Inappropriate self-medication among adolescents and its association with lower medication literacy and substance use

Self-medication practices and their characteristics among French university students

BACKGROUND

Inappropriate self-medication can have major impacts on health. The aim of the study was to describe the prevalence and characteristics of self-medication behaviours among undergraduate and postgraduate students from various academic sectors. We also sought to identify determinants of inappropriate self-medication.

METHODS

We performed a descriptive, cross-sectional study based on a self-questionnaire filled out by students from various academic sectors at the University of Picardy (Amiens, France). The survey comprised four sections: sociodemographic characteristics, health status, self-medication behaviour (including the names of medications taken), and knowledge about medications and the risks associated with self-medication. Inappropriate self-medication was defined as the reported administration of a prescription-only medication without a current prescription.

RESULTS

A total of 1257 students (715 from the health sector and 542 from other sectors; 983 [78.2%] women) completed the survey. In all, 1194 (95%) students reported self-medication. The most reported reason for self-medication was a supposed good knowledge of medications. The most frequently administered drug classes were analgesics (n=736, 46.7%), and anti-inflammatories/antirheumatics (n=299, 19%). In all, 51.7% (n=617) of the self-medicating students used a medicine from an old prescription including prescription-only drugs (mostly analgesics, antibiotics, and anxiolytics). Female sex, studying for a healthcare degree, having a chronic disease, smoking, having a healthcare professional in the family, and stress were all independently associated with inappropriate self-medication behaviours.

CONCLUSION

Our results showed that self-medication in general and the use of old prescription-only medications in particular are frequent among French university students. At-risk situations identification might facilitate the implementation of educational actions.

Relationship Between Medication Literacy and Medication Adherence in Inpatients With Coronary Heart Disease in Changsha, China

Background: Medication literacy may be associated with medication safety, and medication adherence is critical in treating coronary heart disease. Few studies have explored the association between medication literacy and medication adherence in patients with coronary heart disease. The aim was to investigate the status of medication literacy and medication adherence among Chinese inpatients with coronary heart disease, and explore the association between medication literacy and medication adherence.

Methods: The study was a cross-sectional survey. Four hundred seventy inpatients with coronary heart disease were recruited from hospitals in Changsha, Hunan, China. Participants’ demographic and clinical data were retrieved from hospital charts. Medication adherence was assessed using the four-item Morisky Medication Adherence Scale. Medication literacy was assessed using the Chinese Version of the Medication Literacy Scale. For univariate analysis, potential factors influencing medication adherence were tested by T-tests, analysis of variance, and the Kruskal–Wallis H test. Binary logistic regression model was conducted with medication adherence as the outcome variable in order to analyze the association between medication literacy and medication adherence in inpatients with coronary heart disease.

Results: Among 512 participants, 470 (91.8%) produced valid responses for the survey. Mean (SD) of medication adherence score was 2.26 (13.6); only 13.6% had optimal medication adherence. Mean (SD) of medication literacy score was 7.52 (4.09); participants with adequate medication literacy was 30.2% (142). Binary logistic regression analysis indicated that medication literacy was an independent predictor associated with medication adherence. Participants with adequate medication literacy were more likely to have optimal medication adherence (OR 1.461 [95% CI: 0.114, 0.643]; P = 0.005), and participants with a high level of education (OR 0.613 [95% CI: 0.284, 0.694]; P< 0.001), a fewer number of medicines (OR 1.514 [95% CI: -0.631, -0.198]; P < 0.001), having medical insurance (OR 0.770 [95% CI: -1.769, 0.059]; P = 0.043), and single inpatients were more likely to be adherent (OR 1.655 [95% CI:-0.858, -0.149]; P = 0.005).

Conclusions: The study indicates a significant association between medication literacy and medication adherence in patients with coronary heart disease. These results suggest that medication literacy is an important consideration in the development, implementation, and evaluation of medication adherence interventions.

