Factors that influence Italian consumers' understanding of over-the-counter medicines and risk perception

Dermatology Self-Medication in Nursing Students and Professionals: A Multicentre Study

Current evidence shows that the prevalence of self-medication in healthcare professionals and their students is troublingly high despite them knowing the risks involved. There is limited research on self-medication in dermatology, and there are even fewer studies on this practice among nurses and nursing students, despite the potential mucocutaneous health problems that may affect them. The aims of our study were to examine the prevalence of self-medication mainly in the field of dermatology among nurses and nursing students as well as to explore if age or years of professional/academic practice influenced such behaviour. This multicentre cross-sectional study was conducted in 2021. In total, 120 nurses from the University Hospital of Pontevedra and 303 nursing students from the Universities of Vigo and Santiago de Compostela (N-W Spain) participated in this study (n = 423). An ad hoc questionnaire was used to evaluate self-medication decision-making. Self-medication for dermatological diseases was reported by 58.39% (n = 247) of participants. Among our respondents, 44.44% of nurses and 42.68% of students would recommend treatment for skin diseases to a third party. We found a higher prevalence of medication without prescription in nurses than in students (p < 0.001). More experience (p = 0.01) and older age (p < 0.001) were associated with more self-medication in the case of nurses and students, respectively. The prevalence of self-medication and treatment recommendation to a third party are cause for concern. Identifying these situations and associated factors may help to implement evidence-based strategies and education.

Self-Medication during and after Cancer: A French Nation-Wide Cross-Sectional Study

(1) Background: Little data are available in Western countries regarding self-medication practices in the context of cancer. The aim of this study was to describe the prevalence of self-medication practices during (cancer patients) and after cancer (cancer survivors). (2) Methods: This multicenter, cross-sectional, and online study was designed to assess self-medication prevalence. Other objectives were explored, notably the medication types, the perceived risks, and the relation with symptoms and quality of life. (3) Results: Among the 518 patients analyzed, 56.4% declared they practiced self-medication. Dietary supplements and pain medications were used by more than half of the patients. Self-medication was practiced in order to manage the adverse effects of anticancer therapies (63.8%), for which pain was the leading indication (39%), and to improve the efficacy of anticancer therapies (43.8%, cancer patients). Patients believed that self-medication could not lead to drug interactions with anticancer therapies (84.9%, cancer patients), or to adverse effects (84.6%, cancer patients and survivors). Self-medication practices were associated with altered social functioning, pain, insomnia, and financial difficulties. (4) Conclusions: Self-medication was performed by more than half of the responders (ongoing or past cancer) and could be a marker of the undermanagement of cancer and treatment-related adverse effects.

Japanese Consumers' Attitudes towards Obtaining and Sharing Health Information Regarding Over-the-Counter Medication: Designing an Over-the-Counter Electronic Health Record

Designing an over-the-counter medication electronic health record (OTC-EHR) may help improve OTC usage. An online survey for the conceptual OTC-EHR design examined participant characteristics, attitudes towards obtaining user-shared OTC medication information, health-related application usage, and the inclination to share anonymized health information. Descriptive statistics, tests to assess statistical significance, and text mining were used to analyze the results. The findings revealed that Japanese consumers, particularly those with high eHealth literacy and women, possess relatively positive attitudes towards obtaining user-shared OTC medication information than those with low eHealth literacy (t (280.71) = -4.11, p < 0.001) and men (t (262.26) = -2.78, p = 0.006), respectively. Most consumers own smartphones but do not use health-related applications. A minority held positive attitudes about sharing anonymized health information. The perceived helpfulness of OTC-EHR was positively associated with the usage of health-related applications (χ² (4) = 18.35, p = 0.001) and attitude towards sharing anonymized health information (χ² (3) = 19.78, p < 0.001). The study findings contribute towards OTC-EHR's design to enhance consumers' self-medication and reduce risks, while the psychological barriers to sharing anonymized health information should be improved by increasing the OTC-EHR's penetration rate and engaging in appropriate information design.

Knowledge and Use of Over-the-counter Drugs in Italy: An Exploratory Survey-based Study in the General Population

BACKGROUND

During the past decade, the misuse of over-the-counter (OTC) medicines has become a global public health concern, especially among young people. In this study, we aimed to explore the OTC consumption and related misuse in Italy and identify the demographic characteristics of people/individuals involved in this phenomenon, understanding eventual risk factors.

METHODS

The study consisted of an anonymous online survey distributed by direct contact and via the Internet between June-November 2021 to the general population living in Italy. Descriptive statistics were reported, and binary regression analyses were performed to identify risk factors for lifetime misuse of OTC. The University of Hertfordshire approved the study (aLMS/SF/UH/02951).

RESULTS

The final sample size was composed of 717 respondents. The sample was mainly represented by female (69.3%) students (39.9%) in the 20-25 years age group (30.0%). Based on the survey responses, study participants were divided into two groups according to the presence/absence of OTC abuse/misuse (127 versus 590), which were compared for possible predictors of OTC diversion. Multivariate regression showed that OTC abuse/misuse was associated with the knowledge of the effects of OTC [odds ratio/OR = 2.711, 95%Confidence Interval/CI 1.794-4.097, p <0.001]. On the contrary, the educational level appeared to be a protective factor [OR = 0.695, 95%CI 0.58-0.94, p = 0.016].

CONCLUSION

Although, according to our data, the phenomenon of OTC abuse appeared to be limited, increasing attention is needed because of possible underestimation and high-risk outcomes. Preventive strategies, including simplified access to information, may play a key role in limiting OTC misuse.

The usage pattern of patients' drug information leaflet for oral non-prescription drugs among university students in the United Arab Emirates: cross-sectional study

Background

Very few extensive studies have measured the prevalence and usage pattern of drug information leaflet (DIL) for oral non-prescription drugs (ONPDs) or identified the associated risk factors for not reading DIL among university students in the UAE.

Objective

The current study aimed to estimate the prevalence of the usage pattern of DIL for ONPDs, and delineate the associated risk factors for not reading the DIL among university students.

Methods

A cross-sectional survey-based multistage sampling technique conducted among 2875 students at three major universities in UAE. The self-administered validated questionnaire was constructed and developed based on Andersen's behavioral model. Binomial logistic regression performed to ascertain the effects of 25 potential predictors on the likelihood that participants not reading (discarded) the DIL after reading them. The primary outcome measure was reading (discarding without reading) the DIL, and the associated behaviours.

Results

2875 university students were eligible to participate in the study, but only 2519 students agreed to participate, indicating an 88% of intent participation. However, only 2,355 (81.9%) students completed the questionnaire. 1348 respondents reported using NPD (response rate 46.9%) during the past three months before conducting the study, which comprised the sample analysis (1307 were excluded). More than three-quarters of them read the DIL (always or often) at the first use (1049 of 1348, 77.8%). Approximately a quarter of those who read the DIL reported that they discarded them after reading (24.1%). The survey has identified four risk factors for not reading the DIL: those who get the drug information from physicians or pharmacists had lower odds of discarding the DIL (odds ration [OR] = 0.491, 95% confidence interval [CI]: 0.273-0.884, p value< 0.05). Medical students had lower odds of discarding the DIL (OR = 0.598, 95% CI: 0.412-0.868, p value< 0.05). Those participants who believe that NPDs are as effective as prescription drugs had lower odds of discarding the DIL (OR = 0.342, 95% CI: 0.123-0.948, p value< 0.05). Participants who use more than one NPD to treat a single symptom a day have higher odds of discarding the DIL (OR = 1.625, 95% CI: 1.122 -2.355, p value< 0.05).

