Self-medication among the elderly in Iran: a content analysis study

Over the Counter: Self-Care or Self-Harm? A Mixed Method Study Protocol on Prevalence and Determinants of Self-Medication Practices in Wardha

Background Self-medication (SM), a common practice globally, possesses a dual challenge of being a self-care strategy and a potential source of harm observed across all age groups. The study is being conducted to gauge the prevalence of SM of prescription drugs with their over-the-counter access, thus addressing the delicate balance between self-care and self-harm related to SM. Material and methods This ongoing convergent parallel mixed method study with quantitative and qualitative components will be conducted on a sample size of 180 subjects aged more than 18 years from an urban community. For the quantitative component, a semi-structured questionnaire will assess the prevalence of SM, types of medications used, reasons for self-medicating, and socio-demographic factors influencing these practices. Concurrently, qualitative interviews delve deeper into the beliefs shaping SM practices. Sampling will be purposive to capture diverse perspectives, with data analyzed using statistical tools. Results This study protocol will offer a comprehensive understanding of the prevalence and determinants of SM practices. The quantitative data provide numerical insights into SM trends, while the qualitative findings elucidate the nuanced factors driving individuals' SM choices. Conclusions A multifaceted view of SM practices will be provided, aiding in developing interventions to promote safe and effective self-care while mitigating the risks of self-harm through SM. Anticipated findings can include a widespread prevalence of SM amongst the general urban populace. Significant associations can also be expected to be found with various independent variables. The results will be instrumental in informing public health policies and healthcare practices toward enhancing patient safety and well-being.

The prevalence and causes of self-medication among medical university students in Iran during COVID-19 outbreak and its implications for public health and health systems: A cross-sectional study

Background and Aims

Self-medication is a worldwide phenomenon that brings advantages and disadvantages to public health and health systems. This study investigated the extent and causes of self-medication among medical university students and its implications for public health in Iran in 2020.

Methods

The present study was designed as a descriptive-analytical cross-sectional study that examined the knowledge, attitude, and practice of self-medication. The population of the study was the students of health sciences programs who all entered the study. The data collection tool included a questionnaire designed online and available to students. The content validity ratio of the questionnaire was 0.84, and the alpha Cronbach coefficient was calculated at 0.8936.

Results

The prevalence of self-medication among medical university students was 19%. The most common reason for self-medication was the safety of medicines (66.67%). The most usual form of medication used was the tablet (35.67%), the most common drug taken was acetaminophen (69.01%), and the most common disease to self-medicate for was headache (67.36%). Estimating the odds ratio of self-medication with demographic variables showed no relationship. However, after adjusting the variables, age and type of degree showed an association with self-medication, as the older participants and postgraduate students had positive attitudes toward self-medication.

Conclusion

Self-medication may be helpful, but it often needs proper guidance and logic and can carry various risks. Considering that medical sciences students will be influential in society in the future, it is necessary to pay more attention to correcting their drug use culture and providing access to health services for everyone. Appropriate prescription of medicines, controlling drug sales in pharmacies, highlighting the role of pharmacists in safe self-medication, and controlling the prevalence of self-medication is necessary.

Antibiotic Misuse Behaviours of Older People: Confirmation of the Factor Structure of the Antibiotic Use Questionnaire

Antibacterial resistance (AR) is responsible for steadily rising numbers of untreatable bacterial infections, most prevalently found in the older adult (OA) population due to age-related physical and cognitive deterioration, more frequent and long-lasting hospital visits, and reduced immunity. There are currently no established measures of antibiotic use behaviours for older adults, and theory-informed approaches to identifying the drivers of antibiotic use in older adults are lacking in the literature. The objective of this study was to identify predictors of antibiotic use and misuse in older adults using the Antibiotic Use Questionnaire (AUQ), a measure informed by the factors of the Theory of Planned Behaviour (TPB): attitudes and beliefs, social norms, perceived behavioural control, behaviour, and a covariate-knowledge. A measure of social desirability was included, and participants scoring highly were excluded to control for social desirability bias. Confirmatory Factor Analyses and regression analyses were conducted to test the hypotheses in a cross-sectional, anonymous survey. A total of 211 participants completed the survey, 47 of which were excluded due to incompletion and high social desirability scores (≥5). Results of the factor analysis confirmed that some (but not all) factors from previous research in the general population were confirmed in the OA sample. No factors were found to be significant predictors of antibiotic use behaviour. Several suggestions for the variance in results from that of the first study are suggested, including challenges with meeting requirement for statistical power. The paper concludes that further research is required to determine the validity of the AUQ in an older adult population.

