Measuring the knowledge and perception of Jordanian health science students towards self-prescribed medications: a descriptive analysis study

Abstract

Objectives

To assess the level of perception and awareness of health science students towards using over-the-counter (OTC) medicines and reveal any malpractice.

Methods

A descriptive cross-sectional correlational study employing an internet-based self-administered questionnaire collected data from 342 participants. The study model comprised four compartments: introductory, socio-demographic, utilizing OTC medications, and estimating the perception level. Descriptive statistics were used to describe participants’ demographics and main study variables. Non-parametric descriptive analysis and chi-squared tests were used to determine significance across the three medical schools. The response rate among students in their first academic year (33.9%) was the highest.

Findings

Most participants rely on OTC to treat minor conditions like pain and the common cold. Nutraceuticals have been used heavily. The participants showed a positive attitude towards self-treatment; the average perception score was 3.45 (SD = 0.60; 95%CI: 3.38–3.51). Besides, participants on regularly prescribed medications still determined the interaction between their treatments and non-prescribed medications. No significant association between attitude average score and participant age (r = −0.06; P = .273). Likewise, no differences were found in perceived attitude towards OTC based on gender (P = .41), academic level (P = .223), and college (P = .84).

Conclusion

This study provides an overview of the level of medical student’s perception towards self-treatment; despite the promising levels of knowledge and perception, it is necessitated to introduce interprofessional medical education to get an integrated knowledge and qualified graduates to provide the best health services.

OTC, health science colleges, interprofessional medical education, self-prescribing medications

Introduction

The reliance on self-prescribing medications has been heightened during the worldwide pandemic, medical staff shortage, and a consequent rise in healthcare costs [1]. Using over-the-counter (OTC) medications and herbal remedies following a small quantity of non-specialist advice or after traditional recipes has become prevalent among individuals in middle-income and poor-income countries [2].

Patient counselling is one of the crucial roles of healthcare staff, particularly community pharmacists [3]. Accordingly, Qualifying the graduates from healthcare colleges and continually updating their knowledge of the pharmaceutical markets should intercept the misuse of available OTC medications, which eventually should enhance the health status and the health economy.

The incorrect practice of prescribed OTC medications has become an alarming global concern [4]. This might refer partially to the effect of social relationships and social media advertisements of available products with claimed high efficacy in supporting health, boosting immunity, decreasing weight, and even enhancing the fertility profile [5]. On the other hand, various published reports supported using nutraceuticals and herbal remedies for either prophylactic or curative effects against illnesses [6–8].

The repercussions of improper practices and lack of knowledge regarding self-prescribing medications include delaying the ailments detection, prolonging therapy, misdiagnosis, antimicrobial resistance, and others [9, 10]. Multiple organ damage induced by self-administration of OTC and herbal medications was recently reported; acute kidney injury and liver damage were precipitated after approximately 5 days of the OTC intake [11].

The prevalence of the irrational consumption of OTC among non-medical students was extensively studied [12–14]. Students seek the help of accessible medications to relieve stress during exams, improve cognition, or even overcome anxiety and sleep disturbances [15, 16].

Recent reports have explored self-medication among students of health science-related colleges in ameliorating specific conditions such as acne or assessing their knowledge and attitudes [17, 18].

According to a systematic review of self-medication between healthcare students and professionals, the practice of self-treatment is embedded within the culture and attitude of medical students and staff. Moreover, they believe that treating acute and chronic disorders is appropriate. On the other hand, the dilemma of abusing self-medication was considered an occupational hazard for the health profession, as per the authors in Ref. [19].

Self-medication with non-prescribable medicines has become widespread to address self-diagnosed disorders or relieve uncomfortable symptoms. Relying on OTC medicines and herbal remedies with a lack of knowledge and awareness might lead to undesirable implications. The undergraduates from medicine, pharmacy, and nursing colleges are expected to have a proper attitude towards accessible medications. Therefore, the current study aims to evaluate the awareness and perceptions of undergraduate students in medicine, pharmacy, and nursing colleges towards OTC medications and to correlate their knowledge with various socio-demographic factors.

