
_____________________________Ma. Teresa S. Abila, M.A.N.Nursing Research Professor
8/12/2019 Final Thesis With Cv (for Bookbind)
4/138
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
8/12/2019 Final Thesis With Cv (for Bookbind)
5/138
v
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
8/12/2019 Final Thesis With Cv (for Bookbind)
6/138
ABSTRACT
TITLE: Practices of Community Residents on SelfMedication 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: Pamantasan ng Lungsod ng Maynila
DEGREE: Bachelor of Science in Nursing
ADVISER: 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
8/12/2019 Final Thesis With Cv (for Bookbind)
7/138
vii
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 selfmedication with
antibiotics.
8/12/2019 Final Thesis With Cv (for Bookbind)
8/138
TABLE OF CONTENTS
Page
Preliminaries
Title Page i
Recommendation ii
Approval Sheet iii
Acknowledgement iv
Abstract vi
Table of Contents viii
List of Appendices x
List of Figures xi
List of Tables xii
CHAPTER I INTRODUCTION
Background of the Study 1
Statement of the problem 3
Hypothesis 4
Significance of the Study 4
8/12/2019 Final Thesis With Cv (for Bookbind)
9/138
ix
Scope and Limitation 5
CHAPTER II THEORETICAL FRAMEWORK
Review of Related Literature and Studies 7
Synthesis 23
Conceptual Framework 27
Conceptual Paradigm 28
Definition of Terms 29
CHAPTER III METHODOLOGY
Research Design 32
Research Locale 33
Samples and Sampling Technique 33
Instrumentation 34
Data Gathering Procedure 37
Statistical Analysis of Data 38
CHAPTER IV Results and Discussion
CHAPTER V Summary, Conclusion, and Recommendations
Summary 85
8/12/2019 Final Thesis With Cv (for Bookbind)
10/138
8/12/2019 Final Thesis With Cv (for Bookbind)
11/138
LIST OF FIGURES
Figure Title Page
1 Conceptual Paradigm 28
2 Highest Educational Attainments of the Respondents 39
3 Monthly Family Income of the Respondents 40
8/12/2019 Final Thesis With Cv (for Bookbind)
12/138
LIST OF TABLES
Tables Titles Page
1 Extent of Self-Medication of Antibiotics Practices in Terms of
Reasons
42
2 Extent of Self-Medication of Antibiotics Practices in Terms Of
Conditions
44
3 Extent of Self-Medication of Antibiotics Practices in Terms Of
Dosage
46
4 Extent of Self-Medication of Antibiotics Practices in Terms Of
Dosage Change
48
5 Extent of Self-Medication of Antibiotics Practices in Terms Of
Duration
50
6 Anova Results on the Significant Difference on SMA Practices
on Reasons When grouped According to Highest Educational
Attainment
52
7 Post Hoc Tukey
Experience vs Education
53
8 Anova Results on the Significant Difference on SMA Practiceson Reasons When grouped According to Monthly Family
Income
54
9 Anova Results on the Significant Difference on SMA Practices
on Conditions When grouped According to Highest
Educational Attainment
56
10 Post Hoc Tukey HSD
Respiratory Infections vs Education
57
8/12/2019 Final Thesis With Cv (for Bookbind)
13/138
xiii
11 Anova Results on the Significant Difference on SMA Practices
on Conditions When grouped According to Monthly Family
Income
58
12 Post Hoc Tukey
Respiratory Infections vs Monthly Family Income
59
13 Post Hoc Tukey
Gastrointesinal Problems vs Monthly Family Income
61
14 Anova Results on the Significant Difference on SMA Practices
on Dosage When grouped According to Highest Educational
Attainment
62
15 Post Hoc Tukey
Package Checking vs Highest Educational Attainment
63
16 Post Hoc Tukey
Community Health Practitioners vs Highes Educational
Attainment
64
17 Post Hoc Tukey
Family and Friends vs Highest Educational Attainment
65
18 Post Hoc Tukey
Internet vs Highest Educational Attainment
66
19 Post Hoc Tukey
Advertisements vs Highest Educational Attainment
67
20 Anova Results on the Significant Difference on SMA Practices
on Dosage When grouped According to Monthly Family
Income
69
21 Post Hoc Tukey
Package Checking vs Monthly Family Income
70
22 Post Hoc Tukey
Community Health Practitioners vs Monthly Family Income
71
23 Post Hoc Tukey
Internet vs Monthly Family Income
72
8/12/2019 Final Thesis With Cv (for Bookbind)
14/138
xiv
24 Anova Results on the Significant Difference on SMA Practices
on Dosage Changes When grouped According to Highest
Educational Attainment
73
25 Post Hoc Tukey
Insufficient Supply vs Education
73
26 Anova Results on the Significant Difference on SMA Practices
on Dosage Changes When grouped According to Monthly
Family Income
74
27 Post Hoc Tukey
Insufficient Supply vs Income
75
