DOI 10.1515/ijamh-2013-0315 Int J Adolesc Med Health 2014; 26(3): 423–431
Syed Ilyas Shehnaz*, Nelofer Khan, Jayadevan Sreedharan and Mohamed Arifulla
Drug knowledge of expatriate adolescents in the United Arab Emirates and their attitudes towards self-medication Abstract Background: Adolescents have limited knowledge about medicines and their potential adverse effects. In this context, we aimed to investigate the basic knowledge of medicines, any differences in knowledge related to practice of self-medication (SM), attitudes towards SM and sources of information about medicines among expatriate adolescents in the United Arab Emirates (UAE). Methods: A cross-sectional survey was conducted among 324 students from four schools in the UAE using a selfadministered questionnaire. Data were analyzed using SPSS version 19. Results: The sample of multi-ethnic students, with ages ranging from 14 to 19 years, was almost equally distributed between the genders. A total of 289 students reported to be self-medicating. More than 60% of adolescents had responded incorrectly to eight questions related to knowledge about medicines. There were no significant differences between mean scores for drug knowledge (maximum score = 22) of self-medicating adolescents (12.1 ± 4.32; SMAs) and those not practicing SM (12 ± 4.53; NSMAs). Self-assessment of drug knowledge was perceived as good by 33% and satisfactory by 34% of SMAs. The majority of adolescents (87%) believed that SM was acceptable and reported being aware of its advantages and disadvantages. Parents and pharmacists were common sources of information about medicines. Conclusion: The participants showed a positive inclination towards SM. The SMAs and NSMAs had similar knowledge about medicines. However, gaps in knowledge may lead to drug misuse and toxicity. Healthcare providers, pharmacists, educators and parents should be actively involved in health education strategies for rational use of medicines among adolescents in the UAE. Keywords: adolescents; drug knowledge; self-medication; United Arab Emirates. *Corresponding author: Dr. Syed Ilyas Shehnaz, Department of Pharmacology, Gulf Medical University, P.O. Box 4184, Ajman, United Arab Emirates, Phone: +9716-7431333, ext. 316, Fax: +9716-7431222, E-mail: [email protected]
Nelofer Khan: Department of Biochemistry, Gulf Medical University, Ajman, United Arab Emirates Jayadevan Sreedharan: Statistical Support Facility, CABRI, Gulf Medical University, Ajman, United Arab Emirates Mohamed Arifulla: Department of Pharmacology, Gulf Medical University, Ajman, United Arab Emirates
Introduction Self-medication (SM) is defined as the exposure to a drug for self-treatment, without the advice of a physician (1, 2). SM in developed countries is mainly restricted to over-thecounter (OTC) medicines, whereas in developing countries it may occur with both OTC and prescription-only medicine (POM) (3, 4). Risks anticipated due to SM include delayed diagnosis of diseases because of altered signs and symptoms, misdiagnosis, propensity to drug adverse effects owing to prolonged use, drug interactions and polypharmacy, etc. (4–6). By contrast, safe and “responsible” SM can reduce the burden on health services and be cost-effective (2, 6). SM is commonly and universally encountered among the adolescent population. The selection of the drug is usually done by the adolescent himself/herself without adult guidance (3, 7–12) or facilitated by an adult (parent or guardian) who is unauthorized to prescribe (13). Previous research has shown that children and adolescents have limited essential knowledge about medicines to undertake SM and also low awareness of potential adverse effects of medicines (7, 14–18). The practice of POM sharing also bypasses hazard mitigation procedures through the loss of drug information from health professionals (4, 12). Inadequate drug knowledge coupled with independent drug use (without adult guidance) could lead to irrational drug use with all its dangerous repercussions. Consequently, ensuring that adolescents possess adequate knowledge for the rational use of medicines becomes vital. Moreover, attitudes developed during this transitive adolescent period may be carried over to adulthood and subsequently influence the use of medicines.