Conclusion

The prevalence of drug usage pattern in this population was 57.5% as 1348 subjects reported using NPD during the past 90 days before conducting the study. We have identified four risk factors for not reading the DIL, those who get the drug information from physicians or pharmacists, medical students, those respondents who believe that NPDs were as effective as prescription drugs, and respondents self-treating a single symptom with more than one NPD. It was evident from the findings that usage pattern of NPD for DIL varied among the students, with no specific pattern dominating.

Self-Medication Behaviors of Chinese Residents and Consideration Related to Drug Prices and Medical Insurance Reimbursement When Self-Medicating: A Cross-Sectional Study

BACKGROUND

Self-medication has become a common phenomenon. Economic factors are important factors that affect the self-medication of residents. This study aimed to investigate the current status of self-medication behaviors in China and explored the related factors affecting considerations associated with medical insurance reimbursement or drug price in self-medication.

METHODS

A national cross-sectional investigation was conducted among Chinese people over 18 years old under a multi-stage sampling method through a questionnaire, which includes demographic sociological characteristics, self-medication behaviors and scales. The Chi-square test was used to analyze whether the respondents consider medical insurance reimbursement or drug price as an important factor when purchasing over-the-counter (OTC) drugs. Logistic regression was used to examine the associated factors of considering medical insurance reimbursement or drug price.

RESULTS

In total, 9256 respondents were included in this study; 37.52% of the respondents regarded drug prices as an important consideration, and 28.53% of the respondents attached great importance to medical insurance reimbursement. Elderly respondents who lived in the central region, had medical insurance, and had lower levels of health literacy were more likely to consider the medical insurance reimbursement, while respondents with high monthly family income as well as students were less likely to consider the same issue (p < 0.05). Respondents settled in the central and western regions, students, those without fixed occupations, those who suffered from chronic diseases, or those with lower health literacy were more likely to consider drug prices, while the respondents with bachelor degrees, urban population and high per capita monthly income were less likely to consider the drug prices (p < 0.05).

CONCLUSION

Self-medication behaviors with OTC drugs were prevalent in China, and consideration factors of medical insurance reimbursement or drug prices were related to socio-demographic characteristics and health literacy. There is a need to take measures to reduce the economic burden of self-medication, improve the health literacy of residents and strengthen public health education.

Consumers' self-reported adherence to directions for non-prescription medicines and the role of risk perception

BACKGROUND

Non-prescription medicines (NPMs), while relatively safe, are responsible for a small but significant proportion of medication misadventure and inappropriate use may lead to avoidable healthcare cost. Some consumers vary their use of NPMs from the directions provided on packaging or advice from healthcare professionals. Consumers may use NPMs at lower doses or less frequently than directed because of the risk of side effects.

PURPOSE

This study aimed to develop and validate a self-report measure for the extent to which consumers' follow directions (FDs) for NPMs. Secondly, it aimed to explore the relationship between risk perception towards NPMs and following directions.

METHODS

A cross-sectional study was administered online to participants who belong to an Australian agency which conducts consumer research. Participants were Australian adults who had used NPMs within the last month. Items for the FD-NPM scale were developed and validated. Exploratory factor analysis and confirmatory factor analysis were used to validate the FD-NPM scale. Structural equation modelling (SEM) was employed to explore the relationships between risk perception, covariates, and FDs.

RESULTS

There were 403 participants recruited. Less than 20% "always" or "often" self-reported following directions for dose, frequency, or duration of use. Factor analyses confirmed that there are two moderately positively correlated dimensions of FD-NPM (r = 0.46), which were named underuse and overuse. That is, consumers who self-reported underuse of non-prescription medicines were also more likely to self-report overuse. Consumers with high-risk perception towards NPMs, those who were younger and those who were more educated had a greater tendency to not follow directions.

CONCLUSION

A new self-report measure, the FD-NPM scale was developed and validated. That people who perceives NPMs to be harmful, tend to underuse and more concerningly, overuse them, is of great interest to clinicians and policymakers who are required to manage risk communications.

The impact of using pictorial aids in caregivers’ understanding of patient information leaflets of pediatric pain medications: A quasi-experimental study

Introduction

Patient information leaflets (PILs) are one of the main sources of information for over-the-counter medications (OTCs). This study aimed to assess caregivers' understanding of instructions in PILs provided with paracetamol medications and the impact of pictograms use.

Methods

A quasi-experimental study was conducted among caregivers of children aged < 13 years recruited in pediatric outpatient clinics at University Medical City in Riyadh. The calculated sample size was 128; at least 64 participants were needed in each group (the text-only group and the text-plus pictograms group). Caregivers' health literacy was assessed using a validated Arabic version of the Newest Vital Sign scale. Participants’ understanding of PILs instructions was assessed using eight questions on the route of administration, minimal hours between doses, max daily dose, shake medication before use, storage, and reporting adverse events; and was rated based on the number of questions correctly understood. Characteristics of participants were compared by Pearson X² and t-test was used to assess the significance of mean score differences between groups.

Results

A total of 130 caregivers participated in the study; almost half of them were mothers (47%, [n = 61]) and 43% (n = 56) have “a possibility of limited health literacy”. The mean number of correct answers to questions assessing the understanding of PILs instructions was significantly higher among the text-plus pictograms group compared to the text-only group (5.25 ± 1.85 vs. 4.38 ± 1.27; p < 0.001). When results were controlled for age and gender, better health literacy was found to be associated with a better understanding of instructions (B = 0.39, 95 %CI 0.23–0.54).

Conclusion

Limited comprehension of medications instructions was observed; adding pictorial aids to PILs might enhance the comprehension. Differences in health literacy levels of caregivers should be considered when designing PILs.

Thai Patients' Drug Safety Knowledge and Perceptions Relating to Different Forms of Written Medicine Information: A Comparative Study

PURPOSE

The aim of the study was to evaluate the medication safety knowledge, quality of the written medicine information (WMI), and perceptions of taking the medicines in patients receiving package inserts (PIs) in comparison with patient information leaflets (PILs).

METHODS

A cross-sectional, comparative study was conducted from December 2020 to May 2021 at two university hospitals in Thailand. Outpatients who visited the pharmacy departments and were prescribed one of the three medicines: atorvastatin, celecoxib, or metformin were randomly selected by a permuted block randomization. The medication safety knowledge was measured using a set of validated and closed questions. The quality of the WMI was measured by the Consumer Information Rating Form (CIRF). Satisfaction with information and perceptions of the benefits and risks of medications were rated by the participants using a visual analog scale (0 to 10).

RESULTS

Of the 1150 invited patients, 750 completed the questionnaires (65.2%). A higher proportion of respondents with high level of medication safety knowledge was found in those reading the PILs than the PIs (44.5% and 20.8%, respectively). The type of leaflet received was a significant predictor of the high knowledge level (p < 0.001). The mean CIRF scores were significantly higher among those reading the PILs than the PIs (p < 0.001). Patients reading the PILs were also more satisfied with the information and had more positive perceptions of the benefits from taking medicines and intention to adhere than those reading the PIs. Patients' perceptions of risks after reading both leaflets were moderate (median score = 5.0), with the PIL group having slightly more concern about risks than the PI group.

CONCLUSION

The PILs showed superior effectiveness to the PIs in enhancing knowledge about medication safety, providing greater satisfaction with the information, and positive perceptions of benefit and intention to comply with the medications. PILs should be provided more frequently to patients receiving medicines than PIs.

Community Attitudes and Habits Toward Over-The-Counter Drugs: Results of a Study Conducted in Thessaloniki, Greece

OBJECTIVES

To determine the frequency of use, sources of information, and selection criteria of Greek residents regarding over-the-counter (OTC) drugs, as well as their opinion about their dispensing in nonpharmacy settings.