28 Anova Results on the Significant Difference on SMA Practices
on Duration When grouped According to Highest Educational
Attainment
76
29 Post Hoc Tukey
Consumed Supply vs Education
77
30 Post Hoc Tukey
Completion of Treatment vs Education
79
31 Anova Results on the Significant Difference on SMA Practiceson Duration When grouped According to Monthly Family
Income
80
32 Post Hoc Tukey 32After a Few Days vs Monthly Family Income
81
33 Table 33Post Hoc TukeyCompletion of Treatment vs Monthly Family Income
83
8/12/2019 Final Thesis With Cv (for Bookbind)
15/138
1
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 nonprescription 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
8/12/2019 Final Thesis With Cv (for Bookbind)
16/138
2
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 ina 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
8/12/2019 Final Thesis With Cv (for Bookbind)
17/138
3
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 Self-
Medication of Antibiotics practices:
2.1 reasons;
2.2 conditions;
2.3 dosage; and
8/12/2019 Final Thesis With Cv (for Bookbind)
18/138
4
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 self-
medication 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.
8/12/2019 Final Thesis With Cv (for Bookbind)
19/138
5
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
8/12/2019 Final Thesis With Cv (for Bookbind)
20/138
6
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 selfmedication of antibiotics practices will be of another
future undertaking.
8/12/2019 Final Thesis With Cv (for Bookbind)
21/138
7
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 worldwide 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, firstline 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 secondline 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
8/12/2019 Final Thesis With Cv (for Bookbind)
22/138
8
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
8/12/2019 Final Thesis With Cv (for Bookbind)
23/138
9
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.
SelfMedication of Antibiotics Practices
SelfMedication 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
8/12/2019 Final Thesis With Cv (for Bookbind)
24/138
10
a chance of increased drug resistant of some bacteria and if worst not
benn able to be treated (Zdziarski, 2003).
Selfmedication 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 selfmedication 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
8/12/2019 Final Thesis With Cv (for Bookbind)
25/138
11
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 selfmedication 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 easyaccess 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
8/12/2019 Final Thesis With Cv (for Bookbind)
26/138
12
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
8/12/2019 Final Thesis With Cv (for Bookbind)
27/138
13
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).
8/12/2019 Final Thesis With Cv (for Bookbind)
28/138
14
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 well-
educated 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,
8/12/2019 Final Thesis With Cv (for Bookbind)
29/138
15
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 causeof
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 SelfMedication 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
8/12/2019 Final Thesis With Cv (for Bookbind)
30/138
16
entitled Self Medication Practices with Antibiotics Among Tertiary Level
Students in Accra, Ghana: A Cross Sectional Study (2012), observed that
reasons for selfmedication 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 Musa,
Olayeni, and Olayinka (2010), they reported that reasons given for
practice of selfmedication 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 selfmedication 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
8/12/2019 Final Thesis With Cv (for Bookbind)
31/138
17
Zone, South Ethiopia (2012) found out that majority of the respondents
practiced selfmedication 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.
8/12/2019 Final Thesis With Cv (for Bookbind)
32/138
18
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,
8/12/2019 Final Thesis With Cv (for Bookbind)
33/138
19
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 Self-
Medication 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
8/12/2019 Final Thesis With Cv (for Bookbind)
34/138
20
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.
