TITLE: Comparison of knowledge and attitudes about antibiotics and resistance, between

allied health and non-allied health students in Silliman University Commented [U1]: Follow title page format posted in
our GC

CHAPTER I INTRODUCTION Commented [U2]: Should be place below the word

Chapter I
I. BACKGROUND OF THE STUDY
Commented [U3]: Remove roman numerals before
each subheadings
Silliman University is one of the prestigious universities in Negros Oriental. It is Commented [U4]: Subheadings should in bold letters
too
one of the best academic institutions in the Philippines. It is recognized for academic
excellence, topping university rankings, and producing topnotchers from different fields.
It offers not only comfort but also quality education for all. In addition, Silliman University
provides a basic education program from early childhood to senior high school.
Additionally, they also offer allied, and non-allied health courses for higher education,
which are all undergoing evaluation from respective accrediting associations. Also, the
learning opportunities happen within 5 Cs in the classroom, courts, culture, communities,
and church. Thus, ensuring that all students are well-rounded people with character,
competence, and faith reflects the university motto Via, Veritas, Vita.

Antibiotics are imperative as these are the medicines that prevent and treat bacterial
infections. The occurrence of antibiotic resistance occurs when bacteria change in response
to the use of these medicines. In addition, study shows that bacteria become resistant to
antibiotics, not only to humans or animals. These bacteria can infect or harm humans and
animals. In addition, the infections they cause are not easy to treat as those caused by non-
resistant bacteria.

According to the World Health Organization, antibiotic resistance increases

medical costs, and more extended hospital stays, and increased mortality. Therefore, the
world needs an urgent change in the way antibiotics are prescribed and used. However,
even as new drugs develop, antibiotic resistance remains a significant threat without
changing behavior. Behavioral changes should also include measures to reduce the spread
of infection through vaccination, hand washing, safe sex, and good food hygiene.
 Antibiotic abuse such as misuse and overuse are the main drivers behind the
development of drug-resistant pathogens. In addition, lack of clean water and hygiene and
inadequate infection prevention and control contribute to the spread of microorganism
resistant to antibacterial treatment. The development of antibiotic resistance is one of the
greatest threats to public health in the world. Improper use of antibiotics is believed to be
a major cause of antibiotic resistance. (Nepal, Hendrie, Robinson, & Selvey, 2019). The
researchers are interested in assessing the knowledge and attitudes on antibiotic usage and
antibiotic resistance among the students at Silliman University. It also tries to decipher
whether the level of education and the state of an individual's courses has a positive
association with the level of knowledge on antibiotic resistance.

II. STATEMENT OF THE PROBLEM

Antibiotic resistance is seen as a big threat to everyone’s health in different areas
of the world. According to the Centers for Disease Control and Prevention (CDC)
Organization, about a number of 2.8 million people are diagnosed with bacterial or fungal
antibiotic resistance every year. This threat is not limited to a certain group of people
because it attacks and affects every person. It only differs on the highness of risk in having
antibiotic resistance. The more antibiotic-resistant bacteria is, the more difficult it is to treat
different illnesses as antibiotics lose their effectiveness. The bacterial microorganisms gain
immunity against the antibiotics that are designed to kill them. This makes it longer and
harder for the diseases to be treated. If this issue is left unsolved, a big possibility will arise
wherein minor accidents or infections will automatically lead to death.
The World Health Organization (WHO) conducts a global action plan towards
antibiotic resistance. This is to help people be aware by educating them on what antibiotic
resistance means, the possible effects and causes of it, and the plans or ways on how it can
be handled. According to a study conducted by Adeke et al. (2018) on the knowledge of
medical students in Nigeria on antibiotic resistance, the majority of them are
knowledgeable about the topic but they lack the observation of good practices. This shows
that there is a need for the encouragement of people to engage in positive practices on the
use of antibiotics. This will help prevent and avoid the misuse of antibiotics which can
 eventually lead to antibiotic resistance. It is also important for people to apply and practice
the things that they have learned regarding this issue.
Having enough knowledge of something that is threatening the health of people
around the globe is important. As early as now, people should be aware of how antibiotics
work and how it affects their health. With that, the researchers aim to determine who
between the allied health and non-allied health students of Silliman University are more
aware and educated about antibiotics and their resistance. This study will compare two
departments of the university on how much knowledge they have regarding this matter.
This will help them set goals to help students have a better understanding of antibiotic
resistance.

