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 Table of Contents  
ORIGINAL ARTICLES
Year : 2022  |  Volume : 9  |  Issue : 2  |  Page : 154-159

Knowledge, attitude, and practice of ‘over-the-counter’ medications among medical and non-medical professionals during COVID-19 pandemic


Department of Clinical Pharmacy, Poona College of Pharmacy, Bharati Vidyapeeth (Deemed to be University), Erandwane, Pune- 411038, Maharashtra, India

Date of Submission04-Feb-2022
Date of Acceptance19-Apr-2022
Date of Web Publication17-Jun-2022

Correspondence Address:
Prof. Asawari Raut
Department of Clinical Pharmacy, Poona College of Pharmacy, Bharati Vidyapeeth (Deemed to be University), Erandwane, Pune- 411038, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mgmj.mgmj_10_22

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  Abstract 

Background: India is one of the emerging markets for over-the-counter (OTC) drugs and offers significant growth potential for the industry. There has been a huge rise in the use of OTC drugs since the beginning of the pandemic for which some major reasons are lack of time, non-availability of prescribers, and hospital exposure during a pandemic. Aim: To assess knowledge, attitude, and practice (KAP) of ‘over-the-counter’ medications among medical and non-medical professionals during the COVID-19 pandemic. Settings and Design: The study was conducted at Bharati Hospital and Research Center, Pune, Maharashtra, India. Materials and Methods: A descriptive observational study was conducted. Statistical Analysis Used: Descriptive (mean, percentage, and standard deviation) and inferential (chi-square test) statistics were used. Statistical analysis was done using the Statistical Package for the Social Sciences(SPSS) software version 10.0. Results: Out of 310 samples majority showed poor knowledge (50.65%), high practice (56.13%), and negative attitude (70%) towards the use of OTC drugs. There is a significant association found between age (p-value 0) and health care status (p-value 0) with the level of knowledge. Age group (p-value 0.046) and employee status (p-value 0.00033) showed a significant association with the practice of OTC drugs. Healthcare status showed a significant association (p-value 0.0007) towards attitude toward the use of OTC drugs. Conclusion: Participants reported overall poor knowledge with a negative attitude and adopted the high practice use of OTC drugs during the COVID-19 pandemic. Increased awareness about self-medication is important to avoid complications associated with the high practice of OTC medications.

Keywords: COVID-19, knowledge, over-the-counter, practice


How to cite this article:
Raut A, Varghese BE, Singh DR, Reji SM. Knowledge, attitude, and practice of ‘over-the-counter’ medications among medical and non-medical professionals during COVID-19 pandemic. MGM J Med Sci 2022;9:154-9

How to cite this URL:
Raut A, Varghese BE, Singh DR, Reji SM. Knowledge, attitude, and practice of ‘over-the-counter’ medications among medical and non-medical professionals during COVID-19 pandemic. MGM J Med Sci [serial online] 2022 [cited 2022 Oct 1];9:154-9. Available from: http://www.mgmjms.com/text.asp?2022/9/2/154/347682




  Introduction Top


Over-the-counter drugs (OTC) play a vital role in the health care system. India is one of the emerging markets for OTC drugs and offers significant growth potential for the industry but there are no guidelines for licensing OTC in India. Reasons such as easy availability, affordability, and increased awareness among patients are responsible for this trend.[1],[2]

The key factors propelling the growth of the drug market are the shift in consumer attitude toward self-medication, product innovations, and inclination of pharmaceutical companies toward OTC drugs from prescription drugs, high consulting fees of the physicians, and non-availability of the prescribers, and hospital exposure during a pandemic.[3]


  Materials and methods Top


This study was undertaken to evaluate the knowledge, attitude, and practice of OTC drugs among the individuals in and around Bharati Hospital and Research Center, Pune, Maharashtra, India during the Coronavirus disease-19 (COVID-19) pandemic. An internet-based survey was done using a “Google Form” from October 2020 to March 2021 to collect responses from the participants who fulfilled the study criteria. This survey was conducted using a quantitative descriptive research design. Participants who are in and above 18 years of age and are willing to take part in the study, healthcare professionals, non-healthcare workers, patients, and relatives who visited Bharati hospital during the COVID-19 pandemic are among the study’s inclusion requirements. Individuals over the age of 60, those who are seriously ill, and those with comorbidities are all excluded.

Sample Size

The estimated size was 310.

