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Study Protocol

Assessment of knowledge, attitude and practices of self-medication among the geriatric population of the Wardha district in central India: A cross-sectional study

[version 1; peer review: 1 approved with reservations]
PUBLISHED 12 Jan 2024
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This article is included in the Datta Meghe Institute of Higher Education and Research collection.

Abstract

Background

The incidence of self-medication varies greatly for each country. It is a widely used method across advanced and developing nations worldwide. Self-medication is taking pharmaceuticals without seeking physician advice for a diagnosis or treatment. This study will evaluate geriatrics’ knowledge, attitudes, and practices regarding self-medication. The objectives of the current study are to examine the practice of self-medication and assess the knowledge and attitude toward the same in the senior population, as well as the socio-demographic aspects influencing its usage and the reasons for its use. We also aim to test the correlation between demographic issues and self-medication.

Methods

A cross-sectional study will be conducted in the rural community area of the Wardha district. A survey will be used to evaluate the entire sample of geriatric age groups to determine the socio-demographic characteristics and associated risk factors for practicing self-medication. A semi-structured, pre-validated questionnaire Self-Medication Scale (SMS) will be used to understand the participants’ practice and attitudes regarding self-medication. The frequency and percentages of descriptive statistics will be determined. The correlation among variables will be discovered using the Chi-Square Test. Tables, graphs, and charts will present the data analysed.

Study implications

The present study will help formulate guidelines on medicine access and reinforce them with strong policy implementation mechanisms. The study will also help provide medical insurance or free consultations for populations in need.

Keywords

geriatric people, self-medication, drug, o-morbidities, attitude, knowledge

Introduction

The World Health Organisation (WHO) states that self-medication involves the use of medicinal products by the consumer to treat self-recognized disorders or symptoms or the intermittent or continued use of a medication prescribed by a physician for chronic or recurring diseases or symptoms.1 To lessen the load on healthcare service facilities, which are sometimes understaffed and difficult to reach in rural and isolated locations, and in order to manage symptoms effectively and quickly, the World Health Organisation encourages self-medication without consulting a doctor.2 But regularly using over-the-counter medicines and self-medication can result in a wide range of serious side effects. The most frequent issue is the chance of adverse drug reactions (ARDs) with the drugs that are being given.3 Self-medication is broadly used among urban and rural people worldwide and growing nations like India because it offers individuals a cheap alternative and allows for dispensing various pharmaceuticals without a prescription over the counter.4 Several elements, including socioeconomic position, way of life, easy access to medications, and the larger accessibility of medications in developing nations, might cause self-medication.5 As far as a person’s health is concerned, it is an essential health problem. Self-medication must be supported by valid medical knowledge to prevent unreasonable drug abuse; it can ultimately result in the waste of medicinal products and elevated pathogen resistance, leading to major health risks such as extended discomfort, adverse drug reaction, and medication dependency.6

The incidence of self-medication varies greatly for each country. Prevalence rates in the evaluation of 140 study, which included 189,278 people of all ages, ranged from 0.1% to 100%. Various studies examined the high rate of self-medication, such as sixty-five percent in Finland, seventy-eight percent in Yemen, Saudi Arabia (S.A.), also Uzbekistan, 88-92% in Thailand,7 and 60% in central India.8

The worldwide elderly population is increasing, even in developing countries. By 2025, the number of older adults in the globe will increase to 1.2 billion, up from 550 million in 1996.9 In India, the percentage of older individuals is predicted to climb from 8% in 2015 to 19% by 2050, with elderly individuals contributing to one-third of the overall population by the last decade of the century. Multi-morbidity becomes increasingly prevalent as people age and is more prevalent in older adults. According to reports, multi-morbidity affects older persons generally in a range between 24%to 83%.10 Due to co-morbidities, the aging population is more likely to self-medicate. They are not conscious of the dangers of self-medication.9 Elder people are more likely to experience adverse drug reactions (ADRs) due to physiologic variations in metabolism caused by ageing.11

Rationale

Most of the research was conducted on people from the general public, professionals, hospital visitors, or medical students. There are few investigations of elderly self-medication conducted in the community, especially from central India. The current study’s findings will help the government determine the scope of elderly self-medication and devise measures for boosting public awareness of the risks associated with self-medication overuse. Hence, this research project aims to assess people’s understanding, attitudes, and use of self-medication in the rural community area of Wardha District in the Indian state of Maharashtra.

This study evaluates knowledge, attitude and practice of self-medication among the geriatric population in the Wardha district’s rural community region (Table 1).

Table 1. Important study parameters, their variables, source of data and data collection method.