III. HYPOTHESIS
Null hypothesis: There is no statistical difference between the allied health and non-allied Commented [U5]: Put symbol as well

health students in Silliman University about their knowledge and attitudes on antibiotics
and resistance.
Alternative hypothesis: There is a statistical difference between the allied health and non-
allied health students in Silliman University about their knowledge and attitudes on
antibiotics and resistance

IV. SIGNIFICANCE OF THE STUDY

The main goal of this research is to see how students in the Allied Health program
compare to students in the Non-Allied Health program in terms of antibiotic resistance
awareness. This research is particularly essential to the following personalities/entities:

Students. Through this study, the students will be able to assess their knowledge about
antibiotics, the uses of antibiotics, and how it continuously poses a threat to public health.
Teachers. Educators will be aware of whether or not their students have knowledge about
antibiotic resistance. If so, they will partake in the training of the students towards the uses,
effects, and the like about antibiotics.
 Silliman University. With this study, Silliman University will be able to know and assess
the knowledge of their students on antibiotics. This will also act as an alarm for the
University to partake in this intervention, in order to further implement educational
seminars and the like about antibiotics on students.
SU Alumni. The Silliman University Alumni Association is one of the most powerful allies
of the University. This study will be essential for them as they will help partake in helping
not just the student but the whole community on antibiotic awareness.
Future Researchers. This study will provide them with a valuable reference for a
comparable issue. This study might be used as a roadmap for future academics who want
to go more into this subject. Furthermore, the researchers can utilize the information
gathered to analyze their own behaviors and experiences.

V. SCOPE AND LIMITATIONS

This study focuses on the comparison of knowledge and attitudes about antibiotics
and resistance, between allied health and non-allied health students at Silliman University.
The data collection will be conducted to a total of sixty (60) students from medical and
non-medical colleges at Silliman University who will present the population,

The study would be done through the utilization of questionnaires to the students as
a survey and reference. By their strategy, the researchers will be able to know and compare
the knowledge and attitudes about antibiotics and resistance, between allied health and
non-allied health students in Silliman University.

VI. DEFINITION OF TERMS

Antibiotics - a medicine (such as penicillin or its derivatives) that inhibits the growth of or Commented [U6]: Italicize terms

destroys microorganisms.

Antibiotic resistance - happens when germs like bacteria and fungi develop the ability to
defeat the drugs designed to kill them.
 AMR (antimicrobial resistance) - the development by a disease-causing microbe,
through mutation or gene transfer, of the ability to survive exposure to an
antimicrobial agent that was previously an effective treatment.

CHAPTER II REVIEW OF RELATED LITERATURE

I. RELATED LITERATURE

Knowledge of Antibiotic Resistance and the threats to community

Antibiotic-resistant bacterial infections, such as respiratory infections, skin and

soft tissue infections, and even urinary tract infections, are becoming increasingly common
in both health-care and community settings. Because of the high chance of methicillin-
resistant Staphylococcus aureus producing these infections, adjustments in the approach to
empirical treatment, such as with skin infections, have been made. Furthermore, decisive
therapy of these diseases (i.e., based on culture results) is becoming increasingly difficult;
antibiotic resistance has left clinicians with few, if any, licensed drugs to which the bacteria
are obviously susceptible. (Lushniak, MD, MPH 2014)
Antibiotics are a form of wonder drug, but their use is no longer widespread.
When first- and second-line medicines fail, doctors turn to medications that are potentially
more hazardous and useless. Even when effective treatments are available, evidence is
accumulating that antibiotic-resistant diseases take longer to cure, are more expensive, and
are associated with higher mortality than their antibiotic-susceptible counterparts.
(Lushniak, MD, MPH 2014)
Antibiotic usage is the primary cause of antibiotic resistance. Antibiotics are life-
saving medications that provide enormous benefits to individuals suffering from infections.
Antibiotics are frequently used for longer-than-recommended durations or for the treatment
of colonizing or contaminating microorganisms, according to studies.5,6 Additionally,
antibiotics are frequently used for longer-than-recommended durations or for the treatment
of colonizing or contaminating microorganisms. When antibiotics are prescribed
incorrectly and are used inappropriately, individual individuals are exposed to the risks of
antibiotic therapy while receiving no therapeutic benefit. (Lushniak, MD, MPH 2014)
 Patients are also at risk for antibiotic-resistant illnesses when bacteria are passed
from one patient to the next, either through the hands of healthcare staff or by objects used
in patient care. Although interrupting this transmission can sometimes fall to
environmental cleaning and disinfection of patient-care equipment, all health-care
providers must practice optimal hand hygiene—a single action that can have a huge impact
on preventing pathogen cross-transmission in a health-care setting. (Lushniak, MD, MPH
2014)
Medicines are today a scarce resource; there are fewer effective antibiotics
available for some health-care-associated diseases than there was a decade ago, and
antibiotic resistance is a genuine issue. Clinicians can play a role in reducing the impact of
these infections on patients and the health-care system in the health-care context. In order
to prevent the spread of antibiotic-resistant bacteria, prescribers must improve their
prescribing and actively participate in antibiotic stewardship initiatives. As new diagnostic
tests and antibiotics become available, these steps will benefit patients. (Lushniak, MD,
MPH 2014)