Effectiveness of educational intervention in improving medication adherence among patients with diabetes in Klang Valley, Malaysia

Background

The diabetes patients’ adherence to prescription medication is 67.5%, which is lower than that of patients with any other medical conditions. Patients with low medication adherence are more likely to experience clinical complications, repeated hospitalizations, increased mortality, and increased healthcare costs, hence, education on disease and medication adherence is vital now. This study aimed to assess the level of medication adherence, medicine and information-seeking behaviour, and the effectiveness of online educational intervention in improving medication adherence and medicine and information-seeking behaviours among patients with diabetes in Klang Valley, Malaysia.

Methods

Individuals aged 12 years and above with a prior diagnosis of diabetes were identified and randomly divided into (control (n=183), and intervention groups (n = 206). Data about their medication adherence and information-seeking behaviour were obtained. As part of the online educational intervention, a month of daily general reminders to take their medications and educational materials about diabetes had provided to them via WhatsApp groups. After a month, the groups were reassessed, and the data were compared.

Results

The results showed that, at baseline, most of the respondents in the control (58.8% females and 53.08% males) and intervention (65.52% females and 85.12% males) groups had a low level of medication adherence. After a month of intervention, medication adherence was significantly improved in the intervention group (91.4% females and 71.28% males) compared to the control group (38.23% females and 44.44% males). At baseline, only 96 (52.45%) respondents in the control group and 110 (52.38%) in the intervention group preferred to read online educational materials to know more about their condition(s), it was improved after a month of intervention in the intervention group where 204 (99.02%) respondents prefer online materials, however no change in the control group response.

Conclusion

The study concludes that medication adherence and information-seeking behaviours among the study population have been significantly improved after a month of structured intervention. Medication adherence plays a crucial role in risk reduction strategies subsequently it improves the patient’s quality of life. Thus, well-planned more robust educational interventions on chronic diseases are warranted to improve the health outcomes of the patients.

Self-Medication Practices, Use of Brand-Name, and Over-the-Counter Medicines by Peruvian Older Adults

Background

Older adults are a particularly vulnerable group to drug use and self-medication. The aim of the study was to evaluate self-medication as a factor associated with the purchase of brand-name and over-the-counter (OTC) drugs in older adults in Peru.

Methods

A secondary analysis was performed using an analytical cross-sectional design of data from a nationally representative survey from 2014 to 2016. The exposure variable was self-medication, defined as the purchase of medicines without a prescription. The dependent variables were purchases of brand-name and OTC drugs, both as a dichotomous response (yes/no). Information of sociodemographic variables, health insurance, and the types of drugs purchased by the participants was collected. Crude prevalence ratios (PR) were calculated and adjusted using generalized linear models of the Poisson family, considering the complex sample of the survey.

Results

In this study, 1,115 respondents were evaluated, with a mean age of 63.8 years and a male proportion of 48.2%. The prevalence of self-medication was 66.6%, while the proportions of purchases of brand-name and OTC drugs were 62.4% and 23.6%, respectively. The adjusted Poisson regression analysis revealed an association between self-medication and the purchase of brand-name drugs (adjusted PR [aPR]=1.09; 95% confidence interval [CI]: 1.01-1.19). Likewise, self-medication was associated with the purchase of OTC medications (aPR=1.97; 95%CI: 1.55-2.51).

Conclusions

This study evidenced a high prevalence of self-medication in Peruvian older adults. Two-thirds of the surveyed people bought brand-name drugs, whereas one-quarter bought OTC drugs. Self-medication was associated with a greater likelihood of buying brand-name and OTC drugs.

Prevalence of self-medication among the elderly: A systematic review and meta-analysis

BACKGROUND

Self-medication is the use of unprescribed drugs to treat a disease. Elderly self-medication can be more dangerous compared to other age groups because of changes in organ functions that occur due to senescence. This study aimed to estimate the prevalence of self-medication in the elderly, its related factors, and common drugs used in this regard.

MATERIALS AND METHODS

Electronic databases such as PubMed, Scopus, and Web of Science were searched between January 2016 and June 2021. The search strategy was built on two core concepts: "self-medication" and "aged". The search was limited to original articles in the English language. A random effect model was used to estimate the pooled prevalence of self-medication. Heterogeneity among studies was assessed using both the I² statistic and the χ ² test. Also, a meta-regression model was used to investigate the potential sources of heterogeneity of the studies.

RESULTS

Out of 520 non-duplicate studies, 38 were included in the meta-analysis. Self-medication in the elderly ranged from 0.3% to 82%. The pooled proportion of self-medication was 36% (95% CI: 27%-45%). The result of the χ ² test and the I² index (P < 0.001, I²= 99.90%) revealed notable heterogeneity among the included studies in the meta-analysis. The meta-regression showed a significant association between the sample size (adjusted β = -0.01; P = 0.043) and the pooled proportion of self-medication.

CONCLUSION

The prevalence of self-medication in the elderly is high. Education through mass media to raise awareness about the dangers of self-medication can help solve this problem.

