436 International Journal of Collaborative Research on Internal Medicine & Public Health

Self-medication: Awareness and Attitude among

Malaysian Urban Population
Mohamed Irfadh Mohamed Azhar 1, Kabisha Gunasekaran 2, Amudha Kadirvelu 3, Sunil
Gurtu 3, Sivalal Sadasivan 3, Bharti Madanlal Kshatriya 3

1
Honours degree student, Tan Sri Jeffrey Cheah School of Medicine and Health Sciences
2
First year medical student, Tan Sri Jeffrey Cheah School of Medicine and Health Sciences
3
Tan Sri Jeffrey Cheah School of Medicine and Health Sciences, Monash University Sunway Campus,
Malaysia

* Corresponding Author: Amudha Kadirvelu

Tan Sri Jeffrey Cheah School of Medicine and Health Sciences
Monash University Sunway Campus, Malaysia
Email: amudha.kadirvelu@monash.edu

Abstract
Background: Self-medication is defined as obtaining and consuming drug(s) without the
advice of healthcare professionals either for diagnosis, prescription or surveillance of the
treatment. The practice of self-medication is becoming more common worldwide and currently
plays a major role in self-care.

Objectives: The objectives of our study were: (I) To determine the perception and level of
awareness regarding OTC medications, among the general public in Malaysia and (II) to
determine the effect of factors such as socio-demographics, personal health and family history
of illness, on the practice, attitudes and awareness regarding OTC drugs, among the Malaysian
population.

Methods: In this cross-sectional study, a validated self-administered, questionnaire was used

to collect data among University students, working adults and those visiting pharmacies in
Malaysia.

Results: Of the 364 respondents, 116 (31.6%) were male and 248 (67.6%) were female. Half
the population was students while the other half was employed. Overall, 308 (83.9%)
participants consumed OTC medications. The commonly consumed OTC drugs were
supplements and vitamins followed by painkillers, flu/ cough remedies and sore throat
products. The OTC medications were most frequently bought from pharmacies. Easy access,
convenience and time saving were the most frequent reasons for self-medication. Eighty two
percent of the respondents stated that their level of knowledge regarding OTC medications was
moderate to low. Of the study participants, 58 were on regular prescription medications and
half of them were unsure or disagreed that OTC drugs could interfere with the regular
prescription drugs.

Conclusion: Lack of awareness regarding drug interaction is an issue that warrants further
intervention by increasing the knowledge of the public, so as to prevent adverse events from
the drugs.

Key words: self-medication, over-the-counter, non-prescription, drugs, awareness, attitudes

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Introduction
Self-medication, which is a common self-care practice, is often reported around the world.1 It
is defined as obtaining and consuming drug without the advice of heath care professionals
either for diagnosis, prescription or surveillance of the treatment.2 Medicines for self-
medication are often called 'non-prescription' or 'over the counter' (OTC) drugs and can be
purchased without a doctor's prescription, from pharmacies and some from non-pharmacy retail
outlets.
Self-medications or over the counter (OTC) drugs currently play a major role in self-care,
offering individuals the choice of making independent decisions regarding their own health.
The WHO has also pointed out that responsible self-medication can help prevent and manage
conditions that do not require consultation with a physician and provides a cheaper alternative
for treating common illnesses. Potential benefits of OTC drug availability to the public include
enabling people to take responsibility and build confidence to manage their health, thereby
promoting self-empowerment. Furthermore, it allows rapid and convenient access to treatments
and save the time spent in waiting to see a doctor.
The use of OTC drugs has been studied in many different populations and the results
demonstrate that about 25-75% of the population consume OTC medications.3-7 A recent
Malaysian study reported that 75% of the respondents had used OTC drugs atleast once.8 The
most commonly used OTC drugs are analgesics, antipyretics, antibiotics, cough remedies and
supplements,5,6,9 with these medications very frequently being obtained from the pharmacies.8
As expected, in many studies, time saving has been quoted as one of the significant benefits to
self-medication, as these drugs are conveniently available in many pharmacies, supermarkets
and retails stores and, does not require making appointments with doctors to obtain these
drugs.3,10 However, lack of adequate knowledge of the drug dosage and frequency of intake
can potentially lead to adverse effects from the drugs. There is also a possibility of not obtaining
the appropriate medication for the condition, leading to a delay in the diagnosis and treatment
of the condition.3
Previous studies report that generally, people are aware of the effects, potential side effects,
misuse and abuse of OTC drugs.10-12 However the level of understanding about drug
interactions is poor.11,13 This may have special relevance where OTC drugs are taken
concurrently with other prescribed medication. Most of the time, people purchase OTC drugs
based on their knowledge and experience regarding the effectiveness of the medication.
Nevertheless, a doctor or a pharmacist is consulted when in doubt or if more information is
required.8,10,11
The majority of people perceive that doctors should be consulted for major illnesses, while the
OTC drugs could be used for the short term and for minor ailments.8 Patients were generally
happy when doctors inquired regarding the use of OTC drugs and made changes to it, if
required. However, people were unhappy when pharmacists provided advice regarding the
OTC medications, as these people were uncertain of the role played by the pharmacists.4,14
Many studies have been conducted in various countries on the extent of OTC drug use.
However, such studies are still scarce in Malaysia. Therefore, this study was conducted to
evaluate the perception and level of awareness regarding OTC drugs, in the Malaysian
population. The objectives of our study were: (i) To determine the perception and level of
awareness regarding OTC medications among the general public in Malaysia and (ii) to assess

