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Journal of Asian Association of Schools of Pharmacy 2019; 8: 64–71
© 2019 The Asian Association of Schools of Pharmacy Research Paper

Knowledge, attitude and practices on the use of antimicrobials among

residents in Towerville Phase 5, Barangay Minuyan, San Jose del
Monte, Bulacan, Philippines: A Questionnaire Survey

Perlita M. Crucis1,2,*, Elaiza Mariz B. Encarnacion1, April Mergelle Lapuz1,

Mylene Eva P. Magno1, Jocelyn S. Pantia1 and Lourdes Anne Q. Solis1
1 College of Pharmacy, Adamson University, 900 San Marcelino Street, Ermita, Manila 1000, Philippines
2 Graduate School, Centro Escolar University, 1001 San Rafael St, San Miguel Manila, 1008, Philippines

Received May 30, 2019 ABSTRACT

Revised September 27, 2019
Revised November 28, 2019 The development of antimicrobials played significant role in healthcare field. However,
Revised December 3, 2019 misuse of antimicrobials contributes to infections that become resistant to these agents.
Accepted December 4, 2019
Antimicrobial resistance is a global health problem associated with the increase in the
* Corresponding author morbidity and mortality. This study aims to assess the knowledge, attitude and practices on
College of Pharmacy, Adamson University, antimicrobial use in the community in Bulacan, Philippines. This was performed through
900 San Marcelino Street, Ermita, Manila convenience sampling on 153 adults in Towerville, San Jose Delmonte Bulacan, Philippines
1000, Philippines using questionnaire that included questions on demographic profile, knowledge, attitude,
E-mail: pcrucis@adamson.edu.ph
and practices towards antimicrobial use. The study was conducted on the month of
December 2018 to January 2019. Results show that majority of the respondents had poor
knowledge towards antimicrobial use. In contrast, mostly showed positive attitude, 50%
exhibited poor practices on antimicrobial use. Data also revealed that there was no
significant relationship between the respondents’ demographics and their knowledge,
attitude, and practices on use of antimicrobials. This implicates that proper education
regarding antimicrobial use should be employed to improve the knowledge of people.

Key words: antimicrobials, antimicrobial resistance, antimicrobial misuse

problem that is associated with the increase in morbidity and

1. Introduction
mortality rate since limited agents are being ineffective
Antimicrobial agents are drugs that kill or slow the growth against treating numerous diseases. The irrational use results
of pathogenic organism. Over the decades, antimicrobials are to the growth of resistant bacterial strains that leads to
recognized as one of the classes of drugs that are significantly problems on the health system. (Durão et al., 2018).
effective when it comes to fighting infections and curing Antimicrobial resistance is very alarming as it limits the
diseases. Its advancement contributed a lot and played antimicrobial agents. Also, it would require a lot of more
significant role in the field of health care as it increases life researches and supplies of more antimicrobials. Therefore,
expectancy of the people. It is an advantageous agent in many there would be a burden of unnecessary cost in the field of
aspects such as in executing different surgical procedures, in healthcare.
treating various infectious diseases and complications, and in Antimicrobial resistance is widespread in the Philippines
utilizing it as a prophylaxis for illnesses as well (MacGowan as well and has emerged as a public health concern.
and Macnaughton, 2017). Prevalent infections include multi-drug resistant tuberculosis,
Antimicrobial resistance (AMR) as a major health pneumonia, malaria, and HIV-AIDS. It is stated that one of
dilemma worldwide compromises the ability to treat the factors that lead to AMR is self-medication of patients
infectious disease and thus increasing health care costs. and lack of adequate supervision of the physicians. On the
Globally, at least 70,000 die every year because of drug other hand, pharmacists have the responsibility of dispensing
resistance in illnesses like bacterial infection, malaria, drugs like antimicrobials and ethical drugs which are only
HIV/AIDS and tuberculosis. The study of Yusef et al. (2018) dispensed if patient has a prescription. Thus, dispensing of
proves that antimicrobial resistance is a global health ethical drugs without prescription is strongly prohibited