Significance of the study

This research study should provide the stakeholders and the academics in health science colleges with a piece of gap-filling information regarding the knowledge and perception level of the students towards non-prescribed medications. The output should be a determinant criterion to optimize and introduce interprofessional teaching and field training courses to qualify the graduates for proper patient counselling and optimize their knowledge and attitude.

Methodology

This study followed the descriptive and analytical approach by adapting the questionnaire instrument and was conducted in 2022. The questionnaire was distributed through the Internet, WhatsApp®, and student grouping using Google® forms to undergraduate students in health-related colleges in South Jordan. The target population for this study comprised undergraduate students from health science-related colleges in Jordan. The accessible population from which the sample was drawn consisted of 3200 undergraduate students from medicine, pharmacy, and nursing colleges in south Jordan. Dental students are ineligible for enrolment due to the absence of a dental department within universities located in southern Jordan. The researchers calculated the sample size using the G* power 3.1.9.4 software program. Based on that, the required minimum sample size is 300. Considering an estimated 10% dropout of the subjects during the study, the final sample size calculation is 342. Also, according to the general sample rule, 20–30 participants are required for each variable. Given that this study explored six significant characteristics, the required sample size was between 120 and 180. Despite this, the sample size was increased to 342 participants to overcome the issue of incomplete surveys and achieve higher statistical power.

Data were collected using a validated internet-based self-administered questionnaire consisting of four parts: the introductory section, socio-demographic, utilizing OTC medications, and estimating the perception level and level of awareness Scale. In this study, the researchers employed the adapted scale devised by Azhar et al. [20] to assess the undergraduate level of knowledge and perception regarding OTC medications. A 5-point Likert scale was employed to assess undergraduate students’ knowledge and perception levels, ranging from never (1) to always (5). The original scale had a high level of reliability, as all scales exhibited strong internal consistency with a Cronbach’s alpha value over 0.8, indicating exceptional internal consistency [20].

Before commencing the present investigation, the researchers ran a pilot study to accomplish the following objectives: evaluating the reliability and validity of the research instruments and identifying any necessary modifications that should be implemented before their utilization in the main study. The pilot study was carried out using a sample of 30 undergraduate students. The participants for this pilot study were selected from two colleges in Jordan focused on health sciences. The participants were excluded from the study’s participation and data analysis phases. The calculated Cronbach’s alpha value demonstrated a high level of internal consistency, above 0.8, indicating the good instrument’s reliability. Then, the questionnaire was distributed to the students, and a response of 342 was reported and analysed. The study model was designed based on the study goals and previous related pieces of literature [21, 22].

Research model

The study model comprised four compartments: the introductory section, socio-demographic, utilizing OTC medications, and estimating the perception level and level of awareness. The latter three sections adopted the Likert-type scale (1–5). The response range was set for selected items to qualify for the questionnaire; these items are gender, age, academic level, and the presence of chronic diseases. This study aims to study the perception of OTC intake among health science-related students and the frequency of using self-prescribing medications in ameliorating minor disorders. Fig. 1 illustrates the research problem, objectives, and hypothesis.

Figure 1.

Study model: factors affecting the practice towards self-prescribing medications, student’s perception, and frequency of use in certain minor disorders.

Statistical analysis

Statistical Package for Social Sciences (version 23) was used to enter and analyse study data. Values of P ≤ 0.05 are considered to be significant.

Ethical consideration

The study was reviewed and approved by the Institutional Review Board, College of Nursing (protocol number: EC3/2021).

Results

Test of reliability and internal consistency

The implemented measurements confirmed the internal consistency and reliability of the test with a computed Cronbach’s alpha value of 0.872. The acceptable value range in most social research is 0.7–0.95 [23].

Socio-demographic characteristics

The total number of respondents to the distributed questionnaire was 342. All respondents are in their early 20s (20 ± 2.3) since the study targets undergraduate students. The response rate among students in their first and second academic years was the highest (33.9% and 25.4%, respectively). The three health science-related colleges contributed nearly equal with a slightly higher percentage to those in pharmacy school (31.6%, 33.3%, and 35.1% for schools of medicine, nursing, and pharmacy, respectively), and females contributed to 67.8% of the collected data.

