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Drug Information Leaflet (DIL), Non-prescription drug (NPD), Oral Non-Prescription Drug (ONPD), Risk factors, University student
Background: Very few extensive studies have measured the prevalence and usage pattern of drug information leaflet (DIL) for oral non-prescription drugs (ONPDs) or identified the associated risk factors for not reading DIL among university students in the UAE. Objective: The current study aimed to estimate the prevalence of the usage pattern of DIL for ONPDs, and delineate the associated risk factors for not reading the DIL among university students. Methods: A cross-sectional survey-based multistage sampling technique conducted among 2875 students at three major universities in UAE. The self-administered validated questionnaire was constructed and developed based on Andersen’s behavioral model. Binomial logistic regression performed to ascertain the effects of 25 potential predictors on the likelihood that participants not reading (discarded) the DIL after reading them. The primary outcome measure was reading (discarding without reading) the DIL, and the associated behaviours. Results: 2875 university students were eligible to participate in the study, but only 2519 students agreed to participate, indicating an 88% of intent participation. However, only 2,355 (81.9%) students completed the questionnaire. 1348 respondents reported using NPD (response rate 46.9%) during the past three months before conducting the study, which comprised the sample analysis (1307 were excluded). More than three-quarters of them read the DIL (always or often) at the first use (1049 of 1348, 77.8%). Approximately a quarter of those who read the DIL reported that they discarded them after reading (24.1%). The survey has identified four risk factors for not reading the DIL: those who get the drug information from physicians or pharmacists had lower odds of discarding the DIL (odds ration [OR] = 0.491, 95% confidence interval [CI]: 0.273-0.884, p value< 0.05). Medical students had lower odds of discarding the DIL (OR = 0.598, 95% CI: 0.412-0.868, p value< 0.05). Those participants who believe that NPDs are as effective as prescription drugs had lower odds of discarding the DIL (OR = 0.342, 95% CI: 0.123-0.948, p value< 0.05). Participants who use more than one NPD to treat a single symptom a day have higher odds of discarding the DIL (OR = 1.625, 95% CI: 1.122 -2.355, p value< 0.05). Conclusion: The prevalence of drug usage pattern in this population was 57.5% as 1348 subjects reported using NPD during the past 90 days before conducting the study. We have identified four risk factors for not reading the DIL, those who get the drug information from physicians or pharmacists, medical students, those respondents who believe that NPDs were as effective as prescription drugs, and respondents self-treating a single symptom with more than one NPD. It was evident from the findings that usage pattern of NPD for DIL varied among the students, with no specific pattern dominating.
2. Hughes CM, McElnay JC, Fleming GF. Benefits and risks of self-medication. Drug Saf. 2001;24(14):1027-1037. https://doi. org/10.2165/00002018-200124140-00002
3. Qato DM, Alexander GC, Conti RM, et al. Use of prescription and over-the-counter medications and dietary supplements among older adults in the United States. JAMA. 2008;300(24):2867-2878. https://doi.org/10.1001/jama.2008.892
4. Pettie J, Dow M. Management of poisoning in adults. Nurs Stand. 2013;27(47):43-49. https://doi.org/10.7748/ ns2013.07.27.47.43.e7031
5. Graham GG, Davies MJ, Day RO, et al. The modern pharmacology of paracetamol: therapeutic actions, mechanism of action, metabolism, toxicity and recent pharmacological findings. Inflammopharmacology. 2013;21(3):201-232. https://doi.
6. Alshahrani SM, Alavudeen SS, Alakhali KM, et al. Self-medication among King Khalid University students, Saudi Arabia. Risk Manag Healthc Policy. 2019;12:243-249. https://doi.org/10.2147/RMHP.S230257
7. Alshogran OY, Alzoubi KH, Khabour OF, et al. Patterns of self-medication among medical and non-medical University students in Jordan. Risk Manag Healthc Policy. 2018;11:169-176. https://doi.org/10.2147/rmhp.s170181
8. Sharif. Evaluation of self-medication among pharmacy students. Am J Pharmacol Toxicol. 2012;7(4):135-140.
9. Subashini N, Udayanga L. Demographic, socio-economic and other associated risk factors for self-medication behaviour among university students of Sri Lanka: a cross sectional study. BMC Public Health. 2020;4;20(1):613. https://doi.org/10.1186/
10. https://www.techsciresearch.com/news/7008-uae-over-the-counter-otc-drugs-market-to-reach-usd766-15-million-by-2027. html. Accessed June 2022.