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(Carlos et al., 2016). the population of Towerville using 95% Confidence level and
This study aimed to determine the knowledge, attitude and 8% margin of error. The sampling size were 153 residents.
practices on the use of antimicrobials among residents in In recruiting the respondents who participated in the study,
Towerville Phase 5, Barangay Minuyan, San Jose Del Monte, the researchers selected based on the accessibility of the
Bulacan. The research setting is an adopted community of respondents. This can cause bias, hence, the selection was
the Integrated Community Extension Services (ICES) of equally distributed in the different areas of the community in
Adamson University which reaches to marginalized order to reduce the bias.
communities to fulfill its mission to help the poor. The
study serves as basis to develop and implement healthcare 2.4. Inclusion/Exclusion Criteria
programs in this community. The participants of this study were people in the age
This study will help in the analysis of the prevention of group of 18 years old and above considering that they have
AMR by assessing the perception of the residents of the used antimicrobial at least once. The participants were
community of Towerville in terms of their knowledge, residing at Towerville Phase-5, Barangay Minuyan. Lastly,
attitude and practices on their use of antimicrobial agents. all respondents were willing to participate in this study.
This will serve as a reference and help the local leaders and
health care providers to educate the community on the 2.5. Reliability Test and Pre-Test
rational use of antimicrobials and create action plans to The researchers used Cronbach alpha analysis to
combat AMR, thus will be beneficial to the community. determine the reliability of the questionnaire. With a pilot
survey of 15 participants, the analysis measured the interval
2. Methodology consistency of the survey. The qualifications of respondents
who participated in the Pilot study was also similar to the
2.1. Research Design inclusion criteria of the respondents in the actual study. A
This descriptive study utilized a validated survey Cronbach’s Alpha of greater than 0.80 was considered ‘good’
questionnaire that was adapted from an unpublished local and supported the reliability of the instrument. The overall
study of Centro Escolar University– Manila entitled result that was generated was 0.8095. Pilot survey was
“Knowledge, Attitude and Practices on the Use of conducted to examine the feasibility of an approach that is
Antimicrobial of Teaching and Non-teaching personnel of intended for the entire sample size. Changes were applied for
Centro Escolar University– Manila” in order to gather the any probable problems of the questions or questions about
data regarding their use of antimicrobials. instrument.

2.2. Research Setting 2.6. Research Instrumentation and Measurement

This study was conducted in the community of Towerville A survey questionnaire was used in determining the
Phase 5, Barangay Minuyan, San Jose del Monte Bulacan, respondent’s knowledge, attitude and practices on using
Philippines. Since it represents as one of the sub-urban area antimicrobials in the community Towerville. The question-
of the Philippines and an adopted community of Adamson naire was composed of 28 questions classified into four parts:
University, the researchers were able to determine the socio demographic profile, knowledge, attitude and practices
knowledge, attitude and practices of the people regarding on regarding the use of antimicrobials.
the use of antimicrobials in the perspective of the residents in
a sub urban setting. a. Socio demographic profile
Towerville is a community in San Jose del Monte, The demographic characteristics consist of the age, gender,
Bulacan under Barangay Minuyan that is comprised of 950 educational attainment, financial income, and number of
hectares land. The community is divided into five areas: household members of the respondents. These helps correlate
phase-1, phase-2, phase-3, phase-4A, phase-4B, and phase 5. and understand the respondents’ knowledge, their attitude
This study was limited in Phase-5 of Towerville which is and their practices on the use of antimicrobials.
comprised of 2,300 families. The 85% of the population came
from the resettlement project of the National Government b. Assessment on knowledge towards antimicrobials
that was facilitated by the National Housing Agency. The respondent’s knowledge on antimicrobials was
determined by using a Ten-item questionnaire that is
2.3. Sampling and Sampling size answerable by yes or no. The percentage of the correct
A convenience sampling technique was utilized as answers were classified as poor or adequate knowledge. A
sampling method in conducting the survey. The respondents score of 8 out of 10 was considered as adequate knowledge.
were selected because of their convenient accessibility and Scores lower than 8 was considered as poor knowledge
proximity for the study, due to limited resources. The towards antimicrobial use.
researchers used Slovin’s formula to acquire the sample from

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c. Assessment on attitude towards antimicrobials Table 1. Demographic Profile (n = 153).

