Promoting Healthy Reading Strategies as a Self-Care Alternative to Self-Medication among University Students in Sub-Saharan Africa: A Systematic Review

Social cognitive theory

As proposed by (Bandura, 1991), the social cognitive theory emphasises the role of observational learning, self-efficacy, and self-regulation in shaping behaviour. When applied to university students in Sub-Saharan Africa, this theory can offer valuable insights into understanding and modifying behaviours related to reading habits, self-medication, risky sexual practices, and academic performance.

Heeren et al. (2012) demonstrated that interventions based on social cognitive theory could effectively reduce risky sexual behaviours among university students in Sub-Saharan Africa. By incorporating elements such as modelling positive behaviours, building self-efficacy, and providing opportunities for skill development, interventions can empower students to make healthier choices. This aligns with the emphasis on the importance of self-efficacy in behaviour change. Regarding reading habits and academic performance, social cognitive theory suggests that individuals learn through observation and modelling. Encouraging students to observe positive reading behaviours in their peers, instructors, or role models can enhance their reading habits (Wani, 2024; Ali et al., 2023). By fostering a sense of self-efficacy in their reading abilities and academic performance, students are more likely to engage in consistent reading practices that positively impact their educational outcomes.

Moreover, social cognitive theory can also be extended to address self-medication behaviours among university students in Sub-Saharan Africa. Understanding the factors influencing self-medication, such as perceived benefits and self-regulation, can inform interventions that promote safe healthcare practices (Al-Zoubi et al., 2023). By enhancing students’ self-efficacy in seeking professional medical advice and improving their health literacy, interventions can mitigate the risks associated with self-medication.

The social cognitive theory provides a valuable framework for understanding and addressing various behaviours among university students in Sub-Saharan Africa. By leveraging concepts such as observational learning, self-efficacy, and self-regulation, interventions can be designed to promote positive reading habits, safe healthcare practices, and responsible sexual behaviours, ultimately enhancing academic performance and well-being among students in the region. Therefore, we used Bandura’s social cognitive theory to interpret the study findings, emphasising the influence of observation, self-efficacy, and self-regulation in shaping behaviours (Hilton et al., 2010). When applied to university students in Sub-Saharan Africa, this theory offers valuable information on how reading habits and self-medication practices impact academic performance and well-being. Students could learn by observing their peers. If their peers demonstrate positive reading habits or avoid self-medication, they are more likely to adopt these behaviours. Self-efficacy, or the belief in one’s ability to succeed, is crucial in whether students develop healthy reading habits and refrain from self-medication. Self-regulation is another important component of Bandura’s theory (Bandura, 1991). By developing strong self-regulation skills, students can manage their reading habits and make informed decisions about self-medication. Setting goals, monitoring progress, and adapting based on feedback can significantly enhance academic performance and overall well-being. Additionally, the social cognitive theory recognises the power of collective agency (Usher & Ford, 2022). This underscores the influence of group dynamics on individual behaviour. Encouraging a culture of positive reading habits and discouraging self-medication practices at the university level can create a supportive environment promoting students’ academic success and health. By fostering a culture that encourages positive reading habits and discourages self-medication, universities can create a supportive environment that promotes academic success and health among students. This theory can be applied to understand how students’ exposure to diverse reading materials, modelled behaviours of peers and educators, and their own self-efficacy beliefs influence their reading practices (Hilton et al., 2010). Observational learning plays a significant role in shaping reading habits, as students may emulate the reading behaviours they observe in others. By creating environments that promote a culture of reading, universities in Sub-Saharan Africa can leverage social cognitive theory to encourage positive reading habits among students, ultimately enhancing their academic performance and intellectual development. Applying social cognitive theory offers valuable insights into understanding and addressing reading habits, self-medication practices, and their impact on academic performance and well-being among university students in Sub-Saharan Africa. By considering the constructs of this theory, stakeholders can design targeted interventions that promote positive behaviours and support students in achieving academic success and maintaining their health.