The required sample size was calculated applying the below-mentioned formula:



where:

N = required sample size

P = estimated rate of prevalence of self-medication with OTC medications according to accessible population

Z = table value at 0.05 level of significance is 1.96

d = absolute precision (acceptable margin of error) was assumed to be 5% (0.05)







Data sources

A structured questionnaire was prepared, pre-tested, and validated by a subject expert. The Google form was sent to the participants. The questionnaire included 25 questions about knowledge (10 questions), attitude (5 questions), and practice (10 questions) regarding the use of OTC drugs during the COVID-19 pandemic. The pilot study was done on 31 individuals and discrepancies were addressed. Throughout the process, the volunteers’ privacy was protected to the fullest extent possible.

Scoring and interpretation

The scoring and interpretation categories were as follows: those with a score of 4 or less were classified as having “poor” knowledge, those with a score of 5 to 7 were classified as having “average” knowledge, and those with a score of 8 to 10 were classified as having “good” knowledge. Strongly disagree, disagree, neutral, agree, and strongly agree were used to categorize the attitudes. For practice, either “yes” or “no” responses were recorded.

Statistical methods

Descriptive (mean, percentage, and SD) and inferential (chi-square test) statistics were used. Statistical analysis was done using the Statistical Package for the Social Sciences (SPSS) software version 10.0.


  Results Top


Demographic details of the participants

A total of 310 participants were involved in this web-based survey. According to age, the majority (50.65%) of the samples were from the age group of 20–30 years, 25.81% sample was from 31–40 years, 14.91% were from 41–50 years of age and 9.35% sample were from 51–60 years of age group. According to gender, the sample had a female majority of 59.35% and males of 40.65%. The majority of the samples (68.06%) were non-health professionals, whereas 31.94% were health professionals. The majority of employees made up 52.58% of the sample, students made up 40.32%, housewives made up 5.48% of the sample, and businessmen made up 1.61%. Seventy-five percent of the samples had a bachelor’s degree or more, 13.23% had a diploma or certification, 10.65% had a secondary or higher-level education qualification, and 0.97% had a primary education qualification.

Association of the level of knowledge, attitude, and practice of OTC drugs

Out of 310 responses, the majority of respondents had poor knowledge of OTC drugs 50.65%, followed by average knowledge with 30.65% and good knowledge with 18.71% [Figure 1]. The results regarding the practice of the OTC medication among the participants showed dominance in high practice with 56.13%, moderate practice with 34.84%, and low practice with 0.03%. Furthermore, while obtaining results for the attitude over the use of the OTC mediations, the majority showed a negative attitude of 70% responses, and 30% responses showed a positive response. Overall the conclusion can be made, out of 310 responses participants showed poor knowledge, high practice, and a negative attitude while using OTC medications.
Figure 1: Level of knowledge attitude and practice of OTC medications

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Association of the level of KAP of OTC drugs

Knowledge

[Table 1] depicts findings related to the association between levels of knowledge with selected demographic variables. Individuals from the age group 20–30 years and non-healthcare professionals showed poor knowledge regarding the use of OTC drugs. There is a significant association between age (p-value 0) and health care status (p-value 0) with the level of knowledge as the p-value is less than 0.05 level of significance whereas there is no significant association between level of knowledge with other demographic variables including gender, student/employer status and level of education.
Table 1: Findings related to the association of knowledge with demographic variables

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Practice

[Table 2] depicts that non-healthcare professionals, women, employees, individuals of age group 20–30 years, and graduates had the highest rate of usage of OTC medications out of all respondents. Furthermore, there is no significant association between the demographic parameters like gender, healthcare status and education qualifications towards practice (p-value >0.05) whereas age group (p-value 0.046) and employee status (p-value 0.00033) showed a significant association between practice on the use of OTC drugs.
Table 2: Findings related to the association of practice with demographic variables

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Attitude

[Table 3] depicts that females, health care professionals, students, graduates, and people between the ages of 31- and 40 had a higher negative attitude regarding the usage of OTC medications. There is no significant association between the demographic variables age, gender, student or employee status, educational qualification towards attitude (p-value >0.05) whereas health care and non-healthcare professionals showed a significant association (p-value 0.0007) towards attitude toward the use of OTC drugs.
Table 3: Findings related to the association of attitude with demographic variables