The respondent’s attitude regarding the use antibiotics
was assessed using a Ten-item questionnaire that was
answerable by yes or no. The percentage of the correct
answer was classified as negative or positive attitude. A score
of 8 out of 10 was considered as positive attitude. Score lower
than 7 was considered as negative attitude towards the use of
antimicrobials.

d. Assessment of practices towards antimicrobials

The practice of the respondents towards the use of
antimicrobials was determined by using an eight-item
questionnaire that was answerable by yes or no. The
percentage of the correct answers were classified as good or
poor practice. A score of 6 out of 8 was considered as good
practice. Score lower than 5 was considered as poor practice
towards the use of antimicrobials.

2.7. Data Collection and Analysis

The survey was conducted in the residents of Towerville
Phase 5, Barangay Minuyan, San Jose Del Monte, Bulacan,
Philippines on the month of December 2018 to January 2019. household members of the respondents show that most of
The data were presented in frequency, percentages and 95% them have household members within the range of 4–5
confidence interval and were analyzed as: adequate or poor member (33.39%) and more than 5 members (33.33%).
knowledge, positive or negative attitude and good or poor
practice. To determine the significant relationship of the 3.2. Knowledge of the respondents toward antimicrobial
knowledge, attitude and practices to the respondent’s use
demographic profile, Chi-square test was used and a p-value Table 2 shows that 75.82% of the respondents presume
of <0.05 was considered as a significant relationship. If the that the more expensive the antimicrobials are, the more
assumptions for Chi-square test were not met, Fisher’s exact effective it will be. This means that the respondents
test was used. The collected data was analyzed using STATA believed that the more expensive the antimicrobial, the
ver. 13 software. more effective it is. This shows that there is a misconception
that effectiveness of antimicrobials is dependent on its price
2.8. Ethical Considerations (Shrank et al., 2009).
The protocol of this study along with other necessary The study also shows that 62.75% of the respondents
documents was approved by the University Ethics Review answered that antimicrobials can treat common colds and
Committee (UERC) of Adamson University with approval 77.78% of the respondents believed that antimicrobials are
code of 2018-02-PHA-04 issued on November 26, 2018 for indicated to reduce pain and inflammation. The use of
ethical considerations. antibiotics for common colds, pain and inflammation is an
example of irrational use of antimicrobial which may lead to
3. Results AMR (Yusef et al., 2018).
Based on this study, it shows that 97% of the respondents
3.1. Demographic profile of the respondents (Table 1) have poor knowledge. This high percentage is very striking
Majority of the respondents were female (77.12%) since lack of understanding on the use of antimicrobials could
comparing to male (22.8%). A sample of adults within the lead to antimicrobial resistance. One of the most important
ages 18 years and older in which majority were 42 years and factors for battling antimicrobial resistance is ensuring
older (35.29%). 27.45% were within the age group of 36–45 awareness of the community by proper education. Regulating
years old. The educational attainment of the respondents the dispensing of antimicrobials may also help in limiting
shows that majority of them were high school graduate inappropriate and unnecessary use of it (Yusef et al., 2018).
(35.29%) and entered college but was not able to graduate In Figure 1, it shows that out of 153 respondents who
(20.26%). In terms of their financial income, most of the answered the survey, 101 respondents answered that
respondents are not financially stable due to low annual antimicrobials can cure diseases. About 73 respondents
income since the data shows that majority of them have an considered antimicrobials as a strong drug. The same number
annual income of below 785 USD (73.20%). The number of of individuals also believed antimicrobials is used for cough,

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Table 2. Knowledge on the Use of Antimicrobials of Residents in Towerville Phase 5, Barangay Minuyan, San Jose Del Monte, Bulacan,
Philippines.

