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A METHODOLOGICAL STUDY: DEVELOPMENT OF THE RATIONAL DRUG USE SCALE

Yıl 2020, Cilt: 23 Sayı: 4, 498 - 507, 25.12.2020
https://doi.org/10.17049/ataunihem.595394

Öz

Aim: The aim of this study was to develop the Rational Drug Use Scale which can be used to determine the knowledge, attitude and behaviors of patients for rational drug use according to the Theory of Planned Behavior.
Methods: The sample of this methodological study consisted of 550 patients who are being admitted to a Family Health Center. In the validity study of the Rational Drug Use Scale; content validity (content validity rate), construct validity (exploratory and confirmatory factor analysis) and criterion validity (Pearson’s correlation analysis) were evaluated. In reliability analysis; internal consistency (Cronbach’s alpha reliability coefficient) and item analysis were used.
Results: The mean age of the patients was 53.00±9.62 years and 66.9% of them were female. It was found that there was consistence between the expert views on the items of scale (90.71%). As a result of the exploratory factor analysis for construct validity, 36-item scale with 6 factors was reached. After confirmatory factor analysis, it was determined that the model was acceptable with data. For criterion validity, equivalence analysis was performed and Morisky 8-item Medication Adherence Scale was used. A significant positive correlation was found between Morisky 8-item Medication Adherence Scale (X=5.57±2.26) and Rational Drug Use Scale (X=51.04 ± 7.39) mean scores. The Rational Drug Use Scale Cronbach's alpha was found 0.85.
Conclusion: It was determined that Rational Drug Use Scale was a valid and reliable measurement tool. Accordingly, it may be advisable to use Rational Drug Use Scale to assess patients' knowledge, attitudes and behaviors towards rational drug use.

