|Year : 2016 | Volume
| Issue : 2 | Page : 162-167
Self-medication among North Indian first-year undergraduate healthcare students: A questionnaire-based study
Sharat Gupta, Manjinder Singh
Department of Physiology, Gian Sagar Medical College, Patiala, Punjab, India
|Date of Web Publication||5-Jul-2016|
House No # 849, SST Nagar, Rajpura Road, Patiala - 147 001, Punjab
Background: Self-medication is the treatment of common health problems by a patient's own initiatives, without professional supervision. Throughout the world, healthcare students have been found to be more prone to indulge in this unhealthy practice. Aim: This study was conducted to assess the prevalence, practices, and perceptions regarding self-medication among healthcare students from northern India. Materials and Methods: The present survey-based study was conducted on 360 subjects (142 males and 218 females), aged 18-20 years. It included both medical and dental first-year undergraduate students, who were selected using convenience sampling. The data were collected using a validated, semistructured, and self-administered questionnaire. The results were presented as counts and percentages. Statistical Package for the Social Sciences version 13.0 (IBM corporation, Chicago, US) software was used for statistical analysis. Results: The prevalence rate of self-medication was 92.7%. The most common reasons cited were "quick relief" (90.4%) and "illness too trivial for consultation" (88.6%). "Advice from pharmacist" emerged as the main source of self-medication practices (95.8%). Analgesics (92.8%) and antibiotics (90.7%) were the most commonly used drugs, while the most common ailments for which self-medication was used were headaches/body aches (92.8%) and sore throat (85.6%). More than half of the participants had a positive attitude toward self-medication. Conclusion: A vast majority of the healthcare students are oblivious to the potential adverse side effects of self-medication. Therefore, there is an urgent need to appraise them regarding the dangers of indiscriminate drug use along with the implementation of stringent statutory regulations regarding the sale and availability of drugs.
Keywords: Analgesics, medical students, over-the-counter drugs, questionnaire, self-medication
|How to cite this article:|
Gupta S, Singh M. Self-medication among North Indian first-year undergraduate healthcare students: A questionnaire-based study. Trop J Med Res 2016;19:162-7
|How to cite this URL:|
Gupta S, Singh M. Self-medication among North Indian first-year undergraduate healthcare students: A questionnaire-based study. Trop J Med Res [serial online] 2016 [cited 2019 Aug 20];19:162-7. Available from: http://www.tjmrjournal.org/text.asp?2016/19/2/162/185448
| Introduction|| |
Self-medication is defined as the use of any medicine for self-treatment of any health problem without the consultation of a certified physician.  It involves acquiring medicines without a valid prescription, resubmitting old prescriptions to purchase medicines, sharing of medicines with friends and acquaintances, or using leftover medicines at home. 
As per the World Health Organization (WHO) guidelines, responsible self-medication can help in reducing the increasing workload on healthcare professionals by treatment of minor ailments that do not require expert medical consultation.  However, if self-medication is not based on authentic medical information about a particular disease or drug, it can lead to a delay in the accurate diagnosis, or even misdiagnosis due to masking of signs and symptoms of underlying disease, emergence of resistant strains of pathogens, drug dependence, and adverse drug reactions. ,,
Cases of self-medication have been reported by several studies throughout the world with varied frequency. ,,, Research has shown that in developing countries like India, where universal access to quality health services is yet to be achieved, self-medication is the most preferred mode of self-care by the patient. 
The laxity of drug marketing regulations and the aggressive marketing campaigns by pharmaceutical companies on print and electronic media, especially internet, have promoted a constant increase in self-medication, thereby turning this practice into a global health problem.  Several studies have been conducted among different groups of populations regarding self-medication. ,,, However, there is a paucity of similar studies among Indian medical and dental students, especially more so from our region.
Self-medication practices have a special significance among healthcare students as they are exposed to the knowledge about various diseases and drugs during the course of their study period. These students are the future prescribers of drugs, thus it becomes imperative to assess their rationality regarding medicine usage. With this background, the present study was done to assess the prevalence and perceptions regarding self-medication practice among the medical and dental undergraduate students.
| Materials and Methods|| |
Study setting and sample size
A questionnaire-based study was conducted among the first-year medical and dental students from the 2013 and 2014 batches, at a teaching institute in North India. The study protocol was approved by the Institutional Ethical Committee and was designed as per the guidelines of the Declaration of Helsinki.
The students were selected for this study by a convenience sampling method. Objectives of this study were clearly explained to all the participants prior to data collection and only the willing participants were then included. Written informed consent was taken from all of them. For the purpose of the study, certain medical terms (e.g., antibiotics, analgesics, antipyretics, dysmenorrhea, etc.) were explained to the participants. Self-medication was defined as the use of over-the-counter (OTC) drugs or prescription drugs, whether modern or traditional, for self-treatment, without prior consultation with a doctor. A doctor was defined as any person who is medically qualified to prescribe medication. It included allopathic physicians as well as practitioners of other traditional health-care systems (e.g., ayurveda, unani, and homeopathy).