8/12/2019 Final Thesis With Cv (for Bookbind)
35/138
21
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 over-
the-counter antibiotics. According to Dr. Solante, instead of consulting for
the doctor to obtain prescription, some people use previous prescription of
8/12/2019 Final Thesis With Cv (for Bookbind)
36/138
22
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
8/12/2019 Final Thesis With Cv (for Bookbind)
37/138
23
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 out-
patients 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 self-
medicating 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).
8/12/2019 Final Thesis With Cv (for Bookbind)
38/138
24
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
8/12/2019 Final Thesis With Cv (for Bookbind)
39/138
25
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 Chinawhich 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
8/12/2019 Final Thesis With Cv (for Bookbind)
40/138
26
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 Nigeriaare 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
8/12/2019 Final Thesis With Cv (for Bookbind)
41/138
27
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.
8/12/2019 Final Thesis With Cv (for Bookbind)
42/138
28
Conceptual Paradigm
Figure 1
Practices of Community Residents on Self-Medication of Antibiotics
Self-Medication
Antibiotics Practices
Reasons
Conditions
Dosage
Duration
Community Residents
Educational
Attainment
Monthly Family
Income
8/12/2019 Final Thesis With Cv (for Bookbind)
43/138
29
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 self-
medication 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:
8/12/2019 Final Thesis With Cv (for Bookbind)
44/138
30
Reasons: It is the explanation or cause why community residents
resorted in SMA practices (e.g. high cost of hospital consultation).
Condi t ions: 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.
Durat ion: 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
8/12/2019 Final Thesis With Cv (for Bookbind)
45/138
31
income earners), and 10,000/month and below (Families belong to Class E or
very low income earners).
8/12/2019 Final Thesis With Cv (for Bookbind)
46/138
32
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 Keyin 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
8/12/2019 Final Thesis With Cv (for Bookbind)
47/138
33
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.
8/12/2019 Final Thesis With Cv (for Bookbind)
48/138
34
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 self-
medication 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
8/12/2019 Final Thesis With Cv (for Bookbind)
49/138
35
undergraduate, high school graduate or undergraduate and college graduate or
undergraduate.
Educational Attainment Interpretation
Elementary Graduate /Undergraduate
Low level of understanding
High School Graduate /Undergraduate
Middle level of understanding
College Graduate /Undergraduate
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).
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.
Class Family Income Every Month Interpretation
A and B 100,000/month and above High income earner
C 20, 000 - 100,000/month Middle income earner
D 10,000 - 20,000/month Low income earner
E 10,000/month and below Very low income earner
8/12/2019 Final Thesis With Cv (for Bookbind)
50/138
36
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 Always 3.25-4.00 Very Highly
Practice
3 Often 2.50-3.24 Highly Practice
2 Sometimes 1.75-2.49 Low Practice
1 Never 1.00-1.74 Very Low Practice
It is interpreted that the higher the score, the higher the extent of the self-
medication of antibiotics practices.
8/12/2019 Final Thesis With Cv (for Bookbind)
51/138
37
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.
8/12/2019 Final Thesis With Cv (for Bookbind)
52/138
38
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, OneAnalysis of Variance (ANOVA) was utilized
to measure the difference between the respondents practices towards self -
medication of antibiotics when grouped according to profile variables
8/12/2019 Final Thesis With Cv (for Bookbind)
53/138
39
Chapter IV
Results and Discussions
Problem No. 1What is the profile of the respondents according to:
1.1 Highest Educational Attainment
Figure 2Highest 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.
8/12/2019 Final Thesis With Cv (for Bookbind)
54/138
40
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 3Monthly 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
8/12/2019 Final Thesis With Cv (for Bookbind)
55/138
41
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
8/12/2019 Final Thesis With Cv (for Bookbind)
56/138
42
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 1Extent of Self-Medication of Antibiotics Practices in Terms of Reasons
Items WeightedMean
Interpretation Rank
1.Economy 2.96 HighlyPracticed
3
2. Knowledge 2.60 HighlyPracticed
5
3. Experience 3.34 Very HighlyPracticed
2
4. Prognosis 3.43 Very HighlyPracticed
1
5. Time 2.91 HighlyPracticed
4
*Legend:1.00-1.74= Very Low Practiced 2.50-3.24= Highly Practiced1.75-2.49= Low 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
8/12/2019 Final Thesis With Cv (for Bookbind)
57/138
43
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.
