1. Introduction
Self-medication (SM) is a global phenomenon. It is prevalent in every age group, though its extent differs among individuals and regions. Previously, it was considered as unnecessary, however, responsible self-medication is regarded as an important aspect of self-care nowadays [
1]. On the contrary, irresponsible or irrational SM is discouraged as it may not only harm the patient in the form of adverse drug reactions (ADRs) or medication-related problems (MRPs), but may also increase the direct costs, including the cost of treatment and hospital admission [
2,
3,
4].
SM is defined as the use of medicines by a person for self-treatment based on self-diagnosed symptoms without consulting a physician and/or without a valid prescription [
5]. It may incorporate over the counter (OTC) medications that are dispensed without prescription, as well as prescription-only medications (POM) which require a valid prescription, such as antibiotics. Though self-medication with POM is not advisable, the latter is common in those countries which do not have strict regulations on the sale of pharmaceuticals [
6,
7,
8]. Self-medication practice offers ease of access to OTC medications at a lower cost, which serves as an alternative to the costly and time-consuming clinical consultations. Safety issues are a major concern as many diseases have similar symptoms. Additionally, the risk of self-medication is increased if the individual does not have knowledge and understanding of the disease. Additionally, this practice is associated with an increased risk of misdiagnosis, ADRs, drug abuse and misuse [
9].
One of the reasons to indulge in this practice is the financial condition of the patient. This is common in those countries where the individual has to pay direct cost for treating the condition. As a result, patients may prefer self-treatment over costly consultation. Another possible reason can be the non-regulated practices concerning sale of prescription drugs. This may result in the availability of POM without a valid prescription and, hence, patient may skip consultation and directly purchase prescription medications [
10]. Evidence indicates that self-medication is practiced by teenagers, adults, parents, and students in Saudi Arabia [
11]. Familial practice may also render individuals to indulge in self-medication as it lowers their stigma towards SM. This highlights the need to educate parents about the problem as well. A pharmacist or a doctor at the community level can play an important role in this situation. This brings the discussion to the point of evaluating Saudi pharmacy and medical student’s outlooks toward this issue.
Pharmacy and medical students are expected to be more knowledgeable regarding rational use of medications as compared to general public. The curriculum of pharmacy and medicine teaches them about rational use of medicines and consequences of irrational use. Hence, this population is well aware of the phenomenon and issues related to this practice. Additionally, students of medicine would assume portfolio of a prescriber in future and may prescribe medicines. Similarly, pharmacy students would become future pharmacists and may find themselves counseling patients on safe use of medicines. Thus, both of these professionals play a significant role in patient care especially regarding this practice. Hence, understanding the practice and self-beliefs related to self-medication in this population is of paramount importance.
However, previous studies have reported that this population is also affected by the same practice [
12,
13]. A number of studies have been conducted in Saudi academia pertaining to the matter that reported a varying prevalence of SM. However, there were some limitations observed as those studies did not investigate the determinants, such as beliefs of students who either indulge or refrain from practice. Data regarding self-medication has not been reported from this academia before. Our study aimed to document this practice in pharmacy and medicine students at the university. It also had the objective of reporting prevalence of both POM and OTC medicines currently used by students at the campus.
3. Results
3.1. Response Rate
The study incorporated students from pharmacy and medicine colleges. Out of N = 478 students, a total of 450 responses were received, giving a cumulative response rate (RR) of 94.12%. In terms of a college-wise response, a response rate of 96.8% was obtained from College of Clinical Pharmacy as 158 survey questionnaires were handed over to the pharmacy students and 153 were received. Similarly, a total of 320 surveys were handed to the medical students and 297 were received, giving a response rate of 92.81% for the College of Medicine.
3.2. Demographic Information
The majority of students were aged between 18 and 23 years (N = 427, 94.9%). In terms of gender, slightly more than half were males (N = 249, 55.3%). Most of the students (N = 297, 66%) were from College of Medicine. Study year-wise breakdown revealed that most students (N = 138, 30.7%) were from 3rd Professional year, followed by 5th Professional year students (N = 103, 22.9%). The majority of students (N = 385, 85.6%) were single and did not have children (N = 385, 85.6%). A small segment of students were married without children (N = 43, 9.6%). Furthermore, the bulk of students (N = 375, 83.3%) lived with their families. Most of them (N = 195, 43%) had 3–5 siblings, followed by slightly more than a quarter of students (N = 124, 27.6%) who had 6–8 siblings. Amongst them, an overwhelming majority of students (N = 400, 88.9%) considered themselves healthy, while some (N = 10, 2.2%) had glucose 6–phosphate dehydrogenase (G6PD) deficiency and asthma (N = 8, 1.8%). The demographic information is tabulated in
Table 3.
