KNOWLEDGE AND PRACTICES RELATING TO UNPRESCRIBED ANTIBI-

OTIC USE AMONG COMMUNITY MEMBERS OF CENTRAL MINDANAO

UNIVERSITY

A Thesis Proposal will be Presented to the Thesis Committee and Faculty of

System

Technology Institute College of Nursing Global City

In Partial Fulfillment of the Requirements

for the Degree Bachelor of Science in Nursing

Glory Mi Shanley L. Carumba

Mary Claire L. Rosales

Eli Dablio

Presented by

OCTOBER 2022

1
 TABLE OF CONTENTS

PAGE
CHAPTER I: THE PROBLEM AND ITS BACKGROUND
Introduction 1
Theoretical framework 2
Conceptual framework 3
Statement of the problem 3
Hypothesis 3
Significance of the study 3
Scope and limitation of the study 4
Definition of terns 4

CHAPTER II: REVIEWS OF RELATED LITERATURE AND STUDIES

2.1 Review of Related Literature 14 6
2.2 Related Studies 6

CHAPTER III: METHODOLOGY

3.1 Research Design 9
3.2 Research Locale 9
3.3 Study Population 9
3.4 Data Gathering Procedure 9
3.5 Instrument to Use 10
3.6 Ethical Consent 11
3.7 Method of Analysis 11

REFERENCES 12

2
1
 CHAPTER I
THE PROBLEM AND ITS BACKGROUND

Introduction
Antibiotics are one of the drug classes that are sold most often in de-
veloping countries (Buke et al., 2003). When antibiotics are used too much or
for the wrong reasons, bacteria that can't be killed by them grow. This can
cause side effects and put a financial strain on the national health system
(Gyssens, 2001). This irrational use is caused by economic factors, health
policies about medical insurance, doctors who don't care about long-term re-
sistance and effects in favor of treating current symptoms, pharmaceutical
marketing, and the fact that in some countries, antibiotics can be bought with-
out a prescription (Metlay et al., 1998, McManus et al., 1997).
Misusing or overusing antibiotics is a direct cause of antibiotic resis-
tance (ABR), which happens because people don't know enough about antibi-
otics, are careless, or have the wrong ideas about these unprescribed medi-
cations. Antibiotic resistance has a big effect on both the economy and the
health of a country (World Health Organization, 2016). Patients' belief that an-
tibiotics are very effective and that they work for all illnesses has led to their
overuse, which is one of the main reasons why ABR is growing so quickly. Pa-
tients thought, for example, that antibiotics would help them get better from vi-
ral respiratory illnesses like the common cold. People are becoming more re-
sistant to antibiotics because they are overused and not used properly (Bar-
riere, 2015). People who get infected with resistant strains and are often hard
to treat, have to stay in the hospital longer, die more often, and need to take a
wide range of antibiotics that could be dangerous (WHO, 2016). In fact, there
is a lot of evidence (Cosgrove et al., 2005; Sunenshine et al., 2007) that infec-
tions caused by microbes that are resistant to antimicrobials are linked to
higher mortality, morbidity, and financial loss.
Antibiotic resistance poses a burden and stress to the resource-scarce
healthcare system already existing in developing countries through increasing
treatment costs, increasing the risk of adverse drug reactions, long duration of
hospital stays, and increased mortality due to manageable conditions. Glob-
ally, it is thought that 10 million people will die from infectious diseases by
2050 if no new antibiotics are found and existing ones are not protected from
resistance. Several ideas have been put forward to fight antibiotic resistance,
such as educating the public about the right way to use antibiotics and the
dangers of taking them without a doctor's advice. But before intervention
strategies are put in place, it is of the utmost importance to know how much
antibiotic users know about the problem. Therefore, this study will find out
what Central Mindanao University community members know and do about
using antibiotics without a physician’s prescription. Expanding the assess-
ment would give a broader perspective on the issue that would help plan ap-

1
propriate interventions.