Developing and Verifying the Efficacy of "Educational Program for Promoting Appropriate Self-medication via Pharmacies and Pharmacists": A Randomized Controlled Trial

Utilization of community pharmacies/pharmacists is important for promoting appropriate self-medication; however, appropriate self-medication via pharmacies/pharmacists has not been well-implemented in Japan. Based on the transtheoretical model of health behavior change, we constructed an Educational Program for Promoting Appropriate Self-medication via Pharmacies and Pharmacists to inform the public about the assistive services of pharmacies/pharmacists regarding self-medication and the use of medication notebooks for self-medications. We then tested the efficacy of the program through a randomized controlled trial. The subjects were residents living around Gifu City, aged 20 years and above, and recruited through posters and pamphlets. The subjects were randomly allocated to a group that received only a medication/health class (control group) or one that received the medication/health class, as well as the educational program (intervention group). A questionnaire was administered immediately before the medication/health class (T1) and 2 months afterwards (T2), which allowed us to evaluate and compare the changes in the two groups' behavior regarding performing appropriate self-medication via pharmacies/pharmacists. The percentage of people who began consulting with pharmacists concerning self-medication was significantly higher among the intervention group (38.2%, 13/34) than the control group (14.3%, 4/28) (p = 0.047). The percentage of people who began recording details of self-medication in their medication notebooks was significantly higher among the intervention group (38.2%, 13/34) than the control group (10.7%, 3/28) (p = 0.019). The educational program effectively encouraged the public to adopt appropriate self-medication practices to avail the services provided by pharmacies/pharmacists.

Self-medication Pattern and Prevalence Among Iranian Medical Sciences Students

BACKGROUND

Self-medication could be risky behavior and has negative effects. While Over the Counter (OTC) drugs are available at drugstores, the behavior has become prevalent among the general population.

OBJECTIVE

This study aimed at surveying self-medication behavior among medical sciences students of Shiraz, Iran.

METHODS

A sample of 396 students from medical, paramedical, and health sciences disciplines were included in this cross-sectional study. They were asked to fill a questionnaire about their demographics and socioeconomic status, medication usage and self-medication in the last six months, information about the correct use of medication, and information about negative results of selfmedication. Data were analyzed using chi-square, t-test and logistic regression model using R statistical software.

RESULTS

Almost 72% of participants reported self-medication in the past sixth months. The main reasons included trust in their own diagnosis (59.9%), mildness of the disease (56.6%), and having previous experience about the disease (56%). Cough or cold (84.5%), headache (66.3%), and body pain (60.2%) were the most frequent diseases that led to self-medication. The majority of the participants (77.7%) reported they select their medicine on their own decision. Furthermore, self-medication was highly related to having medicine stock at home (OR=2.692), having less information about negative results of self-medication (OR=0.835), and more non-syllabus study time (OR=1.041).

CONCLUSION

Although, medical science students have information about the treatment of illnesses, they should be more informed about negative results and side-effects of self-medication. They should also share their knowledge with society to decrease self-medication.

Healthcare-seeking behavior and its relating factors in South of Iran

INTRODUCTION

Health systems aimed to increase health utilization. Habits and behavior about using health facilities, which is called health-seeking behavior, are different among different cultures and influenced by different factors. The present study is aimed at investigating Iranian Southern population health-seeking behavior and its influencing factors.

MATERIALS AND METHODS

A sample of 397 people was selected using proportional stratified random sampling for this cross-sectional study. They were asked to fill a questionnaire about their health-seeking behaviors (seeking treatment, inattention to treatment, and self-medication) and socioeconomic factors. Data were analyzed using regression models including linear, ordinal, and logistic regressions.

RESULTS

Near 80% of participants reported self-medication and most of them prefer public hospitals as their first point of contact with health system compared to others such as family physician. Using linear regression revealed seeking treatment has significant relationship with age (P = 0.037), living place (P = 0.018), and having complementary insurance (P = 0.013). Self-medication behavior has relation with age (P = 0.015), gender (P = 0.039), education years (P = 0.031), living place (P = 0.005), having complementary insurance (P = 0.001), and satisfaction with health-care providers (P = 0.003) in logistic regression. Using ordinal regression, it was found that inattention to treatment has a relation with education years (P = 0.044), living place (P = 0.042), having complementary insurance (P = 0.049), and severity of illness (P = 0.031).