3.3. Self-Medication Information
The respondents were asked if they indulge in self-medication. More than half of students (N = 248, 55.1%) responded positively. The majority of students (N = 290, 64.4%) rarely indulged (once a month) in the practice, followed by a small segment (N = 54, 12%) that frequently (once every two weeks) indulged in SM. The overall prevalence of self-medication in the whole sample, i.e., among pharmacy and medicine students combined, was 26% (22.01–30.31% for a 95% confidence interval). The prevalence of self-medication among pharmacy students alone was reported at 19.61% (13.64–26.79% for 95% CI) and was 49.3% (44.84–53.77% for 95% CI) for medical students.
Most of the students (N = 124, 27.6%) obtained information from pharmacists followed by a quarter segment (N = 116, 25.8%) using the internet as well as obtaining information from physicians (N = 106, 23.6%). Almost half of students (N = 216, 48%) used non-prescription drugs, followed by a third (N = 152, 33.8%) using both OTC and POMs. An overwhelming majority obtained medications for self-use from a pharmacy store (N = 306, 68%), followed by a third proportion indicating availability of medicines in homes (N = 139, 30.9%). The most common symptoms experienced by students that prompted SM were headache, fever, pain, and dysmenorrhea (N = 64, 14.2%), followed by allergy and cold/flu (N = 16, 3.6%). The majority of students (N = 293, 65.1%) highlighted more than one symptom and few (N = 57, 12.7%) did not experience any symptom that prompted them to self-medicate. Further to this, majority of the students (N = 102, 22.7%) self-medicated with analgesics and antipyretics (paracetamol and NSAIDs), followed by cold and flu medicines (N = 10, 2.2%). A small segment (N = 6, 1.3%) self-medicated with antibiotics.
The prevalence of multivitamins use was reported at 30.53% (26.31–35% for 95% CI). The term ‘dietary supplement’ included only multivitamins. The prevalence of analgesics use, which included paracetamol and NSAIDs, was reported at 72.35% (67.97–76.4%); antihistamines and cold/flu products was 39.16% (34.63–43.83%). The prevalence of antibiotics and anti-diarrheal use among students was found to be 16.59% (13.28–20.35%) and 8.63% (6.21–11.61%), respectively. For antacids use, the prevalence was documented at 6.64% (4.52–9.34%). The detailed summary of self-medication information is graphically represented in
Figure 2 and tabulated in
Table 4.
3.4. Attitudes Towards Self-Medication Practice
The study documented students’ attitude towards self-medication practice. More than a third of students (N = 158, 35.1%) responded positively to SM practice by mentioning ‘mild problems’ that could be treated by SM. Few students (N = 64, 14.2%) indicated that they had ‘previous experience with such medicines’, hence, they felt more poised to self-medicate. Similarly, those who had a negative attitude towards SM practice believed that consultation with a physician was essential to stay healthy (N = 119, 26.4%). A small segment of students (N = 68, 15.2%) was concerned with ADRs and did not self-medicate. Most students (N = 366, 81.3%) highlighted that they were against SM practice in principle, but agreed that it may be used in rare situations. A small segment of students (N = 57, 12.7%) favored SM practice at all times. The details are tabulated in
Table 5.
The association between gender and the source of information regarding SM was statistically significant with the chi square (X2) value reported at 22.302 and p value less than 0.0001, with a low to moderate effect size, i.e., a phi value reported at 0.223. The association between demographic variable of college and source of information regarding SM was also statistically significant with X2 values reported at 13.390 and p value less than 0.05, with a weak effect size, i.e., a phi value reported at 0.172. The association of the variable of college was also significant with nature of medications used by students. The value of X2 was reported at 6.669 and p value was less than 0.05, with a weak effect size, i.e., a phi value reported at 0.122. Moreover, cross-tabulation for the abovementioned three associations had no cell with minimum expected count less than five; therefore, the results are reliable.
Furthermore, cross-tabulation of study year with nature of medications used by students was significant as X
2 value was reported at 30.421 and
p value was less than 0.01, with a weak to moderate effect size, i.e., a phi reported at 0.260. Only five cells (27.8%) had a minimum expected count less than five; therefore, the results may be considered reliable. The association between number of siblings and advice regarding SM practice was found to be statistically significant with the X
2 value reported at 16.079 and
p value less than 0.05, with a weak effect size, i.e., a phi value reported at 0.189. Only four cells (26.7%) had an expected count less than five; therefore, the results may be considered reliable. The summary of cross-tabulation is presented in
Table 6.
4. Discussion
This study was conducted among students of pharmacy and medicine colleges at a public sector university in Dammam, Saudi Arabia. The age and marital status of the students represents the characteristic student enrollment in Saudi academia [
18,
19]. The prevalence of self-medication in both medicine and pharmacy colleges, combined was reported at 26%. This is quite low compared to the prevalence of SM previously reported in allied health students of other public sector universities of Saudi Arabia [
18,
19]. Furthermore, the prevalence of SM in College of Clinical Pharmacy alone was reported at 19.61%. This figure has been reported for the first time in this population as there is a lack of data pertaining to self-medication practice prevailing among Saudi pharmacy students. A study conducted in pharmacy students of a university in Saudi Arabia reported SM prevalence of 77%, however; the figure is not specific for pharmacy students as it was obtained from students of pharmacy, nursing, and dentistry, combined [
20,
21]. In regional context, study conducted in the pharmacy college of a university in the UAE and Pakistan reported SM prevalence of 86% and 67.2%, respectively [
22,
23].