Theoretical Framework

Health Belief Model (HBM)

The Health Belief Model (HBM) theory will be employed in this study to
choose variables. According to HBM, modifying factors (such as age, gender,
ethnicity, level of education, socioeconomic status, and knowledge) as well as
personal views can have an impact on a person's health behavior. The HBM
proposes that a person's belief in a personal threat of illness or disease, along
with a person's conviction in the efficacy of the recommended health behavior
or activity, will predict the likelihood the person would adopt the practice. With
the premise that the two elements of health-related behavior are the desire to
avoid sickness, or alternatively get well if already ill; and, the belief that a spe-
cific health action will prevent, or cure, illness, the HBM is based on psychol-
ogy and behavioral theory. In the end, a person's course of action frequently
hinges on their judgments of the advantages and disadvantages of engaging
in healthy behaviors.
Researchers will utilize this model to figure out why people's behavior
changes when they take medicine. People think that the Health Belief Model
(HBM) is a complete and useful program that will help researchers reach their
goals. The main parts of this model are based on theories of psychology and
behavior. This model's main goal is to find and understand the factors that af-
fect behavior and how they might work. This model also shows how to change
these things in different situations. Based on this model, if a person wants to
change his or her behavior, he or she must first be susceptible to a phenome-
non, like self-medication (perceived susceptibility), and then realize how bad it
is for his or her life (perceived severity). Then, she or he should admit that
changing their behavior would help and stop taking drugs on her or his own
(perceived benefits). Also, he or she should be able to get around problems
like costs that make it hard to act (perceived barriers).

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Conceptual Framework
Community members
of Central Mindanao
University

Independent Dependent vari-

variable able

Knowledge and Prac-

tices
- Indication of the antibi-
otic Unprescribed an-
- Identification of the an- tibiotic consump-
tibiotic tion
- Side effects of the an-
tibiotic
- Antibiotic resistance

Consultation to the
medical doctor

Statement of the Problem

The purpose of this study is to evaluate the knowledge and practices of
community members of Central Mindanao University (CMU) with the use of
unprescribed antibiotics. Specifically, it sought to answer the following sub-
problems:
1. What are the behaviors of the community members of CMU when
seeking a professional medical doctor?
2. What are the associated factors affecting the use of unprescribed
antibiotics?
3. What are the respondent’s understanding of the role of antibiotics,
their side effects, and antibiotic resistance?

Hypothesis
The knowledge and practices of community members of CMU tend to
consume unprescribed antibiotics, which hinders them from seeking profes-
sional advice.

Significance of the Study

The purpose of this study is to evaluate the knowledge and practices of
community members of Central Mindanao University (CMU) with the use of

3
unprescribed antibiotics, which will thereby determine their behaviour in seek-
ing a professional medical doctor.

Scope and Limitation of the Study

This study will be conducted at Central Mindanao University. The selec-
tion of respondents is limited to the community members of the said univer-
sity. Respondents will be chosen regardless of their gender, marital status,
level of education, or job situation. The study is limited to the knowledge and
practices relating to unprescribed antibiotic use among the community mem-
bers of the said location. It does not include the financial issues and other
problems of the respondents.

Definition of Terms
For a better understanding of the study, the following terms are de-
fined according to the context in which they are used.
Antibiotics - A medicine (such as penicillin or its derivatives) that in-
hibits the growth of or destroys microorganisms.
Assessment - The evaluation or estimation of the nature, quality, or
ability of someone or something.
Bacteria - A member of a large group of unicellular microorganisms
which have cell walls but lack organelles and an organized nucleus, in-
cluding some that can cause disease.
Disease - A disorder of structure or function in a human, animal, or
plant, especially one that produces specific signs or symptoms or that
affects a specific location and is not simply a direct result of physical in-
jury.
Drugs - a medicine or other substance which has a physiological effect
when ingested or otherwise introduced into the body.
Infection - The invasion and multiplication of microorganisms such as
bacteria, viruses, and parasites that are not normally present within the
body.
Medicine - A compound or preparation used for the treatment or pre-
vention of disease, especially a drug or drugs taken by mouth.
Microbes - A microorganism, especially a bacterium causing disease
or fermentation.
Phenomenon - A fact or situation that is observed to exist or happen,
especially one whose cause or explanation is in question.
Resistance - The refusal to accept or comply with something; the at-
tempt to prevent something by action or argument.
Respiratory Illnesses - An acute or chronic illness affecting the respi-
ratory system; includes acute respiratory infections, bronchitis, pneu-
monia, influenza, and chronic obstructive pulmonary diseases.
Side Effects - A secondary, typically undesirable effect of a drug or
medical treatment.