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[Table 4] depicts the correlation pattern between knowledge, attitude, and practice among the study samples. The table illustrates that there is a positive correlation between knowledge, attitude, and practice among each other with a p-value of 0.91 between knowledge and practice, 0.35 between knowledge and attitude, and 0.58 between practice and attitude. A weak positive correlation is found between all the variables as the R-value is positive (>0) presenting 0.0063 between knowledge and practice, 0.0054 between knowledge and attitude, and 0.032 between practice and attitude.
Table 4: Correlation between knowledge, attitude, and practice on problems related to use of OTC in pandemic

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  Discussion Top


Out of 310 participants, males and females have no significant difference in the use of OTC products. Gender is considered an important factor in self-medication patterns among young adults including students. Although females have a more negative attitude and more knowledge than males, similar observations were made in a study conducted among students in Nigeria.[4] Not just in older adults, but also in younger adults, gender is an essential variable in self-medication. Although the use of self-medication in students is about similar for both genders, the role of women in family health leads to more cautious and responsible self-medication habits, which can be seen even at a young age.[5]

In this survey, participants reported poor knowledge (50.65%), high practice (56.13%), and negative attitudes (70%). However, this result is similar to the studies conducted in Dehradun, India. Self-medication, when adopted effectively, can be beneficial as it may relieve acute pain, and reduce treatment cost and physician interaction time.[6]

In a similar study conducted by Bekele KM et al. on knowledge, attitude, and practice of OTC drugs among pharmacy and medical students using a cross-sectional study, Results showed that 230 (60.5%) were male by gender and the majority of the 237 (62.4%) were within the age group of 23–25, with a mean age of 23.5 years (SD=6.521). Concerning the profession of education, 229 (60.3%) were medical students while 151 (39.7%) were pharmacy students. Almost all of the participants 377 (99.2%) were single by marital status. The mean knowledge score was 6.59 (SD=1.32). About 257 (67.6%) of the respondents had good knowledge of the OTC medications. The majority of the respondents 303 (79.7%) had reported that they have at least once practiced SM with OTC medications. The mean attitude score was 26.62/40 (SD=3.42). Of the total study participants, 46 (12.1%) strongly agree and 183 (48.2%) agree that OTC medications are cheaper and more convenient to use.[7]

The increase in self-care is due to several factors viz. socioeconomic factors, lifestyle, ready access to drugs, the increased potential to manage certain illnesses through self-care, public health, and environmental factors, greater availability of medicinal products, and demographic and epidemiological factors.[8] Time consumption for consultation, the consultation fees, and frequent visits were the commonly mentioned reasons for self-medication.[9]

From the study findings, it is found that there is no significant relationship between the level of education and practice of OTC drugs although the practice is high among participants who have higher education with a negative attitude as they are aware of the pros and cons of self-medication but with higher practice due to the fear and as a preventive strategy for a pandemic. There are numerous reasons for the increased likelihood of self-medication among colleges students and health care staff. They have easy access to information from medical books, literature, drug indices, internet search, and other senior medical professionals, so they irrationally use drugs more commonly than the general population.[10]

The present study showed that there is a weak positive correlation between knowledge and practice, knowledge and attitude, practice and attitude at the significance level of 0.05. This signifies that there is a relationship between the knowledge of the participants which influenced the attitude and practice of OTC drugs in the study site. As the outcome, we can say that majority of the participants had poor knowledge which had led to a negative attitude towards the use of OTC drugs as they are unaware of the benefits, as well as the side effects of the drugs which are better than a rational point of view in drug use. On the other hand majority of the participants had a high practice of OTC drugs, which is considered to be dangerous and irrational as the study finding revealed a majority with poor knowledge and negative attitude. As a result, we may conclude that participants who are unfamiliar with the indications, composition, and appropriateness of the study drug and have a negative attitude regarding its usefulness and practice make extensive use of OTC products.