Inclusion and exclusion criteria
All the students who were willing to participate in this study and those who took self-medication during the last 1 year were included. The students who either had a certified doctor in their family or had submitted incompletely filled questionnaires were excluded from the study.
It consisted of a self-administered questionnaire that was prepared in English and was adapted from various similar studies conducted previously. The questionnaire was tested for face validity by a panel of subject experts and modified in accordance with their recommendations to ensure comprehensive ability of the participants. Internal consistency of the questionnaire was assessed using Cronbach's alpha and the scores of alpha for the questions were in the range of 0.82-0.87. Also, to ensure the reliability of the data, test-retest agreement of the responses of the questionnaire was assessed in 10% of the participants using Kappa statistic, and it was found that there was 86% agreement for the responses.
The questionnaire consisted of both open-ended and close-ended questions. It had four sections; section A consisted of questions regarding students' age, gender, and whether they self-medicated or not. If their response was in affirmative to self-medication, then they were instructed to fill section B, which consisted of questions regarding their practice of self-medication. Sections C and D consisted of questions concerning their attitudes and perceptions regarding self-medication. The students who did not self-medicate were instructed to fill in only sections C and D. The questionnaires were distributed during lecture hours and were collected immediately upon completion. The questionnaire was designed to have a total duration of 20 min and was filled up by the subjects under close supervision of the authors so as to avoid the influence of one's result by the other. For maintenance of reliability, anonymity, and confidentiality, the subjects were asked to remain anonymous. Only the fully completed questionnaires were considered for final analysis.
The data were analyzed using Statistical Package for the Social Sciences (SPSS) version 13.0 (SPSS-Inc., Chicago, US) and were summarized as counts and percentages. Some of the questions had multiple options of answers to choose from; therefore, the sum total of percentages is not always 100%.
| Results|| |
A total of 392 students initially volunteered to participate in the study, out of which 32 were subsequently excluded as per the exclusion criteria. The responses of the remaining 360 students were considered for final analysis that gives a response rate of 91.8%. All the respondents were in the age group of 18-20 years (mean age 19.3 ± 1.5 years). Out of the 360 participants, 39.4% were males (N = 142) and 60.5% were females (N = 218).
[Table 1] presents the prevalence rates of self-medication among the study subjects. As many as 334 participants admitted to have indulged in self-medication during the past 1 year, thus giving a prevalence rate of 92.7%. Self-medication was slightly more common in males (93.6%) than females (92.2%).
The commonest reason reported for not consulting a doctor was "quick relief" (90.4%), followed by "illness too trivial for medical consultation" (85.6%) and "reluctance to spend money on doctors' fee and laboratory investigations" (79.6%). It was also observed that "advice from the pharmacist/chemist shop" was the most common source of information regarding self-medication (95.8%) followed closely by "Internet" (89.5%) and "advice from friends and family" (83.5%) [Table 2].
|Table 2: Characteristics of students indulging in self-medication (N=334) |
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Analgesics were the most common class of drugs that were self-medicated by the majority of the participants (92.8%), followed by antibiotics (90.7%) and cough syrups (89.2%). Sedatives were the least commonly used self-medication (13.8%). Also, almost half of the participants (50.1%) admitted self-medication with some form of traditional medications [Table 3].
Among the various indications for self-medication reported by the subjects [Table 4], headaches/body aches were the commonest (92.8%), closely followed by sore throat (85.6%) and fever (72.4%). Anxiety/stress was reported to be the reason behind self-medication by 40.7% of our subjects [Table 4].
[Table 5] shows the attitude of participants toward self-medication. More than half of the students (51.2%) believed that self-medication was harmless. Also, 55% of the subjects reported that they will continue with self-medication in the future also. A vast majority of the subjects (67.2%) had a positive attitude toward giving/taking self-medication advice to/from others.
The opinion of students to curb the growing trend of self-medication was also taken [Table 6]. While a majority (53.8%) vouched for preventing the sale/supply of medicines without valid prescription, some others also suggested enforcement of stringent regulations regarding misleading pharmaceutical advertising (23.8%) and making health facilities affordable and easily available (10%).
|Table 6: Perceptions of students regarding methods to prevent the growing trend of self-medication (N=360) |
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| Discussion|| |
Self-medication is a widely prevailing problem especially more so among healthcare students. , It can have grave consequences because it may influence their future professional decisions.  The present study was conducted among first-year medical and dental students to assess their knowledge, attitudes, and perceptions regarding self-medication. This study has shown a 92.7% prevalence rate of self-medication among study subjects in the preceding 1 year. The results were similar to those reported by other Indian authors from Karnataka (88.18%),  Uttar Pradesh (87%),  and Mangalore (92.7%).  However, in studies conducted in other countries, the reported rates of prevalence of self-medication were 55% in Egypt,  56.9% in Nigeria,  55.3% in Pakistan,  and 43.2% in Ethiopia. 
