DEVELOPMENT AND VALIDATION OF A QUESTIONNAIRE ASSESSING KNOWLEDGE, ATTITUDE, AND PRACTICE TOWARD ANTIBIOTIC USE AMONG PARENTS

Parental Antibiotic usage

Authors

  • SIREESHA PARUCHURI Clinical Pharmacy and Pharmacy Practice Unit, Faculty of Pharmacy, AIMST University, Kedah, Malaysia. https://orcid.org/0000-0002-2558-8280
  • SARASWATHI SIMANSALAM 1Clinical Pharmacy and Pharmacy Practice Unit, Faculty of Pharmacy, AIMST University, Kedah, Malaysia. https://orcid.org/0009-0004-6515-2432
  • ELANGKOVAN RAMAKRISHNAN Department of Paediatrics, Faculty of Medicine, AIMST University, Kedah, Malaysia.
  • GANESH PANDIAN BALASUBRAMANIAN Clinical Pharmacy and Pharmacy Practice Unit, Faculty of Pharmacy, AIMST University, Kedah, Malaysia. https://orcid.org/0000-0001-9203-5259

DOI:

https://doi.org/10.22159/ajpcr.2026v19i3.57240

Keywords:

Antibiotics, Pediatrics, Parents Knowledge, Questionnaire Development, Validity, Reliability

Abstract

Objective: Antibiotics can only treat serious bacterial infections. However, public’s misconception, that antibiotics cure every disease including viral infections leads to misuse. Common practices such as irregular intake, self-medication, and obtaining antibiotics without prescription contribute to antimicrobial resistance, which is threatening global health. This study aims to develop and validate appropriate scales to measure parents’ knowledge, attitudes, and practices (KAPs) regarding antibiotic use.

Methods: A questionnaire on assessing KAP about antibiotic use was constructed and tested among the parents in Kedah, Malaysia. Reliability and test-retest stability were assessed using Cronbach’s alpha and the intraclass correlation coefficient. Factor analysis confirmed construct validity, with items expected to load strongly on single factors. Data were collected June–August 2024 from parents of children ≤12 years.

Results: Reliability testing showed a very high internal consistency and test-retest reliability (all scales score higher than 0.7 on Cronbach’s alpha). Exploratory analysis for attitudes revealed four factors, and for practices, two, with good variance accounted for (>70%). Items with loadings <0.4 were eliminated. Kaiser-Meyer-Olkin (KMO) measure > 0.6 and Bartlett’s test p<0.001 confirmed data adequacy. Of the 46 young, educated Chinese parents involved, knowledge and attitude scores were moderate according to Bloom’s criteria.

Conclusion: The final tool included 17 items of knowledge, 11 of attitude, and 9 of practice, which all showed validity and reliability. Participants had moderate knowledge, a neutral attitude, and practices. Further validation is recommended before wider use.

Downloads

Download data is not yet available.

References

1. World Health Report. A Safer Future-Global Public Health Security in the 21st Century. Geneva: World Health Organization; 2007.

2. Centers for Disease Control and Prevention. Antibiotic Resistance. Atlanta: CDC; 2015. Available from: https://www.cdc.gov/getsmart/ community/about/antibiotic-resistance-faqs.html

3. Lim KK, Teh CC. A cross sectional study of public knowledge and attitude towards antibiotics in Putrajaya, Malaysia. South Med Rev. 2012;5(2):26-33. PMID 23532680

4. Antimicrobial Resistance Collaborators. Global burden of bacterial antimicrobial resistance in 2019: A systematic analysis. Lancet. 2022;399(10325):629-55. doi: 10.1016/S0140-6736(21)02724-0, PMID 35065702

5. Ministry of Health Malaysia. Ministry of Agriculture and Agro-Based Industry Malaysia. Malaysian Action Plan on Antimicrobial Resistance (MyAP-AMR) 2017-2021. Putrajaya, Malaysia: Ministry of Health; 2017.

6. Streiner DL, Norman GR. Health Measurement Scales a Practical Guide to their Development and Use. 4th ed. New York: Oxford University Press; 2008. p. 507.

7. Machin D, Campbell MJ, Tan SB, Tan SH. Sample Size Tables for Clinical Studies. 3rd ed. Oxford, UK: John Wiley and Sons Limited; 2009. p. 314.