8/12/2019 Final Thesis With Cv (for Bookbind)
58/138
44
Similarly, Misati (2012) observed that the common reasons for self-
medication 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 2Extent of Self-Medication of Antibiotics Practices in Terms Of Conditions
Items WeightedMean
Interpretation Rank
1. Respiratory Infections 3.20 HighlyPracticed
1
2. Systemic Manifestations 2.71 HighlyPracticed
3
3. Gastrointestinal Problems 2.05 Low Practiced 44. Skin Wounds 2.98 Highly
Practiced2
*Legend:1.00-1.74= Very Low Practiced 2.50-3.24= Highly Practiced1.75-2.49= Low Practiced 3.25-4.00= Very Highly Practiced
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 3rdrespectively. Whereas, gastrointestinal
8/12/2019 Final Thesis With Cv (for Bookbind)
59/138
45
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.
8/12/2019 Final Thesis With Cv (for Bookbind)
60/138
46
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 self-
medication of antibiotics.
2.3 Dosage
Table 3Extent of Self-Medication of Antibiotics Practices in Terms of Dosage
Items Weighted Mean Interpretation Rank1. Package Checking 2.46 Low Practiced 42. Community HealthPractitioners
2.84 Highly Practiced 3
3. Family and Friends 3.06 Highly Practiced 24. Internet 1.28 Very Low Practiced 75. Experience 3.18 Highly Practiced 1
6. Estimating Dosage 2.00 Low Practiced 67. Advertisements 2.23 Low Practiced 5
*Legend:1.00-1.74= Very Low Practiced 2.50-3.24= Highly Practiced1.75-2.49= Low Practiced 3.25-4.00= Very Highly Practiced
8/12/2019 Final Thesis With Cv (for Bookbind)
61/138
8/12/2019 Final Thesis With Cv (for Bookbind)
62/138
48
illness episodes and prior experience of self medication of antibiotics
contributes to practicing selfmedication 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 4Extent of Self-Medication of Antibiotics Practices in Terms of Dosage
Changes
Items Weighted Mean Interpretation Rank1. Improve Conditions 3.60 Very High Practiced 12. Reduce SideEffects
2.45 Low Practiced 2
3. Insufficient Supply 2.40 Low Practiced 3*Legend:
1.00-1.74= Very Low Practiced 2.50-3.24= Highly Practiced1.75-2.49= Low Practiced 3.25-4.00= Very Highly Practiced
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.
8/12/2019 Final Thesis With Cv (for Bookbind)
63/138
49
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 2ndin 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
8/12/2019 Final Thesis With Cv (for Bookbind)
64/138
50
Table 5Extent of Self-Medication of Antibiotics Practices in Terms of Duration
ItemsWeighted
MeanInterpretation Rank
1. After a few days 2.25 LowPracticed 5
2. Symptoms disappeared 3.32Very HighlyPracticed
2
3. After the recovery 3.54Very HighlyPracticed
1
4. Consumed supply 2.59Highly
Practiced3
5. Completion of treatment 2.33Low
Practiced4
*Legend:
1.00-1.74= Very Low Practiced 2.50-3.24= Highly Practiced1.75-2.49= Low Practiced 3.25-4.00= Very Highly Practiced
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.
8/12/2019 Final Thesis With Cv (for Bookbind)
65/138
51
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?
8/12/2019 Final Thesis With Cv (for Bookbind)
66/138
52
3.1 Reasons
Table 6Anova Results on the Significant Difference on SMA Practices on Reasons
When grouped According to Highest Educational Attainment
EducationalAttainment
f-Value p-Value Decision Interpretation
1. Economy 2.37 0.09 Accept There is nosignificantdifference
2.Knowledge
1.00 0.37 Accept There is nosignificantdifference
3.Experience
3.42 0.04 Reject There is asignificant
difference4. Prognosis 0.42 0.41 Accept There is no
significantdifference
5. Time 0.11 0.11 Accept There is nosignificantdifference
*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