Does self-medication reduce medical expenditure among the middle-aged and elderly population? A four-wave longitudinal study in China

Introduction

Self-medication has a high prevalence in the middle-aged and elderly population in China. Despite the published evidence demonstrating the economic benefits of self-medication, limited research has addressed the relationship between self-medication and individual medical expenditures, especially within the Chinese population. This study examined the effect of self-medication on individual medical expenditures in China and analyzed the heterogeneity between outpatient and inpatient cases.

Methods

We conducted a panel data analysis using data from four waves of the China Health and Retirement Longitudinal Study (CHARLS). Two-part mixed-effect models were implemented to estimate the effect of self-medication on total outpatient and inpatient expenses and out-of-pocket (OOP) costs, where mixed-effects logit regression was used as the first part, and generalized linear mixed models with log link and gamma distribution was used as the second part.

Results

We identified 72,041 responses representing 24,641 individuals, of which 13,185 responses incurred outpatient expenses and 9,003 responses incurred inpatient costs. Controlling for all covariates, we found that self-medication behaviors were significantly associated with a higher probability of outpatient service utilization (OR = 1.250, 95% CI = 0.179 to 0.269; P < 0.001), but displayed no significant association with outpatient expenses. Respondents who had taken self-medication were less likely to use inpatient services (OR = 0.865, 95% CI = -0.201 to -0.089; P < 0.001), and their inpatient expenses were significantly reduced by 9.4% (P < 0.001). Inpatient OOP costs were significantly reduced by 10.7% (P < 0.001), and outpatient OOP costs were significantly increased by 11.3% (P < 0.001) among respondents who had self-medicated.

Conclusions

This study allowed us to identify the economic value of self-medication among the middle-aged and elderly population in China. Future work should guide the middle-aged and elderly to take responsible self-medication to reduce their economic burden.

Factors associated with the incidence and the expenditure of self-medication among middle-aged and older adults in China: A cross-sectional study

Background

With the accelerated ageing of population and the growing prevalence of various chronic diseases in China, self-medication plays an increasingly important role in complementing the health care system due to its convenience and economy.

Objective

This study aimed to investigate the incidence of self-medication and the amount of self-medication expenditure among middle-aged and older adults in China, and to explore factors associated with them.

Methods

A total of 10,841 respondents aged 45 years and older from the China Health and Retirement Longitudinal Study (CHARLS) wave 4 which conducted in 2018 were included as the sample of this study. The two-part model was adopted to identify the association between the incidence of self-medication and the amount of self-medication expenditure and specific factors, respectively.

Results

The incidence of self-medication among Chinese middle-aged and older adults was 62.30%, and the average total and out-of-pocket (OOP) pharmaceutical expenditure of self-medication of the self-medicated individuals were 290.50 and 264.38 Chinese yuan (CNY) respectively. Participants who took traditional Chinese medicine (TCM), self-reported fair, and poor health status, suffered from one and multiple chronic diseases had strongly higher incidence of self-medication. Older age and multiple chronic diseases were strongly associated with higher expenditure of self-medication. Those who took TCM had more self-medication expenditure, while those who drank alcohol had less.

Conclusion

Our study demonstrated the great prevalence of self-medication among middle-aged and older adults in China and the large pharmaceutical expenditure that come with it, especially in the high-risk groups of self-medication identified in this paper. These findings enhanced our understanding of self-medication behaviors among Chinese middle-aged and older adults and may contribute to the formulation of targeted public health policy.

Definition of self-medication: a scoping review

Self-medication (SM) is a global and growing phenomenon. It represents a public health problem due to antibiotic resistance, risk of adverse drug reactions, drug–drug interactions, disease masking, and increased morbidity. There is not a consensus on the definition of SM. The definitions found in different studies make it difficult to address this problem from a theoretical perspective and therefore find an adequate solution to this public health problem. The aim of this article is to search the medical literature to characterize the current understanding of SM in the medical community. We conducted a scoping review of definitions of SM by searching on PubMed – Medline, Embase, and LILACS using the following combination of keywords: ‘self-prescription’ or ‘self prescription’, ‘self-medication’ or ‘self medication’, or ‘automedication’ and ‘definition’ or ‘explanation’. The search was limited to articles containing the definition of SM, with no limit on language or year. Duplicate studies and those that did not mention the definition of SM were excluded from the final review. A total of 65 studies were included in the final selection. We found a vast heterogeneity in the definition of SM. Most articles based their definition of SM on the process of obtaining the drug, the nonparticipation of a specific health professional, the source of the medication, and the reason for SM. Other interesting concepts such as self-care, nonadherence to a prescription, reuse of stored drugs, and sharing and lending medicines were also considered forms of SM by other authors, however. This study highlights the need to reach a consensus regarding the definition of SM to adequately propose strategies to address this global health problem. This study shows the diverse concepts that need to be included in a future definition of SM.

