Prevalence of self-medication and associated factors among
students of a Faculty of Health Sciences at a university in Pereira (Colombia)
in 2021
Prevalencia
de la automedicación y factores asociados en estudiantes universitarios de una
Facultad de Ciencias de la Salud en Pereira (Colombia) durante 2021
Óscar
Felipe Suárez-Brochero¹ 
;
María Camila Rojas-Ramírez¹
; Michael
Fernando Agudelo-Murillo¹ 
¹ Universidad Tecnológica
de Pereira, Colombia.
Correo de
correspondencia: oscar.suarez@utp.edu.co
Fecha
de recibido: 25 de septiembre de 2023 - Fecha de
aceptado: 26 de enero de 2025
ISSN:
0121-0319 | eISSN: 1794-5240
Abstract:
Background:
self-administration
of medications is the use of drugs without medical advice. Objective:
determine the prevalence of self-medication and its associated factors in
students of a health sciences students at a university in Pereira (Colombia) in
2021. Methods: Cross-sectional study in students identified by
self-selection using a virtual form, which asked about sociodemographic and
academic characteristics, self-medication practices, and the perception of the
use of health services. A bivariate analysis was constructed and students who
self-medicated were compared to those who did not; a multiple model trough
Poisson regression was built with the significant variables (p<0.05).
Results: of the 265 interviews, 57 % of them were women with a median
age of 21 years; prevalence of self-medication was 89,4 %. The most frequent
symptom reported during the last month was headache (67,2 %). Associated
factors identified were: having familiar self-medication (PR=2,4; CI95
%=1,09-5,3), having sore throat (PR=1,11; CI95 %=1,05-1,18) or diarrhea
(PR=1,08; CI95 %=1,03-1,14), to study advanced semesters (PR=1,15; CI95
%=1,04-1,26), to trust health facilities (PR=0,83; CI95 %=0,75-0,93) and having
been a woman (PR=0,91; CI95 %=0,84-0,99). Conclusions: self-medication
was reported in almost 90 % of participants. We suggest to adjust risk
perception of this practice in students of careers other than Medicine or
students of initial semesters.
Keywords:
self-medication;
drug misuse; pharmacoepidemiology; nonprescription drugs; Colombia; students.
Resumen:
Introducción: la
autoadministración de medicamentos es la utilización de fármacos sin consejo
médico. Objetivo: determinar la prevalencia de la automedicación y describir
sus factores asociados en estudiantes de una Facultad de Ciencias de la Salud
en Pereira (Colombia) durante 2021. Materiales y métodos: estudio
transversal en estudiantes identificados por autoselección mediante formulario
virtual en el cual se preguntó por características sociodemográficas y
académicas, prácticas de automedicación y la percepción sobre el uso de
servicios de salud. Se construyó un análisis bivariado para comparar los
estudiantes que se automedican de aquellos que no; se construyó un modelo
múltiple a través de una regresión de Poisson con las variables significativas
(p<0,05). Resultados: el 57 % de los 265 encuestados fueron
mujeres con una mediana de edad de 21 años; la prevalencia de automedicación
fue del 89,4 %. El síntoma más frecuente durante el último mes fue la cefalea
(67,2 %). Los factores asociados identificados fueron: automedicación familiar
(RP=2,4; IC95 %=1,09-5,3), síntomas como dolor de garganta (RP=1,11; IC95
%=1,05-1,18) o diarrea (RP=1,08; IC95 %=1,03-1,14), cursar semestres avanzados
(RP=1,15; IC95 %=1,04-1,26), manifestar confianza en el prestador de servicios
de salud (RP=0,83; IC95 %=0,75-0,93) y ser mujer (RP=0,91; IC95 %=0,84-0,99).
Conclusiones: cerca del 90 % de los participantes se automedicó, es
importante que se ajuste la percepción del riesgo de esta práctica en
estudiantes de carreras diferentes a Medicina o estudiantes de semestres
iniciales.