Antibiotic Use: Debunking Myths and Addressing Facts

Antibiotic usage has always been a growing record in every country. It was not
until the early 1900’s that antibiotics became known but before its existence, popular
medical textbooks served as a guide for treatments such as bacterial infections in which
only symptomatic therapy was given. In the early 1950’s, Penicillin, an antibiotic became
widely available which quickly superseded symptomatics as the first line treatment.
Antibiotics gained so much popularity which resulted in the “antibiotic revolution” that
took place in the second part of the twentieth century. As time goes by, the number of
antibiotic consumers escalates and phone-based questionnaires were conducted in 28
European countries, with around 1000 people from each country partaking for the gathering
of data. As this number increases, problems regarding the effectiveness of antibiotics arise.
Spain coming out on top in terms of antibiotic use has sparked heated controversy and
debates as to why it has ranked the highest, claiming that unnecessary prescriptions is a
major problem. Furthermore, antibiotic resistance has been identified as one of the three
most serious dangers to human health by the World Health Organization. All of these
problems and pressing issues result from erroneous assumptions and belief in myths that
are not true. As the post-antibiotic era is fast approaching, these misconceptions and false
claims need to be addressed and debunked. Believing in such fallacies can jeopardize one's
health and it is critical to figure out exactly when and how to take antibiotics. (LLor, 2017)

Antibacterial agents have gained a lot of knowledge over the last 8 decades.
Unfortunately, part of what is "known" is inaccurate. The first myth is that antibiotics were
invented by humans in the twentieth century. Prontosil rubrum, a sulfa medication
developed in 1931, was the first clinically relevant antibacterial agent that was both safe
and effective. Prontosil, on the other hand, was not the first antibacterial agent produced,
and humans were not the first to invent it (Brad Spellberg, MD, 2006).

The second myth is that incorrect antibiotic usage causes resistance to develop. This
myth is frequently repeated, implying that if we could remove inappropriate antibiotic use,
resistance would not arise. Antibiotic use, on the other hand, provides selective pressure
by killing bacteria. Appropriate use puts the same selective pressure on the brain that bad
use does. The distinction is that we can and should prohibit inappropriate use since it is
ineffective. Antibiotics, on the other contrary, are required to reduce bacterial infection-
related mortality and morbidity (Brad Spellberg, MD, 2006).

The third myth is that, in order to avoid resistance, patients must take all antibiotics
prescribed, even if they feel better. The myth's roots are a little unclear, however they
appear to date around the 1940s. Despite how common and deeply held this belief is, there
is no evidence to support the concept that continuing antibiotics after the signs and
symptoms of an infection are resolved. Antibiotic resistance is less likely to develop as a
result of infection (Brad Spellberg, MD, 2006).

Antibiotic Resistance Is Usually a Consequence of New Mutations at the Infection

Site, according to the fourth myth. This myth may come from the true understanding that
tuberculosis resistance develops at the site of infection as a result of spontaneous mutations
 that target TB therapy. However, tuberculosis differs from most other acute bacterial
infections in that it has its own characteristics (Brad Spellberg, MD, 2006).

The last myth is that cidal antibiotics have better clinical outcomes and pose a lower
risk of resistance development than static antibiotics. This is yet another widely held
clinical belief that has no basis in fact. First, bacteriostatic "static"antibiotics do kill
bacteria, contrary to popular assumption; they simply require a larger dose to accomplish
specific bacterial reduction thresholds. A bactericidal "cidal" antibiotic is one whose
minimum bactericidal concentration (MBC) is four times or higher than the drug's
minimum inhibitory concentration (MIC). (Brad Spellberg, MD, 2006).