Sample

As part of our study, we (the two authors) systematically reviewed published studies, analysing discussions, arguments, and evidence on the relationship between reading habits, prescription misuse, and academic achievement. A systematic review is designed to summarise all accessible primary research in response to a specific research question (Clarke, 2011). This methodological technique was ideal and appropriate to achieve our study objectives. This study’s inclusion and exclusion criteria are detailed in the table below. We have meticulously defined each criterion to ensure clarity and precision. A comprehensive outline of the parameters for inclusion and exclusion in this study is shown in Table 1.

Instrument and procedure

Data collection and research materials for this study adhered to the guidelines and protocols of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), as illustrated in supplementary Figure 1 (Refer extended data). The narrative review primarily utilised data from databases such as Sage Journals, African Journal Online, ProQuest Dissertations, Google Scholar, and Academia Publications. Studies published between 2010 and 2024 were included. The search focused on keywords and sub-topics related to promoting healthy reading habits, developing guidelines for healthy reading habits, motives for self-medication, and reducing self-medication among university students during examinations.

The articles were sourced from journals in various sectors, including health, corporate, clinical, biological, medical, public health, mainstream, and political sectors, recognising the broad societal impact of health. Systematic reviews have the potential for plagiarism due to their reliance on existing findings (Marschan-Piekkari, & Welch. (2011), this study took precautions to avoid it. Furthermore, the study focussed on relevant articles, thus promoting its clarity and conciseness.

Data analysis

We ensured transparency of this systematic review by following the PRISMA framework outlined by Page et al. (2021). Guided by the four phases of the framework, namely identifying, screening, eligibility, and inclusion, we systematically reviewed all relevant research on the relationship between reading habits and self-medication and reported accurately. We did the thematic analysis of 12 eligible articles as described by Braun and Clarke (2006) and McLeod (2024). This method involved reading and re-reading the selected articles thoroughly to gain an in-depth understanding of the content and context of each selected study. We then identified and labelled relevant data segments and created initial codes related to reading habits and self-medication. We clustered the initial codes into potential themes by observing patterns and relationships within the data. These themes were reviewed and refined to make sure they accurately represented the data. Finally, we defined each theme carefully to reflect the key aspects of the data. This approach makes this study data analysis rigorous and transparent, leading to valuable insights into the relationship between reading habits and self-medication among university students and achievement of academic success.

Prevalence of self-medication

The examined literature highlights a pervasive and potentially hazardous practice: self-medication among college students is concerningly common in different countries. A high prevalence of 81.1% in Nigeria, 70% in Ghana, 70% in Ethiopia, and 61.1% of self-medication was reported in Zambia (Esan et al., 2018; Donkor et al., 2012; Hailemichael et al., 2016; Banda et al., 2021). This research demonstrates the scope of this problem in the African setting. These results imply that among college students, self-medication is a typical coping strategy. An Ethiopian study that suggested that students view self-medication as a component of self-care supports the existing findings of the prevalence of self-medication as a coping method (Soroush et al., 2018). Because of the rigorous demands of university life, especially during test periods, students may look for easy fixes for common problems like headaches, anxiety, and exhaustion. Furthermore, Khalifah et al. (2023) and Orayj et al., (2021) allude that examination periods come with attendant pressure on university students, as they can feel overwhelmed by the volume of coursework, assignments, and study materials and resort to medication misuse to study for longer hours and reduce anxiety associated with preparing for examinations. These students frequently resort to using prescription pharmaceuticals that they obtained without a legitimate prescription or over-the-counter medications in the absence of proper education and professional supervision. This assertion was corroborated by Zewdie et al., (2020). The high rate of self-medication among college students necessitates immediate action from academic institutions and medical professionals.