Risk factors associated with self-medication among the indigenous communities of Chittagong Hill Tracts, Bangladesh

Background

In developing countries like Bangladesh, self-medication has become a predicament associated with health risks and clinical complications. To date, no studies have been conducted on the practice of self-medication among the indigenous population living in Chittagong Hill Tract (CHT).

Objectives

This study was aimed to determine the prevalence of self-medication and analyzing the factors associated with it among the indigenous population in CHT.

Methods

This cross-sectional study was conducted from late October to early December 2020; among different indigenous group populations residing in the three districts of CHT aged 18 or more. A pre-tested and semi-structured questionnaire was developed to collect data on socio-demographic characteristics, health status, frequency of self-medication, reasons for self-medication in last one year, as well as other variables. Multivariate logistic regression was performed to assess associated factors with self-medication.

Results

A total of 1350 people from different indigenous populations were interviewed, among whom 49.9% practiced self-medication. The rate of self-prescribed antibiotics usage (80.9%) was significantly higher compared to other drugs. Self-prescribed medications were mostly used for diarrhea and food poisoning (60.6%), cough, cold and fever (51.4%), and headache (51.4%). A common source of self-prescribed medicines was community or retail pharmacy and the most reported reason for self-prescribed medication was the long-distance of healthcare facilities from home.

Conclusion

The prevalence of self-medication is substantially high among indigenous people and the effect is alarming. Particular concern is the misuse of antibiotics and analgesic drugs. Increasing awareness among the population of the negative effect of self-medication and implementation of proper policies and actions are urgently needed to prevent self-medication among indigenous population in Bangladesh.

Association between Self-Medication for Mild Symptoms and Quality of Life among Older Adults in Rural Japan: A Cross-Sectional Study

Self-medication, a help-seeking behavior to control individual symptoms, can be promoted to prevent the overuse of medical care and improve self-management among older adults. However, evidence regarding the association between self-medication and quality of life (QOL) is lacking. The purpose of this study is to investigate the association between QOL and the usage of self-medication among rural older adults. This cross-sectional study included participants older than 65 years in rural Japanese communities. Data were collected using a questionnaire regarding self-medication trends, the EQ-5D-5L to assess QOL, and a demographics questionnaire. Participants were divided into exposure and control groups based on their tendencies toward self-medication usage. Differences in the demographics between groups were adjusted using propensity score matching. Results: The health status in the exposure group was statistically significantly better than that in the control group in the dimensions of movement, self-care, and usual activities. Conversely, the pain/discomfort and anxiety/depression dimensions were not statistically significantly different. The quality of self-medication behaviors for mild symptoms can be improved with practical knowledge of and access to home remedies and over-the-counter drugs. Educational interventions and system development for better self-medication for mild symptoms and medical care for critical symptoms in rural contexts can be effective in improving QOL among rural older adults.

Prevalence of self-medication in children under-five years by their mothers in Yogyakarta city Indonesia

BACKGROUND

The trend of combating minor ailments at home in children is a common practice in Indonesia. When it comes to very smaller children like those of age under-five.

AIMS

Consequences can be worse if not managed well. Self-medication among these children is not well studied in Yogyakarta, Indonesia.

MATERIALS AND METHODOLOGY

In this study a questionnaire-based random survey among different areas of Yogyakarta city from the mothers bearing children if age under five. Questionnaire were validated by three experts, for reliability test a pilot study conducted on 10 mothers, after that questionnaire used for data collection. Data were analyzed by using SPSS Descriptive analysis to get frequency and percentage.

RESULTS

The overall prevalence reported is 58.82% (50/85). An increasing trend of self-medication was seen among high-higher secondary schools education mothers with 35.3%. In income factor 2600K-3000K mostly found in the self-medication. The residential area also seems influential upon this practice, i.e., 58.8% rural people depends on self-medication while urban people only 39.2% involved in self-medications.

CONCLUSION

As a large population of very small children is under this practice so, proper education of mothers especially in rural areas is needed for the appropriate use of medicines.

Assessing unmet health-care needs of the elderly in west of Iran: A case study

Purpose

The purpose of this study is to investigate the status of perceived need, seeking behavior and utilization of health services in the elderly population of Sanandaj (west of Iran).

Design/methodology/approach

This is a cross-sectional study conducted on 800 elderly people in Sanandaj. Subjects were selected using multistage sampling and data were collected using self-report questionnaires. A multivariate logistic model with odds ratios (ORs) was used to determine the relationship of independent variables with seeking perceived need. Also, the concentration index was used to measure the inequality in using health services.