Palabras clave: automedicación;
abuso de medicamentos; farmacoepidemiología; medicamentos sin prescripción;
Colombia; estudiantes.
Introduction
Self-medication
is a common practice that lacks a single, universally accepted definition. It
has been described in relation to the acquisition of medications, the absence
of healthcare professionals in prescribing them, and the purposes for which
individuals choose to self-medicate1. According to the World Health
Organization (WHO), self-medication aims to prevent, relieve, or treat symptoms
or conditions that individuals can identify themselves, and is related to the
concept of self-care2. However, this habit entails the deliberate
use of medications without necessarily understanding the risks involved—such as
symptom masking, delays in seeking professional care, incorrect therapeutic
regimens, adverse drug reactions, and antimicrobial resistance—especially when
it involves the self-prescription of medications that legally require a medical
prescription3.
A
meta-analysis that included approximately 61,000 university students in studies
up to October 2017 found that the overall prevalence of self-medication among
students was around 70 %; notably, the figure reached as high as 97 % among
medical students4. An exploratory review identified 23 articles
published between 2017 and 2021, indicating an upward trend in self-medication
practices during the pandemic period. These studies highlight increased
vulnerability among young individuals and report that the main sources of drug
recommendations are family members, neighbors, friends, pharmaceutical
advertising, websites, and social media platforms5.
Among
1,257 university students from various academic disciplines at the Université
Jules Verne in France, 95 % reported self-medicating—rising to 97 % among
health sector students6. In Pakistan, before the pandemic,
self-medication was reported by up to 99 % of 300 surveyed medical students7.
A 2021 Spanish study among nursing students found that 73,8 % had
self-medicated in the past month; 28,9 % did so because they felt knowledgeable
about the condition and its pharmacological treatment, while 25 % considered
their ailment to be minor8. Similarly, a 2023 study in Iran among
nursing students revealed that most self-medicated for minor illnesses based on
personal or others’ experiences, and viewed the practice positively as it saved
both time and money9.
According
to data from the United States Food and Drug Administration (FDA), the most
commonly overdosed medications include antipyretics and analgesics, followed by
antidepressants, antipsychotics, and other drugs affecting the central nervous
system10. Additionally, it has been reported that approximately 6 %
of poisoning cases involve acetaminophen, and up to 55 % of acute liver failure
cases are attributed to its misuse11. This highlights that pain is a
major driver of self-medication and underscores the severe health risks not
always perceived by vulnerable populations who face barriers to healthcare
access12 and are frequently exposed to media pressure. It is
noteworthy that up to one-third of televised pharmaceutical advertisements in
Colombia have been found to violate current advertising regulations13.
In
2016, a study conducted in Bogotá, Colombia, among 276 medical students found a
self-medication prevalence of 79,3 %. The most frequently used medications were
acetaminophen (10,8 %) and ibuprofen (4 %); nearly 4 % of students
self-prescribed antibiotics such as amoxicillin, azithromycin, or ampicillin14.
The only available data on self-medication in Pereira pertains to the general
population, where an estimated 39 % of adults over the age of 18 in urban areas
practiced self-medication, with only 14 % expressing concern about potential
adverse effects15.
Characterizing
self-medication practices within a Faculty of Health Sciences is crucial in
order to address associated factors from an institutional perspective. The
objective of this study was to determine the prevalence of self-medication and
to describe its associated factors among university students from a Faculty of
Health Sciences in Pereira, Colombia, during 2021.
Materials
and Methods
Study
Design and Population
A
cross-sectional observational study with analytical scope was conducted in 2021
involving students over the age of 18 enrolled in the Medicine, Veterinary
Medicine, Sports and Recreation Sciences, and Prehospital Care Technology
programs of a Faculty of Health Sciences at a university in Pereira, Colombia.
Participation was voluntary and contingent upon informed consent. No exclusion
criteria were applied. The sample was non-representative, as participation was
based on self-selection. Data collection was conducted over a two-month period
between August and September 2021.