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the correlation between socio-demographic factors & personal / family history of illness AND
awareness, attitudes & practice of OTC drugs, among the Malaysian population.

Methods
Participants of the study included consenting males and females of the general public aged 18
years and above with an ability to read and understand English.
Study Design: In this cross-sectional study performed from October 2012 to March 2013,
employed questionnaires that were placed in offices, university class rooms and pharmacies,
with prior permission of the respective departments/ institutions. Explanation regarding the
study was provided via the explanatory statement and the consenting participants that fulfilled
the inclusion criteria completed the questionnaire. The finished questionnaires were returned
to a box that was placed at the selected study sites.
Questionnaires: A self-administered questionnaire was employed for this study that comprised
of four parts which included personal details, basic health status, non-prescription medication
use and level of awareness. No data was requested from the questionnaire that could lead to
the identification of the participants. The questionnaire was validated via a pilot study done
among 30 subjects. All scales had good internal consistency with cronbach alpha value of more
than 0.8.
All data collected were entered into SPSS version 20.0. Non-parametric descriptive analysis
and chi-squared tests were employed for evaluation.15

Results
The preliminary results of this on-going study included three hundred and sixty four completed
questionnaires and all the data was included in the analysis. Of the 364 respondents, 116
(31.6%) were male and 248 (67.6%) were female. Approximately, half the population was
between 18 to 25 years of age reflecting the fact that almost half of the participants were
students, while the other half was employed and a third of them were married. Self-declared
weight and height was used to calculate the body mass index (BMI) of the participants which
was compared to the World Health Organization’s BMI classification for Asians.16 Of the
participants, 12% were obese, 29% were overweight, 13% were underweight and only 38%
were of normal weight. Almost half of them had a history of chronic illness in the family with
diabetes and hypertension being the most common followed by cardiovascular disease. Fifty
eight (16%) participants were on regular prescription medications for various conditions.
Consumption of OTC medication: Overall, 308 (84%) participants consumed OTC
medications. The number of males that consumed OTC drugs was significantly higher when
compared to females (χ2 (1, n=363) =6.27, p=0.012). The number of people below the age of
25 that used OTC drugs was significantly higher when compared to people at the aged 25 and
above (χ2 (1, n=352) =10.55, p=0.001). There were no significant associations between the use
of OTC drugs and body mass index (χ2 (3, n=336) =0.692, p=0.875) and family history of
illness (χ2 (1, n=366) =0.11, p=0.741). The OTC medications that were commonly consumed
among Malaysians are shown in Figure 1 (Appendix 1). Supplements/ vitamins (41%) were
the most frequently used OTC medications followed by painkillers (27%), flu/ cough remedies

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(27%), sore throat products (27%) and medication for skin care (23%). Most of the participants
purchased the OTC medications from the pharmacy (69%) with the rest obtaining them from
the retail shops.
Reason for consumption of OTC drugs: Minor illness was the most common (91.2%) reason
for the use of OTC medications. However 12 participants (3.9%) used OTC drugs for severe
illness as well. Almost half the population stated that self- prescription was more convenient
(53%), easier to access (51%) and time-saving (42%), when compared to consulting a doctor.
About 43% of the participants also thought that consulting a doctor was unnecessary as the
condition that required self-medication, was a minor problem.
Knowledge and attitude regarding OTC medications: About 82% of the respondents stated
that their level of knowledge regarding OTC medications was moderate to low. Eighty one
percent of the participants said that they would stop using the OTC drug if it did not work
within the proposed time frame, while a small number of them would increase (7%) or decrease
(5%) the dose. Almost three quarter of the subjects sought for advice regarding OTC
medications and 61% of them obtained this advice from the pharmacists, while 33% from
friends or family and 28% from the doctor. The participants’ views on 14 statements regarding
the safety and effectiveness of the use of self-medication are presented in Table 1 (Appendix
2). It is noteworthy that out of the 58 participants who were on regular prescription medications,
only 35% agreed that OTC drugs could interfere with the prescribed ones, while the rest either
27% disagreed or were unsure.

