Research Paper JPHS 2017, 8; 51–57 ª 2017 Royal Pharmaceutical Society This is an open access article under the terms of the Creative Commons AttributionNonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. Received October 19, 2016 Accepted December 21, 2016 DOI 10.1111/jphs.12167 ISSN 1759-8885
Factors affecting knowledge and practice of medicine use among the general public in the State of Penang, Malaysia Omar Thanoon Dawooda, Mohamed Azmi Hassalia and Fahad Saleemb a Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Minden, Penang, Malaysia and bFaculty of Pharmacy and Health Sciences, University of Baluchistan, Quetta, Pakistan
Abstract Objectives This study aimed to evaluate the knowledge and practice of medicine use among the general public and the factors affecting the practice of the safe use of medicines. Methods A cross-sectional survey was carried out in public using a convenience sampling technique to recruit the required sample at the household level. A self-administered questionnaire was used for data collection. A total of 888 questionnaires were completed and returned to the researchers. The data were coded and analysed using descriptive and inferential statistics to find the differences between factors at a confidence level of 95%, and a P-value < 0.05 was considered significant. Key findings This study indicated that the respondents have limited knowledge about some aspects of medicine use (mean SD = 6.45 2.43). Additionally, there were inappropriate practices of using medicines in terms of taking less than the recommended dose, sharing medicines with others, reusing old prescriptions, stopping use of prescribed medicines and not informing a doctor about other medications used (mean SD = 35.15 8.31). Respondents with a higher score of knowledge were more likely to use medicines appropriately (OR = 1.26, 95% CI 1.17–1.35, P < 0.001). Conclusions There is a lack of knowledge about medicine use among the general public, and this issue was associated with inappropriate practices of using medicines. In addition, knowledge about medicine use was significantly associated with an increase in age, females, Malay respondents, higher education level, higher monthly income and respondents suffering from chronic diseases. Keywords knowledge; medicines; practice; public
Introduction
Correspondence: Omar Thanoon Dawood, Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 Minden, Penang, Malaysia. E-mail:
[email protected]
In this modern era, the prevalence of irrational use of medicines has been increasing throughout the whole world in both developing and transitional countries.[1] The World Health Organization aims to achieve the rational use of medicines by referring to the ‘responsible use of medicines’, which means that ‘patients receive the right medicines at the right time, use them appropriately, and benefit from them’.[2] The irrational use of medicines occurs when one or more of these issues are not involved.[1] The overuse, underuse or misuse of medications leads to the waste of resources and results in negative health effects.[3] Usually, communities of developing countries have limited knowledge and awareness of the safety of drugs commonly found in the home and the proper storage of medicine.[4] In addition, people who have chronic problems were reported to suffer from accidental drug poisoning as a result of drug interactions between medications that they take and alcohol, smoking or other kinds of medications.[5] Other studies have shown that patients who use complementary medicines are unaware of the potential side effects and possible interactions with their prescription medicines.[6,7] They are advised by their family or friends to try the treatment, and very few of them will refer to doctors.[8] The tendency of the general public towards excessive intake of a certain supplement is closely related to the lack of knowledge regarding the side effects of medicines.[9] On the other hand, previous studies have shown that a high percentage of respondents stopped taking
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their medication once they felt well and treated themselves based on their previous experience when they felt unwell.[8,10] Accordingly, the rational use of medicines has become a priority for many healthcare providers. However, little attention has been paid to public education due to insufficient human and financial resources.[10] In Malaysia, the Ministry of Health Malaysia developed a national strategy to foster the concept of quality use of medicines in the country. The goal of this strategy focused on educating consumers and promoting quality use of medicines through effective self-care practices via the ‘Know Your Medicine’ campaign.[11] In line with the objective of the ‘Know Your Medicine’ campaign, this study aimed to increase the knowledge of the safe use of medicines in the community by improving the current strategy and paying more attention to the factors that affect the safe use of medicines. This study is important to evaluate the current knowledge and practices of safe use of medicines among the general public and the factors affecting the knowledge and practice of medicine use.