Data
Collection Techniques and Instruments
An
online survey —previously piloted and including informed consent—was used to
gather information on sociodemographic variables (such as age, sex, insurance
status, place of origin, socioeconomic level, family income, and access to
public services) and academic characteristics (academic program and semester).
Additionally, questions addressed patterns of medication use, type of
medication consumed, reasons for consumption, and use of health
services. Given the broad definition of the event and the lack of a
standardized measurement period in the literature, self-medication was
operationally defined as the consumption of any medication without a
prescription in the three months prior to the survey. The questionnaire was
distributed via Google Forms to institutional email addresses authorized by the
Faculty Council (following approval by the Ethics Committee). Authorization was
obtained to contact 2,030 students through their institutional emails, which
were managed confidentially by the research team for the purposes of this
project.
Data
Analysis
Data
analysis involved reporting means and standard deviations or medians and interquartile
ranges, depending on adherence to a normal distribution as determined by the
Shapiro-Wilk test. Frequencies were used for qualitative variables.
Socioeconomic status was categorized into three levels (low – medium – high),
income was classified as either below or equal to/above four times the legal
monthly minimum wage (SMMLV), and academic semester was grouped into the
following categories: semesters 1–3, 4–6, 7–9, and 10–13. The main dependent
variable for bivariate analysis was the history of self-medication. To identify
statistically significant differences between groups (self-medication vs. no
self-medication), proportions were compared using the Chi-square test when all
expected values in contingency tables were greater than 5; otherwise, Fisher’s
exact test was used. Student’s t-test was used for comparing means, while the
Mann–Whitney U test was employed to compare medians. Due to the frequency of
the self-medication event, a Poisson regression model was constructed to
estimate prevalence ratios for variables with p ≤ 0.05 in the bivariate
analysis, as well as for those variables considered potential confounders. A
parsimonious multivariate model was built using the backward-stepwise method.
Data analysis was performed using Stata v14 (StataCorp, Texas, USA).
Ethical
Considerations
According
to Article 11 of Resolution 8430 of 1993, this study was categorized as
“risk-free.” Data collection was conducted in accordance with Law 1581 of 2012
regarding the protection of sensitive data and its regulatory decrees. The
project was reviewed and approved by the Research Ethics Committee of the
participating university. Finally, the results of the study were duly
communicated to the participants as part of the research feedback process.
Results
Data
were collected from 265 students who voluntarily participated in the online
survey. The median age was 21 years, and 57 % were women. In terms of academic
program distribution, 41 % were from Medicine, 27 % from Sports and Recreation
Sciences, 19 % from Veterinary Medicine, and the remaining from the Prehospital
Care Technology (PCT) program. Sixty-seven percent of students were enrolled in
the first six semesters of their respective programs. Gender distribution
showed a higher participation of women in the PCT (75 %) and Veterinary
Medicine (65 %) programs. Sixty-nine percent of students were affiliated with
the contributory healthcare regime. Additional univariate information is
presented in Table 1.
Table 4. Poisson
regression model on factors associated with self-medication among students of
the Faculty of Health Sciences. 2021.
|
Factor Associated Factor
|
PR (IC95 %)
|
p-value
|
|
Female sex
|
0,91 (0,84-0,99)
|
0,044
|
|
Family self-medication
|
2,4 (1,09-5,3)
|
0,029
|
|
Trust
in the healthcare provider
|
0,83 (0,75-0,93)
|
≤0,001
|
|
Sore throat
|
1,11 (1,05-1,18)
|
≤0,001
|
|
Diarrhea
|
1,08 (1,03-1,14)
|
≤0,001
|
|
Semester
|
|
|
|
Semester I - III
|
1
|
-
|
|
Semester IV - VI
|
1,07 (0,96-1,19)
|
0,167
|
|
Semester VII - IX
|
1,10 (0,99-1,23)
|
0,053
|
|
Semester X - XIII
|
1,15 (1,04-1,26)
|
0,003
|
*PR: Prevalence ratio. *IC95 %: 95 % confidence interval.
