CENTRO ESCOLAR UNIVERSITY- MANILA

SCHOOL OF PHARMACY

We are 3rd Year students from Centro Escolar University- Manila. We are currently
conducting a Research entitled “Consumer's Level of Awareness and Attitude Towards
Patient Counselling Services and its Impact on Antibiotic Adherence Among Filipino
Adults in Selected Provinces of the Philippines” This study aims to determine the level
of awareness and attitude of consumers towards patient counselling services.

With this, we'd like to invite you to take part in this survey by filling out the form. Please
answer truthfully and to the best of your knowledge throughout this survey
questionnaire. Rest assured that all information gathered from each participant will be
managed to keep completely private.

Part I
Demographic Data
Name (optional): Gender: Highest Educational
Female Attainment:
Male Elementary graduate
High School graduate
Age: Occupation: Bachelor’s degree
18-29 years old Student Postgraduate degree
30-49 years old Employed
50-59 years old Self-employed
Unemployed

Community Type: Marital Status:

Rural Single
Urban Married
Separated/Divorced
Part II

Awareness And Attitude Towards Patient Counselling

Strongly Disagree Agree Strongly
disagree agree

1. Do you think patient

counselling is important?

2. Are you interested in

patient counselling?

3. Should patient
counselling be a
professional duty of a
pharmacist?

Part III

Awareness On Antibiotic Adherence

Strongly Disagree Agree Strongly
disagree agree

A. Action and Use

1. Different antibiotics are

needed to cure different
diseases

2. Antibiotics are effective

against bacteria

3. Antibiotics can kill the

bacteria that normally live
on the skin and in the gut

4. Antibiotics speed up the

recovery from most
coughs and colds
5. Antibiotics work on most
coughs and cold

6. Antibiotics are effective

against viruses

Strongly Disagree Agree Strongly

disagree Agree

B. Side Effects

7. If you get side effects

during a course of
antibiotics treatment you
should stop taking them
as soon as possible

8. If you get some kind of

skin reaction when using
an antibiotic, you should
stop taking them as soon
as possible

9. Antibiotics can cause

imbalance in the body’s
own bacterial flora

Strongly Disagree Agree Strongly

disagree agree

C. Resistance

10. Unnecessarily use of

antibiotics can increase
the resistance of bacteria
to them

11. Resistance to antibiotics is

a worldwide problem

12. The use of antibiotics

among animals can
reduce the effect of
bacteria among humans
13. Humans can be resistant
to antibiotics

Part IV

Attitude on Antibiotic Adherence

Yes No

Preference for use of Antibiotics

1. When I have a cold, I should take antibiotics to prevent

getting a more serious illness

2. When I get fever, antibiotics help me to get better quickly

3. I would rather take an antibiotic that may not be needed

than wait to see if I get better without it.

Antibiotic Resistance and Safety

4. Whenever I take an antibiotic, I contribute to the

development of antibiotic resistance

5. Skipping one or two doses does not contribute to the

development of antibiotic resistance.

6. Antibiotics are safe drugs, hence they can be commonly

used

Attitudes to doctors prescribing of antibiotics

7. If I expect to receive an antibiotic, I am less satisfied with

a doctor’s visit if I do not received an antibiotic

8. If a doctor does not prescribe an antibiotic when I think

one is needed, I will go to another doctor.
 Strongly Disagree Agree Strongly
disagree Agree

Attitudes in Relation to
Antibiotic Use

1. If you feel better, after taking

2-3 doses of antibiotics, do you
still complete the full course of
treatment?

2. Do you prefer to obtain

antibiotics from the pharmacy
rather than the doctor/ health
worker if you have an illness

3. Do you prefer to take an

antibiotic when you have a
cough and sore throat?

4. Do you consult a doctor before

starting an antibiotic?

5. Do you check the expiry date of

the antibiotic before using it?

Part V

Medication Adherence Scale Test

Yes No

Do you ever forget to take

your prescribed antibiotic
medication?

Are you careless at times

about taking your
medicines?

When you feel better, do

you sometimes stop taking
your medicine?
Sometimes if you feel
worse when you take the
medicine, do you stop
taking it?