Risk factors for self-medication

The evaluated research found some risk variables for university students who self-medicate. These studies show that students’ propensity to self-medicate is greatly influenced by high levels of academic stress, which are frequently made worse by poor study practices. Stress, anxiety, and sleep deprivation are factors described by different authors as the primary causes of student self-medication (Simpson, 2018; Hashmi et al., 2022). Factors uncovered by this review include long wait times and queues at clinics and a lack of time to visit clinics due to academic workload (Esan et al., 2018; Banda et al., 2021); year of study and course of study were predictors of self-medication (Bunduki et al., 2017; Zelalem et al., 2020). Poor time management as a concern for students was alluded to by Adom et al. (2020), who stated that procrastination and poor time management were predictors of academic stress for students. The consequences are obvious: students who are under much stress and don’t have good coping skills are more prone to turn to self-medication, especially as the students described self-medication as a time-saving measure rather than visiting health facilities to seek medical care for their ailments (Ikwara et al., 2024; Bunduki et al., 2017). This behaviour is frequently an ill-advised self-care attempt to control or lessen the psychological and physical effects of their academic obligations as students. Academic workload and academic stress, therefore, are precursors to the irrational use of medications, described as self-medication in this context. A major risk factor of time-saving described by participants in different studies by Ikwara et al. (2024), Banda et al. (2021), and Bunduki et al. (2017) underscores the overwhelming burden of academic stress and workload. The need for effective time-management strategies through the development of healthy study habits was opined by Ogbodu et al. (2024) and Sikhwari et al. (2019) in a Nigerian and South African study, respectively, where university students described academic stress as one of the factors implicated in self-medication. According to Zelalem et al. (2020) and Donkor et al. (2012), study findings from Ethiopia and Ghana revealed that non-medical and health science students were found to indulge more in self-medication practices, most probably due to low awareness of the dangers and consequences of self-medication. Another interesting factor revealed by this review is the year of study and adolescent age of less than 20 years as described by authors in different sub-Saharan countries of Ethiopia and the Democratic Republic of Congo (Zelalem et al., 2020; Bunduki et al., 2017; Hailemichael et al., 2016). This finding is further underscored by Ogbodu et al. (2024), who posit that most university students as undergraduates belong to the adolescent age bracket, where adolescents are more prone to experimentation and risk-taking.

Interventions to reduce self-medication

Several interventions suggested to reduce self-medication included health awareness campaigns on university campuses and providing counselling and support services in response to the study’s identification of measures to address the growing problem of self-medication among college students. According to the review, health education initiatives such as organising campaigns on the rational use of drugs by students as a coping mechanism for academic stress can be extremely important in increasing public knowledge of the dangers of self-medication, as suggested by (Ikwara et al., 2024; Obi et al., 2023; Fentesa et al., 2021). This was corroborated by Okyay and Erdoğan (2017) as a recommendation for a study that assessed the habits related to drug use among Turkish students; even in a non-sub-Saharan African region, the authors found that the awareness of rational drug use among university students was inadequate.

Additionally, some authors opined that the provision of counselling services by the college and university authorities would go a long way to aid the self-care choices of destressing by students (Fetensa et al., 2021). The de-stressing choices recommended other than self-medication include engagement in a healthy lifestyle, such as exercise and support services (Simpson, 2018). Corroboratively, Ogbodu et al. (2024) and Sikhwari et al. (2019) stated that cultivating effective study habits and self-discipline by students aids in coping with academic stress whilst reducing the resort to self-medication as a coping, self-care measure. Oriogu et al. (2017), in a study conducted at Afe Babalola University, Nigeria, underscored the significance of cultivating a reading culture and offering academic assistance services to improve students’ academic performance. Healthy habits such as reading for leisure and pleasure have contributed to relieving academic stress and resulted in academic achievement for students (Hilton et al., 2010), while Kasyoka (2023) found a correlation between study habits and academic achievement. A previous study by Fareo (2012) also suggests that good study habits can be strengthened without the use of medications to keep students artificially awake if they combine healthy study habits with enough time for relaxation The author also recommended that Drug Awareness Units be established to assist students in resolving the socio-psychological issues related to self-medication. In addition to improving academic performance, students can lessen their likelihood of self-medication by providing support services and encouraging good reading habits. As a result, we advise using a multifaceted approach to combating university students’ self-medication. Universities are in a position to encourage good reading habits among students and lessen reliance on self-medication by integrating health education, stress management, reading skills programs, counselling services, mindfulness programs, and academic support services. The findings highlight the urgent need for thorough health education curricula designed specifically for college students. To effectively address the peculiar challenges which students face, these programs must incorporate training on stress management, mental health awareness, and good coping methods. Universities also, need to prioritise offering easily available counselling services and aggressively encourage a help-seeking culture. Promoting the use of these materials among students can help to create a welcoming learning atmosphere. To counteract self-medication for academic purposes, for instance, Ogbodu et al.’s study from 2023 emphasised the significance of developing productive study habits and putting regular public health campaigns into action. The study also emphasised how important social support is for reinforcing students’ positive behavioural changes.