METHODS

This was a survey study in which an anonymous cross-sectional questionnaire was used to assess the knowledge, habits, and attitudes about OTC drugs. Data were collected from March 2017 to July 2017 in Thessaloniki, the second largest city in Greece. Logistic regression was used to investigate significant factors that affect the participants' behavior.

RESULTS

A total of 782 participants completed the questionnaire. The population had a mean (SD) age of 46 (17) years and 55.1% were females. About one-third (32.5%) of the participants used nonsteroidal anti-inflammatory drugs more than once per week. OTC drugs acting on the gastrointestinal tract were used to a lower extent (13.2%). The majority (84%) of the respondents consult a healthcare professional about the information on OTC drugs. Furthermore, when not sure about which OTC drug to use, 510 participants (65.6%) valued their physician's advice, whereas 480 participants (60.2%) valued their pharmacist's advice. Most participants (61.2%) were negatively inclined toward the purchase of OTC drugs in nonpharmacy settings, with younger participants being more receptive to out-of-pharmacy OTC drug purchase than older ones (odds ratio 2.20; 95% confidence interval 1.37-3.54).

CONCLUSIONS

Healthcare professionals play an important role in providing people information on their selection of OTC drugs. This could be the main reason why participants prefer to buy OTC drugs from community pharmacies rather than retail shops.

Evaluation of painkillers according to the principles of rational drug use in patients registered to a family medicine unit

AIMS

We aimed to evaluate knowledge, attitudes and usage of the painkillers within the framework of rational drug use.

METHODS

This study was conducted in a family medicine unit with a questionnaire consists of 27 questions.

RESULTS

Total of 506 patients participated in the study. The number of people who used pain medication every day was 29 (5.7%) and paracetamol was the most common analgesic (51.1%). The use of painkillers was more common in women and amongst the patients over 65 years of age. The rate of those who preferred painkillers in the form of pills was higher in married patients and the singles preferred injectables (P = .004). Inappropriate use of painkillers was much more prominent in nonsteroidal antiinflammatory drug users (P < .05).

CONCLUSION

Demographic features and disease characteristics were the notable factors that affected painkillers selection and the level of knowledge about them.

Factors Influencing Administration, Recognition, and Compliance of Medicine among Community Residents from Jilin Province, China: A Questionnaire Study

INTRODUCTION

To identify and analyze factors that influence administration, recognition, and compliance of medicine among community residents in Jilin Province, China.

METHODS

A survey was carried out among 2417 community residents in Jilin Province, China, to study their administration (CRA), recognition (CRR), and compliance (CRC) of medicine. Multivariate logistic regression analyses and chi-squared tests were performed to assess factors influencing CRA, CRR, and CRC.

RESULTS

Logistic analyses showed that gender, educational level, and occupation were influencing factors on CRA; age, educational level, smoking status, and health condition were influencing factors on CRR; and gender, age, occupation, and health condition were influencing factors on CRC.

CONCLUSIONS

CRA, CRR, and CRC are associated with specific lifestyles and social economic statuses of community residents. Attention should be paid to influencing factors in order to facilitate community pharmaceutical care, promote the rational use of drugs, and ensure the safe use of medications. This study explores the type and extent of professional services provided through community pharmacies in Jilin Province, China, and provides evidence for optimizing the quality of community pharmacy services.

Pro-Environmental Behaviors: Determinants and Obstacles among Italian University Students

The awareness of citizens concerning the health risks caused by environmental pollution is growing, but studies on determinants of pro-environmental behaviors have rarely examined health-related aspects. In this study, we investigated these determinants using data from a large survey among Italian university students (15 Universities: 4778 filled questionnaires). Besides the health-related aspects, represented by environmental health risk perception and functional health literacy, we considered social and demographic characteristics (gender, area of residence, sources of information, trust in institutional and non-institutional subjects, and students’ capacity of positive actions, indicated as internal locus of control). The attitudes towards pro-environmental behaviors were positive for more than 70% of students and positively related with health risk perception, internal locus of control, and health literacy. The correspondence between the positive attitudes towards pro-environmental behaviors and the real adoption of such behaviors was approximately 20% for most behaviors, except for the separate collection of waste (60%). Such a discrepancy can be attributable to external obstacles (i.e., lack of time, costs, lack of support). The health-related aspects were linked to the pro-environmental attitudes, but to a lesser extent to pro-environmental behaviors, owing to the complexity of their determinants. However, they should be taken in account in planning education interventions.

Virtual pharmacist interventions on abuse of over-the-counter medications during COVID-19 versus traditional pharmacist interventions

OBJECTIVES

This study aimed to investigate the frequency, nature, and clinical significance of pharmacist interventions on over-the-counter (OTC) medicines with abuse potential across community pharmacies with and without virtual care.

METHODS

In this prospective observational study, a trained research team observed the dispensary teams of 12 community pharmacies in the United Arab Emirates (UAE), 6 of which were operating virtual pharmacy care. A standardized data collection form was used to include information about dispensing of OTC medicines and pharmacist interventions on those with abuse/misuse potential. The clinical significance of the interventions was evaluated by a multidisciplinary committee.

RESULTS

The frequency of pharmacist interventions on OTC medicines with abuse potential across pharmacies with and without virtual services was 83.2% versus 91.0%, respectively, whereas the frequency of pharmacist interventions on OTC medicines with misuse potential across pharmacies with and without virtual services was 79.8% versus 41.2%, respectively. The proportions of clinically significant interventions across pharmacies with and without virtual services were 19.7% versus 10.5%, respectively. Cough medicines were dispensed significantly more across pharmacies with virtual care than across pharmacies without virtual care (25.6% vs. 9.7%, respectively; P = 0.04). Asking the patient to seek the advice of an addiction specialist (adjusted odds ratio = 4.11; P = 0.001) versus refusing to sell the drug was more likely to be associated with pharmacies with virtual services than with pharmacies operating traditional pharmacy services.

CONCLUSION

Virtual pharmaceutical care is a potential approach to reduce the abuse/misuse of OTC medicines but needs some improvements regarding detection of these cases. The UAE is the first country in the region to implement and regulate virtual pharmacy practice.

Vulnerability of poorly literate adult consumers regarding over-the-counter drugs

Purpose

This study aims at verifying the impact of literacy on over-the-counter (OTC) drug consumer vulnerability as evaluated by health literacy and label comprehension.

Design/methodology/approach

The item response theory (IRT) was used to estimate the health literacy of two groups and the two-way analysis of variance tests was used to test the hypotheses for the existence of mean differences between the two populations. The convenience sample involved 188 OTC consumers: 94 (50%) poorly literate and 94 (50%) university students/graduates.

Findings

University consumers/graduates have a level of health literacy and label comprehension that is superior to those presented by poor literate consumers. Also, age does not influence the level of health literacy by OTC drug users but has a significant impact on the understanding of OTC drug labels. Finally, the level of schooling and the “age group,” simultaneously, does not impact the understanding of OTC drug labels or health literacy.

Research limitations/implications

This study has added in the field of knowledge by investigating the behavior of poor literate consumers in Brazil, a developing country. The results may be relevant to Marketing professionals, especially those in the pharmaceutical industry, and to police makers, as they help identify the main problems faced by poorly literate consumers.

Practical implications

It is necessary to raise awareness of the dangers of self-medication and wrong use of medications, mainly focused on people with low literacy. As a suggestion, a simple glossary presented along with the label could provide explanations of scientific terms, thus increasing health literacy and reducing the vulnerability of the consumers.