Findings

The perceived need for outpatient (during the last 30 days) and inpatient health-care services (during the past 12 months) was 69.7% and 29.7%, respectively. Among them, the unmet need for outpatient and inpatient health-care services was 46.6% and 17%, respectively. Having health insurance (adjusted OR 12.08; 95% confidence interval [CI] 1.04–140.11), middle economic status (adjusted OR 5.18; 95% CI 1.30–20.51) and being in an age group of 65–70 years (adjusted OR 7.60; CI 1.42–40.61) increased the chance of seeking inpatient care. Also, being in an age group of 60–65 years (adjusted OR 0.41; 95% CI 0.18–0.95) reduced the chance of seeking outpatient care. There was also a pro-rich inequality in using outpatient health services.

Originality/value

The elderly population suffers from unmet health-care needs, especially in outpatient services. The most important reason for not seeking outpatient and inpatient services was financial barriers and self-medication, respectively. So, designing targeted policies and interventions to address barriers in the conversion of need to demand in the elderly population is essential.

Self-Medication in the COVID-19 Pandemic: Survival of the Fittest

OBJECTIVE

After the World Health Organization (WHO) declared coronavirus disease 2019 (COVID-19) a pandemic, intense efforts to combat the novel coronavirus were undertaken, with many fatalities in most regions of the world. The high fatality rate and socioeconomic collapse affected the health of uninfected individuals because healthcare measures and scheduled clinical and hospital visits were avoided by people in an attempt to reduce their exposure to the contagion. The general population began self-medication practices as means to safeguard against exposure to the virus.

METHODS

The present study investigated the effectiveness of self-medication compliance among the general population. For this purpose, a questionnaire on the Zenodo scale was developed and adults and teen respondents were asked to complete it, after providing consent. The data gathered were analyzed using IBM SPSS Statistics Version 26.

RESULTS

The study amazingly found high compliance with self-medication among the focused population during the period of COVID-19. Estimated results showed a highly significant correlation of 0.000, P < 0.05, between the adaptation of self-medication and pandemic situation, which was estimated from chi-squared and Fisher test results.

CONCLUSIONS

However, the fear of coronavirus made the practice, or malpractice, a survival of the fittest, innate ability of human nature.

Influencing factors and their relationships of risk perception and decision-making behaviour of polypharmacy in patients with chronic diseases: a qualitative descriptive study

OBJECTIVES

In order to understand the influencing factors of the medication-taking behaviour in patients with chronic diseases, reveal the deep-seated causes underlying the phenomenon of polypharmacy, explore the formation rules of the risk perception of polypharmacy and how risk perception affect the medication decision-making behaviour of patients with chronic diseases.

DESIGN

A qualitative descriptive design was used. Study data were collected through semi-structured interviews with patients and physicians. We used the grounded theory approach to refine influencing factors, followed by interpretative structural modelling that analysed the interaction between these factors.

SETTING

Patients from two hospitals, two nursing homes and two communities. Physicians from two community hospitals in Wuhan, China.

PARTICIPANTS

Patients with chronic diseases with high willingness to cooperate and good communication ability. Physicians with rich experience in the treatment of chronic diseases.

RESULTS

Twenty-nine interviews were conducted (20 patients and 9 physicians). A total of 35 influencing factors of the medication-taking behaviours in patients with chronic diseases were extracted from the interview data, further integrated into 10 integrated influencing factors and ultimately clustered into three aspects: 'medication benefit', 'medication risk' and 'medication strategy'. Medication risk can be divided into four specific dimensions: economic risk, physical risk, psychosocial risk and time risk. 10 integrated influencing factors constituted the interpretative structural model of the medication decision-making behaviours in patients with chronic diseases.

CONCLUSIONS

The causes underlying the medication decision-making behaviour of patients with chronic diseases are complex, involving a series of influencing factors such as their risk perception of the medication-taking behaviour. In order to alleviate the adverse effects of polypharmacy on patients' health and medical costs, further safety measures should be proposed to improve the medication-taking behaviour in patients with chronic diseases based on the relationship and internal mechanism of the influencing factors of the medication decision-making behaviour.

Knowledge, attitude, and practice of pharmacy and medical students regarding self-medication, a study in Zabol University of Medical Sciences; Sistan and Baluchestan province in south-east of Iran

BACKGROUND

Self-medication is defined as using medicinal products to treat the disorders or symptoms diagnosed by oneself. Although informed self-medication is one of the ways to reduce health care costs, inappropriate self-treatment can pose various risks including drug side effects, recurrence of symptoms, drug resistance, etc. The purpose of this study was to investigate the knowledge, attitude, and practice of pharmacy and medical students toward self-medication.

METHODS

This study was conducted in Zabol University of Medical Sciences in 2018. Overall, 170 pharmacy and medical students were included. A three-part researcher-made questionnaire was designed to address the students' knowledge, attitude, and practice. Statistical analysis was performed in SPSS 25 software.