11. Al Ali L, Jagal J, Joseph J, et al. Pharmaceutical equivalency of locally and regionally manufactured generic pharmaceutical products in UAE. Saudi Pharm J. 2022;30(9):1243-51. https://doi.org/10.1016/j.jsps.2022.06.027
12. Calamusa A, Di Marzio A, Cristofani R, et al. Factors that influence Italian consumers’ understanding of over-the-counter medicines and risk perception. Patient Educ Couns. 2012;87(3):395-401. https://doi.org/10.1016/j.pec.2011.10.003
13. Bolaños H. Responsible self-medication in Latin America. Drug Inf J. 2005;39(1):99-107. https://doi. org/10.1177/009286150503900113
14. The Story of Self-Care and Self-Medication, 40 years of progress. Global Self-Care Federation. https://www.selfcarefederation. org/resources/story-self-care-and-self-medication-40-years progress. Accessed July 2022.
15. Krajewska-Kułak E, Kułak-Bejda A, Kułak P, et al. A comparative analysis of self-treatment in a population of medical students in 2012 and 2017. Fam Med Prim Care Rev. 2019;21(1):35-40.
16. Brass EP, Weintraub M. Label development and the label comprehension study for over-the-counter drugs. Clin Pharmacol Ther. 2003;74(5):406-412. https://doi.org/10.1016/s0009-9236(03)00239-x
17. Department DHA-HR. Dubai Community Pharmacy Licensure and Pharmaceutical Practices Guide. Gov.ae. https://www.dha. gov.ae/ar/uploads/022022/Licensure%20of%20Health%20Professionals2022212957.pdf. Accessed November 2022.
18. Snell KIE, Archer L, Ensor J, et al. External validation of clinical prediction models: simulation-based sample size calculations were more reliable than rules-of-thumb. J Clin Epidemiol. 2021;135:79-89. https://doi.org/10.1016/j.jclinepi.2021.02.011
19. Andersen R, Newman JF. Societal and individual determinants of medical care utilization in the United States. Milbank Mem Fund Q Health Soc. 1973;51(1):95-124.
20. Robert CC, Bradley H. Sociocultural, economic and regulatory influences on medicine use by consumers in a rural. South Med Rev. 2011;4(1). https://doi.org/10.5655/smr.v4i1.73
21. Self-Reported Medication Use and Polypharmacy: A Glance at Non-Steroidal Anti-Inflammatory Drugs Use.Repositorio-aberto. up.pt. https://repositorio-aberto.up.pt/bitstream/10216/22095/3/TESE19022008.pdf. [Thesis Accessed June 2022].
22. Sarahroodi S, Maleki-Jamshid A, Sawalha AF, et al. Pattern of self-medication with analgesics among Iranian University students in central Iran. J Family Community Med. 2012;19(2):125-129. https://doi.org/10.4103/2230-8229.98302
23. Sawalha AF. A descriptive study of self-medication practices among Palestinian medical and non-medical university students. Res Social Adm Pharm. 2008;4(2):164-172.
24. Ramia E, Zeenny RM, Hallit S, et al. Order of Pharmacists Scientific Committee - Medication Safety Subcommittee. Assessment of patients’ knowledge and practices regarding their medication use and risks in Lebanon. Int J Clin Pharm. 2017;39(5):1084-
25. Bali DPN, Chitti MR, Moktan DJB, et al. A study on patients’ behavior towards product information leaflets at basaveshwar teaching and general hospital. International Journal of Pharmaceutics and Drug Analysis. 2021;56-65. https://doi.org/10.47957/
26. Scuri S, Petrelli F, Tanzi E, et al. European university students of pharmacy: survey on the use of pharmaceutical drugs. Acta Biomed. 2019;90(1):83-91. https://doi.org/10.23750/abm.v90i1.7572
27. Huang Y-M, Chen L-J, Hsieh L-L, et al. Evaluation of use, comprehensibility and clarity of over-the-counter medicine labels:Consumers’ perspectives and needs in Taiwan. Health Soc Care Community. 2022;30(2):753-761. https://doi.org/10.1111/
28. Major C, Vincze Z. Consumer habits and interests regarding non-prescription medications in Hungary. Fam Pract. 2010;27(3):333-338. https://doi.org/10.1093/fampra/cmp105
29. Mühlbauer V, Prinz R, Mühlhauser I, et al. Alternative package leaflets improve people’s understanding of drug side effects-A randomized controlled exploratory survey. PLoS One. 2018;13(9):e0203800. https://doi.org/10.1371/journal.pone.0203800