positive attitude on antimicrobial use. This reveals that the

respondents were aware that antimicrobials should be used
only when prescribed by a physician. Since antimicrobials are
used to treat different infections, it is important to ask for the
physician’s advice first. The community can seek medical
advice from the barangay health centers since there are
enough barangay health centers in the community. However,
the availability of the health centers limits their visit to the
barangay centers because of its distance. Access on the health
centers are only restricted on weekdays and there is only one
Figure 1. Respondents’ Own Perception on Antimicrobial.
doctor present in the said health centers.
Figure 2 presents the respondents’ basis on the selection
colds and sore throat but only few individuals were aware of antimicrobials. Out of 153 respondents, 148 chose doctor’s
that antimicrobials could be used for pain. These implies prescription as their basis of selecting antimicrobials. Most of
that most of the respondents were unmindful of what the respondents had a positive attitude when it comes to
antimicrobials are used for. In addition, 64 respondents selection of antimicrobials. The respondents were aware that
considered antimicrobials as their first choice of treatment. doctor’s prescription should be the primary basis in selecting
This shows that the respondent’s first line of treatment in an antimicrobial. This result is comparable to the study of
terms curing diseases is the use of antimicrobials and they use Abu-Mostafa et al. (2017) in which it showed that the
it even for pain. The role of the pharmacists plays very consumers use antimicrobials from the advises of physician.
important in the education the patients on drug use. A study Figure 3 shows the factors considered by the respondents
in Jordan highlights the educational intervention an effective when buying antimicrobials. It shows that 99 respondents
tool in order to improve the knowledge of the people with answered that brand is a significant factor when buying
regards to the proper use of drugs. This include prevention of antimicrobials while 97 respondents also answered that the
unnecessary use of antimicrobials. Pharmacists as one of the price is one of the aspects to be considered. This study shows
healthcare providers are the one responsible in providing that the main factors considered by the respondents when
drug information in order to improve the knowledge of buying antimicrobials are the brand and the price. In the study
people on antibiotics use and AMR. Pharmacists plays a key conducted by Shrank et al. (2009), consumers preferred
role being more accessible educators than other healthcare branded drugs over generic ones because they believed that
professionals (Shehadeh et al., 2016). branded drugs are more effective than generic drugs. Another
factor that was considered is the price of the antimicrobials
3.3. Attitude of the respondents toward antimicrobial use since drug prices of antimicrobial drugs are usually expensive,
Based on Table 3, all of the questions were correctly they tend to check on the price before buying it but also
answered by the respondents which means they showed ensuring the quality of the drug product.

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Table 3. Attitude on the Use of Antimicrobials of Residents in Towerville Phase 5, Barangay Minuyan, San Jose Del Monte, Bulacan,
Philippines.

investigated in the study by Tong et al. (2018), there are

reasons for non-compliance to antimicrobial therapy which
include factors that are patient-related such as financial
limitation, poor knowledge and communication skills of the
medical staff contributes to the poor compliance to the
treatment.
Figure 4 shows that 73% of them stated that their reason
is the antibiotic’s cost is very expensive. The cost of the
medicine is still the primary reason why full compliance on
Figure 2. Respondents’ Basis on their Selection of Antimicrobials. drugs is not achieved. In this study, majority (73.20%) of the
respondents has an annual income of below 785 USD which
may imply that they are financially not capable to comply to
the suggested regimen (Tong et al., 2018).
Figure 5 shows that 38% of them stated that their reason
was in order to save expenses and time from consulting the
doctors. This shows that respondents do self-medication
which is contributing factor of AMR. Self-medication is
rooted to expensive health care system. Thus, government
must formulate proper healthcare policies and regulate
approaches regarding appropriate self-medication (Rather et
al., 2017). In line with this, pharmacists play a crucial role in
the community by emphasizing to the general public the
Figure 3. Factors considered by the Respondents when buying an
antimicrobial.
importance of safe and effective medicines use (Hadi et al.,
2016).
Based on the status of the community of Towerville, it
3.4. Practices of the respondents toward antimicrobial use shows that it is composed of relocated informal settlers
Table 4 shows that 60.13% of the respondents reported from different areas in Manila due to improvement and
that they do not purchase the complete dose of antibiotic that rehabilitation of North Rail-South Rail Linkage Project of the
was prescribed to them for several reasons. 58.82% of the National Government. Due to that factor, it indicates that
respondents do not self-medicate and 54.25% of the majority of the residents in the community shows that they
respondents stop taking their antibiotics the moment they feel are generally not well-off in terms of economic status,
better. This is a misconception of the respondents that once educational attainment, and financial income that may affect
they feel better, they will quit the treatment. Non-compliance their practices regarding the use of antimicrobials.
to antibiotics treatment can lead to antimicrobial resistance as Figure 6 shows the health conditions for which the