Kaynakça

  • 1. Pinar N. Drug Expenditures in Our Country. Inonu University Faculty of Medicine Journal, 2012;19(1):59-65.
  • 2. Mahmood A, Elnour AA, Ali AAA, Hassan NAGM, Shehab A, Bhagavathula AS. Evaluation of Rational Use of Medicines (RUM) in four Government Hospitals in UAE. Saudi Pharmaceutical Journal, 2016;24(2):189-96.
  • 3. World Health Organization. Therational Use of Drugs: Report of the Conference of Experts, Nairobi, 1985;25-29 November.
  • 4. Ozatik FY, Babaoglu, UT, Sen M, Yurter K, Akcan C., Cevik B, et al. Effect of Peer Group Training on Popularizing of Rational Drug Use Among University Students. Süleyman Demirel University Journal of Faculty of Medicine, 2018;25(3):256-64.
  • 5. Yilmaz M, Kirbiyikoglu FI, Aric Z, Kursun B. Determination of Rational Drug Use by Patients at a Dentistry Faculty Hospital. Journal of Erciyes University Faculty of Health Sciences, 2014;2(1):39-47.
  • 6. Ozyurt E, Aydin I, Aydin H, Erduran S, Ugurlu D, Akar Y, et al. Knowledge, Attitude and Behaviors of Patients in Diskapi Yildirim Beyazit Education Research Hospital About Rational Drug Use. Journal of Health Scholars, 2018;5(3):208-19.
  • 7. Akici A, Kalaca S, Ugurlu U, Cali S, Oktay S. Evaluation of Rational Drug Use of General Practitioners’ in Management of Elderly Patients. Geriatri, 2001;4(3):100-5.
  • 8. Akici A. Prescribing in Elderly According to the Principles of Rational Drug Use and the Dimentions of Drug Utilization in Elderly in Turkey. Turk Geriatri Dergisi, 2006;9(Supplement):19-27.
  • 9. Iskit AB. Rational Drug Therapy. Surekli Tıp Egitim Dergisi, 2006;15(7):4-5.
  • 10. Maxwell S. Rational Prescribing: The Principles of Drug Selection. Clinical Medicine, 2009;9(5):481-5.
  • 11. Ulupinar S. Akici A. Rational Use of Medicine in Nursing Practice. Turkiye Klinikleri J Pharmacol-Specialtopics, 2015;3(1):84-93.
  • 12. World Health Organization. Guide to Good Prescribing. Action Programme on Essential Drugs, Geneva, 1994.
  • 13. World Health Organization. Promoting Rationaluse of Medicines: Core Components. WHO Policy Perspectives on Medicines. Report WHO/EDM/2002.3. Geneva, 2002.
  • 14. Deniz S, Oguzoncul AF, Bentli R. Evaluation of Drug Use Habits and Rational Drug Use of Persons Registered to Primary Health Care. Medicine Science, 2018;7(4):930-4.
  • 15. Toklu HZ, Demirdamar R, Gumusel B, Yaris E, Dulger G. Rational Drug Use Awareness of the Nurses in the Turkish Republic of Northern Cyprus Near East University Hospital. Marmara Pharmaceutical Journal, 2012;16(2):150-4.
  • 16. Pirincci E, Bozan T. Rational Drug Use Among Nurses Who Work in a University Hospital. Firat Medical Journal, 2016;21(3):129-36.
  • 17. Aydin B, Gelal A. Rational Drug Use: Promotion and the Role of Medical Education. Dokuz Eylul University Faculty of Medicine Journal, 2012;26(1):57-63.
  • 18. Ugrak U, Teke A, Cihangiroglu N, Uzuntarla Y. Inpatients’ Attitudes Towards the Rationale Use of Drugs at a Cardiology Ward. TAF Preventive Medicine Bulletin, 2015;14(2):137-44.
  • 19. Ciftci B, Aksoy, M. Rational Drug Use in Children and Nurse’s Responsibilities. Gumushane University Journal of Health Sciences, 2017;6(3):191-4.
  • 20. Yapici G, Balikci S, Ugur O. Attitudes and Behavior of Drug Usage in Applicants to Primary Health Care Center. Dicle Medical Journal, 2011;38(4):458-65.
  • 21. Karatas Y, Dinler B, Erdogdu T, Ertug P, Seydaoglu G. Evaluation of Drug Use Attitudes of Patient and Its Relatives Attending to Cukurova University Medical Faculty Balcali Hospital. Journal of Cukurova University Medical Faculty, 2012;37(1):1-8.
  • 22. Akici A, Kalaca S. Rational Use of Drugs for the Community. T.R. Social Security Institution Presidency, Ankara: SSI Publication No 93, 2013;15-47.
  • 23. Bilgili N, Karatay G. Determination Of Some Practices About Drug Consumption Of Individuals Living in Sait Yazici Health Center Area. Journal of Hacettepe University School of Nursing, 2005;12(1):39-48.
  • 24. Kocagoz E, Dursun Y. How can Perceived Behavioral Control be Positioned in the Ajzen’s Theory: Alternative Model Analyses. KMU Journal of Social and Economic Studies, 2010;12(19):139-52.