Patients need accurate and understandable information about the potential advantages and risks of medications they are taking, including self-medication. Pharmacists must increase their clinical knowledge and abilities, as well as demonstrate their desire to be responsible for a patient’s medication therapy and create effective working relationships with other healthcare providers. Consequently, health promotion activities are vital in improving KAP towards the use of OTC drugs during the COVID-19 pandemic, and it is recommended to conduct interventional studies using the results of this study. Though self-medication is promoted by WHO, because of the affordability and inaccessibility of health services in the developing world, the benefit must be weighed against adverse effects.[6],[11]


  Conclusion Top


Participants reported overall poor knowledge with a negative attitude and adopted the high practice use of OTC drugs during the COVID-19 pandemic. Self-medication with OTC drugs is widely practiced among medical, pharmacy students, and the general population. Educational programs and training for residents for better preparedness for tackling COVID-19 and rational use of OTC must be arranged. Public awareness, regular updates of the infection prevention protocol, and provide adequate IPC training during this pandemic, and adequate logistic supply. Strategies should be implemented to improve some of the malpractices practiced by medical, pharmacy students, and the general population. Medical and pharmacy professionals should also hold a great deal of responsibility and serve as role models for residents when it comes to the proper use of pharmaceuticals, as they are the experts on whom others will rely.

Acknowledgement

We would like to express our gratitude to all the respondents for spending their valuable time answering our questionnaire that helped us to complete our study.

Ethical consideration

Approval/clearance has been obtained from the Institutional Ethics Committee, Bharti Vidyapeeth Medical College (Deemed to be University), Pune, Maharashtra, India for undertaking the proposed research study on “Knowledge, attitude, and practice of ‘over-the-counter’ medications among medical and non-medical professionals during COVID-19 pandemic” vide their letter no. BVDUMC/IEC/19 date 18/09/2020.

Financial support and sponsorship

Nil

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Marathe PA, Kamat SK, Tripathi RK, Raut SB, Khatri NP Over-the-counter medicines: Global perspective and indian scenario. J Postgrad Med 2020;66:28-34.  Back to cited text no. 1
    
2.
Shankar R Editorial: Regulatory framework for OTC drugs. September 8, 2021. Available from: http://pharmabiz.com/ArticleDetails.aspx?aid=142383&sid=3. [Last accessed on 25 Mar 2022].  Back to cited text no. 2
    
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India Over the Counter Drugs (OTC) Market | 2021 - 26 | Industry Share, Size, Growth -Mordor Intelligence [Internet]. Available from: https://www.mordorintelligence.com/industry-reports/india-otc-drugs-market. [Last accessed on 29 Sep 2021].  Back to cited text no. 3
    
4.
Esan DT, Fasoro AA, Odesanya OE, Esan TO, Ojo EF, Faeji CO Assessment of self-medication practices and its associated factors among undergraduates of a private university in nigeria. J Environ Public Health 2018;2018:5439079.  Back to cited text no. 4
    
5.
Klemenc-Ketis Z, Hladnik Z, Kersnik J A cross sectional study of sex differences in self-medication practices among university students in slovenia. Coll Antropol 2011;35:329-34.  Back to cited text no. 5
    
6.
Maheshwari S, Gupta PK, Sinha R, Rawat P Knowledge, attitude, and practice towards coronavirus disease 2019 (COVID-19) among medical students: A cross-sectional study. J Acute Dis 2020;9:100-4.  Back to cited text no. 6
    
7.
Bekele KM, Abay AM, Mengistu KA, Atsbeha BW, Demeke CA, Belay WS, et al. Knowledge, attitude, and practice on over-the-counter drugs among pharmacy and medical students: A facility-based cross-sectional study. Integr Pharm Res Pract 2020;9:135-46.  Back to cited text no. 7
    
8.
Mohamed Saleem TK, Sankar C, Dilip C, Azeem AK Self-medication with over-the-counter drugs: A questionnaire-based study. Der Pharmacia Lettre: Abstract. Available from: https://www.scholarsresearchlibrary.com/abstract/self-medication-with-over-the-counter-drugs-a-questionnaire-based-study-2971.html. [Last accessed on 25 March 2022].  Back to cited text no. 8
    
9.
Parikh D, Sattigeri B, Kumar A, Brahmbhatt S A survey study on the use of over-the-counter OTC drugs among medical students, nursing and clerical staff of a tertiary care teaching rural hospital. Int J Res Med Sci 2013;1:83.  Back to cited text no. 9
    
10.
Al-Radeef MY A Comparative Study on the Knowledge and Usage Assessment of the Over the Counter Medications among Students from Tikrit University. Tikrit J Pharm Sci 2017;12:1-26.  Back to cited text no. 10
    
11.
Maguire TA Ibuprofen: A model medicine for self-care of common conditions. Int J Clin Pract Suppl 2013:43-6. doi: 10.1111/ijcp.12052.  Back to cited text no. 11
    


    Figures

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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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