| Agree completely | Agree mostly | Agree somewhat | Disagree somewhat | Disagree mostly | Disagree completely | Score | |
| I am convinced of the importance of my prescription medication | 0 | 0 | 7 | 7 | 20 | 20 | |
| I worry that my prescription medication will do more harm than good to me | 14 | 14 | 4 | 4 | 0 | 0 | |
| I feel financially burdened by my out-of-pocket expenses for my prescription medication | 2 | 2 | 0 | 0 | 0 | 0 | |
| Total: | |||||||