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424 Shehnaz et al.: Drug knowledge and attitudes towards self-medication The United Arab Emirates (UAE) is a country in the Middle-Eastern region and a member of the Gulf Cooperation Council (GCC) (19). Expatriates constitute almost half of the population of the GCC countries (total population: 45.9 million) (19) and the UAE is no exception, with their proportion approximating 83% of the total population (20). The expatriates, who live with their families in the UAE, are mostly educated, professionally qualified and belong to the middle or higher income group (20). Differences in accessibility to public healthcare system; procurement of OTC medication (or even POM) and drug information from their home countries may influence SM practices, and subsequently knowledge about medicines in this population. Globally, the published literature on the knowledge of medicines among adolescents is scarce (7, 14–18) and studies exploring the same among adolescents and expatriates in the Middle Eastern countries are lacking. Furthermore, the paucity of data on the level of drug knowledge among adolescents in the UAE gave a lead to explore this aspect. The data generated from this study can assist in planning health educational programs targeting this population. The objectives of the study were: –– to investigate the basic knowledge of medicines among expatriate adolescents in the UAE; –– to assess any differences in knowledge associated with the practice of SM and sociodemographic characteristics of the adolescents; –– to determine the attitudes towards SM among selfmedicating adolescents; and –– to ascertain the sources of information about medicines among the adolescents.
Materials and methods A cross-sectional, self-administered, questionnaire-based survey was conducted among expatriate high school students in private schools in Dubai, Sharjah and Ajman, UAE after obtaining institutional Ethics Committee approval. Four schools were selected through the convenience sampling procedure to recruit the subjects. By estimating the prevalence of SM as 75% (marginal error as 5%), the minimum sample size was calculated as 300. Anticipating a non-response rate of 10%, the questionnaires were distributed to 330 s tudents. A total of 324 students responded. To obtain a representative sample, students majoring in natural sciences, commerce and humanities/arts were approached. Briefing about the study objectives and instructions for filling the questionnaires were explained to teachers, who then conveyed them to their students. Voluntary participation was stressed, confidentiality of data was assured and informed consent was obtained from all students prior to administration of the questionnaire.
The data presented in this study, which formed part of a larger study, is restricted to the analysis of basic knowledge of medicines, attitudes towards SM and sources of information about medicines.
Study instrument and validation procedure The structured questionnaire, with close-ended statements, was developed through a series of focus group discussions with subject experts (three pharmacologists, two pharmacists and one internal medicine specialist) and was based on a review of the literature (6, 7, 14–18, 21). The questionnaire was content validated by the subject experts and ambiguities in the statements were removed after pilot testing. The operational terms in the questionnaire were defined as follows: Self-medication: use of OTC or POM for self-treatment, without prior consultation with a doctor; Doctor: any person who was medically qualified to prescribe medications; Medication: substance used for treatment or prevention of disease, both modern medications and those from other healthcare systems. The study questionnaire consisted of the following five sections: 1. Socio-demographic details. 2. Prevalence of SM was ascertained through a Yes or No response to a statement inquiring whether the adolescents were taking medications without the advice of a doctor. Data about SM in the previous 2 weeks, monthly use of medicines in the preceding year and health complaints experienced in a month in the preceding year were also obtained. 3. Knowledge about SM: adolescents were asked for definitions of certain terms: drug, antibiotic, analgesic and side effects, and other questions ascertaining general knowledge about medicines either through a Yes or No response or through single/ multiple responses. Technical terms were avoided and common brand names of acetaminophen were also included for clarity. The participants’ self- assessed knowledge about medicines on a scale from Good to Bad was also requested. 4. Sources of drug information: a list of sources with the option for multiple responses was included. Additionally, information about reading package inserts before SM was obtained through a Yes or No response. 5. Attitudes towards SM were determined through agreement or disagreement with statements elaborating risks and benefits of SM. These statements were based on articles highlighting the pros and cons of SM (6, 21). A statement about the acceptability of SM was also included.