Discussion
This study has identified that 85% of the urban participants consume OTC medications which
is comparable to another study done among the Malaysian population which showed that 75%
of the participants used self-medications.8 Previous reports have demonstrated a wide variation
in the frequency of OTC drug use, ranging from 25-75%,3-7 which may be due to the different
socio-demographic background and different methodologies adapted in the studies.
The results of many studies have pointed out that analgesics were the most commonly used
self-medication, followed by cough remedies and supplements.5,6,8,17 Our study also shows that
painkillers, flu/ cough remedies and sore throat products were commonly consumed drugs.
However, it was found in our study that supplements and vitamins were more frequently used
than the rest of the medications. This was similar to the results from an American study and it
may be attributed to the perception that supplements are safe, effective and a necessity for good
health.18
Minor illnesses such as fever, pain, cough, cold were the most common indication for using
OTC drugs. For these indications, self-medication was the preferred option among the majority,
when compared to consulting a doctor, as this was more convenient, easier to access and time-
saving. These medications were most of the time obtained from the pharmacists with a few of
the participants purchasing them from retails shops. Other studies have also quoted similar
results.3,10 In the recent years, many pharmacies have been strategically located in convenient
places such as shopping malls and supermarkets, with a wide display of advertisements. This
has resulted in easier access to OTC drugs from the pharmacies. Along with this, the busy
schedule of the students and working people, incline them more towards the option of self-
medication.

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Majority of the participants stated that their level of knowledge regarding self-medication was
moderate to low. Self-medications were consumed at recommended dosages and duration, by
most of them. However, more than a third of them were unsure regarding the side effects and
drug interactions of the OTC medications. This was similar to the results of other studies.10-13
Furthermore, half of the participants, who were on regular prescription medications and
consumed OTC drugs, were unsure or disagreed that there can be potential drug interactions
between the prescribed and non-prescribed drugs. This lack of awareness may possibly lead to
major and even fatal adverse events from the drugs. Hence, as suggested by Indermitte et al,
efforts should be made to raise awareness regarding these drug interactions.13 Pharmacists as
well as health care professionals would be able to play a major role to overcome this identified
issue.

Conclusion
Self-medication is widely prevalent among the Malaysian population. The study shows that
supplements and vitamins are most commonly consumed followed by analgesics, flu/ cough
remedies and sore throat products. Participants had a higher level of awareness regarding the
dosage and duration of OTC drugs compared to side effects and drug interactions. Hence,
pharmacists and doctors should make the effort to educate the public on this deficiency in
knowledge.

Acknowledgements: The researchers would like to express their utmost appreciation to the
participants for their valuable time that they had spent to take part in the study.

Conflict of Interest: None.

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understanding of over-the-counter medicines and risk perception. Patient education and
counseling. Jun 2012;87:395-401.
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2002;27:243-248.
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awareness of selected potential drug interactions with self-medication. Journal of clinical
pharmacy and therapeutics. Apr 2007;32:149-159.
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15. Statistical Product and Service Solutions [computer program]. Version 20. United States
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http://bemedwise.org/survey/final_survey.pdf. Accessed 10th April, 2013.

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APPENDIX 1

Frequency (%)

Medicated skin care 23

Supplements/ vitamins 41

Sleep aids 5

Antidiarrheals 6

Medicated ear care 6

Medicated foot care 13

Medicated eye care 15

Herbal medicines 14

Allergy relief medicines 11

Sore throat products 27

Flu/ cough remedies 27

Laxatives for constipation 6

Indigestion/ heart burn 12

Painkillers 27

0 5 10 15 20 25 30 35 40 45

Figure 1: Consumption of OTC drugs

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Appendix 2

Table 1: Level of Awareness on OTC Drugs (Frequency - %)

Strongly agree/ Strongly disagree/
Unsure
agree disagree
OTC Drugs- better option compared to obtaining PMs
42.2 21.8 33.8
from your doctor
Consuming OTC drugs are safe 37.1 21.5 39.5
OTC drugs could interfere with your natural healing
27.2 27.2 42.2
process
With continuous use of OTC drugs, it may lose
41.7 23.4 30.8
effectiveness
Continuous use of OTC drugs may result in adverse
32.2 32.2 31.9
effects
Continuous use of OTC drugs may cause dependency
42.2 31.1 24
or addiction
I consume OTC drugs according to recommended
60.2 18 15.8
dosage
I follow recommended consumption duration of OTC
52.9 22.6 17.2
drugs
I consume OTC drugs to get high or lose weight 10.4 65.9 15.8
I usually follow the instruction on the label of OTC
60.5 15.3 16.3
drugs packaging
I obtain the desired outcome from the usage of OTC
46.9 15 30.8
drugs
I had experienced adverse effects from the usage of
12.3 52.3 27.8
OTC drugs
OTC drugs can sometimes worsen certain disease 31.6 28.1 34.3
OTC drugs could interfere with other prescribed
32.7 23.7 37.9
medicines

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