Important study parametersVariablesSources of dataMethod of data collection
Socio-demographic profile

  • Name

  • Gender

  • Age

  • Highest level of education

  • Marital status

  • Chronic illness

Geriatric people (60 yrs. and above)A survey using a Questionnaire
Knowledge of geriatric people on ‘self-medication’

  • Percentage of geriatric people aware of self-medication

A survey using a Questionnaire
The attitude of geriatric people toward ‘self-medication’

  • Part of self-care

  • No need for training

  • Recommend self-medication to others

  • Easy access

  • Availability and belief in safety

A survey using a Questionnaire
Self-medication practice in geriatric people

  • Duration of last use

  • Frequency of self-medication use

  • Name of drug purchase

  • Indication of drug use

  • Source of information

  • Any side effects

A survey using a Questionnaire

Objectives

  • 1) To assess the socio-demographic features influencing self-medication usage and the rationale for its use.

  • 2) To assess elderly patients’ knowledge, attitudes, and self-medication practices.

  • 3) To evaluate the relationship between demographic factors and self-medication.

Methods

Study plan

The current study will be descriptive and cross-sectional.

Study setting/location

The research will be conducted in the School of Epidemiology and Public Health field practice area, DMIHER, Wardha.

Study duration

The study will be carried out between August 2023 and May 2024.

The review of the literature started in August 2023 and, currently, the study proposal has been submitted for the IEC approval. As soon as the ethical approval is received, we will start the study.

Study participants/population

Geriatric individuals aged 60 and above who live in Wardha district’s rural community areas.

Inclusion criteria:

  • 1) The study will comprise all people aged 60 years and above.

  • 2) Those who will be able to give answers to the questions asked by the interviewer.

  • 3) People who will be willing to participate in the study and give consent.

  • 4) Geriatric people who understand at least one Marathi, English, or Hindi language.

Exclusion criteria:

  • 1) People below the age of 60 years will not be a part of this study.

  • 2) The study will not include those who are hesitant or unwilling to participate.

Sample size

The prior research study, which was utilized as a mother research study, found that the majority had inadequate knowledge (88%) regarding consuming self-medication, the estimated proportion, i.e., P value is 0.88, and the following articles were used to estimate the number of participants for this investigation.12

With the help of following formula, the sample size was calculated:

nZ1α/22×p1pd2

Estimated proportion (p): 0.88

Estimated error (d): 0.05

Alpha (α): 0.05

Sample size: 163

As the outcome of 163 sample size elderly peoples will be selected for the data collection.

As a result, a sample size of 163 older people will be used to collect data and examine self-medication knowledge in senior adults living in rural locations.

Sampling method

The technique known as convenience sampling will be used to interview people.

Variables

The research will examine variables related with socio-demographic data, knowledge, attitude, and practice.

Demographic characteristics of the sample such as age in year, sex, highest level of education, occupation, chronic illness, and health insurance.

Study tools

The study using the Self-medication scale (SMS)13 and includes a semi-structured interview survey, employing inquiries in the local languages (Marathi/Hindi) and English to evaluate knowledge, attitude, and practice of self-medication among the geriatric age group.

There are three sections in the structured questionnaire.

Section A: Consists of 8 questions related to knowledge of self-medication.

Section B: Consists of a five-point Likert scale scoring the attitude of the sample from 1 to 5 from strongly disagrees to strongly agrees respectively strongly.

Section C: Comprises 13 questions that represent the practise of self-medication.

Procedure of data collection

Every home in the targeted zone will be visited until a sufficient sample size is reached. The purpose of the interview will be explained to the participants in their local language so they can understand the objectives of study properly and can decide if they are willing to participate in the study. House-to-house visits will be done and information will be obtained using interviews. The planned data recording technique will be used for each participant separately, in which the investigator asks the questions, provides the options as specified in the proforma, and ticks the responses provided by the participants.

Bias

Recall bias may influence results. The current study included a six-month memory span, which could have resulted in recall bias. We’ll reduce this prejudice by employing a well-made, straightforward, and basic questionnaire.

Ethical issues

The study will commence after receiving approval from the DMIHER (DU) Institutional Ethical Committee. Before our research, we will obtain written consent from the participants and explain the purpose of the survey to them. During the interview, using a questionnaire, we’ll ensure the interviewee is at ease and enjoys privacy during the conversation.

Data analysis

The data will be analysed using R Statistical software, a statistics program, after being imported into Microsoft Excel. The frequency and percentages of descriptive statistics will be determined. The correlation among variables will be discovered using the Chi-Square Test. Tables, graphs, and charts will present the data analysed.