Methods Study design A cross-sectional study was carried out to evaluate the public’s knowledge and practice of medicine use in the state of Penang, Malaysia. This study was conducted between September and November 2015. Study approval was obtained from the Joint Ethics Committee of the School of Pharmaceutical Sciences, USM–Hospital Lam Wah Ee on Clinical Studies (USM-HLWE/IEC/2015 (0001)). In addition, written informed consent was obtained from all the participants in this study. Study population This study was conducted in the state of Penang which is one of the urbanised states in Malaysia. The study population was Malaysian adults aged 18 years and above from both genders. In addition, people who are able to read and write in the Malay language and agreed to participate in the survey were included in this study. People who were 64 Gender Male Female Ethnicity Malay Chinese Indian Others Education level No formal education Primary school Secondary school College/University Occupation Government Private/Self-employed Retired Student Unemployed Living status Alone With family With non-family Monthly income* ≤RM 1000 RM 1001–2000 RM 2001–3000 RM 3001–4000 RM 4001–5000 >RM 5000 Chronic disease Yes No
N (%)
226 261 161 135 69 36
(25.4) (29.4) (18.1) (15.2) (7.8) (4.1)
360 (40.5) 528 (59.5) 472 277 116 23
(53.2) (31.2) (13.1) (2.5)
28 69 283 508
(3.2) (7.8) (31.9) (57.2)
148 410 42 207 81
(16.7) (46.2) (4.7) (23.3) (9.1)
235 (26.5) 629 (70.8) 24 (2.7) 260 159 186 111 72 100
(29.3) (17.9) (20.9) (12.5) (8.1) (11.3)
131 (14.8) 757 (85.2)
*1 RM = 0.23 USD.
(OR = 2.83, 95% CI 1.17–6.82, P = 0.020). In addition, the respondents with chronic diseases were two times more likely to have good knowledge of medicine use (OR = 2.06, 95% CI 1.31–3.24, P = 0.002).
The practice of using medicines As shown in Table 5, most of the respondents have not taken more than the recommended dose (mean = 4.04 1.21, median = 5.0) and have not taken more than the number of instructed dosages per day (mean = 4.09 1.20, median = 5.0). However, the respondents showed an inappropriate practice of using medicines in terms of taking less than the recommended dose, sharing medicines with others, reusing old prescriptions, stopping
54 Table 2
Journal of Pharmaceutical Health Services Research Knowledge about medicine use among the respondents Correct (%)
Incorrect (%)
431 (48.5)
457 (51.5)
738 (83.1)
150 (16.9)
2017; 8: 51–57 Table 3 Knowledge about medicine use based on demographic information (average: 0–10) Socio-demographic
1. Do you know that the same generic content of medicines is available under different names? 2. Do you always follow the directions given by doctor or pharmacist when taking your medicine? 3. Overuse of Panadol ®(Paracetamol) will cause liver toxicity 4. Vitamins are a health food, so overusing it will not cause negative effects to human body 5. Storing ointment or gel in the refrigerator could extend the expiration date 6. Storing syrup in the refrigerator could extend the expiration date 7. Are you aware that there are medicines/food that should not been taken together? 8. Are you aware that there are some of modern and traditional medicines should not to be taken together? 9. Are you aware that certain medication/supplement may cause an adverse drug reaction? 10. All the medicines registered in Malaysia are totally safe to use without any side effects
630 (70.9)
258 (29.1)
476 (53.6)
412 (46.4)
511 (57.5)
377 (42.5)
499 (56.2)
389 (43.8)
638 (71.8)
250 (28.2)
611 (68.8)
277 (31.2)
648 (73.0)
240 (27.0)
463 (52.1)
425 (47.9)
use of prescribed medicines and not informing their doctor about other medications being used. As shown in Table 6, the appropriate practice of using medicines was influenced by some factors. The highest score of appropriate practice was significantly associated with Malay respondents (P < 0.001), higher education level, retired people and respondents suffering from chronic disease (P < 0.05). As shown in Table 7, the significant factors were included in this model to find the predictors that highly contributed to appropriate practice of medicine use. The respondents with a higher score of knowledge were more likely to use medicines appropriately (OR = 1.26, 95% CI 1.17– 1.35, P < 0.001). Indians were less likely to have good practice compared to Malay respondents, and the respondents with a low education level were less likely to have a high score of appropriate practice compared to respondents with a college/university education level. In addition, students were less likely to have adequate knowledge about medicine use (OR = 0.43, 95% CI 0.23–0.80, P = 0.008).
