Table 1 Questionnaire for survey of population awareness of risks related to medicinal products use
Answers | ||||
|---|---|---|---|---|
A. Sociodemographic characteristics | ||||
1. Gender | o Male | o Female | ||
2. Age | ____ | |||
3. Status in the household | o Head of household | o Spouse or husband of head of household | ||
o Other, specify ________ | ||||
4. Occupation | o Housekeeper | o Farmer | o Other job | |
o Retired/disabled | o Student | |||
5. Monthly household income (Lao kip) | o ≤ 1 000 000 | o >1 000 000 | ||
6. Religion | o Buddhism | o Animism | o Other, specify _______ | |
7. Level of education | o Secondary school or higher | o Primary school or no education | ||
8. Can you read? | o Yes | o No | ||
9. Do you have easy access to internet? | o Yes | o No | ||
B. Medicinal product use | ||||
1. Have you ever consumed modern medicine(s)? | o Yes | o No | ||
Was the last time during the last 12 months? | o Yes | o No | ||
If yes, name(s) of the medicine(s) and its (their) indication(s) | ________ ________ | |||
2. Have you ever consumed traditional medicine(s)? | o Yes | o No | ||
Was the last time during the last 12 months? | o Yes | o No | ||
If yes, name(s) of the medicine(s) and its (their) indication(s) | ________ ________ | |||
C. Awareness of medicinal product risks | ||||
1. Do you think that modern medicines can be harmful in case of normal use and normal doses? | o Yes | o No | o Do not know | |
Comment(s)_____________________________________________ | ||||
2. Do you think that modern medicines can be harmful in case of overdosage? | o Yes | o No | o Do not know | |
3. Do you think that traditional medicines can be harmful in case of normal use and normal doses? | o Yes | o No | o Do not know | |
4. Do you think that traditional medicines can be harmful in case of overdosage? | o Yes | o No | o Do not know | |
5. Have you ever heard what an adverse drug reaction is? | o Yes | o No | ||
Comment(s)_____________________________________________ | ||||
6. Have you ever heard of poor quality medicines? | o Yes | o No | ||
If yes, do you think that poor quality medicines can be harmful? | o Yes | o No | o Do not know | |
Comment(s)_____________________________________________ | ||||
7. Where have you heard of poor quality medicines? | o Healthcare providers | o Magazine, journal | ||
o TV | o Relative, friend | o Other, specify ________ | ||
D. Experience of adverse drug reaction | ||||
1. Have you (or one of your relative) ever taken a medicine (modern medicine, traditional medicine) that made you feel worse? | o Yes | o No | ||
If yes, please describe the reaction and the name(s) of the medicine(s)_________________________ | ||||
A Pharmacovigilance system is a ‘drug monitoring’ system. This system works through spontaneous reporting of drug-related problems by health care professionals and patients. | ||||
2. Would you agree to notify a drug-related problem to the national pharmacovigilance center? | o Yes | o No | ||