There are many reasons for the increased prevalence of self-medication among healthcare students. These students have an easy access to information from drug indices/literature and also from senior medical students, thus initiating self-diagnosis and self-medication. Additionally, they have an easy access to the medicines itself through physician samples provided by pharmaceutical representatives, while their "white coat" guarantees an easy access to drugs in pharmacies. 
In our study, it was found that more male students (93.6%) practiced self-medication than female students (92.2%). This observation is in agreement with a previous study conducted among medical students in which 94% males practiced self-medication as compared to only 9% females.  However, some other studies showed a greater prevalence of self-medication among female students compared to male students. 
The majority of study participants cited "quick relief" as the main reason behind self-medication. Similar results were reported by another study.  However, it has been reported by a majority of authors that "minor illness not requiring a doctor's visit" was the most common reason behind self-medication. ,, The reasons for the above variations between the results of the present study and other studies may be due to difference in the sample size, methodology, socioeconomic profiles, and demographic characteristics of study subjects. It has been observed that self-medication might lead to the improper use of prescription drugs, intake of excessive or inadequately low doses, misdiagnosis, delay in seeking professional care, and prolonged morbidity. 
In agreement with various other studies, ,,,, analgesics and antibiotics were most commonly used for self-medication by our study participants. However, in some other studies, antipyretics emerged as the most common class of self-medicated drugs. , The higher prevalence rate of self-medication with analgesics is consistent with our observation of "headaches/body aches" as the most common indications behind self-medication. In this study, the usage of antibiotics was also quite high (90.7%). This finding is important in the wake of the rising emergence of resistant strains of microorganisms, which has become a major source of concern for health personnel. "Sore throat" emerged as the most common indication for antibiotic use. Similar observations were reported by a Chinese study  and a European study.  However, in a Nigerian study,  diarrhea and gastrointestinal infections were reported as the commonest reasons of antibiotic use, whereas in Greece  and Turkey,  common cold was the most common indication.
"Advice from the pharmacist" was the main source of information for participants regarding self-medication, which is similar to the observations of some other authors. ,, However, in most of the other studies done on medical students, ,, their textbooks were reported as the main source of information. This variation might have arisen because of the fact that our study participants were first-year undergraduate students who are yet to acquire the knowledge of pharmacology but the participants in other studies included students from senior classes, especially final year and interns, who have already studied pharmacology in detail, and thus were more confident about their knowledge of drugs. Also over the recent years, there has been a mushrooming of retail pharmacy outlets and drug stores in strategic locations in various towns and cities to which our students belong.
In the present study, 43.6% of the subjects felt that self-medication was a part of self-care that was comparable to that reported by other Indian studies , but much lower to that reported by Ethiopian  and Pakistani  researchers. More than half of the subjects wished to start/continue with self-medication. Nearly one-third were even ready to advise their family and friends in favor of self-medication. This is also in accordance with another Indian study.  These findings imply that there is a lack of awareness regarding the correct usage of medicines and problems associated with self-medication.
Our study participants expressed a variety of opinions regarding the methods to curtail the ever increasing trend of self-medication. One of the most common suggestions given by our subjects was to prevent the supply of medicines without a valid prescription while some others felt that enforcing strict regulations on pharmaceutical advertisements might be helpful.
Self-medication has its pros and cons. When practiced responsibly, it is a convenient alternative to treat minor illness. However, the WHO stresses that self-medication can be used only in those countries that are able to provide adequate healthcare and education to their citizens, thus empowering them to self-medicate responsibly.  Self-medication is strongly embedded within the mindset of both physicians and medical students as an accepted way of enhancing work performance, and this self-directed care behavior is a potential occupational health hazard for medical profession. 
The present study has some limitations that need to be mentioned. First, the study was based on self-reported data about self-medication in the last 1 year, hence the possibility of recall bias cannot be ruled out. Second, the study was based on a convenience sampling method, which is inferior to probability sampling. Third, the findings are based on a single center study in North India and hence they cannot be generalized per se.
Future research directions
More multicentric studies need to be conducted periodically among healthcare students as well as general population, to understand the various factors influencing the practice of self-medication in India. Also the influence of socioeconomic status and rural/urban lifestyle on self-medication practices needs to be meticulously explored in the future studies. It would be interesting to evaluate the changes in self-medication patterns as the students' progress through the medical school.
| Conclusion|| |
This study has revealed that the practice of self-medication among healthcare students is alarmingly high. A vast number of students are oblivious to the deleterious side effects of self-medication which they either take themselves or suggest to others. Since inappropriate self-medication might prove harmful, potential risks and adverse effects of indiscriminate and unsupervised drug usage needs to be emphasized among the students so as to curb this unhealthy behavior. At the same time, it is also imperative to sensitize the pharmacists regarding their responsibility of insisting on a valid prescription while dispensing medications. Strict legislations regarding accessibility to these drugs are also warranted.
We would like to express our warm gratitude to the all the study participants, without whose active participation, this study would not have been possible.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]