Social implications

This study showed that when using common words such as gastritis to define a health problem, there is a higher degree of correctness. These results suggest the adoption of a more straightforward language and more precise explanations. By doing that, the pharmaceutical industry and policymakers will improve their social impact by increasing consumer power and taking care of the health of the most vulnerable population: the illiterate people.

Originality/value

This study contributes to the international literature, as it enhances and clarifies the knowledge about the customers’ power and vulnerability in developing countries. It fills a gap by evaluating label comprehension and heath literacy at the same time, giving an academic contribution for pharmaceutical consumers’ studies.

Instruments assessing medication literacy in adult recipients of care: A systematic review of measurement properties

OBJECTIVES

The assessment of medication literacy in patients is an important step in assisting clinicians to plan for education, prescription simplification, assistance and/or medication aids. There have been several attempts to develop a standardised, objective measure of medication literacy. The objectives of this systematic review were to critically appraise, compare and summarise the measurement properties of existing instruments that assess medication literacy in adult recipients of care.

DESIGN

A systematic review was performed.

SEARCH METHODS

Structured searches were conducted in Embase, MEDLINE PubMed, CINAHL, APA PsycINFO and Web of Science Core Collection in March 2020. Additional searches were performed in ProQuest Dissertations and Theses, DART Europe, and Google Scholar, followed by citation tracking of included studies.

REVIEW METHODS

Two researchers independently identified eligible studies. Two researchers then assessed the methodological quality of the studies and quality of measurement properties, using the Consensus-based Standards for selection of health Measurement Instruments (COSMIN) guidelines. A best-evidence synthesis for each instrument was performed.

RESULTS

From the 5035 citations, 17 studies were included that concerned 13 instruments using different administration methods (i.e., performancebased or self-report), medication type (i.e., prescribed or nonprescribed) and context of use (i.e., clinical or community settings). Very low- to moderate-quality evidence supported satisfactory content validity regarding relevance and comprehensibility, while comprehensiveness remained inconsistent. Other measurement properties were less frequently examined and were supported by moderate-quality evidence (i.e., structural validity) to low- or very low-quality evidence (i.e., internal consistency, reliability, construct validity). The bestvalidated instrument is the unidimensional 14-item Medication Literacy in Spanish and English assessment tool (MedLitRxSE), based on direct testing of participant performance regarding four hypothetical scenarios on medication use. Nine instruments have the potential to be recommended but require additional research, while for others, their psychometric soundness is too limited and they require content revisions.

CONCLUSION

This is the first systematic review to identify instruments for medication literacy. None of the identified instruments had all measurement properties properly assessed and none reported measurement invariance, measurement error and responsiveness of the instrument. Further research is necessary for a better theoretical understanding of medication literacy in order to assist health professionals in identifying patient needs for education, regimen simplification, assistance and/or medication aids. Such research will help conceptualise new instruments that not only cover relevant domains dedicated to specific populations (e.g., polymorbid and/or older individuals), but also exhibit satisfactory measurement properties.

Diabetes patient’s pharmacovigilance knowledge and risk perception: the influence of being part of a patient organisation

Objective:

The aim was to assess the perception of risk for developing adverse drug reaction (ADRs) and knowledge, attitudes and opinions regarding pharmacovigilance in diabetic patients, and to investigate the effect of being a member of a patient organisation for diabetes on these factors, in comparison with other patients.

Methods:

A cross-sectional study looking for patients’ risk perception of experiencing ADRs. Diabetes patients followed at the Portuguese Diabetes Association (APDP) were included, together with two comparison groups (patients with and without diabetes). Kruskal-Wallis followed by post hoc Dunn’s multiple-comparison test were used to compare patients’ groups.

Results:

A total of 314 patients participated in the survey (104 followed at APDP, 106 with diabetes not followed at APDP and 104 without diabetes diagnosis that used chronic medication). APDP patients presented higher risk perception scores for medicines related to their disease compared with two groups. Those patients affirmed that doctors explained possible ADRs on medication to them, and showed higher intention to report ADRs in the future if serious or unexpected.

Conclusions:

Patients with diabetes showed greater understanding of ADRs and higher need to report them than patients without diabetes. They would like to have more information about general ADRs related to anti-diabetic medication and present higher intention to acquire information on how and when to report compared with non-diabetic patients. Patients followed in APDP presented higher score of risk perception, which could be influenced by the presence of the diabetes disease in the patients’ life, by their previous experiences using medicines, but also by information received from the patient organisation. The two groups of patients with diabetes have different experiences of the disease, but both present higher perception of side effects related with medicines they use respectively in their diabetes type. Hence, patient organisations are well positioned to be a source where patients can obtain reliable information, changing their attitudes and perceptions about the disease and drug treatments.

Drug-related problems and pharmacy interventions in non-prescription medication, with a focus on high-risk over-the-counter medications

Background The risks associated with over-the-counter medication are often underestimated by consumers. The incorrect use of certain medications can lead to significant patient harm. Inappropriate use can be prevented by pharmaceutical counselling. Objective To determine the number and nature of drug-related problems in over-the-counter medication with a special emphasis on high-risk over-the-counter medications. Setting Fifty-two community pharmacies in Finland. Method This observational study was conducted as a questionnaire survey. The pharmacists working in participating pharmacies documented the observed drug-related problems and pharmacy interventions in over-the-counter medication during 1 week using an electronic study form based on the Westerlund drug-related problem classification system. Main outcome measure The prevalence of drug-related problems and problem types in different medication categories. Results The 52 community pharmacies documented 339 drug-related problems in 0.6% of over-the-counter customers, the most common problem being “Uncertainty about the indication for the drug” (39.2%). A significant proportion of the documented problems (26.3%) concerned high-risk over-the-counter medications, and the majority of these cases were associated with non-steroidal anti-inflammatory drugs (21.8%). In total, pharmacies made 641 interventions to resolve the drug-related problems. For majority of drug-related problems (87%), pharmacist’s intervention involved counselling. In more than half of the problem cases, the pharmacy intervention was precautionary. Conclusion Pharmacists intervene in and prevent problems related to over-the-counter medications, including high-risk medications like analgesics, in which inappropriate use due to consumers’ lack of knowledge can lead to severe consequences. As the selection and use of over-the-counter medications is continuously increasing, pharmaceutical counselling should be readily available and actively provided for consumers to achieve safer self-medication.

Environment and health: Risk perception and its determinants among Italian university students

Among the determinants of environmental health risk perception, health literacy and social media messages have been generally neglected. This study details the environmental health risk perception and its determinants in Italian university students, including a measure of functional health literacy and an analysis of newspapers and social media. A cross sectional survey was carried out among students from 15 Italian universities and different disciplines (grouped into Scientific-Health and Humanistic-Legal-Social sectors) using a self-administered anonymous questionnaire, divided into six sections: socio-demographic characteristics, information on health and environment, environmental health risk perception, trust, attitudes and behaviors and functional health literacy. Local newspapers and tweets in the same areas and period were analyzed in relation to quantity and topics. The study population included 4778 students (65.1% female) aged 21 ± 4.3 years, and functional health literacy was low (below the cutoff value) for 44.4% of students. A new outcome of the survey is that the detected association between high functional health literacy a higher global health risk perception and trust in institutions both as sources of information and as actors for protection against environmental risks. The internet and social networks were the most frequently consulted sources of information (77.7%), which was predictive of a higher risk perception. The possible relation between environmental health risk perception and tweet communication was highlighted by a comparison between the risk perception in the city with the highest number of tweets (Modena) and another one similar for socio-demographic characteristics (Pisa). In conclusion, the results of our study may be of help to strengthen information and education programs: functional health literacy should be taken into account in school programs, to produce a basic knowledge for a better understanding of health and environment. Moreover, mass and social media should be included in planning communication intervention and in verifying their results.