CONCLUSION

Southern population does not accept family physician as the first point of interaction with the health system, and they prefer to go to public hospitals directly. Moreover, self-medication is a prevalent behavior among the population and thus their acceptance of health care is low. Based on the findings, it can be suggested providing more satisfying health care, increasing insurance coverage, and informing population could lead to better utilization of health-care services.

Association Between Medication Literacy and Medication Adherence Among Patients With Hypertension

Background: Few studies have investigated the association between medication literacy and medication adherence as well as the influence of medication literacy on medication adherence in hypertensive patients. Thus, the goal of the present study was to determine the association between medication literacy and medication adherence in hypertensive patients. Methods: A cross-sectional survey was conducted between August 2016 and December 2016. Self-administered questionnaires were completed, including a self-developed and structured socio-demographic questionnaire; a self-developed, validated, and self-reported Medication Literacy Scale for Hypertensive Patients (C-MLSHP) used for medication literacy measurement; and the Chinese Version of the Morisky Medication Adherence Scale-8 (C-MMAS-8), an eight-item validated, self-report scale for adherence measurement with a total score range of 0-8. A cut-off of 6 was applied to differentiate adherence levels, including patients with an MMAS score <6 (low adherence), MMAS score = 8 (high adherence), and MMAS score ≥6 and <8 (moderate adherence). In this study, hypertensive patients' medication literacy levels and adherence to antihypertensive agents were identified. Pearson correlation analysis was carried out to identify the correlation between medication literacy and adherence. Binary logistic regression analysis was performed with medication adherence as the outcome variable in order to confirm factors associated with medication adherence. Results: A total of 420 hypertensive patients, including 198 women and 222 men with a mean age of 60.6 years (SD = 12.4), were recruited. The mean score of hypertensive patients on the medication literacy scale was 24.03 (SD = 5.13). The mean scores of the four dimensions of knowledge, attitude, skill, and behavior on the medication literacy scale of this study were 6.22 ± 2.22, 5.04 ± 1.16, 4.50 ± 2.21, and 8.27 ± 1.90, respectively. Regarding medication adherence, the mean score of the C-MMAS-8 in this study was 4.82 (SD = 2.11). A total of 63.6% of patients presented with low adherence, 29.5% presented with moderate adherence, and 7.6% presented with high adherence. The Pearson correlation results showed that medication literacy (r = 0.342, P < 0.01) as a whole variable and the three dimensions of knowledge (r = 0.284, P < 0.01), attitude (r = 0.405, P < 0.01), and behavior (r = 0.237, P < 0.01) were significantly associated with medication adherence. Binary logistic regression analysis indicated that annual income [OR 1.199 (95% CI: 1.011-1.421); P = 0.037] and two dimensions of attitude [OR 2.174 (95% CI: 1.748-2.706); P = 0.000] and behavior [OR 1.139 (95% CI: 1.002-1.294); P = 0.046] in medication literacy were found to be independent predictors of medication adherence. Individuals with better attitudes and behavior literacy in medication literacy were more likely to adhere to the use of antihypertensive agents. Those who had higher annual incomes were more likely to adhere to the use of antihypertensive agents. Conclusion: The levels of medication literacy and medication adherence of hypertensive patients are suboptimal and need to be improved in China. The level of medication literacy in patients with hypertension could affect their adherence to antihypertensive drugs. It was suggested that hypertensive patients' medication adherence could be improved and driven by increasing the medication literacy level, especially in the attitude and behavior domains. Pertinent strategies that are specific to several dimensions of medication literacy should be developed and implemented in order to promote full medication literacy among hypertensive patients, thus facilitating optimal adherence and blood pressure control.