Assuming that the presence of chronic disease should affect the intake frequency of OTC and might urge the need for regular intake of prescribed drugs, the study surveyed the percentage of respondents with a history of chronic diseases, which was found to be minimal (8.5%) subsequently, the majority of the respondents do not take prescribed medications regularly (73.4%). Table 1 presents an overview of the socio-demographic characteristics of the participants.

Table 1.

Demographic details of study participants (n = 342).

Variable		n (%)
Age (years)		20.1 (2.30)
Gender	Male	110 (31.6)
	Female	232 (67.8)
Faculty	Medicine	108 (31.6)
	Pharmacy	120 (35.1)
	Nursing	114 (33.3)
Academic level (year)	First	116 (33.9)
	Second	87 (25.4)
	Third	49 (14.3)
	Fourth	41 (12)
	Fifth	21 (6.1)
	Sixth	28 (8.2)
History of chronic diseases	Yes	29 (8.5)
	No	313 (91.5)
Regularly prescribed medication	Yes	91 (26.6)
	No	251 (73.4)

Source of knowledge

The highest percentage of participants (37%) referred to information on the Internet as their primary source of drug knowledge. A comparable percentage of the respondents consider healthcare professionals and their families their preferred source of knowledge (17.8% and 16.1%, respectively). While the rest of the participants pointed out that social and commercial adverts are their inception. Fig. 2 illustrates the percentage distribution of the primary source knowledge according to the participants.

Figure 2.

The primary source of drug information used by the participants (n = 342).

The reported frequency of using over-the-counter medications

As illustrated in the stacked bar chart, Fig. 3 and Table 2, painkillers were the most frequently used by the respondents, in parallel with nutraceuticals and herbal remedies. On the other hand, the use of sleep aid products was found to be limited (55.6% never used them). Medicated ear and eye products, foot products, laxatives, and anti-diarrheal medications were reported to be used in a low-frequency manner.

Table 2.

The reported frequency of used OTC products among study participants.

Medication	Never N (%)	Rarely N (%)	Sometime N (%)	Usually N (%)	Always N (%)	Mean (SD)
Painkillers	24 (7)	81 (23.7)	77 (22.5)	110 (32.2)	50 (14.6)	3.24 (1.17)
Common cold	22 (6.4)	115 (33.6)	86 (25.1)	100 (29.2)	19 (5.6)	2.94 (1.05)
Nutraceuticals	73 (21.3)	74 (21.6)	77 (22.5)	78 (22.8)	40 (11.7)	2.82 (1.31)
Antiallergy	123 (36)	74 (21.6)	78 (22.8)	48 (14.0)	19 (5.6)	2.32 (1.24)
Anti-diarrhoea	164 (48.0)	88 (25.7)	45 (13.2)	35 (10.2)	10 (2.9)	1.94 (1.13)
Sleep aids	190 (55.6)	58 (17)	49 (14.3)	36 (10.5)	9 (2.6)	1.88 (1.16)
Dyspepsia	141 (41.2)	76 (22.2)	67 (19.6)	46 (13.5)	12 (3.5)	2.16 (1.20)
Laxatives	173 (50.6)	81 (23.7)	51 (14.9)	34 (9.9)	3 (0.9)	1.87 (1.05)
Medicated skincare	111 (32.5)	75 (21.9)	75 (21.9)	53 (15.5)	28 (8.2)	2.45 (1.30)
Medicated foot care	167 (48.8)	72 (21.1)	67 (19.6)	28 (8.2)	8 (2.3)	1.94 (1.10)
Sore throat products	66 (19.3)	115 (33.6)	103 (30.1)	49 (14.3)	9 (2.6)	2.47 (1.04)
Medicated ear care	170 (49.7)	81 (23.7)	64 (18.7)	24 (7)	3 (0.9)	1.86 (1.013)
Medicated eye care	138 (40.4)	94 (27.5)	72 (21.1)	31 (9.1)	7 (2)	2.05 (1.07)
Herbal medicines	52 (15.2)	79 (23.1)	106 (31)	67 (19.6)	38 (11.1)	2.88 (1.21)

Figure 3.