Consumer internet purchasing of medicines using a population sample: A mixed methodology approach

BACKGROUND

Malta has an average of 3-4 private community pharmacies per locality, providing patients with easy access to medicines yet according to general statistics gathered from European organisations, Internet is used to purchase various online products with medicines being amongst them.

OBJECTIVES

To identify patterns around internet purchasing of medicines among Maltese residents.

METHODS

The study followed a mixed methods approach, employing a cross-sectional survey followed by semi-structured interviews. A random sample of 1996 residents were selected from the Maltese electoral register to participate in a postal questionnaire designed to gather data about purchasing prescription-only-medicines (POM) as well as over-the-counter (OTC) medicines. Results were analysed using descriptive statistics and Chi-square to establish associations between responses. Five interviews investigated participants' concerns related to sourcing of medicines. The participants were purposively chosen from the questionnaire respondents. Data were analysed using thematic analysis.

RESULTS

The survey had a 22% response rate (N = 444) (60% female; mean age 52 years ± 17). Two (0.45%) participants reported purchasing POMs online in the past, while 4.3% (n = 19) purchased OTCs including vitamins, supplements and herbal combinations. The main reasons for OTC online purchasing were lack of local availability (n = 6; 1.4%) and lower price (n = 11; 2.5%). A total of 89% (n = 395) of respondents provided a reason for not purchasing online, with safety issues being the primary reason for 41% (n = 181) of these. Interviewees expressed disregard towards internet purchasing of medicines that was evident from the themes that emerged: definition of 'medicines', health autonomy and trust in self-care, relationships and trust in health professional, restrictions of medicine supply, influence of cost, need for options.

CONCLUSIONS

The Maltese appear to be rather cautious and do not purchase POMs online, citing the risks that may be associated with internet purchasing. With regards to OTCs, a small percentage purchase these online and exposing them to risks associated with unauthorised sites.

Analysis of spontaneous reporting of suspected adverse drug reactions for non-analgesic over-the-counter drugs from 2008 to 2017

BACKGROUND

Adverse drug reaction (ADR) reporting practices by health care professionals remain poor. Over-the-counter (OTC) drugs are perceived as safe; however, they can also cause ADRs. The objective of this study was to analyze ADR reporting for OTC drugs in a 10-year period, in order to evaluate frequency of ADRs, population that ADRs most affect and reporters of ADRs of OTC drugs in Croatia.

METHODS

Spontaneously reported ADRs of non-analgesic OTC drugs, collected from January 2008 to December 2017 were analyzed. Data was obtained from Agency for Medicinal Products and Medical Devices of Croatia (HALMED).

RESULTS

There were 547 ADRs of OTC drugs reported in total and an increase in number of reports through the years was observed. Pharmacists reported 45.4% of all ADRs, and were most frequent reporters (p < 0.001). In 2017 majority of reports, 62 (49.2%), were obtained from consumers. ADRs were most frequently observed in patients aged 70 years and older (15% of ADRs). Five percent of all reports were accidental exposures among children.

CONCLUSIONS

Pharmacists most frequently reported ADRs of OTC drugs and consumers' awareness of ADR reporting has risen. Other health care professionals (e.g., nurses and dentists) must be offered proper education in order to improve reporting practice of ADRs. Health care professionals should address concerns about OTC drug safety in elderly and children.

Who self-medicates? Results from structural equation modeling in the Greater Paris area, France

OBJECTIVES

Our study aimed to describe the prevalence of self-medication among the Paris adult population and to identify the factors associated with self-medication.

MATERIALS AND METHODS

This cross-sectional study was based on data collected from the SIRS cohort (a French acronym for "Health, inequalities and social ruptures") in 2005 in the Paris metropolitan area using a face-to-face administration questionnaire among a representative sample of 3,023 French-speaking adults. Structural equation models were used to investigate the factors associated with self-medication in the overall population and according to income.

RESULTS

The prevalence of self-medication in the past four weeks was 53.5% in the Paris metropolitan area. Seven factors were directly associated with self-medication in the structural equation model. Self-medication was found more common among women, young people, in active employment or student, with a high income, but also among people with a health information seeking behavior, with a high daily mobility, and/or with a history of unmet healthcare needs due to economic reasons. When looking at these coefficients according to income, the association between self-medication and daily mobility appeared stronger in the bottom quartile of income whereas it was no longer significant in the rest of the survey population.

CONCLUSION

Self-medication is a frequent practice in the Paris metropolitan area. This study confirms the role of some factors found to be associated with self-medication in the literature such as age or gender and draws attention to other factors rarely explored such as daily mobility, especially among people with a low income, or health information seeking behavior.

Development of a Theory-Based Intervention to Enhance Information Exchange during Over-The-Counter Consultations in Community Pharmacy

(1) Background: Community pharmacy personnel help mitigate risks of self-care by consumers who seek over-the-counter (OTC) medicines or treatment of symptoms and/or conditions. Exchange of information facilitates the OTC consultation, but pharmacy personnel often report difficulties in engaging consumers in a dialogue. The aim of this study was to describe the development of a behaviour change intervention to enhance information exchange between pharmacy personnel and consumers during OTC consultations in community pharmacies. (2) Methods: The Behaviour Change Wheel methodological framework was used to link factors that influence consumer engagement with information exchange during OTC consultations with intervention functions to change behaviour. Options generated were rationalized and the final intervention strategy was derived. (3) Results: Education, persuasion, environmental restructuring, and modelling were determined to be potential intervention functions. The intervention incorporated placing situational cues in the form of posters in the community pharmacy modelling information exchange behaviour, persuading through highlighting the benefits of exchanging information and educating about its importance. (4) Conclusions: A systematic, theoretically underpinned approach was applied to develop candidate interventions to promote information exchange in OTC consultations. The feasibility and efficacy of the intervention strategy has since been tested and will be reported elsewhere.

Adolescents' Misuse of Over-The-Counter Medications: The Need for Pharmacist-led Intervention

Adolescents' misuse of over-the-counter (OTC) medications is a growing patient safety concern, resulting in an alarming number of poisonings and emergency department visits. OTC medications are easily accessible and adolescents often have the misconception that these medications are safe, even at higher than recommended doses. Dextromethorphan and acetaminophen are the most common and frequently misused OTC medications among adolescents, with significantly dangerous health risks if used improperly. Pharmacists are critical to the provision of education on safe OTC medication use for adolescents and their family caregivers by leading and implementing relevant community-based interventions. Ideal channels in which to do this in the community are pharmacies and schools. It is challenging to gain the attention of adolescents and to engage them; methods that include innovative measures and initiatives may be the solution. Research is needed to determine how pharmacists can improve adolescents' knowledge and safe use of OTC medications. Pharmacists must be supported through training and acquisition of expertise specific to adolescent engagement and education. The development of pharmacist-led educational interventions that are tailored for adolescents that address their limited OTC medication knowledge and raise awareness of safety risks associated with misuse is crucial to preventing and reducing this patient safety problem in the community.