  • 25. Ajzen I. The theory of Planned Behaviour: Reactions and Reflections. Psychology and Health, 2011;26(9):1113-27.
  • 26. Barua P. The Moderating Role of Perceived Behavioral Control: The Literature Criticism and Methodological Considerations. International Journal of Business and Social Science, 2013;4(10):57-9.
  • 27. Ajzen I. From Intentions to Actions. A Theory of Planned Behavior. In: Kuhl J, Beckmann J. (Eds.): Action-Control: From Cognition to Behavior, Heidelberg, 1985;11-37.
  • 28. Ajzen I, Manstead ASR. Changing Health-Related Behaviors: An Approach Based on The Theory of Planned Behavior. In: Hewstone M, Schut HAW, De Wit JBF, Den Bos KV, Stroebe MS. (Eds). The Scope of Social Psychology: Theory and Applications. 1st ed. NewYork: Psychology Press, 2007;43-63.
  • 29. Ajzen I. Consumer Attitudes and Behavior: The Theory of Planned Behavior Applied to Food Consumption Decisions, Rivista di Economia Agraria, Anno LXX, 2015;2:121-38. doi:10.13128/REA-18003.
  • 30. Buyukozturk S. Factor Analysis: Basic Concepts and Its Use in Scale Development. Education Management in Theory and Practice, 2002;8(4):470-83.
  • 31. Aksoy M, Alkan A, Isli F. Activities of the Ministry of Health to Increase the Use of Rational Drugs. Sarigol E, eds. Turkey Rational Drug Use Bulletin. Ankara: T.C. Ministry of Health of Turkey Pharmaceuticals and Medical Devices Agency, 2015;2(9):1-18.
  • 32. Tezbasaran AA. Likert Type Scale Preparation Guide. (3nd version e-book). Mersin 2008. p.1-65.
  • 33. Karakoc FY, Donmez L. Basic Principles of Scale Development. Medical Education World, 2014;13(40):39-49.
  • 34. Ajzen I. The Theory of Planned Behaviour. Organizational Behaviour and Human Decision Processes, 1991;50(2):179-211.
  • 35. Muslu GK, Basbakkal Z. The Planned Behavior Theory and Breastfeeding Behavior. Turkey Klinikleri Journal of Nursing Sciences, 2013;5(1):28-40.
  • 36. Morisky DE, Ang A, Krousel-Wood M, Ward HJ. Predictive validity of a medication adherence measure in an outpatient setting. Journal of Clinical Hypertension (Greenwich) 2008;10(5):348-54.
  • 37. Oguzulgen IK, Kokturk N, Isikdogan Z. Turkish Validation Study of Morisky 8-item Medication Adherence Questionnaire (MMAS-8) in Patients with Asthma and Chronic Obstructive Pulmonary Disease. Tuberculosis and Thorax, 2014;62(2):101-7.
  • 38. Ercan I, Kan I. Reliability and Validity in the Scales. Uludag University Faculty of Medicine Journal, 2004;30(3):211-6.
  • 39. Buyukozturk S. Manual of Data Analysis For Social Sciences (9nd edn). Ankara: Pegem Academy 2008. p.167-71.
  • 40. Kalayci S. Multi-Variable Statistical Techniques with SPSS Application. (5nd edn). Ankara: Asil publishing 2010.
  • 41. Pallant J. SPSS User Manual. Step-by-Step Data Analysis with SPSS. (Translated: Balcı S and Ahi B.) Ankara: Ani publishing 2016. p.199-223.
  • 42. Tavsancil E. Measuring Attitudes and Data Analysis with SPSS. Ankara: Nobel 2002. p.46-51.
  • 43. Schermelleh-Engel K, Moosbrugger M, Muller H. Evaluating the Fit of Structural Equation Models: Tests of Significance and Descriptive Goodness-of-Fit Measures. Methods of Psychological Research Online, 2003;8(2):23-74.
  • 44. Capik C. Use of Confirmatory Factor Analysis in Validity and Reliability Studies. Anatolian Journal of Nursing and Health Sciences, 2014;17(3):196-205.
  • 45. Sencan H. Sosyal ve Davranissal Olcumlerde Guvenilirlik ve Gecerlilik. (2nd edn). Ankara: Seckin Yayincilik 2005. p.246-400.
  • 46. Tavakol M, Dennick R. Making sense of Cronbach’s alpha. International Journal of Medical Education, 2011;2:53-5.
  • 47. Kilic S. Cronbach’s alpha reliability coefficient. Journal of Mood Disorders, 2016;6(1):47-8.
  • 48. Sezer A, Kadioglu H. Development of Adult Health Literacy Scale. Anatolian Journal of Nursing and Health Sciences, 2014;17(3):165-70.
  • 49. Buyukozturk S. Data Analysis Handbook. (4nd edn). Ankara: Pegem 2004. p.117-75.
  • 50. Buyukozturk S. Manual of Data Analysis For Social Sciences. Ankara: Pegem Academy 2011. p.167-71.