Peer networks and mentoring programs are examples of social support systems that can be quite helpful in assisting students in navigating the demands of their studies and their health. Similarly, Hailemichael et al., 2016) suggest that increasing students’ awareness and knowledge of the possible risks associated with self-medication practices is one way to reduce or eliminate self-medication among students. This suggests that the university administration should offer support systems for university students. Universities ought to think about including health literacy in the curriculum in addition to counselling and health education. Through this combination, students can gain a deeper understanding of health-related concerns as well as the long-term effects of self-medication. Universities can influence and enable students to make better decisions and lessen their dependence on self-medication by creating an atmosphere that values and encourages health literacy. Given this, Fareo (2012) supports developing drug education programs and their integration into all educational levels. Adom et al. (2020), in a Ghanaian study, recommended that the organs of government, such as the Ministry of Education and the regulatory bodies of higher institutions in Ghana, ensure the setting of guidance and counselling units as well as task welfare committees to periodically organise workshops and seminars to sensitise the members of the higher institutions on the dangers of academic stress and effective approaches in curtailing them. A study by Sikhwari et al., (2019) conducted in South Africa specifically called for intentional campaigns and programs to accommodate students in their first year of study on campus, another indicator of the high propensity to take risks during adolescent years. This South African study further described personal motivation, self-discipline, study habits, and self-efficacy as factors influencing students’ academic achievement, a justification of the importance of self-efficacy as a component of human behaviour theory to guide behaviour change and health promotion interventions.

Enhancing health literacy and offering strong support services are crucial elements of a holistic strategy to tackle self-medication among college students. Universities may establish a safe space that supports good health habits and academic achievement by implementing focused health education programs, enhancing counselling services, and encouraging a help-seeking culture.

Role of policy making to support reduced medication misuse among university students

The critical role that policymakers have to play in formulating and implementing policies that promote the rational distribution of drugs in different countries of the world has been expounded by several studies (Fetensa et al., 2021; Bunduki et al., 2017; Hailemichael et al., 2016). These authors concisely described policymakers’ roles in supporting and promoting the reduction of self-medication practices. The enactment of policies to promote safe and responsible healthcare behaviours among students was specifically proposed by Fetensa et al. (2021), Bunduki et al. (2017), and Donkor et al. (2012) opined that healthcare policymakers should provide a strict policy on selling without prescription medicine, to act as a deterrent to defaulters and policymakers have a crucial role of providing strategic guidance on drug distribution and availability in countries, respectively.

Interpretation and analysis through a social cognitive theory lens

The study findings highlight the widespread issue of self-medication among university students, revealing the influence of observational learning, self-efficacy, and environmental factors on this behaviour. The Social Cognitive Theory has been used to guide behaviour change and health promotion interventions hence its suitability for this study.

Observational learning

The high prevalence of self-medication suggests that students may be observing and imitating the behaviour of their peers who self-medicate to cope with stress and academic pressure. Normalising this practice within the student community can create a social environment where self-medication is acceptable. Furthermore, identifying stress and poor reading habits as significant risk factors highlights the impact of the academic environment on students’ behaviours. Observing others struggle with stress and resorting to self-medication can reinforce this coping mechanism as a viable option, emphasising the observational learning construct which stresses that if individuals see a successful demonstration of a behaviour, they can also complete the behaviour.