RESULTS

According to the results, 97 (57.1%) students had carried out self-medication within the past 6 months. Overall, the students self-medicated on average 4.2 ± 2.9 times per year. Self-medication was more common in male students (65.4%, P = 0.043). Cold was the most common ailment treated with self-medication (93.2%), and antibiotics (74.4%) were the most commonly used drugs. The primary information sources used by the students were their previous prescriptions (47.4%). Pharmacy students had a higher level of drug information (P < 0.001). There was a statistically significant association between the level of drug information and the tendency for self-medication (P = 0.005). Disease recurrence was the most common negative complication of self-medication.

CONCLUSION

There is a need to educate pharmacy and medical students regarding self-medication and its side effects. The high prevalence of self-medication and the overuse of antibiotics can pose a significant risk of drug resistance.

Application of Freire's adult education model in modifying the psychological constructs of health belief model in self-medication behaviors of older adults: a randomized controlled trial

Background

Self-medication by older adults has been always a public health concern. The present study aimed to modify the psychological constructs of Health Belief Model (HBM) in relation to self-medication behaviors using Freire’s Adult Education Model (FAEM) among older adults in Khorramabad, Iran, from 2017 to 2018.

Methods

The mean age of the older adults was 66.28 ± 7.18 years. This was a randomized controlled trial study conducted on 132 individuals older than 60 who were referred from different health care centers. The participants were selected using multistage sampling method and randomly divided into two groups of intervention and control. The data collection instruments included a questionnaire which was designed based on both HBM and self-medication behaviors questionnaire. The phase of adult education model (AEM) was used to modify the psychological constructs of HBM and self-medication behaviors. Data were analyzed using SPSS software version 20 with a significant level of 0.05. Descriptive statistical tests, chi-squared test, paired t-test, independent t-test, and univariate modeling were employed for the purpose of analyzing data.

Results

There was no significant difference between groups in terms of self-medication. Unawareness of the effects of medicine were the most important reason for self-medication (p = 0.50). The two groups were not significantly different in terms of knowledge, HBM constructs, and self-medication behaviors (p > 0.05). However, they came up to be considerably different for the above variables after the intervention was implemented (p <  0.05). When the findings were adjusted for the effects of confounding variables, there were significant differences between the two groups in almost all constructs of HBM and their behaviors (p <  0.05). However, the perceived barrier modality of HBM did not reach to a significant level of difference between two groups.

Conclusion

The educational intervention, which was based on Freire’s AEM, had positive effects on the constructs of HBM and consequently on self-medication behaviors. The psychological constructs of HBM were affected at the phases of listening to problems. Self-medication was tempered at the action-reflection phase with shared creation and evaluation of the action plan geared toward the achievement of the behavioral objectives. The results might be of importance to healthcare professionals involved in care of older patients.

Trial registration

Current Controlled Trials IRCT2013091814512N2. Registered on January 2 - prospectively registered, the trial was registered in the Iranian Clinical Trials Registry http://www.irct.ir.

Prevalence and associated factors of self-treatment behaviour among different elder subgroups in rural China: a cross-sectional study

Background

Self-treatment is a common and widespread behaviour, of which the risks are multiplied in old age. However, the determinants of self-treatment among elders in rural China remain unclear. This study aims to explore the prevalence and associated factors of self-treatment among elders in rural China, trying to discover the vulnerable groups as well as the service gaps among the rural elders.

Methods

Based on a multi-stage stratified random sampling method, a cross-sectional household survey was conducted among 30 villages in Sinan County, an impoverished county in western China. Data were collected through a household–individual combined questionnaires. The analysis was restricted to elders who reported illness within the last 2 weeks, and the final sample size was 330 (individuals). Bivariate and multiple logistic regression analysis were performed in the whole sample group and four subgroups to obtain the prevalence ratios regarding the associated factors.

Results

In the present study, 35.2% of the elders with illness within the last 2 weeks reported self-treatment. The variables associated with self-treatment in the whole sample group were health status (OR 6.75, 95%CI 1.93–23.60), recent alcohol consumption (OR 0.42, 95%CI 0.21–0.83) and the utilisation of family practice services (OR 0.59, 95%CI 0.36–0.96); the same predictors were found in the subgroup of elders with chronic diseases. No significant predictors were found in the subgroup of elders without chronic diseases. Empty-nest elders with higher affinity to traditional Chinese medicine (OR 0.39, 95%CI 0.18–0.86) or drinking alcohol recently (OR 0.28, 95%CI 0.09–0.82) were less likely to self-treat, while the non-empty-nest elders who were no less than 75 years old (OR 3.10, 95%CI 1.33, 7.22) or at better health status (OR 9.20, 95%CI 1.73–48.75) were more likely to self-treat.