METODOLOJİK BİR ÇALIŞMA: AKILCI İLAÇ KULLANIMI ÖLÇEĞİ’NİN GELİŞTİRİLMESİ

Yıl 2020, Cilt: 23 Sayı: 4, 498 - 507, 25.12.2020
https://doi.org/10.17049/ataunihem.595394

Öz

Amaç: Planlı Davranış Teorisi’ne göre hastaların akılcı ilaç kullanmaya yönelik bilgi, tutum ve davranışlarını belirlemede kullanılabilecek Akılcı İlaç Kullanımı Ölçeği geliştirmektir.
Yöntem: Metodolojik olarak yapılan araştırmanın örneklemini; bir Aile Sağlığı Merkezi’ne başvuran 550 hasta oluşturdu. Akılcı İlaç Kullanımı Ölçeği’nin geçerlik incelemesinde; kapsam geçerliği (kapsam geçerlik indeksi), yapı geçerliği (açımlayıcı ve doğrulayıcı faktör analizi) ve ölçüt geçerliği (Pearson’s korelasyon analizi) değerlendirildi. Güvenirlik incelemesinde; ölçek iç tutarlık (Cronbach’s alfa güvenirlik katsayısı) ve madde analizleri kullanıldı.
Bulgular: Çalışmaya katılanların yaş ortalaması 53.00±9.62 yıl ve %66.9 kadındır. Ölçekte yer alan maddelere ilişkin uzman görüşleri arasında uyum olduğu saptandı (%90.71). Yapı geçerliği için yapılan açımlayıcı faktör analizi sonucunda 36 maddelik 6 faktörlü bir ölçek yapısına ulaşıldı. Doğrulayıcı faktör analizi sonucunda modelin veri ile kabul edilebilir bir uyum gösterdiği belirlendi. Ölçüt geçerliği için eş değerlik analizi yapıldı ve Morisky 8-Maddeli Tedavi Uyum Ölçeği kullanıldı. Morisky 8-Maddeli Tedavi Uyum Ölçeği (X=5.57±2.26) ile Akılcı İlaç Kullanımı Ölçeği (X=51.04 ± 7.39) puan ortalamaları arasında pozitif yönde anlamlı ilişki bulundu. Akılcı İlaç Kullanımı Ölçeği Cronbach's alfa 0.85 bulundu.
Sonuç: Akılcı İlaç Kullanımı Ölçeği’nin geçerli ve güvenilir bir ölçüm aracı olduğu belirlendi. Buna göre, hastaların akılcı ilaç kullanmaya yönelik bilgi, tutum ve davranışlarını değerlendirmek için bu Akılcı İlaç Kullanımı Ölçeği’nin kullanılması önerilebilir.