The determinants of access to information on the Internet and knowledge of health related topics in European countries

The aim of this study is to analyze the determinants of access to health-related information on the Internet and their influence on perceived knowledge of health-related topics in European countries. Referring to the European citizens' digital health literacy survey and applying structural equation modelling hypotheses, the obtained results showed that assumption of acceptance of information and capacity level are the main determinants which have the biggest influence on the perception of access to health-related information on the Internet. The access to health-related information negatively determined the perceived level of knowledge about health-related topics, which reveals that people making more use of the information are more critical in assessing the level of their knowledge. People who evaluated their health status as poor stated that they knew about health-related topics less. Therefore, the high level of access to health-related information does not mean that people would assume having more knowledge about health-related topics. The establishment of a platform on the Internet, which would supply all understandable information on health-related topics, would be the main tool for enhancing the level of knowledge of health-related topics.

Attitudes towards sales and use of over-the-counter drugs in Sweden in a reregulated pharmacy market: a population-based study

OBJECTIVES

To analyse attitudes towards sales and use of over-the-counter (OTC) drugs in the Swedish adult population.

METHODS

Data were collected through the web-based Citizen Panel comprising 21 000 Swedes. A stratified sample of 4058 participants was emailed a survey invitation. Questions concerned use of OTC drugs, and attitudes towards sales and use of OTC drugs. Correlations between the attitudinal statements were assessed using Spearman's rank correlation. Associations between attitudes and participant characteristics were analysed using multinomial logistic regression.

KEY FINDINGS

Participation rate was 64%. Altogether 87% reported use of OTC drugs in the last 6 months. Approximately 10% of participants stated that they used OTC drugs at the first sign of illness, and 9% stated that they used more OTC drugs compared with previously, due to increased availability. The statement on use of OTC drugs at first sign of illness correlated with the statement about using more OTC drugs with increased availability. Socio-demographic factors (age, sex and education) and frequent use of OTC drugs were associated with attitudes to sales and use of OTC drugs.

CONCLUSIONS

Increased use due to greater availability, in combination with OTC drug use at first sign of illness illustrates the need for continuous education of the population about self-care with OTC drugs. Increased awareness of the incautious views on OTC drugs in part of the population is important. Swedish policy-makers may use such knowledge in their continuous evaluation of the 2009 pharmacy reform to review the impact of sales of OTC drugs in retail outlets on patient safety and public health. Pharmacy and healthcare staff could be more proactive in asking customers and patients about their use of OTC drugs and offering them advice.

Public risk perception of non-prescription medicines and information disclosure during consultations: a suitable target for intervention?

OBJECTIVE

Optimisation of non-prescription medicine (NPM) supply from community pharmacies could reduce demand on other healthcare providers, including general practitioners and emergency department personnel. Outcomes can be maximised if patients disclose relevant information, for example concomitant medication, during pharmacy-based consultations. Strategies to promote information disclosure are needed. This study used the psychometric paradigm of risk to explore whether the public's risk perception of NPMs was associated with information disclosure.

METHODS

This national, cross-sectional population study used a random sample of 3000 adults (aged ≥ 18 years) from the Scottish Electoral register. Postal questionnaires collected data on risk perceptions, information disclosure and demographic information. Exploratory factor analysis was used to determine constructs to which the risk questions could be grouped. Factors were scored and the scores compared across demographics.

KEY FINDINGS

Just over half (57%) of the 927 respondents perceived NPMs to be associated with low general risk. For 19 of the 23 statements (83%), respondents indicated general agreement, that is low-risk perception of NPMs. Individuals with higher risk perception of NPMs were less likely to disclose information during consultations compared with respondents with lower risk perception.

CONCLUSION

There is general low public risk perception of NPMs. Individuals with higher risk perception are less likely to disclose information. Interventions that raise risk perception are unlikely to enhance the safe and effective supply of NPMs.

Use patterns of over-the-counter (OTC) medications and perspectives on OTC medications among Korean adult patients with chronic diseases: gender and age differences

BACKGROUND

A number of symptomatic patients tend to use over-the-counter (OTC) medications and prescription medications. OTC medications can be easily obtained in pharmacies for self-treatment, but using OTC medications is not always safe and beneficial for patients. The aims of this study were to examine the use patterns of OTC medications and assess patients' perspectives regarding the use of OTC medications in Korean patients with chronic diseases.

PATIENTS AND METHODS

A descriptive, cross-sectional survey was carried out with Korean patients who visited the community pharmacy, located at the southern region of South Korea, during September 2015.

RESULTS

A total of 345 patients participated in this survey. Approximately 64% of Korean survey respondents reported that they had used OTC drugs. The most commonly used OTC medications were antipyretics, analgesics and anti-inflammatory drugs. The perception level of Korean consumers on adverse drug reactions and drug-drug interactions from OTC medications was relatively low. Although OTC package leaflets are a main source of information about OTC medications, Korean consumers' level of reading OTC package leaflets was relatively low.

CONCLUSION

Based on these results, this study can serve as a meaningful starting point for interventions of health care professionals regarding OTC medications in South Korea. In particular, pharmacists should inform their consumers of drug-related problems from OTC drugs during consultation with the consumers; however, information about OTC drugs should be tailored to consumer information needs with the consideration of his or her circumstance. It is somewhat difficult to generalize the results from this study to other regions of South Korea since most of the respondents were probably residents of a small rural city located in the southern region of South Korea.

Assessment of health seeking behaviour and self-medication among general public in the state of Penang, Malaysia

Background:

Patients’ behaviour in making decisions regarding health is currently changing from passive recipients to recipients who play an active role in taking action to control their health and taking self-care initiatives.

Objectives:

This study was conducted to evaluate the health seeking behaviour among general public and its associated factors; and to evaluate the medicine taking behaviour in public and the practice of self-medication.

Methods:

A cross-sectional study was undertaken among general public in Penang Island, Malaysia. A convenience sampling of 888 participants successfully completed the survey. Self-administered questionnaires were distributed among the residents in the north east of Penang Island.

Results:

This study showed that most of the participants chose to consult the physician when they experience any health problems (66.7%), followed by self-medication (20.9%). The first action for consulting the physician was significantly predicted by Malay respondents and retired people (OR 3.05, 95% CI 1.04-8.89). The prevalence of self-medication was 54%. The practice of self-medication was significantly associated with Chinese participants, educated people, people with alone living status and people with more self-care orientation.

Conclusion:

Increasing the awareness of the public about the rational choice of getting medical assistance is a very important issue to control their health. A health education program is needed to increase the awareness about the use of medicines among the general public and to enable them to make the right decisions relating to health problems.

Consumer views on safety of over-the-counter drugs, preferred retailers and information sources in Sweden: after re-regulation of the pharmacy market

BACKGROUND

The availability of over-the-counter drugs (OTCs) has increased in Sweden since a re-regulation of the pharmacy market in 2009, through which non-pharmacy retailers became permitted to provide certain OTCs.

OBJECTIVE

To examine the adult general public's views on safety, purchasing and information channels, storage and disposal of OTCs in Sweden, three years after the re-regulation of the pharmacy market.

METHODS

A questionnaire study in 2012-13 in a stratified, random sample of all inhabitants in Sweden ≥ 18 years old.

RESULTS

Totally 8,302 people (42%) answered the questionnaire. Seven percent found OTCs completely harmless regardless of how they are being used, 18% felt they should be used only on health professionals' recommendation. Differences in how OTCs are perceived were however found with regards to respondents' country of birth, family type, educational level and income. The pharmacy was still the preferred OTC drug retailer by 83% of the respondents and preferred information source by 80% Reasons for preferred retailers were primarily due to out of habit (45%), counseling provided (35%), the product range (34%) and the confidence in staff (27%). Analgesics are the most common OTCs to have at home (90%). The bathroom cabinet is the primary site for storage (42%) and 16% throw their OTC leftovers in the trash.