Discussion This study showed that there was limited knowledge about some aspects of medicine use. Around half of the respondents did not understand that the generic names of medicines can be under different brand names. Previous studies have indicated that people were more familiar with the
Age group 18–24 25–34 35–44 45–54 55–64 65 and above Gender Male Female Ethnicity Malay Chinese Indian Others Education level No formal education Primary school Secondary school College/University Occupation Government Private/Self-employed Retired Student Unemployed Living status Alone With family With non-family Monthly income† ≤RM 1000 RM 1001–2000 RM 2001–3000 RM 3001–4000 RM 4001–5000 >RM 5000 Chronic disease Yes No
Knowledge total score Mean SD
6.10 6.59 6.83 6.28 6.39 6.66
2.22 2.30 2.53 2.57 2.69 2.86
6.23 2.38 6.60 2.49
Median (IQR)
6.0 7.0 7.0 7.0 7.0 7.0
(3.0) (3.0) (4.0) (3.0) (3.0) (4.75)
P-value
0.037*
6.0 (3.0) 7.0 (4.0)
0.010**
6.60 6.44 5.98 5.82
2.45 2.37 2.43 2.36
7.0 6.0 6.0 6.0
(3.0) (3.0) (3.75) (3.0)
0.026*
5.42 6.08 6.16 6.71
2.71 2.28 2.44 2.39
5.0 6.0 6.0 7.0
(3.75) (4.0) (3.0) (4.0)
0.001*
6.66 6.32 6.59 6.43 6.67
2.45 2.46 2.31 2.37 2.47
7.0 6.5 7.0 7.0 7.0
(4.0) (3.0) (3.25) (3.0) (4.0)
0.625
6.32 2.53 6.49 2.39 6.54 2.41 6.25 5.98 6.37 6.79 6.98 7.11
2.39 2.32 2.36 2.24 2.80 2.55
7.20 2.24 6.32 2.43
6.0 (3.0) 7.0 (3.0) 6.5 (2.0)
0.771
6.0 6.0 6.0 7.0 8.0 8.0
0.025*
(3.0) (2.0) (3.0) (4.0) (4.0) (3.0)
7.0 (3.0) 6.0 (3.0)
RM 5000 Chronic disease No Yes
OR (95% CI)
1.00 1.38 1.94 1.33 1.43 1.90
(0.93–2.04) (1.22–3.08)* (0.79–2.24) (0.75–2.72) (0.80–4.51)
1.00 1.57 (1.18–2.10)* 1.00 2.50 (1.01–6.15)* 1.79 (0.72–4.47) 1.32 (0.50–3.46) 1.00 1.44 (0.56–3.74) 2.03 (0.85–4.88) 2.83 (1.17–6.82)* 1.00 0.77 0.99 1.40 1.69 1.41
(0.50–1.18) (0.66–1.49) (0.85–2.30) (0.96–2.99)* (0.82–2.42)
1.00 2.06 (1.31–3.24)*
† 1 RM = 0.23 USD. *Statistically significant P < 0.05.