Conclusion

Self-treatment was prevalent among the elders in rural China. Better health status, no recent alcohol consumption and no utilisation of family practice are associated with self-treatment among rural elders. Older elders in the non-empty nest group were more likely to self-treat, while the empty-nest elders with self-care habits in traditional Chinese medicine were less likely to self-treat. Deeper understanding of the self-treatment behaviour among rural elders may provide insights for identifying the potential service gaps and developing improvement strategies in the health care delivery system for the elderly in China.

Medication Consumption Patterns and Polypharmacy among Community-Dwelling Elderly in Lomé (Togo) in 2017

BACKGROUND

In the sub-Saharan African, region of the world with a fast growing aging population and where the use of herbal products is very common, there is a paucity of data on medication consumption patterns among elderly people. The objective of this study was to assess the prevalence of polypharmacy and its associated factors among community-dwelling elderly in Lomé, Togo, in 2017.

METHODS

A cross-sectional study was conducted from March to June 2017 in Lomé, Togo among people aged 60 years and older. The Respondent Driven Sampling method was used to recruit participants. Data on socio-demographic characteristics and medication consumption patterns, including the use of medicinal plants and dietary supplements, were collected using a standardized questionnaire during a face-to-face interview at participants' home. Descriptive and binary logistic regression analyses were performed.

RESULTS

A total of 370 participants with median age 65 years, (IQR: 62-71) were enrolled in the study. Almost three elderly in five (57.6%) were multimorbid (had two or more chronic diseases). Conventional drugs (78.4%), medicinal plants (14.3%) and other dietary supplements (9.5%) were used by participants. The prevalence of polypharmacy was 22.7% (95% CI: 18.5-27.3%). Concurrent use of conventional drugs and medicinal plants or other dietary supplements was observed among 17.0% of participants and 67.3% reported self-medication. Multimorbidity (aOR = 4.55; 95% CI: [2.42-8.54]) and female sex (aOR = 1.86; 95% CI: [1.00-3.47]) were associated with polypharmacy.

CONCLUSION

One elderly in five uses five or more medications in Togo. Further studies are needed to assess drug-drug interactions and herb-drug interactions among this population.

A model to explain self-medication by Iranian people: a qualitative grounded theory study

Background

Self-medication (SM) is a common and global health problem. The process of attempting SM is still unclear. Exploration of SM and its contributing factors would help policymakers design and develop preventive programs. This qualitative study aimed to explore the process of attempting SM among Iranian people.

Methods

This grounded theory (GT) study was conducted among people with the experience of attempting SM (n = 17) and medical staff (n = 9) in Iran selected via semi-structured interviews. The recorded and transcribed interviews were analyzed using open, axial, and selective coding based on Strauss and Corbin’s (1998) approach.

Results

The study results revealed that people sought to deal as simply and quickly as possible with their illnesses/symptoms according to their attitudes towards and perceptions of illnesses/symptoms as well as their economic and social problems. This simple and quick approach was the participants’ main concern, resulting in taking decision-making strategies as SM facilitators. SM, in turn, provided short-term improvement and temporary satisfaction as a predominant outcome. Overall, “to avoid being trapped in the vortex of illness” was the central category, which covered and connected all the other categories developed in this study.

Conclusions

The elements of this model could be used as a guide for healthcare policymakers to design preventive programs and to plan for increasing people’s knowledge about the complications and consequences of SM. In addition, identification of barriers to referral to physicians and treatment of illnesses through the right way as well as reducing the health system’s problems would help reduce SM.

Demographic determinants of self-medication in the population covered by health centers in Tabriz

Background: Self-medication is the choice and use of medications by people to treat a self-diagnosed illness or symptom. The aim of this study was to search the relationship between a number of socio-demographic conditions and self-medication in the population covered by health complexes in Tabriz, Iran. Methods: This study was a cross-sectional descriptive-analytic study and was carried out on the population covered by health complexes in Tabriz. Participants were recruited by a multi-stage sampling method. A total of 1000 participants were included in the study. Data collection was done using a researcher-created questionnaire. Data were analyzed using chi-square test and logistic regression. Results: The incidence of self-medication was 70.9% for participants who reported illness in the last month. The chance of self-medication was higher in young (P=0.007) and middle-aged (P=0.012) groups, and housewives (P=0.048); and was lower among participants who were not literate (P=0.047). There was no significant relationship between gender and self medication (P=0.553). The high cost of visits was mentioned as a reason for self-medication. The most frequently mentioned drugs used in self-medication were analgesics, cold medicines, and antibiotics, respectively. More frequent reasons for self-medication were the previous experience of the disease, the assumption that the ailment was not important, and the high cost of visits, respectively. Conclusion: The prevalence of self-medication in this study was high. Considering the results, education in the community, financial support, and monitoring the delivery of drugs can play an important role in improving the pattern of drug use.