CONCLUSIONS

The study population does not consider OTCs as harmless regardless of how they are used, but on the other hand feels they should not be taken on health professionals' recommendation only. The pharmacy is still the preferred retailer and information source, and there is room for further improvement in the storage and disposal of OTCs. A return of OTC drug leftovers to the pharmacy should be further encouraged. Due to several limitations, great caution should however be observed when generalizing the results to the adult population of Sweden.

Administration of oral medication by parents at home

AIMS AND OBJECTIVE

The objective of this study was to determine parents' experiences and problems with administering medication to their children at home.

BACKGROUND

Parents' experiences and access to information for the treatment of their children's illnesses at home is necessary for their children's safety.

DESIGN

A descriptive cross-sectional study.

METHODS

Four hundred parents from children's hospital outpatient clinics were included. A questionnaire was used to determine parents' experiences and problems with administering medication to their children at home. Descriptive statistical analyses were performed using the spss software package (version 22.00).

RESULTS

Antipyretics (59%) and antibiotics (25%) were the most commonly used medicines by parents without prescription. Nearly half of the parents stated that they gave liquid medicine with a household spoon. It was found that 54% of the parents whose children refused to take tablets or liquid medicine mixed these medications into foods. Treatment was delayed in 20·7% of the children who refused to take tablets and in 29·1% of the children who refused to take liquid medicine. As a result of the project, a form and device were developed as a solution to the problems experienced by parents while administering oral medication in the home environment.

CONCLUSION

The results of the study showed that a significant percentage of the parents did not use the correct equipment to administer medications, used non-prescription medicines, did not administer medications at correct intervals and mixed medication into foods.

RELEVANCE TO CLINICAL PRACTICE

Healthcare professionals, especially nurses, should continually evaluate medication administration by parents at home and the readmission rate in the emergency department to further improve children's health.

Beliefs about medicines are strongly associated with medicine-use patterns among the general population

AIMS

To investigate self-reported beliefs and perceived sensitivity to medicines and their effects in relation to self-reported use of medicines and herbal remedies.

METHODS

A survey sent to 13,931 randomly selected Swedish adults included the Beliefs about Medicines Questionnaire-General (BMQ-General) Questionnaire and the Perceived Sensitivity to Medicines Scale (PSM). The survey also asked about individuals' use of prescribed and over-the-counter (OTC) medicines and herbal remedies in the past month. We examined all associations between scores on the BMQ-General subscales and PSM in relation to the use of medicines and herbal remedies, using analysis of covariance adjusted for potential confounders.

RESULTS

Among 7099 respondents, those using herbal remedies exclusively believed strongly that prescription and OTC medicines are harmful and overprescribed. Respondents using prescription and OTC medicines reported more positive beliefs [coefficient 0.67 (95% CI 0.47-0.87) and 0.70 (95% CI 0.51-0.90)] on the benefits of medicines compared with those using herbal remedies [-0.18 (95% CI -0.57-0.20)]. Perceived sensitivity to medicines was higher among those using herbal remedies only [1.25 (95% CI 0.46-2.03)] compared with those using no medicines (reference 0) or prescription [-0.44 (95% CI -0.84 to -0.05)] or OTC [-0.27 (95% CI -0.66-0.12)] medicines alone.

CONCLUSION

Respondents using prescription and/or OTC medicines reported stronger positive beliefs about the benefits of medicines in general, supporting the hypothesis that beliefs influence medicine use. Therefore, addressing beliefs and concerns about medicines during patient counselling may influence medicine use, particularly regarding unintentional non-adherence.

Consumer preferences for over-the-counter drug retailers in the reregulated Swedish pharmacy market

Following a large regulatory reform in 2009, which ended the state's pharmacy monopoly, non-pharmacy retailers in Sweden today sell certain over-the-counter (OTC) drugs. The aim of this study was to investigate consumer preferences regarding OTC drug retailers and the reasons for choosing a pharmacy versus non-pharmacy retailer. We conducted a web survey aimed at Swedish adults. Out of a stratified sample of 4058 persons, 2594 agreed to take part (48% women; mean age: 50.3 years). Questions related to OTC drug use, retailer choice and factors affecting the participants' preferences for OTC drug retailers. Logistic regression was conducted to analyse OTC drug use and reasons for retailer choice in relation to sex, age and education. Nine in ten participants reported OTC drug use in the 6 months prior to the study. For their last OTC purchase, 76% had gone to a pharmacy, 20% to a grocery shop and 4% to a convenience store, gas station or online. Geographic proximity, opening hours and product range were reported as the most important factors in retailer choice. Counselling by trained staff was important to 57% of participants. The end of the state's pharmacy monopoly and the increase in number of pharmacies seem to have impacted more on Swedish consumers' purchase behaviours compared with the deregulation of OTC drug sales.

Use of over-the-counter (OTC) drugs and perceptions of OTC drug safety among German adults

PURPOSE

In Europe, little empirical evidence is available about over-the-counter (OTC) drug consumption and risk perceptions. The objective of this study was to describe consumers' OTC drug use and perceptions of OTC drug safety in Germany.

METHODS

An online survey based on a quota sample with combined strata for age, gender, and education of 300 adult German participants was conducted in June and July 2013. The survey questionnaire covered the participants' OTC and prescription drug use, risk perceptions of OTC and prescription drugs, package leaflet reading habits, and OTC drug off-label use.

RESULTS

Seven day prevalences of OTC drug use were higher in women (52.0%) than in men (40.8%). The risk perception of specific OTC drugs was impacted by the route of administration, the indication, and the drugs' ingredients. Products for dermal application or plant-based products were considered 'rather not risky' by 82.7-96.6 of the participants, depending on the product. Products for oral use or chemically synthesized substances were considered less safe. While 48.0% of consumers reported always reading the package leaflet of OTC drugs, 44.5% reported not reading it if they knew the drug or believed the drug was very safe. People, 60 years and older, reported significantly lower levels of OTC drug off-label use (9.3%) than younger people (22.0%).

CONCLUSIONS

The 7-day prevalence of OTC drug use in Germany is high, especially among women. Consumers generally have balanced perceptions regarding OTC drug safety. Behaviours and knowledge related to OTC drug use should be considered by health care providers and regulators.

Associations between Self-medication, Health Literacy, and Self-perceived Health Status: A Community-Based Study

BACKGROUND

Although the frequency of self-medication has been well-documented in the public health literature, but no study has examined the relationship between health literacy and self-medication yet. This study was aimed to investigating the relationship between health literacy and self-medication in a community-based study.

METHODS

This cross-sectional study was conducted on 924 adults to survey association between health literacy and self-medication among peoples in Ardabil city in 2014 who were selected using a multi-stage random sampling method. Health literacy was measured by the test of functional health literacy in adults and general health status was measured by the 12-item General Health Questionnaire, and self-reported self-medication (overall, sedative, antibiotic and herbal) in last 3 months was assessed. All statistical analysis was performed using the SPSS version 18 and a P < 0.05 was considered significant.

RESULTS

The mean age and weight of respondents were 37 years and 74.7 kg, respectively. The prevalence of self-medication was 61.6%, and the percentage of self-administering antibiotics, sedative, and herbal medicines were 40%, 54.4%, and 59.1% in the last 3 months, respectively. Significant relationship was found between of total health literacy and general health status with self-medication. The prevalence of self-medication among participants with poor and very poor self-rated physical and mental health was significantly higher than other participants (P < 0.001).

CONCLUSIONS

Self-medication had a significant relationship with health literacy and health status. Therefore, the design and implementation of training programs are necessary to increase the perception on the risk of self-medication.

Public knowledge and factors associated with inappropriate analgesic use: a survey in Thailand

Objective

This study aims to evaluate knowledge of analgesics and factors associated with inappropriate analgesic use among the public.