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Table 4. Practices on the Use of Antimicrobials of Residents in Towerville Phase 5, Barangay Minuyan, San Jose Del Monte, Bulacan,
Philippines.

Figure 4. Reasons of the Respondents’ for not buying the complete

dose.
Figure 6. Health Conditions for which the Respondents have used
antimicrobials.

respondent’s used an antimicrobial. It shows that 87 of the

respondents used an antimicrobial for their cough. The reason
for this may be because many Filipinos have used an
antimicrobial for the treatment of their persistent cough
and tuberculosis. It also shows that 83 respondents use
antimicrobials for skin wounds and injuries. This study shows
that people tend to practice using antimicrobials as a
treatment for skin wounds and injuries by wrong manner of
administration. It has been a norm before that the active
ingredients inside the capsule were mistaken to be used as a
dusting powders for skin wounds which is considered as an
Figure 5. Respondents’ Reason for Self Medication. antimicrobial misuse. Irrational use of antimicrobials is one
of the significant causes of AMR which is validated by the
study of Jones et al. (2005).

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Table 5. Relationship of the Respondents' Demographics and their Knowledge, Attitude, and Practices on the Use of Antimicrobials.

3.5. Relationship of the respondents’ demographics and be explained by Reasoned Action theory which states that a
knowledge, attitude, and practices towards antimicrobial person’s intention to a specific behavior is determined by the
use person’s belief that a given outcome will occur if he will
Based on Table 5, there is no significant relationship perform the behavior. In relation to this study, the practices
between the respondents’ demographics and their knowledge, of the community related to antibiotic use were dependent on
attitude and practices on the use of antimicrobials since the their knowledge in this aspect.
p-value is > α = 0.05 for it to be considered to have significant The results showed only 97% of the respondents had a
relationship. It shows that results revealed to be independent poor knowledge on antimicrobials. The high percentage of
regardless of the demographic profile of the respondents. the respondents failed to recognize the proper indication of
Several factors can be correlated as to why it shows no antimicrobials. In contrary to this, the respondents have
significant relationship. One of the factors was that the positive attitude on antimicrobials. They may lack awareness
respondents may have similar behavior since they belong to regarding the use of antimicrobials but showed positive
one community. People tend to adapt the habits of other beliefs on the course of treatment for antimicrobials.
individuals surrounding them. Moreover, the community of The results revealed that 64% of the respondents exhibited
Towerville is composed of relocated families from Metro a positive attitude towards the use of antimicrobials.
Manila that specify that the respondents may have similar Regardless of the positive attitude on antimicrobial use, the
way of living. result showed they have poor practice. They are hierarchical
in a sense that knowledge influences the development of
4. Discussion
attitude, and attitude influences the practice. However, there
The study shows that 64.71% of the respondents’ is a gap that shows struggle in some developing countries
exhibited poor practice on antibiotic use that results to since respondents shows positive attitude but have poor
information on the respondent’s behavior on what they know, practice. This can be explained that despite being mindful
which can be validated by weak correlation (r = 0.026) about the correct attitude, people weren’t able to apply it into
between knowledge and practice on the use of antibiotics of practice due to some factors like financial incapacity of the
the community as shown in this study. This weak correlation respondents. (Ibrahim et al., 2018).
between the two; poor knowledge results to poor practice can

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5. Conclusion Resistance. Research Institute for Tropical Medicine. 2016; 1-61.

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