provided by the adverse drug reactions monitoring in Malaysia.[18] Interestingly, around 70% of the respondents in this study have good knowledge about drug interactions with certain foods or traditional medicines, in contrast to previous studies that indicated limited information about drug interactions between certain medications or supplements and foods because of the high consumption of vitamins and herbal supplements.[18–20] Respondents believed the expiry date of ointment and syrup can be extended by storing them in refrigerator. The proper storing of medicine makes it valid until the expiry date. Similar findings have been documented in different studies that people intended to store expired medications.[21,22] A lack of information about expired medications and the way to dispose of them is a possible reason for keeping expired medications.[23,24] Regarding the practice of using medicines, some respondents have inappropriate practices in using medicines, such as sharing medicines with others, reusing old medicine, discontinuing medicines when the symptoms are relieved and not informing their doctor or pharmacist about other medicines they are using. These problems in using medicines always occurred as a result of limited information about the proper use of medicines, which should be provided by healthcare providers.[12,18,25] Regarding adherence to
Table 5
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The appropriate practice of using medicines
Questions 1. Have you ever taken more than the recommended dose of your medicine? 2. Have you ever taken less than the recommended dose of your medicine? 3. Have you ever taken the next dose sooner than directed on the label? 4. Have you ever taken more than the number of dosages per day as directed? 5. Have you ever shared any medicine with others have similar illness? 6. Have you ever combined alternative medicines when you take modern medicine? 7. Have you ever taken medicines according to your others’ suggestion? 8. Have you ever reused doctor’s prescription when you get similar complaints? 9. When your symptoms are relieved, will you discontinue your prescription medicines by yourself? 10. Do you inform your doctor/pharmacist you are taking other medications/supplements?
Mean
Median
4.04 1.21
5.0
3.56 1.20
4.0
3.77 1.20
4.0
4.09 1.20
5.0
3.48 1.34
3.0
3.78 1.25
4.0
3.67 1.21
4.0
3.34 1.30
3.0
2.15 1.37
2.0
3.23 1.46
3.0
prescribed medicines, this study showed that the respondents stated low adherence in terms of stopping use of their prescribed medicines when they felt recovered, similar to what was found in other studies that people do not adhere to their treatment regimens.[10,26] Patients’ inadequate knowledge about medicines is a reason for non-adherence and less use of medical resources.[27] In the present study, knowledge and the practice of medicine use were predicted by certain factors, including the socio-demographic information of the respondents. The age group of 35–44 years had a higher score of knowledge compared to other age groups. Other studies have shown that knowledge of medicines decreases with an older age[28] and a younger age.[29] Elderly people are less likely to understand some information about their medications. This can be due to the fact of cognitive ability that is becoming low in advancing age which can also lead to inappropriate use of medicines.[10] In addition, females were more knowledgeable about medicines than males. Abahussain et al.[30] reported that females were more intent on getting information about medicines and more likely to use medicines such as NSAID during their monthly menstrual pains. Moreover, Malay respondents have better knowledge and practice of medicine use compared to Chinese and Indian respondents. The ethnic backgrounds of people have contributed to create beliefs about medicines that are generated from the local culture and customs which make people more interesting or less interesting to know about medicines. A previous study showed that the Chinese people are less likely to comply with medicine use instructions and have low awareness about medicines education programme.[9] The various cultural beliefs about disease and treatment may affect people’s perception about the therapeutic effects of medicines. On
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Table 6 Total practice score based on demographic information (average: 10–50)
2017; 8: 51–57 Table 7
Predictors factors of the appropriate practice of medicine use
Variables Socio-demographic
Age group 18–24 25–34 35–44 45–54 55–64 >64 Gender Male Female Ethnicity Malay Chinese Indian Others Education level No formal education Primary school Secondary school College/University Occupation Government Private/Self-employed Retired Student Unemployed Living status Alone With family With non-family Monthly income† ≤RM 1000 RM 1001–2000 RM 2001–3000 RM 3001–4000 RM 4001–5000 >RM 5000 Chronic disease Yes No
Practice total score Mean SD
35.23 35.18 34.98 35.33 35.26 34.22
6.33 7.83 8.46 9.49 10.14 12.73
34.86 8.72 35.35 8.02
Median (IQR)
36.0 36.0 37.0 38.0 37.0 39.5
(9.0) (9.0) (8.5) (10.0) (10.0) (18.75)
36.0 (10.0) 36.0 (9.0)
0.410
0.594
36.61 33.97 32.61 32.21
7.16 8.63 10.09 10.56
37.0 35.0 36.0 36.0
(10.0) (9.0) (13.0) (15.0)