Methods

The cross-sectional study was carried out in one large city in the south of Thailand. The survey was conducted using interview of people of age 16 or older. The questionnaire elicited information regarding knowledge, attitudes and behaviours on analgesic use including prevalence of taking paracetamol &gt;4 g/day (overdosage) and not taking non-steroidal anti-inflammatory drugs (NSAIDs) with meals (inappropriate taking).

Key findings

Of 1982 participants, paracetamol overdose (n = 595) and inappropriate NSAID users (n = 751) were less likely to give correct answers about analgesics compared with appropriate users. The overdose use was inversely associated with knowledge on paracetamol (odds ratio (OR) 0.90; 95% confidence interval (CI), 0.83, 0.98) but directly associated with positive attitudes towards high dose taking (OR 2.15; 95% CI, 1.49, 3.11), and high frequency of analgesic use (OR 1.78; 95% CI, 1.24, 2.54). Inappropriate NSAID ingestion was inversely associated with knowledge on NSAIDs and directly associated with more commonly obtaining analgesics from community pharmacies (OR 0.87; 95% CI, 0.82, 0.92 and OR 1.27; 95% CI, 1.01, 1.61, respectively).

Conclusions

Poor knowledge, positive attitudes towards high dose or high frequency of analgesic consumption and the patterns of using drugs were associated with inappropriate analgesic use especially that of paracetamol.

"But it's just paracetamol": Caregivers' ability to administer over-the-counter painkillers to children with the information provided

OBJECTIVE

To determine whether caregivers are able to make informed decisions about their families' use of over-the-counter (OTC) painkillers through access to and use of three mechanisms of information provision.

METHODS

A cross sectional, face-to-face questionnaire was administered to 60 caregivers and seven pharmacists in Cape Town, South Africa. Caregivers answered questions related to paracetamol (acetaminophen) labels, inserts and Patient Information Leaflets (PIL).

RESULTS

Most study caregivers received labels with the painkillers they purchased. Many pharmacists (43%) felt that the information provided was ineffective in preventing overdosing. Study caregivers found it difficult to understand the scientific terms in all three mechanisms of information provision. Most respondents (80%) found the PIL easiest to understand, yet few had received PILs with their purchase. Ten percent of literate respondents were unable to understand the dosage requirements for children.

CONCLUSION

Most caregivers are not able to make informed decisions from the information provided with OTC painkillers. This is mostly attributable to limited provision of information and low health literacy.

PRACTICE IMPLICATIONS

Written information with OTC medications in simple language and verbal counselling at dispensaries would play a significant role in increasing the health literacy of especially at risk populations of over-dosing their children.

Readability of medicinal package leaflets: a systematic review

OBJECTIVE

To review studies on the readability of package leaflets of medicinal products for human use.

METHODS

We conducted a systematic literature review between 2008 and 2013 using the keywords “Readability and Package Leaflet” and “Readability and Package Insert” in the academic search engine Biblioteca do Conhecimento Online, comprising different bibliographic resources/databases. The preferred reporting items for systematic reviews and meta-analyses criteria were applied to prepare the draft of the report. Quantitative and qualitative original studies were included. Opinion or review studies not written in English, Portuguese, Italian, French, or Spanish were excluded.

RESULTS

We identified 202 studies, of which 180 were excluded and 22 were enrolled [two enrolling healthcare professionals, 10 enrolling other type of participants (including patients), three focused on adverse reactions, and 7 descriptive studies]. The package leaflets presented various readability problems, such as complex and difficult to understand texts, small font size, or few illustrations. The main methods to assess the readability of the package leaflet were usability tests or legibility formulae. Limitations with these methods included reduced number of participants; lack of readability formulas specifically validated for specific languages (e.g., Portuguese); and absence of an assessment on patients literacy, health knowledge, cognitive skills, levels of satisfaction, and opinions.

CONCLUSIONS

Overall, the package leaflets presented various readability problems. In this review, some methodological limitations were identified, including the participation of a limited number of patients and healthcare professionals, the absence of prior assessments of participant literacy, humor or sense of satisfaction, or the predominance of studies not based on role-plays about the use of medicines. These limitations should be avoided in future studies and be considered when interpreting the results.

Where to buy OTC medications? A cross-sectional survey investigating consumers' confidence in over-the-counter (OTC) skills and their attitudes towards the availability of OTC painkillers

OBJECTIVE

To examine consumers' confidence in their own, and also in other people's, over-the-counter (OTC) skills and to describe their attitude towards the availability of OTC painkillers. Moreover we examined the association between confidence in OTC skills and attitudes.

DESIGN

Cross-sectional survey. Mixed methods (postal and electronic) self-administered questionnaire.

PARTICIPANTS

Members of the Dutch Health Care Consumer Panel.

MAIN OUTCOME MEASURES

Consumers' confidence in their own, and in other people's, OTC skills was examined. Confidence was measured by three questions regarding obtaining information on, choosing and using OTC medication. Consumers' attitudes towards availability were assessed using six safety profiles, by asking which channel consumers prefer for each profile.

RESULTS

The response rate was 68% (n=972). Consumers feel confident about their own OTC skills (mean 3.74; 95% CI 3.69 to 3.79, on a 5-point Likert scale), but have less confidence in OTC skills of others (mean 2.92; 95% CI 2.88 to 2.96). Consumers are conservative in their attitudes towards the availability of OTC painkillers. Most consumers prefer painkillers to be available exclusively in pharmacies (41-71% per profile indicated pharmacy only). Moreover, there is an association between confidence in OTC skills and attitudes (p=0.005; β=-0.114). Consumers who are more confident about their own OTC skills prefer OTC painkillers to be more generally available.

CONCLUSIONS

Consumers feel confident about their own OTC skills. However, they would prefer painkillers with safety profiles resembling those currently available OTC, to be available as OTC in pharmacies exclusively. Consumers' confidence in the OTC skills of others is more consistent with their attitudes towards availability of OTC painkillers. Until consumers themselves realise that they are also one of the others, they may overestimate their own OTC skills, which may entail health risks.

Swedish teenagers and over-the-counter analgesics - responsible, casual or careless use

BACKGROUND

Teenagers in Sweden were given greater access as consumers of OTC drugs in 2009 after the reregulation of the pharmacy market, which allowed for the establishment of private pharmacies and sale of specific over-the-counter (OTC) drugs in retail stores and gas stations. Increased access to OTC drugs could provide new opportunities for self-care but attenuates the opportunity for the traditional expert surveillance of pharmacists, thus increasing the possibility of inappropriate OTC drug use.

OBJECTIVES

Views of 16-19 year old Swedish teenagers on OTC drugs, with special regard to analgesic drugs were explored and described, based on the following questions: How and where did they acquire their knowledge and attitudes regarding OTC drugs? What perceptions did they have about the use of OTC drugs?

METHODS

A qualitative approach with a descriptive design was chosen. Data were collected in 2011 with 10 focus group discussions with high school students aged 16-19 years from different parts of Sweden. A total of 77 teenagers participated, 33 males and 44 females. A manifest qualitative content analysis was performed.

RESULTS

While most teenagers appeared to have responsible attitudes toward OTC drugs and their use, some teenagers had attitudes that ranged from casual to careless. The focus group discussions also revealed knowledge gaps among teenagers regarding OTC drugs, and the significant influence of parents and peers on their OTC drug use.

CONCLUSIONS

This study provides insight into how vulnerable some teenagers could be as new consumers of OTC drugs and suggested that educational efforts could be geared toward parents as well as teenagers.