4
Susceptible - Likely or liable to be influenced or harmed by a particular
thing.

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 CHAPTER II

REVIEW OF RELATED LITERATURE AND STUDIES

Antibiotic use and resistance

According to Ghaddar, A., et al., (2020) in the last 50 years, antibiotics
have been shown to be a powerful weapon against a number of diseases.
Pathogenic bacteria that are resistant to antibiotics are becoming more com-
mon and spreading in the human population. This is a growing problem
around the world and a major threat to public health in the 21st century, espe-
cially in developing countries. Self-medication, wrong prescriptions, wrong
use, and too much use of these antimicrobial drugs could be the main causes
of the growth and spread of antimicrobial resistance (AMR), along with other
social and cultural factors that are just as important. This rise in antibiotic re-
sistance will eventually make them less effective as treatments and lead to
more treatment failures, which will cause more severe illnesses with higher
death rates. Not to mention how hard this will be on the world's economies
and the different systems for managing health care.
When antibiotics are used carelessly, bacteria that are resistant to an-
tibiotics grow. These bacteria can cause infections that are hard to treat. An-
timicrobial resistance is also a global problem, according to the World Health
Organization. Misusing antibiotics leads not only to antibiotic resistance, but
also to failed treatments, longer stays in the hospital, and a financial burden.
Self-medication, poor compliance, buying antibiotics over-the-counter, not
knowing how to use antibiotics correctly, and getting health care from sources
other than a doctor are all things that lead to the wrong use of antibiotics
(Bhardwaj, K., et al., 2021).

Self-Medication with Antibiotics

Antibiotic self-medication has become a big problem and is one of the
main reasons antibiotics don't work as well as they used to. Self-medication
with antibiotics can happen for a number of reasons, such as a lack of knowl-
edge and attitude about antibiotics, easy access to antibiotics in many places,
and a lack of policies to raise awareness about how antibiotics should be
used [8]. Several studies have found that university students use antibiotics
incorrectly because they self-medicate and don't know enough about them. In
particular, their uses, how well they work against pathogens, and how well
they work with dosage schedule.

Antibiotic abuse
The emergence of antibiotic resistance – "an inherent nature of the
bacteria as a means of survival (Mutagonda et al., 2022)", is still a rising pub-
lic health concern as many individuals are using antibiotics without proper
knowledge of what an antibiotic is. Antibiotics refer to "medicines that fight in-

6
fections caused by bacteria in humans and animals by either killing the bacte-
ria or making it difficult for the bacteria to grow and multiply (CDC, 2021)." Of-
ten, the problem that has been identified in delivering effective health care is
the inappropriate consumption of antibiotics (Radyowijati & Haak, 2003). Self-
medication, a common practice among the community members in the Philip-
pines, is defined as a self-care referring to the use of medicinal products or
the misuse of administering prescribed medications through sharing, mostly
within family members, to treat self-diagnosed symptoms (Barber et al.,
2017).

People who are likely to abuse antibiotic

Irrespective to individuals' education level, antibiotics, however, are be-
ing misuse (Mallah et al., 2022). Developing countries, such as Philippines,
are more likely to be vulnerable in antibiotic abuse as poverty exposes them
in neglecting medical professional consultation. The major contributor of mor-
bidity and mortality in low-income countries are those diseases that are bacte-
rial in origin (Radyowijati & Haak, 2003). Furthermore, poor healthcare system
and services is nevertheless the greatest factor in influencing the actions of its
subjects.
Factors of antibiotic misuse
According to several pharmacists, due to their accessibility, people pre-
fer to get antibiotics from neighborhood pharmacies rather than hospitals.
These pharmacists assert that going to community pharmacies not only saves
patients' time by preventing the long lines they would have to wait in for con-
sultations or for their prescriptions to be filled or dispensed, but it also saves
them money since private hospitals typically charge more for consultations.
(Alhomoud, et al., 2018). The use of antibiotics by patients is influenced by a
variety of crucial elements, including attitudes and beliefs, subjective norms,
self-efficacy, and knowledge, according to prior studies. (Byrne, et al., 2019;
Alurman, et al., 2014; Hawkings, et al., 2008).
Furthermore, Vasquez-Cancela et al. (2021) said that the primary
causes of antibiotic misuse and abuse as cited by the general people were
found to be: ignorance of antibiotics; issues with the doctor-patient relation-
ship; issues with adherence; and usage without a prescription. The following
were also noted, even though they were not stated as causes: a failure to rec-
ognize the issue; and external attribution of blame.