30. Nathan JP, Zerilli T, Cicero LA, et al. Patients’ use and perception of medication information leaflets. Ann Pharmacother. 2007;41(5):777-782. https://doi.org/10.1345/aph.1H68
31. Ghosh DAK, Bhadani A, Debnath S. “medicos self-medicate more”- A comparative study among medical and non-medical undergraduate students. Saudi J Med Pharm Sci. 2019;05(12):1083-1090. https://doi.org/10.36348/sjmps.2019.v05i12.010
32. James H, Handu SS, Al Khaja KAJ, et al. Evaluation of the knowledge, attitude and practice of self-medication among first-year medical students. Med Princ Pract. 2006;15(4):270-275. https://doi.org/10.1159/000092989
33. James H, Handu SS, Khaja KAJA, et al. Influence of medical training on self-medication by students. Int J Clin Pharmacol Ther. 2008;46(1):23-29. https://doi.org/10.5414/cpp4602
34. Hang LJ, Subramaniyan V, Xiaojun K, et al. Influence of medication error among medical and non-medical students in a Malaysian university. J Young Pharm. 2019;11(4):399-403. https://doi.org/10.5530/jyp.2019.11.82
35. Kasulkar AA, Gupta M. Self-medication practices among medical students of a private institute. Indian J Pharm Sci. 2015;77(2):178-82. https://doi.org/10.4103/0250-474x.156569
36. Patel P, Prajapati A, Ganguly B, et al. Study on impact of pharmacology teaching on knowledge, attitude and practice on selfmedication among medical students. Int J Med Sci Public Health. 2013;2(2):181. https://doi.org/10.5455/ijmsph.2013.2.173-178
37. Anoopkumar-Dukie S, Mey A, Hall S, et al. Non-prescription medicines may contribute to non-adherence to prescription medicines in people living with chronic health conditions. Int J Clin Pract. 2020;74(6):e13489. https://doi.org/10.1111/
38. Nasiri A, Gholami Chaboki B, Saeedi Saravi SS, et al. Sources of drug information and the rate of reading patient information leaflets by medical sciences students. Int J Epidemiol res. 2020;7(4):179-82. https://doi.org/10.34172/ijer.2020.32
39. scotpublichealth. The role of patient information leaflets in the treatment of patients [Internet]. #ScotPublicHealth. 2020. Available from: https://scotpublichealth.com/2020/04/26/the-role-of-patient-information-leaflets-in-the-treatment-ofpatients/.
Accessed July 2022.
40. Mullen RJ, Duhig J, Russell A, et al. Best-practices for the design and development of prescription medication information: A systematic review. Patient Educ Couns. 2018;101(8):1351-1367. https://doi.org/10.1016/j.pec.2018.03.012
41. Baker D, Roberts DE, Newcombe RG, et al. Evaluation of drug information for cardiology patients. Br J Clin Pharmacol. 1991;31(5):525-531. https://doi.org/10.1111/j.1365-2125.1991.tb05574.x
42. Davis TC, Fredrickson DD, Arnold C, et al. A polio immunization pamphlet with increased appeal and simplified language does not improve comprehension to an acceptable level. Patient Educ Couns. 1998;33(1):25-37. https://doi.org/10.1016/s0738-
43. Dowe MC, L awrence PA, Carlson J, et al. Patients’ use of health-teaching materials at three readability levels. Appl Nurs Res.1997;10(2):86-93. https://doi.org/10.1016/s0897-1897(97)80151-6
44. Eaton ML, Holloway RL. Patient comprehension of written drug information. Am J Health Syst Pharm. 1980;37(2):240-243.45. Ley P, Jain VK, Skilbeck CE. A method for decreasing patients’ medication errors. Psychol Med. 1976;6(4):599-601. https://doi.
46. McCarthy DM, Wolf MS, McConnell R, et al. Improving patient knowledge and safe use of opioids: a randomized controlled trial. Acad Emerg Med. 2015;22(3):331-339. https://doi.org/10.1111/acem.12600
47. Dascalu MD, Paraschiv IC, Nicula B, et al. Intelligent platform for the analysis of drug leaflets using NLP techniques. In Istrate, A., Gasner, P. (eds) 2019 18th RoEduNet Conference: Networking in Education and Research (RoEduNet). IEEE, Galati (2019).