During the week, did you miss or were you late in taking your medicine because: |
1. You felt good and decided you didn't need your medicine. |
Often |
Sometimes |
Never |
2. You felt good and forgot. |
Often |
Sometimes |
Never |
3. You were involved in an activity and forgot. |
Often |
Sometimes |
Never |
4. You were interrupted and forgot. |
Often |
Sometimes |
Never |
5. There was a planned change in your normal routine. |
Often |
Sometimes |
Never |
6. There was some unexpected change in your normal routine. |
Often |
Sometimes |
Never |
7. Your medicine caused you to be sick (side effects). |
Often |
Sometimes |
Never |
8. You ran out of medicine. |
Often |
Sometimes |
Never |
9. You felt the medicine may not work as well if you used it too much. |
Often |
Sometimes |
Never |
10. You felt that the medicine wasn't working. |
Often |
Sometimes |
Never |
11. It was inconvenient. |
Often |
Sometimes |
Never |
12. You were confused about what medicine you should take. |
Often |
Sometimes |
Never |
Look back over your week's records and your answers to the questions above. Use this information to identify the problems you have most often in taking medicine as prescribed. |