Statistical analysis Data analysis was performed using SPSS version 19. Categorical variables were described by frequencies and percentages. The Pearson χ2-test and Fischer exact test (if the expected cell value was
Syed Ilyas Shehnaz*, Nelofer Khan, Jayadevan Sreedharan and Mohamed Arifulla
Drug knowledge of expatriate adolescents in the United Arab Emirates and their attitudes towards self-medication Abstract Background: Adolescents have limited knowledge about medicines and their potential adverse effects. In this context, we aimed to investigate the basic knowledge of medicines, any differences in knowledge related to practice of self-medication (SM), attitudes towards SM and sources of information about medicines among expatriate adolescents in the United Arab Emirates (UAE). Methods: A cross-sectional survey was conducted among 324 students from four schools in the UAE using a selfadministered questionnaire. Data were analyzed using SPSS version 19. Results: The sample of multi-ethnic students, with ages ranging from 14 to 19 years, was almost equally distributed between the genders. A total of 289 students reported to be self-medicating. More than 60% of adolescents had responded incorrectly to eight questions related to knowledge about medicines. There were no significant differences between mean scores for drug knowledge (maximum score = 22) of self-medicating adolescents (12.1 ± 4.32; SMAs) and those not practicing SM (12 ± 4.53; NSMAs). Self-assessment of drug knowledge was perceived as good by 33% and satisfactory by 34% of SMAs. The majority of adolescents (87%) believed that SM was acceptable and reported being aware of its advantages and disadvantages. Parents and pharmacists were common sources of information about medicines. Conclusion: The participants showed a positive inclination towards SM. The SMAs and NSMAs had similar knowledge about medicines. However, gaps in knowledge may lead to drug misuse and toxicity. Healthcare providers, pharmacists, educators and parents should be actively involved in health education strategies for rational use of medicines among adolescents in the UAE. Keywords: adolescents; drug knowledge; self-medication; United Arab Emirates. *Corresponding author: Dr. Syed Ilyas Shehnaz, Department of Pharmacology, Gulf Medical University, P.O. Box 4184, Ajman, United Arab Emirates, Phone: +9716-7431333, ext. 316, Fax: +9716-7431222, E-mail: [email protected]
Nelofer Khan: Department of Biochemistry, Gulf Medical University, Ajman, United Arab Emirates Jayadevan Sreedharan: Statistical Support Facility, CABRI, Gulf Medical University, Ajman, United Arab Emirates Mohamed Arifulla: Department of Pharmacology, Gulf Medical University, Ajman, United Arab Emirates
Introduction Self-medication (SM) is defined as the exposure to a drug for self-treatment, without the advice of a physician (1, 2). SM in developed countries is mainly restricted to over-thecounter (OTC) medicines, whereas in developing countries it may occur with both OTC and prescription-only medicine (POM) (3, 4). Risks anticipated due to SM include delayed diagnosis of diseases because of altered signs and symptoms, misdiagnosis, propensity to drug adverse effects owing to prolonged use, drug interactions and polypharmacy, etc. (4–6). By contrast, safe and “responsible” SM can reduce the burden on health services and be cost-effective (2, 6). SM is commonly and universally encountered among the adolescent population. The selection of the drug is usually done by the adolescent himself/herself without adult guidance (3, 7–12) or facilitated by an adult (parent or guardian) who is unauthorized to prescribe (13). Previous research has shown that children and adolescents have limited essential knowledge about medicines to undertake SM and also low awareness of potential adverse effects of medicines (7, 14–18). The practice of POM sharing also bypasses hazard mitigation procedures through the loss of drug information from health professionals (4, 12). Inadequate drug knowledge coupled with independent drug use (without adult guidance) could lead to irrational drug use with all its dangerous repercussions. Consequently, ensuring that adolescents possess adequate knowledge for the rational use of medicines becomes vital. Moreover, attitudes developed during this transitive adolescent period may be carried over to adulthood and subsequently influence the use of medicines.