Kaynakça

  • 1. Pinar N. Drug Expenditures in Our Country. Inonu University Faculty of Medicine Journal, 2012;19(1):59-65.
  • 2. Mahmood A, Elnour AA, Ali AAA, Hassan NAGM, Shehab A, Bhagavathula AS. Evaluation of Rational Use of Medicines (RUM) in four Government Hospitals in UAE. Saudi Pharmaceutical Journal, 2016;24(2):189-96.
  • 3. World Health Organization. Therational Use of Drugs: Report of the Conference of Experts, Nairobi, 1985;25-29 November.
  • 4. Ozatik FY, Babaoglu, UT, Sen M, Yurter K, Akcan C., Cevik B, et al. Effect of Peer Group Training on Popularizing of Rational Drug Use Among University Students. Süleyman Demirel University Journal of Faculty of Medicine, 2018;25(3):256-64.
  • 5. Yilmaz M, Kirbiyikoglu FI, Aric Z, Kursun B. Determination of Rational Drug Use by Patients at a Dentistry Faculty Hospital. Journal of Erciyes University Faculty of Health Sciences, 2014;2(1):39-47.
  • 6. Ozyurt E, Aydin I, Aydin H, Erduran S, Ugurlu D, Akar Y, et al. Knowledge, Attitude and Behaviors of Patients in Diskapi Yildirim Beyazit Education Research Hospital About Rational Drug Use. Journal of Health Scholars, 2018;5(3):208-19.
  • 7. Akici A, Kalaca S, Ugurlu U, Cali S, Oktay S. Evaluation of Rational Drug Use of General Practitioners’ in Management of Elderly Patients. Geriatri, 2001;4(3):100-5.
  • 8. Akici A. Prescribing in Elderly According to the Principles of Rational Drug Use and the Dimentions of Drug Utilization in Elderly in Turkey. Turk Geriatri Dergisi, 2006;9(Supplement):19-27.
  • 9. Iskit AB. Rational Drug Therapy. Surekli Tıp Egitim Dergisi, 2006;15(7):4-5.
  • 10. Maxwell S. Rational Prescribing: The Principles of Drug Selection. Clinical Medicine, 2009;9(5):481-5.
  • 11. Ulupinar S. Akici A. Rational Use of Medicine in Nursing Practice. Turkiye Klinikleri J Pharmacol-Specialtopics, 2015;3(1):84-93.
  • 12. World Health Organization. Guide to Good Prescribing. Action Programme on Essential Drugs, Geneva, 1994.
  • 13. World Health Organization. Promoting Rationaluse of Medicines: Core Components. WHO Policy Perspectives on Medicines. Report WHO/EDM/2002.3. Geneva, 2002.
  • 14. Deniz S, Oguzoncul AF, Bentli R. Evaluation of Drug Use Habits and Rational Drug Use of Persons Registered to Primary Health Care. Medicine Science, 2018;7(4):930-4.
  • 15. Toklu HZ, Demirdamar R, Gumusel B, Yaris E, Dulger G. Rational Drug Use Awareness of the Nurses in the Turkish Republic of Northern Cyprus Near East University Hospital. Marmara Pharmaceutical Journal, 2012;16(2):150-4.
  • 16. Pirincci E, Bozan T. Rational Drug Use Among Nurses Who Work in a University Hospital. Firat Medical Journal, 2016;21(3):129-36.
  • 17. Aydin B, Gelal A. Rational Drug Use: Promotion and the Role of Medical Education. Dokuz Eylul University Faculty of Medicine Journal, 2012;26(1):57-63.
  • 18. Ugrak U, Teke A, Cihangiroglu N, Uzuntarla Y. Inpatients’ Attitudes Towards the Rationale Use of Drugs at a Cardiology Ward. TAF Preventive Medicine Bulletin, 2015;14(2):137-44.
  • 19. Ciftci B, Aksoy, M. Rational Drug Use in Children and Nurse’s Responsibilities. Gumushane University Journal of Health Sciences, 2017;6(3):191-4.
  • 20. Yapici G, Balikci S, Ugur O. Attitudes and Behavior of Drug Usage in Applicants to Primary Health Care Center. Dicle Medical Journal, 2011;38(4):458-65.
  • 21. Karatas Y, Dinler B, Erdogdu T, Ertug P, Seydaoglu G. Evaluation of Drug Use Attitudes of Patient and Its Relatives Attending to Cukurova University Medical Faculty Balcali Hospital. Journal of Cukurova University Medical Faculty, 2012;37(1):1-8.
  • 22. Akici A, Kalaca S. Rational Use of Drugs for the Community. T.R. Social Security Institution Presidency, Ankara: SSI Publication No 93, 2013;15-47.
  • 23. Bilgili N, Karatay G. Determination Of Some Practices About Drug Consumption Of Individuals Living in Sait Yazici Health Center Area. Journal of Hacettepe University School of Nursing, 2005;12(1):39-48.
  • 24. Kocagoz E, Dursun Y. How can Perceived Behavioral Control be Positioned in the Ajzen’s Theory: Alternative Model Analyses. KMU Journal of Social and Economic Studies, 2010;12(19):139-52.
  • 25. Ajzen I. The theory of Planned Behaviour: Reactions and Reflections. Psychology and Health, 2011;26(9):1113-27.
  • 26. Barua P. The Moderating Role of Perceived Behavioral Control: The Literature Criticism and Methodological Considerations. International Journal of Business and Social Science, 2013;4(10):57-9.