Study status

The study is not yet started. The proposal of this study has been submitted for ethical approval to the IEC department of DMIHER (DU) and is under process.

Expected outcomes/Results

The knowledge, attitude, and self-medication practices of elderly individuals will be assessed in this study. Also, examine how socio-demographic factors impact the use of self-medication and the reasons for its use and test the association between demographic characteristics and self-medication.

To raise awareness among the general public, this study will assist in the conduct of numerous studies, such as public awareness campaigns, education, and group discussions.

Discussion

A cross-sectional research was done in rural Sahaswan, Northern India, with the goals of studying the association between research factors and self-medication, identifying the kinds of medications used for self-medication, and identifying typical illnesses for self-medication, Indicated that men, those above 15 years individuals with a lesser education or illiteracy, and those with limited financial resources were more likely to self-medicate.2

Al Ghofaili and Fatimah (2021) did a cross-sectional study on self-medication habits in Qassim Province, Saudi Arabia. The goals of this study are to investigate OTC medical practises in the general community, report on their quantity, most commonly purchased medications and reasons for purchase, and raise public awareness about self-medication. In the study region, there was a significant prevalence of non-prescribed drugs purchased from community pharmacies, according to the findings of this study.3

Cross-sectional descriptive research was conducted in Kermanshah, Iran, by Faranak Jafari, Alireza Khatony, and Elham Rahmani (2015) to look into older people’s use of self-medication and the factors that may be associated with it. The study included 272 participants. According to this survey, 83% of people self-medicate.11

Almalki et al. (2022) performed a cross-sectional study in western Saudi Arabia to assess knowledge, attitude, and practise of self-medication, determine its prevalence, and identify variables and sources of information impacting such practise. This survey included 647 respondents from three main cities: Jeddah, Makkah, and Taif. According to this study, around 67.7% of individuals use self-medication.7

Varun Kumar et al. (2015) did a cross-sectional study on the ‘prevalence and trend of self-medication as practices in an urban region of Delhi, India’. This study aims to determine the prevalence and pattern of self-medication in metropolitan areas. According to this survey, 92.8% of individuals used self-medication, most of which were allopathic medications.14

A cross-sectional study on self-medication in Saudi Arabia was carried out in 2019 by Yahya Ibrahim Mahzari et al. It intends to assess the prevalence and types of self-medication in the Saudi Arabian Kingdom. According to this survey, the frequency of self-medicating in KSA is dangerously high, with analgesics being the most commonly utilized drug with a prescription.15

Study implications

The present study will help formulate guidelines on medicine access and reinforce them with strong mechanisms to implement the policy. This could aid in preventing the widely accepted detrimental effects of self-medication among older adults. Also, it helps to provide medical insurance and free consultations for people in need.

Limitations

Data will be collected using interviews, which may affect the accuracy of the results. The study may be affected by selection bias, measurement bias, or confounding factors, distorting the impact and reducing their validity and generalizability. This study does not consider long-term changes or trends in knowledge, attitude, or self-medication practice because it only provides a one-time measurement of the variables. The results of the study may be affected by seasonal or cyclical variations.

Dissemination

This study protocol will be published in an indexed journal and will be presented in seminars and conferences.

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Ghodkhande K and Gaidhane DA. Assessment of knowledge, attitude and practices of self-medication among the geriatric population of the Wardha district in central India: A cross-sectional study [version 1; peer review: 1 approved with reservations]. F1000Research 2024, 13:57 (https://doi.org/10.12688/f1000research.142500.1)
NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article.
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Key to Reviewer Statuses VIEW
ApprovedThe paper is scientifically sound in its current form and only minor, if any, improvements are suggested
Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.
Not approvedFundamental flaws in the paper seriously undermine the findings and conclusions
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Reviewer Report 29 May 2024
Mainak Bardhan, Miami Cancer Institute, Miami, Florida, USA 
Approved with Reservations
VIEWS 3
  • The manuscript does not provide details on the validity and reliability of the Self-Medication Scale (SMS) in the context of the geriatric population in India. It would be helpful to include information on whether the SMS has
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Bardhan M. Reviewer Report For: Assessment of knowledge, attitude and practices of self-medication among the geriatric population of the Wardha district in central India: A cross-sectional study [version 1; peer review: 1 approved with reservations]. F1000Research 2024, 13:57 (https://doi.org/10.5256/f1000research.156055.r264630)
NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article.

Comments on this article Comments (0)

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VERSION 1 PUBLISHED 12 Jan 2024
Comment
Alongside their report, reviewers assign a status to the article:
Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested
Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.
Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions
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