Time from Symptom Onset to Diagnosis and Treatment among Haematological Malignancies: Influencing Factors and Associated Negative Outcomes

Background and objectives: Diagnostic delay causes unfavorable outcomes among cancer patients. It has been widely analyzed in solid tumors. However, data regarding hematological malignancies diagnostic delay are scarce. We aimed to evaluate diagnostic intervals, their influencing factors, and the negative effect on clinical outcomes among multiple myeloma and lymphoma patients. Materials and methods: One hundred patients diagnosed with multiple myeloma (n = 53) or lymphoma (n = 47) (ICD codes-C90, C81-C84) were asked to participate during their scheduled hematology consultations. Interval durations and the majority of influencing factors were assessed based on a face-to-face questionnaire. Data of disease characteristics were collected from medical records. Results: The median interval from symptom onset to registration for medical consultation was 30 (0-730) days, from registration to consultation 2 (0-30) days, from first consultation to diagnosis 73 (6-1779) days, and from diagnosis to treatment 5 (0-97) days. Overall time to diagnosis median was 151 (23-1800) days. Factors significantly prolonging diagnostic intervals in multivariate linear regression were living in big cities (p = 0.008), anxiety and depression (p = 0.002), self-medication (p = 0.019), and more specialists seen before diagnosis (p = 0.022). Longer diagnostic intervals resulted in higher incidences of multiple myeloma complications (p = 0.024) and more advanced Durie-Salmon stage (p = 0.049), but not ISS stage and Ann-Arbor staging systems for lymphomas. Conclusion: Median overall diagnostic delay was nearly 5 months, indicating that there is room for improvement. The most important factors causing delays were living in big cities, anxiety and depression, self-medication, and more specialists seen before diagnosis. Diagnostic delay may have a negative influence on clinical outcomes for multiple myeloma patients.

European university students of pharmacy: survey on the use of pharmaceutical drugs

BACKGROUND AND AIM

In recent years, self-medication is an increasing public health issue, also among the European young people. Only 48% of people throughout the world use prescribed medications, while the remainder admits that they self-medicate with over the counter drugs or leftover prescribed drugs. Also, the risk of antibiotic resistance, throughout the world, has doubled, due to the recourse to these drugs when they are not called for, or to failure to follow their instructions for use.

METHODS

A five-part questionnaire, translated into the national languages and validated, was given to Pharmacy students in Italy, Spain, the Czech Republic and Romania obtain anonymous information about their pharmaceutical drugs use.

RESULTS

Regarding the use of pharmaceutical drugs, students in Spain and Romania indicated the highest percentages of use. In Italy and Romania, the pharmacist is rarely consulted, while the advice of family members or friends is more frequently requested. In all four countries the problem of taking antibiotics without a medical prescription is significant, and 50% of Romanian students use antibiotics to treat the flu. Another important result is that, in Spain, 38.4% of the respondents admitted to using medicines with alcohol.

CONCLUSIONS

Considering that the drug information leaflet is not read by 50% of young people interviewed, it would be important for public health entities to instruct the population, especially younger age groups such as secondary school students, about the importance of reading this information carefully. The use of mass media in such a preventive medicine campaign could be effective.

Using machine learning to investigate self-medication purchasing in England via high street retailer loyalty card data

The availability alongside growing awareness of medicine has led to increased self-treatment of minor ailments. Self-medication is where one ‘self’ diagnoses and prescribes over the counter medicines for treatment. The self-care movement has important policy implications, perceived to relieve the National Health Service (NHS) burden, increasing patient subsistence and freeing resources for more serious ailments. However, there has been little research exploring how self-medication behaviours vary between population groups due to a lack of available data. The aim of our study is to evaluate how high street retailer loyalty card data can help inform our understanding of how individuals self-medicate in England. Transaction level loyalty card data was acquired from a national high street retailer for England for 2012–2014. We calculated the proportion of loyalty card customers (n ~ 10 million) within Lower Super Output Areas who purchased the following medicines: ‘coughs and colds’, ‘Hayfever’, ‘pain relief’ and ‘sun preps’. Machine learning was used to explore how 50 sociodemographic and health accessibility features were associated towards explaining purchasing of each product group. Random Forests are used as a baseline and Gradient Boosting as our final model. Our results showed that pain relief was the most common medicine purchased. There was little difference in purchasing behaviours by sex other than for sun preps. The gradient boosting models demonstrated that socioeconomic status of areas, as well as air pollution, were important predictors of each medicine. Our study adds to the self-medication literature through demonstrating the usefulness of loyalty card records for producing insights about how self-medication varies at the national level. Big data offer novel insights that add to and address issues that traditional studies are unable to consider. New forms of data through data linkage may offer opportunities to improve current public health decision making surrounding at risk population groups within self-medication behaviours.