Self-efficacy

The negative association between poor reading habits and self-medication suggests that students with lower self-efficacy in their academic abilities may be more likely to self-medicate to manage the resulting stress and anxiety. The success of reading skills programmes in reducing self-medication demonstrates the positive impact of improving students’ self-efficacy. By enhancing their academic skills and confidence, students may be less likely to turn to self-medication as a coping mechanism. This reinforces a person’s confidence in his or her ability to successfully perform a behaviour.

Environmental factors

The high levels of academic stress experienced by students underscore the role of the environment in influencing self-medication behaviour. The lack of adequate support services and stress management programmes can contribute to an environment where self-medication is considered a necessary coping mechanism. The effectiveness of health education programmes, counselling services, and mindfulness programmes suggests that modifying the environment can promote healthier coping mechanisms and reduce dependency on self-medication. Therefore, universities should create an environment that fosters positive health behaviours by providing students with the necessary skills and support. A key environmental factor is policy-making which shapes the context of the distribution and availability of medications, stipulating the indications for rational drug use and the sale of prescription medications only on the production of a valid prescription by a qualified medical practitioner. This will reduce the ease of access and availability of drugs without prescription as such availability impacts self-medication and abuse.

Policy implications for Universities in Africa

The study’s findings emphasise a number of crucial policy implications for African institutions and highlight the necessity of focused initiatives to address the pervasive problem of student self-medication. First and foremost, academic institutions ought to establish all-encompassing health education initiatives that augment students’ health literacy. These programs ought to be specifically designed with university students’ needs in mind and should include workshops on mental health awareness, stress management, and healthy coping techniques. Universities have the propensity and backing by constitution to drastically lower the prevalence of self-medication by providing students with the information, structures and abilities they need to make wise health decisions.

In addition, it is critical to build easily accessible and widely advertised counselling services. In order to ensure that students are aware of and have easy access to mental health and counselling options, universities should foster a culture of asking for help. To help kids deal with stress related to school and other issues that may cause them to turn to self-medication, these services ought to provide them with individualised support and direction. Universities should include health literacy in their curricula as well. Students will gain a broader awareness of health-related concerns and the long-term effects of self-medication as a result of this integration. University programs that incorporate health education can foster a positive atmosphere that promotes healthy habits and lessens the need for self-medication.

The necessity of regular public health campaigns that address self-medication and encourage healthy reading habits is another crucial policy conclusion. All students should be the target audience for these initiatives, which should educate them about the dangers of self-medication and offer helpful coping mechanisms for the stress of school.

In conclusion, it is imperative to reinforce social support networks through regular public health campaigns, create platforms to educate and counsel students on embracing healthy lifestyles and offer mentorship initiatives. These networks of support can be extremely helpful to students in overcoming both health and academic obstacles. Universities can increase student resilience and reduce self-medication risk by creating a supportive community.

From a social cognitive theoretical lens, universities should promote positive role models by highlighting and promoting students who successfully manage stress and academic pressures without self-medication. These positive role models can inspire and encourage other students to adopt healthier coping mechanisms. In addition, implementing programmes that improve academic skills, such as reading skills programmes, can enhance students’ self-efficacy and reduce their reliance on self-medication to manage academic stress. Likewise, universities should prioritise creating a supportive environment that addresses the root causes of stress and promotes healthy coping mechanisms. This can include providing easily accessible counselling services, stress management programmes, and health education initiatives. In the same vein, the University should foster a Culture of Help-Seeking: By actively promoting support services and creating a culture where seeking help is encouraged, universities can empower students to address their challenges healthily and constructively.

Study limitations

The study is limited to articles written in English; therefore, some relevant studies might have been omitted due to the language barrier.

Suggestions for future research

Future research should continue to explore the mechanisms underlying this relationship and investigate the long-term benefits of reading skills programmes and effective study habits in improving academic performance in university students.