Antibiotic Resistance: Prevalence and Impact

Antibiotic resistance is a growing worldwide danger to human health. More than

600,000 antibiotic-resistant illnesses and 33 000 associated fatalities are predicted to have
occurred in European Union and European Economic Area nations in 2015 (Buckley et al.,
2019).

In addition to deaths and illnesses, antibiotic resistance increases the cost of more
expensive and lengthy therapies. Antibiotic resistance is expected to rise further in affluent
nations, with 10% of all communicable disease spending going toward resistance-related
consequences. Antibiotic resistance may spread considerably quicker in underdeveloped
nations, resulting in a tremendous number of fatalities, primarily among newborns, young
children, and the elderly, in health systems that are already under-resourced and
overburdened (Buckley et al., 2019).

Antibiotic overuse and incorrect usage have been implicated as key contributors to
the emergence of antibiotic resistance. Antibiotic resistance is more common in countries
with high antibiotic usage levels. Significant correlations have been shown between the
intake of various antibiotics and the prevalence of antibiotic resistance in the
microorganisms that they target. Despite increased worldwide acknowledgment of the
problem's importance and attempts in many nations to enhance antibiotic stewardship,
 antibiotic usage in humans, animals, and crops continues to rise year after year. Antibiotic
usage might be reduced via immunization (Buckley et al., 2019).

Vaccines against bacterial illnesses may minimize antibiotic usage directly by

lowering disease incidence. Vaccines against viral or parasite infections with fever or
diarrhea as predominant symptoms may also minimize antibiotic use by reducing
symptom-based antibiotic prescribing. Furthermore, indirect advantages to non-recipients
via the herd effect may reduce antibiotic use in the general population (Buckley et al.,
2019).

However, the ability of vaccination to minimize antibiotic use may be influenced

by vaccine efficiency and coverage. Furthermore, any influence of bacterial vaccinations
on antibiotic usage or resistance may be confounded or mitigated by pathogen strain
substitutions, when sickness in the population changes to serotypes not covered by the
vaccines. The purpose of this systematic review is to offer a complete and up-to-date
assessment of the evidence pertaining to the influence of vaccinations on antibiotic usage,
as well as to assess the quality of the evidence (Buckley et al., 2019).

Antibiotic Resistance and the COVID-19 Pandemic

Since the uproar of COVID-19, patients that have been admitted to hospitals are
being administered antibiotics. Information on antibiotic use upon the treatment of
COVID-19 has been laid out to the public, especially throughout the internet. Increased
availability of over-the-counter antibiotics has been directly influenced by a lack of
understanding about the benefit of antibiotics, as well as the fear of COVID-19 infection.
This happens particularly in low- and middle-income countries with weak antibiotic control
activities and limited access to health settings (Ghosh, et. al., 2021).

As a result of SARS-CoV-2, there have been some adjustments in medical

procedures ever since the world started to increase the use of antibiotics in February 2020.
According to some research, antibiotic medication was recommended to 70-97% COVID-
19 infected inpatients. Antibiotics are said to be ineffective in treating COVID-19, hence
this extensive prescription is quite surprising (Sargen, 2021).

The Pew Charitable Trusts conducted research in the US which showed that over
50% of the total population of the COVID-19 in-patients were treated with antibiotics
within the first six months of the pandemic. Furthermore, 96% of the overall cases were
found to be administered with the therapy even before a contagion caused by any bacteria
has been detected. These results were similar to that of a study of COVID-19 cases back in
2020 which reported that more than 70% of the patients had undergone antibiotic therapy
despite having bacterial and fungal coinfection in far less than 10% of the incidences. The
substantial percentage of COVID-19 patients that received antibiotic therapy, according to
David Hyun, head of Pew’s Antibiotic Resistance Project, was presumably because of the
worries about bacterial co-illnesses and difficulties distinguishing the difference between
bacterial infections and COVID-19 so soon into the pandemic. The significant use of
antibiotics is one of the misconceptions on the correct medication for COVID-19.
According to a report by BMJ, this may have driven to excess and inappropriate use of
antibiotic therapy in the initial phases of the pandemic (Jimenez, 2021).