Brought to you by | University of Connecticut Authenticated Download Date | 6/6/15 2:25 AM
424 Shehnaz et al.: Drug knowledge and attitudes towards self-medication The United Arab Emirates (UAE) is a country in the Middle-Eastern region and a member of the Gulf Cooperation Council (GCC) (19). Expatriates constitute almost half of the population of the GCC countries (total population: 45.9 million) (19) and the UAE is no exception, with their proportion approximating 83% of the total population (20). The expatriates, who live with their families in the UAE, are mostly educated, professionally qualified and belong to the middle or higher income group (20). Differences in accessibility to public healthcare system; procurement of OTC medication (or even POM) and drug information from their home countries may influence SM practices, and subsequently knowledge about medicines in this population. Globally, the published literature on the knowledge of medicines among adolescents is scarce (7, 14–18) and studies exploring the same among adolescents and expatriates in the Middle Eastern countries are lacking. Furthermore, the paucity of data on the level of drug knowledge among adolescents in the UAE gave a lead to explore this aspect. The data generated from this study can assist in planning health educational programs targeting this population. The objectives of the study were: –– to investigate the basic knowledge of medicines among expatriate adolescents in the UAE; –– to assess any differences in knowledge associated with the practice of SM and sociodemographic characteristics of the adolescents; –– to determine the attitudes towards SM among selfmedicating adolescents; and –– to ascertain the sources of information about medicines among the adolescents.
Materials and methods A cross-sectional, self-administered, questionnaire-based survey was conducted among expatriate high school students in private schools in Dubai, Sharjah and Ajman, UAE after obtaining institutional Ethics Committee approval. Four schools were selected through the convenience sampling procedure to recruit the subjects. By estimating the prevalence of SM as 75% (marginal error as 5%), the minimum sample size was calculated as 300. Anticipating a non-response rate of 10%, the questionnaires were distributed to 330 s tudents. A total of 324 students responded. To obtain a representative sample, students majoring in natural sciences, commerce and humanities/arts were approached. Briefing about the study objectives and instructions for filling the questionnaires were explained to teachers, who then conveyed them to their students. Voluntary participation was stressed, confidentiality of data was assured and informed consent was obtained from all students prior to administration of the questionnaire.
The data presented in this study, which formed part of a larger study, is restricted to the analysis of basic knowledge of medicines, attitudes towards SM and sources of information about medicines.
Study instrument and validation procedure The structured questionnaire, with close-ended statements, was developed through a series of focus group discussions with subject experts (three pharmacologists, two pharmacists and one internal medicine specialist) and was based on a review of the literature (6, 7, 14–18, 21). The questionnaire was content validated by the subject experts and ambiguities in the statements were removed after pilot testing. The operational terms in the questionnaire were defined as follows: Self-medication: use of OTC or POM for self-treatment, without prior consultation with a doctor; Doctor: any person who was medically qualified to prescribe medications; Medication: substance used for treatment or prevention of disease, both modern medications and those from other healthcare systems. The study questionnaire consisted of the following five sections: 1. Socio-demographic details. 2. Prevalence of SM was ascertained through a Yes or No response to a statement inquiring whether the adolescents were taking medications without the advice of a doctor. Data about SM in the previous 2 weeks, monthly use of medicines in the preceding year and health complaints experienced in a month in the preceding year were also obtained. 3. Knowledge about SM: adolescents were asked for definitions of certain terms: drug, antibiotic, analgesic and side effects, and other questions ascertaining general knowledge about medicines either through a Yes or No response or through single/ multiple responses. Technical terms were avoided and common brand names of acetaminophen were also included for clarity. The participants’ self- assessed knowledge about medicines on a scale from Good to Bad was also requested. 4. Sources of drug information: a list of sources with the option for multiple responses was included. Additionally, information about reading package inserts before SM was obtained through a Yes or No response. 5. Attitudes towards SM were determined through agreement or disagreement with statements elaborating risks and benefits of SM. These statements were based on articles highlighting the pros and cons of SM (6, 21). A statement about the acceptability of SM was also included.
Statistical analysis Data analysis was performed using SPSS version 19. Categorical variables were described by frequencies and percentages. The Pearson χ2-test and Fischer exact test (if the expected cell value was
