Appendix G

INFORMATION SHEET

I am K. A. Sunil Master's degree in science, a student of KIU. I would like to invite you to take
part in the research study titled “Knowledge, attitudes, practices, its associated factors and
Barriers on Medication Administration Process among Caregivers qualified from three selected
training centers governed by the Tertiary and Vocational Education Commission, Sri Lanka”.
This research is conducted under the supervision of Dr H.E.Yapa.
1. Purpose of the study
The purpose of this research is to describe Knowledge, attitudes, practices, its associated
factors, and barriers on medication administration process among caregivers qualified from
three selected training centers governed by the Tertiary and Vocational Education Commission,
Sri
Lanka” “
2. Voluntary participation
Your participation in this study is voluntary. You are free to not to participate at all or to
withdraw from the study at any time despite consenting to take part earlier. There will be no
loss of medical care or any other available treatment for your illness or condition to which you
are otherwise entitled. If you decide not to participate or withdraw from the study you may do
so at any time.
3. Duration, procedures of the study and participant’s responsibilities
The procedure to be carried out is to answer a questionnaire form containing 55 questions
within 30- 40 minutes at the caregiver training center or online. If you wish to participate in
qualitative study you have to face an interview for around one hour.
4. Potential benefits
Participation in this study may benefit you/others by getting an education about caregiver
knowledge, attitude, practices its associated factors, and barriers on medication through this
study, will consequently help education for you and other caregivers and Further necessary
adjustments will be implemented by the policy makers benefit and prevent medication errors.
Also information gained from this study will benefit you and your clients.
5. Risks, hazards and discomforts
No potential Risks, hazards, and discomfort to you by participating in this study.

6. Reimbursements
Kindly note that you will not be paid any amount of money for this participation.
Appendix G

7. Confidentiality
Confidentiality of all records is guaranteed and no information by which you can be identified
will be released or published. These data will never be used in such a way that you could be
identified in any way in any public presentation or publication without your express permission.
8. Termination of study participation
You may withdraw your consent to participate in this study at any time, with no penalty or effect
on medical care or loss of benefits. Please notify the investigator as soon as you decide to
withdraw your consent.
9. Clarification
If you have questions about any of the tests / procedures or information please feel free to
contact:
Mr. KA Sunil, No 06, Shanthi Mawatha, Koswatta, Battaramulla. Mobile: 0716465088
Dr Harith Eranga Yapa, Brisbane, Australia. Mobile: 0493849647
 CONSENT FORM
Knowledge, attitudes, practices, its associated factors and barriers on medication administration
process among caregivers qualified from three selected training centers governed by the Tertiary
and Vocational Education Commission, Sri Lanka

To be completed by the participant

The participant should complete the whole of this sheet himself/herself.
1. Have you read the information sheet? (Please keep a copy for yourself) YES/NO
2. Have you had an opportunity to discuss this study and ask any questions? YES/NO
3. Have you had satisfactory answers to all your questions? YES/NO
4. Have you received enough information about the study? YES/NO
5. Who explained the study to you? …………………………………………………………
6. Do you understand that you are free to withdraw from the study at any time, without having to give a
reason and without affecting your future medical care? YES/NO
7. Sections of your medical notes, including those held by the investigators relating to your participation
in this study may be examined by other research assistants. All personal details will be treated as
STRICTLY CONFIDENTIAL. Do you give your permission for these individuals to have access to your
records? YES/NO
8. Have you had sufficient time to come to your decision? YES/NO
9. Do you agree to take part in this study? YES/NO
Participant’s signature…………………………..…………Date…………………….
Name (BLOCK CAPITALS)…………………………………………………………
To be completed by the investigator
I have explained the study to the above volunteer and he/ she has indicated her willingness to take part.
Signature of investigator……………………....…………..Date……………………….
Name (BLOCK CAPITALS)……………………………………………………………
Appendix C

Knowledge, attitudes, practices on medication administration process among caregivers

questionnaire
Please answer the following questions by making a cross mark (X) next to the appropriate
answer or by writing an answer in the space provided.