Antibiotics do not treat infections that are caused by viruses, hence it is not effective
to work against the COVID-19 virus. COVID-19 suspected patients are sometimes
hospitalized due to infections caused by bacteria or fungi (Centers for Disease Control and
Prevention, 2021). Overall, the selection and development of highly resistant bacteria as a
result of the increased use of antibiotics will have an impact on the clinical prognosis of
severe COVID-19 patients receiving hospital care and result in poor patient outcomes. In
this context, highly and pan drug-resistant organisms have been documented to cause
significant coinfections in COVID-19 patients, and mortality has recently been recorded in
situations when bacterial coinfections were discovered with COVID-19 (Ghosh, et. al.,
2021).
Impact of vaccination on antibiotic usage

Antimicrobial resistance is a hidden threat lurking behind the COVID-19 pandemic

which has claimed thousands of lives prior to the emergence of the global outbreak.
Antimicrobial resistance has the potential to become a double-edged sword in the event of
a pandemic on the size of COVID-19, with the overuse of antibiotics having the ability to
return us to the pre-antibiotic period. Antimicrobial resistance is majorly attributed to
widespread and unnecessary use of antibiotics, among other causes, which has facilitated
the emergence and spread of resistant pathogens. Our study aimed to conduct a rapid
review of national treatment guidelines for COVID-19 in 10 African countries (Ghana,
Kenya, Uganda, Nigeria, South Africa, Zimbabwe, Botswana, Liberia, Ethiopia, and
Rwanda) and examined its implication for antimicrobial resistance response on the
continent. Our findings revealed that various antibiotics, such as azithromycin,
doxycycline, clarithromycin, ceftriaxone, erythromycin, amoxicillin, amoxicillin-
clavulanic acid, ampicillin, gentamicin, benzylpenicillin, piperacillin/tazobactam,
ciprofloxacin, ceftazidime, cefepime, vancomycin, meropenem, and cefuroxime among
others, were recommended for use in the management of COVID-19. This is worrisome in
that COVID-19 is a viral disease and only a few COVID-19 patients would have bacterial
co-infection. Our study highlighted the need to emphasize prudent and judicious use of
antibiotics in the management of COVID-19 in Africa. (Adebisi et al, 2021)

The role of medical students in preventing antimicrobial resistance

Antibiotic resistance is one of our generation's most pressing public health issues.
Drug-resistant bacteria, parasites, and viruses are spreading all over the world. Fighting
this hazard is a public health concern that entails a multi-sectoral worldwide response. The
Global Alliance for Patient Safety of the World Health Organization (WHO) has identified
the combined concerns posed by the rise in drug-resistant bacteria and the fall in antibiotic
innovation. Medical students, who can help address this problem as future physicians, are
currently being educated in an era where the toll of antimicrobial-resistant illnesses is seen
daily (Castano, Parikh, & Yu, 2009).
The role of medical students in medical schools

Extracurricular activities at medical schools, particularly in the preclinical years,

might be devoted to student forums dedicated to educating peers and addressing
antimicrobial resistance with faculty members from several fields. Students can assist teach
fellow students at health professional schools in their region after they have a basic grasp
of the subject at the local, community, national, and worldwide levels. In addition to
epidemiology, pathophysiology, and therapy, medical students should be proficient in
pertinent international, national, and local policies impacting antibiotic resistance. Medical
students should be reminded that they have a responsibility in eliminating antimicrobial
resistance (Castano, Parikh, & Yu, 2009).

The role of medical students in hospitals

Medical students in hospitals play a crucial role in the containment of AMR, both
as healthcare professionals and as unwitting contributors to pathogen dissemination.
Antimicrobial stewardship committee lectures and in-house publications can provide
hospital-specific resistance trends and antibiotic sensitivities for certain species. Knowing
where to find such materials can help determine the best antibiotic decisions. Drug
resistance and sensitivity data for individual individuals with culture-positive infections
are also crucial. Calling the microbiological lab or contacting outside hospitals for
transferred patients can help medical students discover this information. This up-to-date
culture information will help physicians make better decisions and utilize antibiotics more
effectively (Castano, Parikh, & Yu, 2009).