Neglecting professional health consultation

Even if a patient has health insurance and is therefore unconcerned
about the price of the consultation or the medication, these fees are neverthe-
less upsetting. Even people with insurance considered going to a private hos-
pital to be difficult because of the lengthy waits (a doctor's appointment could
take three to four hours), as well as the longer travel distances. (Alhomoud, et
al., 2018). Going to a private hospital will cost you extra money because you'll

7
be charged for both the visit and the medication. Bahnassi (2018). In contrast
to hospitals, where patients must wait longer to see a doctor, pharmacies al-
low patients to explain their ailments and receive antibiotics right away. (Abry,
et al., 2014).

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 CHAPTER III

RESEARCH METHODOLOGY

3.1 Research Design

A qualitative research design will be used to collect data through one-
on-one interviews to find out what the respondent/s know about antibiotics,
antimicrobial resistance, and how they buy antibiotics without a prescription.
The researchers will employ open and close-ended questions as it produce a
process that enables participants to self-disclose, which offers insight into
their behavior (Khan et al., 1991). The interview guide will be developed
based on a study of the literature on antibiotic awareness, knowledge, atti-
tudes, beliefs, and behavior and will be structured in accordance with best
practice guidelines (Krueger & Casey, 2015).

3.2 Research Locale

The study will be conducted at Central Mindanao University, University
Town, Musuan, 8710 Bukidnon, Philippines.

Figure 1. Map of Central Mindanao University

3.3 Study Population

The target population of the interview will be the community surround-
ing Central Mindanao University. Respondents will be chosen regardless of
their gender, marital status, level of education, or job situation.

3.4 Data Gathering Procedure

In-depth qualitative interviews will be used to collect the data from the
respondents. The interviews will be semi-structured and based on an inter-
view guide that is thematically organized based on the application of Health
Belief Model (HBM) constructs to antibiotic issues. The Health Belief Model
(HBM) will be utilized to make the interview guide, analyze the data, and dis-
cuss the results. HBM is a psychological model that is used a lot to explain

9
how and why people change and maintain healthy behaviors, especially in
studies of infectious diseases. The HBM says that personal demographic and
psychological factors affect how people think about how serious a disease is
and how likely they are to get it, as well as the barriers to treatment and the
benefits of treatment. Each of these ideas can help explain how people act in
ways that are good for their health. By comparing these health beliefs to pos-
sible cues for action and the person's sense of self-efficacy, the researchers
can get a better idea of how people act in terms of their health. Table 1 de-
scribes how HBM constructs will be applied to this study. Open-ended an-
swers will be looked at to find out as much information as possible about the
respondent's experiences and points of view about unprescribed antibiotic
use.

Table 1. Application of the Health Belief Model constructs

Construct Application

Perceived susceptibility Participants’ subjective perception of

the likelihood of being affected by AR

Perceived seriousness Participants’ perception of the sever-

ity of the AR situation

Perceived benefits Participants’ perception of the bene-

fits of engaging in judicious behavior
in relation to antibiotics

Perceived barriers Participants’ perception of barriers in

engaging in judicious behavior in re-
lation to antibiotics

Perceived self-efficacy Participants’ perceived competence

in engaging in judicious behavior in
relation to antibiotics

Cues to action Trigger mechanisms to prompt en-

gagement in judicious behavior in re-
lation to antibiotic use

3.5 Instrument to Use

The research instrument consists of two parts. Part 1 of the research
instrument includes the collection of items that gather the respondents' pro-
files, such as their name (though optional), sex, age, educational attainment,
and occupation. Part 2 of the research instrument is the structured interview. It
consists of five open-ended questions, which will require a maximum time of

10
fifteen minutes.

3.6. Ethical Consent

In order to assess the research proposal and the sample tools that will
be utilized in this study and receive a certificate confirming that the data col-
lection procedure is moral and ethical, approval will be requested from the
Central Mindanao University's ethics committee office.
The study's participants would be asked to give their informed consent
after thoroughly explaining the purpose of the study to them. The participants
in this study will also be given the assurance that any information requested
from the respondents should not divulge any information that could identify
their names, and that the information obtained from them will be kept private
and utilized solely for this study. The participation of the respondents would be
entirely optional, and they may opt out of the study whenever they wanted.

3.7. Method of Analysis

The researchers will employ a Thematic analysis approach to explore
community knowledge and use of antibiotics in the sampled population and to
analyze the collected data and create a logical structure for the research.

11
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