The reported frequency of using OTC medications by undergraduates from health science colleges.

Perception and awareness towards over-the-counter medications

The obtained data showed that the computed average score regarding the awareness and perception of OTC usage was 3.45 (SD = 0.60; 95%CI: 3.38–3.51). The attitude total score was normally distributed; therefore, a univariate analysis test was performed to examine the association between attitude average score and the participant’s age, gender, and academic level. Pearson correlation revealed no significant association between attitude average score and participant age (r = −0.06; P = 0.273). Independent t-test revealed no differences in perceived attitude towards OTC between male and female students (P = 0.41). Also, there was no difference in attitude towards OTC based on the academic level (P = 0.223) and school (P = 0.84). The perceptions of health science students toward OTC use are shown in Table 3.

Table 3.

Participants’ perceptions towards OTC products.

Statement	Mean (SD)
OTC medications—are a better option compared to the ones I have from my doctor.	2.25 (1.71)
Consuming OTC medications is safe.	2.53 (1.18)
OTC medications could interfere with your natural healing process.	3.34 (1.11)
With continuous use of OTC medications, they may lose effectiveness.	3.60 (1.14)
Continuous use of OTC medications may result in adverse effects.	3.60 (1.16)
Continuous use of OTC medications may cause dependency or addiction.	3.46 (1.13)
I consume OTC medications according to the recommended dosage.	3.42 (1.22)
I follow the recommended consumption duration of OTC medications.	5.51 (1.15)
I consume OTC medications to get gain or lose weight.	2.20 (1.19)
I obtain the desired outcome from the usage of OTC medications.	3.16 (1.02)
I usually follow the instructions on the label of OTC medications packaging.	3.54 (1.14)
I have experienced adverse effects from the usage of OTC medications.	2.65 (1.21)
OTC medications can sometimes worsen certain diseases.	3.37 (1.09)
OTC medications could interfere with other prescribed medicines.	3.65 (1.15)
Total score	3.45 (0.60)

Discussion

Measuring and evaluating the knowledge and perception level towards self-prescribed medications is crucial to highlight the strengths and weaknesses points among students in health colleges. The socio-demographic analysis revealed the absence of a statistically significant difference in attitudes towards non-prescribed drugs depending on academic level (P = 0.223) and college (P = 0.84), even though it is important to note that students in their early academic years occupied the highest response rate, which might refer to their motivation and reduced study workload compared to those in advanced academic levels. Females contributed to the majority (67.8%) of collected data, which is expected since most enrolled students in the three medical colleges in South Jordan are females. During the academic years 2019–2022, the approximate percentage of admitted females to the total number of enrolled students in the faculties of medicine, pharmacy, and nursing was 61%, 78%, and 68%, respectively (according to the database available upon request from the admission unit of a randomized selected university).

Unsurprisingly, the highest percentage of participants (37%) referred to information found on the Internet as their primary source of knowledge about drugs. This finding matches the demographic characteristics of the participants, where the highest contribution was from students in their early academic years. According to the academic curriculum and education strategies adopted in Jordanian Universities, only basic sciences, such as general chemistry, general biology, and medical terminology, were taught in the early academic years. Accordingly, theoretical and practical courses that cover pharmacology and therapeutic disciplines will be covered later.

At a distance, it is worrying that undergraduates rely on non-confident sources of knowledge regarding drug information. Assuming they are configured to counsel patients and recommend the correct health behaviour and OTC recipes, their awareness and their level of knowledge must be measured to be optimized [24]. Collaborative efforts by interprofessional health education are needed to intensify the curriculum, enhancing the quality of health profession graduates.

As illustrated in the stacked bar chart, Fig. 3 and Table 2, painkillers were the most frequently used by the respondents, in parallel with nutraceuticals and herbal remedies. At the same time, the use of sleep aid products was found to be limited (55.6% never used them). Medicated ear and eye products, foot products, laxatives, and anti-diarrheal medications were reported to be used in a low-frequency manner. Previously published reports were consistent with our findings regarding the frequency of using self-prescribed medications. Parallel to the obtained results, Jordanian students deemed analgesics the most consumed OTC, and headache was considered the most common discomfort [25–27].