The role of medical students in the community

Medical students may serve as educators and advocates in their communities

in addition to pressing change in their schools and hospitals. Learning local AMR
patterns utilizing the resources listed above is the first step toward performing these
functions. Students can then use opinion pieces and factual articles to educate their
peers about the rising problem of antibiotic resistance and its local manifestations.
 Community audiences will benefit most from publications that expressly outline ways
for community members to reduce the growth of resistance. In addition to reinforcing
recognized containment strategies, such as not sharing drugs, approaches emphasized
for a community should relate to its particular conditions. Students can also figure out
how much local public health and sanitation policies are limiting the development of
antibiotic resistance, and in knowing this, they can push lawmakers to amend such
laws to safeguard public health (Castano, Parikh, & Yu, 2009).

II. CONCEPTUAL FRAMEWORK Commented [U7]: Include correct label below and
short description of framework

CHAPTER III. METHODOLOGY

I. RESEARCH DESIGN Commented [U8]: Remove roman numerals and bold

subheadings
This study uses a qualitative research design to compare the knowledge and
attitudes about antibiotics and resistance, between allied health and non-allied health
students in Silliman University. The study uses survey questionnaires for its research
instrument and uses random sampling for its sampling procedure.

II. RESEARCH ENVIRONMENT

The locale of this study is done in Silliman University, a Christian institution which
is located in Dumaguete City. The university has an area of sixty-two (62) hectares and is
situated in front of Dumaguete’s sea port. Silliman University has an estimated population
 of ten thousand (10,000) college students and sixty (60) respondents were selected from
different college departments.

III. RESPONDENTS AND SAMPLING PROCEDURE

A total of sixty (60) students from medical and non-medical colleges at Silliman
University will be tested on their knowledge, attitude, and practice on antibiotic use. Each
group will have 30 students in it. Data will be gathered through an online survey made
using google forms. Students enrolled in pre-medicine and medicine programs (pharmacy,
medical technology, physical therapy, medicine, and nursing) are classified as allied-health
students. Other university students were classified as non-allied-health students.

The researchers will use random sampling since the study will be a Likert-scale
survey. The computer will carry out the random sampling process through the SPSS
program, and for each section, the program will select six (6) respondents at random from
a list of student's names in the worksheet provided by the school records. Thus, there will
be a total of 10 sections chosen for the random sampling.

IV. RESEARCH INSTRUMENT

We, the researchers, will be using survey questionnaires to gather the data needed
for our research. To get the appropriate data needed, the researchers will have to answer
twenty (20) statements about the knowledge they have on antibiotics and resistance. Each
question will be answered using the Likert-scale questionnaire, to which the respondent
will answer strongly disagree, disagree, undecided, agree, or strongly agree to the
statements given in the questionnaire.

V. DATA GATHERING PROCEDURE

We allotted our time, efforts, and participation in developing a questionnaire with

clear phrases to benefit its respondents. The survey was conducted out using appropriate
 questions adapted from related research as well as individual questions developed by the
researchers. The questionnaire is a likert-scale questionnaire, to which respondents can
respond if they strongly disagree, disagree, are undecided, agree, or strongly agree with the
situation or question provided. After the researchers have completed and finalized the
questionnaire, surveys are distributed to (60) students from Silliman University's medical
and non-medical colleges using an online platform. Respondents had also allotted their
time to complete the survey.

The data collected from the research instrument were collected and organized based
on the responses provided by the participants.

VI. DATA ANALYSIS PROCEDURE

The researchers used Likert scale in order to get the respondents to choose an option
which best describes how well they know about antibiotic resistance, and by comparing
the indexes of attitude, knowledge, and practice based on socio demographic features, and
antibiotic consumption. Using Mann-Whitney U test after verifying the non-compliance
with the normality assumption, checked with Kolmogorov-Smirnov test and using
Lilliefors for corrections. Linear regression will finally be performed for each of the index
in order to know if the associations found in the bivariate analysis were deceptive to the
extent that variables in the model which were appended are those with p-value of <0.05 in
the bivariate analysis. These were all performed using SPSS.

VII. ETHICAL CONSIDERATIONS

Since this study involves human subjects, it is critical that human research ethics
approval be acquired. As human research ethical boards cannot award approval for research
after data collection has begun, it is critical that approval be obtained prior to the start of
data collection from human participants.
Informed consent
Participants must be thoroughly informed about what will be required of them, how
the data will be used, and the potential consequences (if any). Participants must give
explicit, active, signed agreement to participate in the study, which includes recognizing
their rights to view their data and the ability to withdraw at any time. The process of
informed consent can be thought of as a contract between the researcher and the
participants.
Clear explanations on the following features of 'informed' should be included.
● Who are the researchers,
● The purpose of the research,
● The method of how the data will be collected from the participants,
● How the data will be used and reported.