What is in the drug packet?: access and use of non-prescribed poly-pharmaceutical packs (Yaa Chud) in the community in Thailand

BACKGROUND

'Yaa Chud' is a non-prescribed poly-pharmaceutical pack containing several types of drugs, including antibiotics and steroids, which can be purchased over the counter in Thailand for self-medication. Although it is illegal, it is still available at some community outlets. This study aimed to understand access to and use of Yaa Chud at the community level in order to raise awareness on its usage and to provide policy recommendations to address the problem.

METHODS

This study employed qualitative methods, including in-depth interviews with 18 drug suppliers and 16 community members, and six focus group discussions. It included inventories from 17 drug suppliers. Data were collected in selected communities of the Kanchanaburi Demographic Surveillance System, located in the western region of Thailand.Thematic analysis was based upon the Health Services Utilization Model and conducted using the Open Code qualitative software program.

RESULTS

Overcrowding, long waiting times, and a perceived unwelcoming environment at public health-care service outlets were identified as factors that drive people into the private sector, where loose regulation of drug laws facilitates access and use of Yaa Chud. Migrants and older people were most likely to seek and use Yaa Chud, especially for mild illness. Availability, easy access through a user's network, low cost, and perceived effectiveness were identified as factors that enable access and use of Yaa Chud.

CONCLUSIONS

Though illegal in Thailand, Yaa Chud is likely to remain available for self-medication by community members, due to the persisting demand by the elderly and migrant workers. There is an urgent need to replace these mixed medications with better choices. Safer Yaa Chud may be a preferred, first-line health-care option, which could help reduce congestion in the formal health-care setting. At the same time, enforcement of regulatory compliance needs to be continued in order to stop the supply of unsafe Yaa Chud.

Physicians' role in the development of inappropriate polypharmacy among older adults in Iran: a qualitative study

OBJECTIVES

The use of unnecessary or excessive medications (inappropriate polypharmacy) is a major health challenge among older adults which is driven by several factors. This study aims to provide in-depth descriptions of the physician's role in the development of inappropriate polypharmacy among older adults in Iran.

DESIGN

Qualitative content analysis of interviews, field notes and other relevant documents available (eg, medical records). Data collection and analyses were done concurrently to guide the sampling process.

SETTING

Three purposively selected referral hospitals in Tehran, Iran.

PARTICIPANTS

A total of 7 physicians, 10 older adults, 3 caregivers and 3 pharmacists with a median age of 54 (IQR 23) years were recruited through convenience sampling.

RESULTS

Emerged categories included misdiagnosis, inappropriate prescribing, insufficient patient education, poor communication, unprofessional behaviour and limited perspectives which highlight the role of physicians in the development of inappropriate polypharmacy among older adults in Iran under the main concept of poor medical practice.

CONCLUSION

This study provides valuable insight on the role of physicians in the development of inappropriate polypharmacy among the elderly in the healthcare setting in Iran by exploring the viewpoints of physicians, patients, caregivers and pharmacists. Physicians can be an influential factor in tackling this challenge through proper diagnosis, prescription, patient education and follow-up. In Iran, physicians' practice styles are affected by potentially adverse factors such as the novelty of geriatric medicine, lack of a referral system, patient unfamiliarity with the system and lack of a monitoring system for multiple prescriptions. Furthermore, clinics tend to be overcrowded and visit fees can be low; in this setting, lack of physician assistants leads to limited time allocation to each patient and physician dissatisfaction with their income.

Experiences of self-medication among people: a qualitative meta-synthesis

BACKGROUND

Self-medication is one of the major health-related problems in the world, which causes many problems for people and health systems. No comprehensive qualitative meta-synthesis has been done to understand the perceptions and experiences of self-medication among people.

OBJECTIVES

This study aimed to analyze, re-interpret, and synthesize the existing qualitative studies on perceptions and experiences of self-medication among people around the world.

METHODS

In this meta-synthesis, all published qualitative studies in PubMed, Scopus, CINAHL, and Web of Science databases were searched in May 2018. A total of 543 articles were screened in the primary stage and finally five articles that met the inclusion criteria were included in the meta-synthesis. The included studies were analyzed using Noblit & Hare approach.

RESULTS

Initially, 115 codes were identified. In the second stage, the codes were merged based on similarity and shared meanings. Finally, after checking by two authors, the following five themes were emerged: cost-effectiveness, affectivity, inefficiency of the healthcare system, previous experiences, and oversimplification.

CONCLUSION

The findings of this first meta-synthesis provided a comprehensive understanding of the perceptions and experiences of self-medication around the world. The findings showed that the experiences of self-medication could be classified into personal, social, organizational, and cultural categories. These findings could help policymakers address these perceptions and experiences in effective health planning.