8. Marx RG, Menezes A, Horovitz L, Jones EC, Warren RF. A comparison of two time intervals for test-retest reliability of health status instruments. J Clin Epidemiol. 2003 Aug;56(8):730-5. doi: 10.1016/ S0895-4356(03)00084-2, PMID 12954464

9. Acock AC. Discovering Structural Equation Modeling using Stata. Texas: Stata Press; 2013. p. 306.

10. Islam MW, Shahjahan M, Azad AK, Hossain MJ. Factors contributing to antibiotic misuse among parents of school-going children in Dhaka City, Bangladesh. Sci Rep. 2024;14(1):2318. doi: 10.1038/s41598-024- 52313-y, PMID 38282010

11. El-Din MA. Assessment of parental knowledge, attitudes and practice towards antibiotic use in Egyptian pediatric community, Qalyubia. Egypt J Hosp Med. 2024;94:24.

12. Hansen MB, Rasmussen IS, Marloth T, Jarløv JO, Arpi M, Mogensen D, et al. A pre-post intervention study: knowledge among parents about child infections and antibiotic use facilitated by maternal and child health nurses. Nurs Open. 2022;10(2):641-8. doi: 10.1002/nop2.1330, PMID 36097329

13. Ivanovska V, Angelovska B, Van Dijk L, Zdravkovska M, Leufkens HG, Mantel-Teeuwisse AK. Change in parental knowledge, attitudes and practice of antibiotic use after a national intervention programme. Eur J Public Health. 2018 Aug;28(4):724-9. doi: 10.1093/eurpub/ckx240, PMID 29325065

14. Kandeel A, Palms DL, Afifi S, Kandeel Y, Etman A, Hicks LA, et al. An educational intervention to promote appropriate antibiotic use for acute respiratory infections in a District in Egypt-pilot study. BMC Public Health. 2019;19 Suppl 3:498. doi: 10.1186/s12889-019-6779-0, PMID 32326918

15. Szymczak JE, Klieger SB, Miller M, Fiks AG, Gerber JS. What parents think about the risks and benefits of antibiotics for their child’s acute respiratory tract infection. J Pediatr Infect Dis Soc. 2018;7(4):303-9. doi: 10.1093/jpids/pix073, PMID 28992328

16. Karuniawati H, Anjani RH, Utami K, Ismail WI. Evaluation of quantitative and qualitative use of antibiotics in community health centers, Boyolali District, Indonesia. Int J Appl Pharm. 2024;16(6):61-5.

17. Hammour KA, Jalil MA, Hammour WA. An exploration of parents’ knowledge, attitudes and practices towards the use of antibiotics in childhood upper respiratory tract infections in a tertiary Jordanian Hospital. Saudi Pharm J. 2018;26(6):780-5. doi: 10.1016/j. jsps.2018.04.006, PMID 30202217

18. Nshimiyimana M, Habtu M, Manishimwe F, Ndayisenga J, Murekatete A. Parental knowledge, attitudes and practices on antibiotics use for childhood upper respiratory tract infections in Kicukiro District, Rwanda. J Med Nurs Public Health. 2022;5(2):109-30. doi: 10.53819/81018102t5062

19. Paredes JL, Navarro R, Watanabe T, Morán F, Balmaceda MP, Reateguí A, et al. Knowledge, attitudes and practices of parents towards antibiotic use in rural communities in Peru: A cross-sectional multicentre study. BMC Public Health. 2022;22(1):459. doi: 10.1186/ s12889-022-12855-0, PMID 35255863

20. Qu W, Wang X, Liu Y, Mao J, Liu M, Zhong Y, et al. Self-medication with antibiotics among children in China: A cross-sectional study of parents’ knowledge, attitudes, and practices. Infect Drug Resist. 2023;16:7683-94. doi: 10.2147/idr.s431034, PMID 38144221

21. Shah NM, Rahim MA. Parental knowledge, attitudes and practices (KAPs) on the use of antibiotics in children for upper respiratory tract infections (URTIs). Int J Pharm Pharm Sci. 2017;9(3):105. doi: 10.22159/ijpps.2017v9i3.15674

Published

07-03-2026

How to Cite

SIREESHA PARUCHURI, et al. “DEVELOPMENT AND VALIDATION OF A QUESTIONNAIRE ASSESSING KNOWLEDGE, ATTITUDE, AND PRACTICE TOWARD ANTIBIOTIC USE AMONG PARENTS: Parental Antibiotic Usage”. Asian Journal of Pharmaceutical and Clinical Research, vol. 19, no. 3, Mar. 2026, pp. 200-4, doi:10.22159/ajpcr.2026v19i3.57240.

Issue

Section

Original Article(s)