  • 27. Ajzen I. From Intentions to Actions. A Theory of Planned Behavior. In: Kuhl J, Beckmann J. (Eds.): Action-Control: From Cognition to Behavior, Heidelberg, 1985;11-37.
  • 28. Ajzen I, Manstead ASR. Changing Health-Related Behaviors: An Approach Based on The Theory of Planned Behavior. In: Hewstone M, Schut HAW, De Wit JBF, Den Bos KV, Stroebe MS. (Eds). The Scope of Social Psychology: Theory and Applications. 1st ed. NewYork: Psychology Press, 2007;43-63.
  • 29. Ajzen I. Consumer Attitudes and Behavior: The Theory of Planned Behavior Applied to Food Consumption Decisions, Rivista di Economia Agraria, Anno LXX, 2015;2:121-38. doi:10.13128/REA-18003.
  • 30. Buyukozturk S. Factor Analysis: Basic Concepts and Its Use in Scale Development. Education Management in Theory and Practice, 2002;8(4):470-83.
  • 31. Aksoy M, Alkan A, Isli F. Activities of the Ministry of Health to Increase the Use of Rational Drugs. Sarigol E, eds. Turkey Rational Drug Use Bulletin. Ankara: T.C. Ministry of Health of Turkey Pharmaceuticals and Medical Devices Agency, 2015;2(9):1-18.
  • 32. Tezbasaran AA. Likert Type Scale Preparation Guide. (3nd version e-book). Mersin 2008. p.1-65.
  • 33. Karakoc FY, Donmez L. Basic Principles of Scale Development. Medical Education World, 2014;13(40):39-49.
  • 34. Ajzen I. The Theory of Planned Behaviour. Organizational Behaviour and Human Decision Processes, 1991;50(2):179-211.
  • 35. Muslu GK, Basbakkal Z. The Planned Behavior Theory and Breastfeeding Behavior. Turkey Klinikleri Journal of Nursing Sciences, 2013;5(1):28-40.
  • 36. Morisky DE, Ang A, Krousel-Wood M, Ward HJ. Predictive validity of a medication adherence measure in an outpatient setting. Journal of Clinical Hypertension (Greenwich) 2008;10(5):348-54.
  • 37. Oguzulgen IK, Kokturk N, Isikdogan Z. Turkish Validation Study of Morisky 8-item Medication Adherence Questionnaire (MMAS-8) in Patients with Asthma and Chronic Obstructive Pulmonary Disease. Tuberculosis and Thorax, 2014;62(2):101-7.
  • 38. Ercan I, Kan I. Reliability and Validity in the Scales. Uludag University Faculty of Medicine Journal, 2004;30(3):211-6.
  • 39. Buyukozturk S. Manual of Data Analysis For Social Sciences (9nd edn). Ankara: Pegem Academy 2008. p.167-71.
  • 40. Kalayci S. Multi-Variable Statistical Techniques with SPSS Application. (5nd edn). Ankara: Asil publishing 2010.
  • 41. Pallant J. SPSS User Manual. Step-by-Step Data Analysis with SPSS. (Translated: Balcı S and Ahi B.) Ankara: Ani publishing 2016. p.199-223.
  • 42. Tavsancil E. Measuring Attitudes and Data Analysis with SPSS. Ankara: Nobel 2002. p.46-51.
  • 43. Schermelleh-Engel K, Moosbrugger M, Muller H. Evaluating the Fit of Structural Equation Models: Tests of Significance and Descriptive Goodness-of-Fit Measures. Methods of Psychological Research Online, 2003;8(2):23-74.
  • 44. Capik C. Use of Confirmatory Factor Analysis in Validity and Reliability Studies. Anatolian Journal of Nursing and Health Sciences, 2014;17(3):196-205.
  • 45. Sencan H. Sosyal ve Davranissal Olcumlerde Guvenilirlik ve Gecerlilik. (2nd edn). Ankara: Seckin Yayincilik 2005. p.246-400.
  • 46. Tavakol M, Dennick R. Making sense of Cronbach’s alpha. International Journal of Medical Education, 2011;2:53-5.
  • 47. Kilic S. Cronbach’s alpha reliability coefficient. Journal of Mood Disorders, 2016;6(1):47-8.
  • 48. Sezer A, Kadioglu H. Development of Adult Health Literacy Scale. Anatolian Journal of Nursing and Health Sciences, 2014;17(3):165-70.
  • 49. Buyukozturk S. Data Analysis Handbook. (4nd edn). Ankara: Pegem 2004. p.117-75.
  • 50. Buyukozturk S. Manual of Data Analysis For Social Sciences. Ankara: Pegem Academy 2011. p.167-71.
Toplam 50 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Sağlık Kurumları Yönetimi
Bölüm Makaleler
Yazarlar

Vahide Çakmak 0000-0003-3481-9500

Sezgi Çınar Pakyüz 0000-0002-6598-8801

Yayımlanma Tarihi 25 Aralık 2020
Gönderilme Tarihi 23 Temmuz 2019
Yayımlandığı Sayı Yıl 2020 Cilt: 23 Sayı: 4

Kaynak Göster

Vancouver Çakmak V, Çınar Pakyüz S. A METHODOLOGICAL STUDY: DEVELOPMENT OF THE RATIONAL DRUG USE SCALE. Anadolu Hemşirelik ve Sağlık Bilimleri Dergisi. 2020;23(4):498-507.

Dergimiz 2019 dan itibaren EBSCO CINAHL Database'de listelenmektedir.

Anadolu Hemşirelik ve Sağlık Bilimleri Dergisi Creative Commons Attribution-NonCommercial 4.0 (CC BY-NC 4.0) ile lisanslanmıştır.

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