Knowledge on administering medications among caregivers

YES NO NOT
SURE

1. I know what medication management is

2. I know there are five rights (5R) related to medication administration.

3. I know the right timing for administrating all medication is after food

4. I know different medication has different routes of administration.

5. I know if residents miss a medication dose, the next dose should be

doubled

6. I know label on medication should have the name of the medication

7. I know label on medication should have expiry date

8. I know label on medication should have resident's name

9. I know label on medication should have route of administration

10. I know different dosage form has different storage condition

11. I know all medications must be kept in the refrigerator

12. I know all medications must be kept in a cool and dry place

13. I know all medication must be keep away from direct sunlight

14. I know the difference between side effect and adverse drug effect

15. I know all medications have adverse drug reaction

16. I know adverse drug reaction can be prevented by dose adjustment

17. I know follow up is needed after initiating the medication

18. I know resident's allergy to some medication must be informed to doctor

Appendix C

19. I know what medication error is

20. I know adverse drug event of the medication must be documented

21. I know medication error must be documented

22. I know the resident's allergy on medication must be documented

Attitudes towards administering medication among caregivers

Strongly disagree neither agree strogly

disagree disagree agree
nor
agree
1.5R concept can lead to good medication
management

2. Medication management is the main

problem in nursing homes

3. Older patients will have more problems in

taking the medication

4. The right storage of medication can give a

good effect to the patient

5. Do you agree that caregivers should be

given training session on medication
management
6. Do you agree having a record book for
patients is important

Practices on administering medication among caregivers

Always Very Sometimes Rarely Never

often
1. How often do you check the identity of
the resident before administering the
medication to the resident?

2. How often do you check the dose of the

medication before administering it to
residents?
Appendix C

3. How often do you check the timing of the

medication before you administer it to the
patient?

4. How often do you document all

medications that you had administered to the
resident in the
record book?

5. How often do you crush the tablet if the

patient is unable to consume the medication?

6. How often do you mistakenly give the

wrong dose to the patient?

7. How often do you get complaints from the

patients after they take the medication?

8. How often do you notice any wrong

labeling on the medication?

9. How often do you keep all the

medications under sunlight?

10. How often do you inform the doctor if

the medication is not labeled?

11. How often do you ensure that the

medication is stored at the right place?

12. How often do you follow up on the

patient after initiating the medication?

13. How often do you observe adverse drug

reaction experienced by patients?
 Appendix A

Socio-demographic information instrument

Please answer all of the following questions.

SOCIO-DEMOGRAPHIC INFORMATION (to be completed by participants)

Please answer the following questions by making a cross mark (×) next to the appropriate answer
or by writing an answer in the space provided.

1. Gender:

Male
Female

2. Age: (years)

3. Area of living:

(Name of the village, town, or suburb)

4. Number of people you are living within your household:

5. Are you:
Married
Divorced
Widowed
Single/never married

6. What is your

religion: Buddhism
Christianity
Christianity
Islam

Other: please specify

7. What is the highest education

reached: Up to grade 8
Up to ordinary level (grade 9 – 11) Up
to advanced level (grade 12 – 13) Up
to certificate/diploma level
Undergraduate
Postgraduate
 Appendix A

9. How many years of work experience you have as a care giver?

(please mention)

10. Do you have any childhood experience for care giving?

Yes

No

11. Do you think your vision level affects to your caregiving?

yes

No

12. Do you receive support from family members?

Yes

No

12. if yes in for question No. 12 How do you receive the Cooperation of family members of care

recipient.

Very Good corporation Good

cooperation moderate

cooperation very few cooperation

13 How is the status of care recipient

Very Good condition

Good condition

Normal condition

Bad condition

very Bad condition

 Appendix A

14. Monthly income in your family (Rupees) Below

5000

5001-10000

10001- 25000

25001-50000

Above50000