Although the practice of using and self-prescribing accessible medications has been augmented in recent years, positive observations were recorded; it was satisfying and secure to find out that most of the undergraduates from health science colleges have a positive perception regarding the use of OTC medications. The awareness of the efficacy and safety of OTC drugs was fair. This finding is compatible with a previous similar survey by Parikh et al. [9]. On the contrary, the respondents who regularly prescribed drugs and used OTC were uncertain about potential drug interactions between the prescribed and non-prescribed medications. This has been supported previously by Hersh et al., who provided evidence of the relatively well-known drug–drug interactions between prescribed OTC drugs (NSAIDs) and alcohol and antihypertensive medications [28]. This lack of awareness might lead to bad health consequences. The participants were in a higher sense of the ability of these medications to interfere with the natural healing processes, diminish potency with recurrent and prolonged use, and induce undesirable effects. In addition, following proper drug instructions, being acquainted with drug–drug interactions, and knowing the correct dosage should positively influence the medical professions and the quality of health science graduates. The results obtained from the current study were consonant with published reports concerning the perception and awareness of the correct use of self-prescribed medications and self-care [25, 29–31]. On the other hand, other studies went further to analyse the reasons medical students rely on OTC medication over referring to a specialist, which is mostly due to time consumption and consultation fees, as found by the researchers [9].

The results obtained from the independent T-test revealed there is significant perceived knowledge by medical students (P = 0.001). OTC medications are considered safe and effective when students adhere to the instructions on the label or those provided by the healthcare team members. Also, an independent T-test revealed that there is significance in the perceived attitude of medical students concerning OTC consumption; sometimes, OTC might worsen certain diseases (P = 0.010). A Chi-square test revealed the association between OTC consumption and gender, speciality, and educational level. Since the P value (P < α) is more than the chosen significant level of 0.05, there is no significant relation between gender, speciality, and educational levels (P = 0.447, 0.334, and 0.379), respectively. Independent T-test and Chi-square test values are shown in Supplementary Appendix 1.

Limitations and future directions

The present study is subject to some limitations, mostly from its focus on a specific subset of undergraduate students enrolled in medicine, pharmacy, and nursing programmes. Consequently, the output needs to be more generalizable to the broader community. Additionally, the limited sample size impedes the ability to extrapolate the knowledge and perception towards self-prescribed medications beyond our specific demographic. Furthermore, the evaluation of knowledge and perception was conducted using a self-reporting methodology, which introduces the potential for response bias and may compromise the accuracy and sincerity of the respondents’ answers. Moreover, it is recommended that future research endeavours repeat the study mentioned above within a sample of non-medical students to assess the extent to which self-medication practises are prevalent, identify the factors that influence the choice of pharmaceuticals, and afterwards compare the outcomes with those obtained from medical students. Furthermore, the evaluation of knowledge and perception was conducted using a self-reporting methodology, which introduces the possibility of response bias and may impact the accuracy and truthfulness of the responses.

Conclusion

The output of the current study showed a positive attitude among undergraduates from medicine, pharmacy, and nursing colleges towards utilizing OTC medications and herbal remedies. Students relied on OTC to medicate themselves against minor disorders such as painful sensations and the common cold, notwithstanding the promising responses collected and analysed from students in medical-related colleges, increasing awareness of using self-prescribed medications becoming a warranty. In recent years, the role of health staff, particularly pharmacists, has shifted from only administering the health service to effectively providing patient counselling and integrated healthcare. Therefore, interprofessional health education is highly recommended to qualify the health students’ perceptions and skills.

Acknowledgement

Many thanks to Tamam M. El-Elimat (PhD) and Samah F. Al-Shatnawi (Pharm.D., PhD) from the Faculty of Pharmacy/Jordan University of Science and Technology for their valuable comments pertaining to the article.

Conflict of interest

None declared.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Data availability

The data supporting this study’s findings are available from the corresponding author upon reasonable request.