Home treatment and use of informal market of pharmaceutical drugs for the management of paediatric malaria in Cotonou, Benin

BACKGROUND

Malaria is the main cause of hospital admissions in Benin and a leading cause of death in childhood. Beside consultations, various studies have underlined the management of the disease through home treatment. The medicines used can be purchased in informal market of pharmaceutical drugs (IMPD) without prescription or any involvement of healthcare professional. Pharmaceutical drugs are sold by informal private vendors, who operate at any time in the immediate environment of the patients. The present study was conducted in Cotonou to study the health-seeking behaviour of caregivers to treat malaria in children under 12 years old. Factors associated with malaria home treatment and drugs purchase in IMPD were studied.

METHODS

A cross-sectional study was carried out among 340 children's caregivers who were interviewed about their socio-demographic characteristics and their care-seeking behaviour during the most recent episode of malaria in their children under 12. Medicines used and purchase place were also collected. Multivariate logistic regression model was used to determine factors associated with malaria home treatment and drug purchase in IMPD.

RESULTS

Beyond all the 340 caregivers, 116 (34%) consulted healthcare professional, 224 (66%) home treat the children, among whom 207 (61%) gave pharmaceutical drugs and 17 (5%) gave traditional remedies to children. Malaria home treatment was associated with family size, health insurance (OR = 0.396, 95% CI 0.169-0.928), and wealth quintiles where home treatment was less used by the richest (OR = 0.199, 95% CI 0.0676-0.522) compared to those in the poorest quintile. The caregivers age group 30-39 years was associated to the use of IMPD (OR = 0.383, 95% CI 0.152-0.964), the most economically wealthy people were less likely to use IMPD (wealth quintile richest: OR = 0.239, 95% CI 0.064-0.887; wealth quintile fourth OR = 0.271, 95% CI 0.100-0.735) compared to those in the poorest quintile. All caregivers who benefited from health insurance did not use IMPD.

CONCLUSION

This study highlights the link between worse economic conditions and accessibility to medical care as one of the main factors of malaria home treatment and drug purchase in IMPD, even if those two phenomena need to be understood apart.

Assessment of Knowledge, Attitude, and Practice toward Antibiotic Use among Harar City and Its Surrounding Community, Eastern Ethiopia

Purpose

Community plays significant role in the process of emergence and spread of antibiotic resistance. The aim of this study is to assess knowledge, attitude, and practice toward antibiotic use among Harar city and its surrounding community, Eastern Ethiopia.

Patient and Methods

A cross-sectional study was conducted among 384 subjects from February 1 to May 1, 2017, through interview using pretested structured questionnaires. The data was entered into EpiData 3.1 and analyzed using Statistical Package for Social Science for windows version 20.

Results

A large number of the respondents (83%) replied that antibiotics speed up the recovery from coughs and colds. The majority of participants (78.4%) agreed that the unnecessarily use of antibiotics can increase the resistance of bacteria. Many respondents agreed on the importance of taking full dose (92.1%) and not to keep antibiotics for future use in their home (87.2%). They (90%) also had belief that antibiotics should not be shared from family or friends without a physician consultation and significant participants (73.1%) emphasized on the need for prescription to collect antibiotics from pharmacy. Around 79% of the subjects reported the use of antibiotic 1 year prior to study period at least once. During this period many subjects (65.3%) self-prescribed antibiotics without consulting physicians.

Conclusion

In the present study, widespread use of antibiotics was reported, most of this antibiotics being accessed without prescription. Respondent exhibited poor knowledge and attitude toward antibiotics use. There were also malpractices such as failing to take full dose. Therefore, educational interventions on antibiotics use and its association with drug resistance are needed to promote judicious use of antibiotic. Introducing and enforcing antibiotics regulations should be also considered to reduce antibiotics self-prescription.