The informing aspect should consider the participants thus, it should be carefully worded
that is understandable and making sure the fonts are readable. Consent should explicitly
include the following elements:
● a 'opt in' approach rather than a 'opt out' strategy
● information on the right to withdraw at any moment and for any reason (including
the right to withdraw data previously submitted),
● Confidentiality of the participants’ identity,
● a clear understanding of who owns the data (participants own their raw data,
researchers own the analysis data),
● their right to access their personal information,
● the right to request additional information.

Anonymity and Confidentiality

Participants' identities must be kept private or anonymous, and assurances must go
beyond preserving their names to include avoiding the use of self-identifying comments
and information. A key step in protecting participants from potential damage is anonymity
and confidentiality.
 The terms "participant anonymity" and "participant confidentiality" are often used
interchangeably, however they are not interchangeable. Anonymity refers to the fact that
the researcher is unaware of the participant's identity (for example, when utilizing
anonymous surveys, the researcher is completely unaware of the participant's identity).
Participant confidentiality means that the researcher knows the participant's identity, but
the data has been deidentified and the identity is kept private (for example, in interviews,
where the researcher knows the participant's name, only confidentiality, not anonymity,
can be granted).

Voluntary Participation
Participants must be informed that participating in this study is voluntary. At any
time in conducting the data collection, participants may or may not continue in the process
without any discrimination. That even though they are encouraged to participate, they are
not obliged to do so thus, giving them the right to refuse participation in starting the data
collection.

Do no harm
The potential for harm to participants, the researcher, the wider community, and the
institution must all be considered in the research design. Physical, financial, emotional, and
reputational injury are all possible consequences. When assessing the risk of harm, the aim
should be to remove, isolate, and decrease the risk in descending order, with participants
well informed about the hazards.
QUESTIONNAIRE (LIKERT SCALE) Commented [U9]: Place under appendices

[strongly disagree, disagree, undecided, agree, strongly agree]

1. A cough that is longer than one week always needs to be treated with antibiotics so that it will
disappear.
2. People can become resistant to antibiotics.
3. Buying antibiotics without a doctor’s prescription leads to bacteria becoming resistant
4. Antibiotic resistant bacteria can be spread to other people
5. Certain pathogens that have antibiotic resistance are more harmful to the human body than those
bacteria without antibiotic resistance.
6. The longer and more often antibiotics are used, the less effective they are against those bacteria
that they are intended to kill.
7. Antibiotics are immediately needed for sinus infections and ear infections.
8. Bacterias are more likely to affect children that is why antibiotic resistance is not that much of
a concern, especially to adults.
9. Different bacterial infections need different antibiotics so there isn’t a single antibiotic that
caters to all infections.
10. Antibiotic resistance developed due to the misuse of antibiotics which led to its ineffectiveness.
11. It is not a good idea to use leftover antibiotics from a previous treatment to treat other
infections.
12. Antibiotic resistance is not developed by skipping one or two doses of an antibiotic treatment.
13. Antibiotics remove the need for surgical or other intervention
14. If you are taking antibiotics, it's OK to stop taking the medicine when you start to feel better.
15. Antibiotics only work on bacterial infections and should not be used to treat viral infections.
16. Antibiotics come in different forms such as tablets, capsules, liquid, lotions, injections and drip
administrations.
17. Colds and runny noses, regardless of how thick, yellow, or green the mucus is, cannot be
treated by any antibiotic.
18. Antibiotics can induce negative effects and lead to antibiotic resistance whenever they are
taken simultaneously.
19. If one feels better after only partially completing an antibiotic course, one can terminate the
therapy immediately.
20. The body can usually fight mild infections on its own without antibiotics.
21. I usually know how infections should be treated
22. If I get an infection, I often wait and see if the infection goes away on its own
23. I think that it is good that one needs a prescription to acquire antibiotics from pharmacies in
the Philippines
24. I think that it is good to be able to acquire antibiotics from relatives or acquaintances, without
having to be examined by a doctor
25. I often know before I visit a doctor, whether I need antibiotics or not.
References Commented [U10]: Follow APA format

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