Translation and Validation of the Filipino Version of the Knowledge, Attitudes and Practices Questionnaire on Personal Antibiotic Use (KAPQ-PAU-FIL): Potential Utility in Public Health Programs in the Philippines

Maxine Francesco Gwyneth C. Baculo, Samantha Nicole L. Babao, Francesca Anne I. Bandarlipe, Fitz Cornelius I. Banez, Evelyn Siao-Brigino, Wennielyn F. Fajilan, Roberto D. Ampil, Marvin M. Zapico, Maria Rosario R. Aranda, Rosalyn G. Mirasol, Ivan Neil B. Gomez

Apr 2026 DOI 10.35460/2546-1621.2025-0123     Access   

Abstract

Introduction: The growing misuse of antibiotics and the escalating threat of antibiotic resistance in the Philippines pose significant public health concerns. While various Knowledge, Attitudes and Practices (KAP) questionnaires on personal antibiotic use have been employed in local studies, none have been fully validated and a standardized, culturally appropriate tool remains lacking.

Objective: This study aims to develop a Filipino-translated and culturally adapted KAP questionnaire on personal antibiotic use (KAPQ-PAU-FIL) and evaluate its validity and reliability.

Methodology: The research consisted of two phases. The first phase is the translation and cross-cultural adaptation of the original questionnaire in collaboration with the UST Sentro sa Salin at Araling Salin. The second phase is the validity and reliability testing of the KAPQ-PAU-FIL using a sample of 176 Filipino adults. This included assessment of its face validity, content validity, construct validity, internal consistency, test-retest reliability and equivalent forms reliability.

Results: Most items were translated without difficulty, though four items were modified to better fit the linguistic and cultural context. The KAPQ-PAU-FIL demonstrates strong psychometric properties, with face validity (SFVI/Ave = 0.99), content validity (SCVI/Ave = 0.99), construct validity (CFI = 0.92, RMSEA = 0.06, SRMR = 0.04; FL = 0.60-0.85; ITC = 0.58-0.71), test-retest reliability (ICC = 0.83), internal consistency (α = 0.929) and equivalent forms reliability (p>0.05; κ = 0.62-0.74).

Conclusion: The KAPQ-PAU-FIL is the first ever, Filipino-translated, culturally adapted questionnaire designed to assess KAPQ-PAU-FIL, demonstrating strong validity and reliability to support public health programs against antibiotic misuse.

Key Words: Translation, validation, KAP questionnaire, antibiotic, Philippines

  1. Aslam B, Wang W, Arshad MI, Khurshid M, Muzammil S, Rasool MH, et al. Antibiotic resistance: a rundown of a global crisis. Infect Drug Resist [Internet]. 2018;11:1645–58. Available from: http://dx.doi.org/10.2147/IDR.S173867 
  2. Wang Y, Guo F, Wei J, Zhang Y, Liu Z, Huang Y. Knowledge, attitudes and practices in relation to antimicrobial resistance amongst Chinese public health undergraduates. J Glob Antimicrob Resist [Internet]. 2020;23:9–15. Available from: http://dx.doi.org/10.1016/j.jgar.2020.07.023 
  3. Department of Health (PH). DOH program on combating antimicrobial resistance [Internet]. 2014. Available from: https://pharma.doh.gov.ph/doh-program-on-combating-antimicrobial-resistance/ 
  4. Mallah N, Rodríguez-Cano R, Figueiras A, Takkouche B. Design, reliability and construct validity of a knowledge, attitude and practice questionnaire on personal use of antibiotics in Spain. Sci Rep [Internet]. 2020;10(1):20668. Available from: http://dx.doi.org/10.1038/s41598-020-77769-6 
  5. Hair JF. Multivariate data analysis: An overview. In: International Encyclopedia of Statistical Science [Internet]. Berlin, Heidelberg: Springer Berlin Heidelberg; 2011. p.904–7. Available from: http://dx.doi.org/10.1007/978-3-642-04898-2_395
  6. Zun AB, Ibrahim MI, Mokhtar AM, Halim AS, Wan Mansor WNA. Translation, cross-cultural adaptation, and validation of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) into the Malay language. Int J Environ Res Public Health [Internet]. 2019;16(11):2054. Available from: http://dx.doi.org/10.3390/ijerph16112054 
  7. Beaton DE, Bombardier C, Guillemin F, Ferraz MB. Guidelines for the process of cross-cultural adaptation of self-report measures. Spine (Phila Pa 1976) [Internet]. 2000;25(24):3186–91. Available from: http://dx.doi.org/10.1097/00007632-200012150-00014. PMID: 11124735.
  8. Yusoff MSB, Department of Medical Education, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, MALAYSIA. ABC of response process validation and face validity index calculation. Educ Med J [Internet]. 2019;11(3):55–61. Available from: http://dx.doi.org/10.21315/eimj2019.11.3.6 
  9. Holle H, Rein R. The Modified Cohen’s Kappa: Calculating Interrater Agreement for Segmentation and Annotation. In: Lausberg H, editor. Understanding Body Movement: A Guide to Empirical Research on Nonverbal Behaviour With an Introduction to the NEUROGES Coding System. Frankfurt, M: Peter Lang; 2013. p.261–78.
  10. Portney LG, Watkins MP. Foundations of Clinical Research: Applications to Practice. 3rd ed. Philadelphia: F.A. Davis Company; 2015.
  11. Taherdoost H. Validity and reliability of the research instrument; How to test the validation of a questionnaire/survey in a research. SSRN Electron J [Internet]. 2016;5(3):28–36. Available from: http://dx.doi.org/10.2139/ssrn.3205040 
  12. Castillo NCT. Kagalingan: The Filipino’s search for well-being, happiness and health [Internet]. [Amsterdam]: Amsterdam Institute for Social Science Research (AISSR); 2019 [cited 2025 June 10]. Available from: https://hdl.handle.net/11245.1/8602b6f3-9540-4389-8ee3-9673399b878f 
  13. Jamindang MDO. Sakit: A preliminary linguistic analysis of Tagalog pain concept and language. UP Working Papers in Linguistics [Internet]. 2022;1(1):64–105. Available from: https://linguistics.upd.edu.ph/wp-content/uploads/2022/08/12-Sakit-A-Preliminary-Linguistic-Analysis-of-Tagalog-Pain-Concept-and-Language.pdf 
  14. Tolabing MCC, Co KCD, Mamangon MAM. Development and validation of a functional health literacy instrument in the Philippines. Int J Public Health Sci (IJPHS) [Internet]. 2022 [cited 2025 June 10];11(4):1157. Available from: https://ijphs.iaescore.com/index.php/IJPHS/article/view/21755 
  15. Hill LS, Ghorpade S, Galappaththi M. Toward decolonizing sustainability research: a systematic process to guide critical reflections. Facets (Ott) [Internet]. 2023;8:1–11. Available from: http://dx.doi.org/10.1139/facets-2022-0254 

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