The prevalence of SM in College of Medicine was found to be 49.3%. Studies have reported varying prevalence in medicine colleges from 66% to 87% among Saudi universities [
18,
19,
21,
23,
24,
25]. Our study has reported lowest SM prevalence in a medical college of Saudi university as of now. In regional context, the difference in prevalence between pharmacy and medicine colleges within universities can be attributed to the fact that students of medicines are deemed to become future prescribers. Hence, they find themselves more confident in indulging in self-medication. On the other hand, pharmacy students have more knowledge about drugs and their toxicology which may increase reluctance to indulge in the practice [
18,
25]. Further investigation is warranted.
There was a surge in the use of multivitamins as our study reported a prevalence of 30.53% which is quite high as compared to previously-reported prevalence of 3–5% [
18,
19,
25,
26]. In the region, prevalence of multivitamins use in university students of the UAE was reported at 39% [
27]. The use of analgesics, such as paracetamol and NSAIDs, was quite high. Our study reported the prevalence at 72.35% which is the second highest figure reported among Saudi universities currently. The prevalence for the same was reported in previous literature in ranges of 28.7% to 80% among other Saudi universities [
18,
19,
22,
25]. Our study also reported the prevalence of antibiotics use among students which was documented at 16.59%. This was second to the lowest figure, i.e., 5% previously reported from King Saud University [
19]. High prevalence of antibiotic use was previously reported in the range of 30% to 32% from Taibah and Qassim University, respectively [
18,
21,
25]. Additionally, prevalence of antihistamines and cold/flu products use was comparatively higher than figures reported from other universities of the country. Our study reported a prevalence of antihistamines use at 39.16% which was far higher than figures reported from Taibah University (1.1%) and King Saud University (5%) [
18,
19]. It was second to highest prevalence reported i.e. from Qassim University, (41%) [
25]. The prevalence of anti-diarrheals and antacids was reported for the first time from this population.
Self-medication with anti-fungal (N = 1), corticosteroids (N = 2), anti-acne, i.e., Isotretenoin (N = 1), and anti-emetic i.e., ondansetron (N = 2), CNS stimulants i.e., methylphenidate (N = 1) and anti-spasmodic, i.e., mebavarine (N = 1) was also reported. The prevalence of depression and psychoactive stimulants use in pharmacy students of Pakistan was reported at 1.31% [
12,
28]. Previous studies conducted in Saudi Arabia found a number of students indulged in substance abuse, especially abuse of such products. Studies have reported the growing substance abuse among students of Saudi universities [
24,
25,
29]. In our study, only a single student acknowledged self-medicating with methylphenidate.
The most common source of information regarding SM were pharmacists, as well as physicians. This finding was also statistically associated with gender and colleges. Pharmacists were the preferred choice for males to seek SM-related information. Females were more inclined towards physicians. Pharmacy students sought information regarding SM from pharmacists. Similarly, students from the College of Medicine highlighted their preference of a physician for such information. Since students of medical college were taught by physicians, it may have promoted confidence in seeking such information from physicians [
19,
20]. The same principle may apply to pharmacy students.
The majority of the students self medicated with OTC medicines, however, a third proportion of the students used both OTC and POMs. This finding was statistically associated with college and year of study. Medical students and those studying in the 2nd Professional year self-medicated with POM, more than their counterparts. One possible explanation regarding this association could be the fact that physicians in this part of the globe have sole prescribing rights and are deemed by society to prescribe medicines. Medical students who were taught by physicians may find themselves in a much more comfortable position to use POMs as compared to pharmacy students since they are ingrained with a prescribing authority. They may be more inclined towards this practice. Students appeared self-medicating with POM in the 2nd year in higher numbers compared to any other study year. The professional education in pharmacy and medicine at the university starts when the students have progressed from the preparatory year into 2nd year. As the students progress in their educational career, they become more educated and informed about the phenomenon. Professional education may influence their perception towards SM practice and use of POMs. As a result, they may develop reluctance in self-medicating with POM progressively. Hence, our study found that the number of students self-medicating with POMs decreased as they progressed in their educational career.
The most common reasons given as a justification to indulge in SM were ‘mild problem’ and ‘previous experience with medicine’. This finding was congruent with previous literature reported from the country, as well as the region [
18]. The importance of physician consultation was stated the most common reason against this practice, which was also reported from university students of Pakistan [
13]. Contrastingly, an overwhelming majority of students highlighted their stance that they were against SM practice, in principle, but clarified that SM could be used in rare situations. This was a novel finding as previous studies conducted among the same population reported that most of the students of Jazan University (52.6%) and Taibah University (87%) appeared totally against the practice [
18,
23]. It can be deduced from this finding that students at Imam Abdulrahman Bin Faisal University understand importance of responsible self-medication.