Source: Authors.
Discussion
This
study found that nearly 9 out of 10 students engage in self-medication. This is
a high proportion compared to other studies involving university students in
the health field. For example, at the University of Rosario, a prevalence of 79,3
%14 was reported among medical students in 2016; in Spain, between
2016 and 2017, a prevalence of 73,8 % was documented among nursing students8;
while in Kathmandu (Nepal), a prevalence of 76 % was found among medical students16.
However, this prevalence should not be extrapolated to all university students,
as being part of the health field increases the likelihood of self-medication.
A meta-analysis of university students showed that self-medication in
non-health-related careers was 44,7 %, while in medical students it was 97,2 %4;
this difference is also observed in Central American countries, as seen in
Costa Rican university students, where self-medication frequency was reported
at 57 %, increasing to 61 %17 among health science students.
The
particularly high prevalence identified in this study is noteworthy, especially
considering the restricted mobility and limited access to healthcare services
due to the pandemic lockdown. In this context, a medical university in Pakistan
recorded an 84 % prevalence of self-medication at the beginning of 202118.
It is
consistent across various contexts and times that, despite university students
being generally aware of the risks, they continue this practice for various reasons,
including easy access to medications, financial constraints, the perception of
mild illnesses, or considering symptoms as non-serious19–21, as well
as in cases of chronic and difficult-to-manage conditions22. In our
study, an association was also found between certain symptoms, such as sore
throat and diarrhea, that increased the likelihood of self-medication.
In this
regard, a Nepalese study of female medical and nursing students found that 18 %
of self-medicated students did so because of diarrhea23. This
article also showed that other gastrointestinal symptoms, such as abdominal
pain (67 %), loss of appetite (34 %), or nausea (30 %), had an even higher
frequency of self-medication. Another Nepalese study reported that diarrhea is
a common symptom among all medical students, while self-medication for
respiratory symptoms (such as a sore throat) only occurred in more advanced
students, particularly due to knowledge of antibiotic use for presumed
bacterial causes16.
It is
important to mention that being female is a factor associated with
self-medication, particularly due to gynecological and general symptoms related
to the menstrual cycle. One of the Nepalese studies described evaluated
students with dysmenorrhea symptoms, and among this population, 73 % of medical
students reported self-medication, while only 44 % of nursing students did so23.
Other authors from the same country documented self-medication in only 36 % of
medical students with the same syndrome24. In the association
between self-medication and gender, it is believed that some residual
confounding phenomenon may exist, as women may be more likely to seek greater
attention from healthcare services.
On the
other hand, the factor most strongly associated with self-medication was the
family history of self-medication. This finding is similar to that reported by
a study on adolescents in Cartagena (Colombia), which showed that in nearly
one-third of cases, the recommendation to self-medicate came from a family
member, as beliefs and learning about this practice often originate within the family25.
Similarly, in a study on family self-medication in Medellín (Colombia), it was
shown that the primary sources of information were television or non-medical
family members, who were more influenced by this medium26. In
another Spanish study on university students, a higher prevalence of
self-medication was found among students whose parents had lower educational
levels, with no association found with their gender, age, or family income. A
higher prevalence was also found in students with favorable opinions toward
self-medication and whose parents engaged in it27.
It is
presumed that the media have a negative impact on individuals and families who
are accustomed to frequent self-medication practices13, which appear
to resolve problems in the short term but generate long-term issues. However,
in Mexico, it has been reported that the influence of the media is only 40 %,
compared to the perceived efficacy of self-medication in resolving symptoms,
which stands at 74 %28. The debate continues regarding whether the
media should be better regulated to provide clear and safe information about
the possibilities and risks of self-medication.
In
addition to the media in the digital age, a study in Madrid showed that 61 % of
individuals had used the internet as a source of health information, with a
higher prevalence in populations with middle-high educational and socioeconomic
levels. Furthermore, 53 % reported that the internet had changed their thinking
and could even lead to changes in their lifestyle, particularly in individuals
under 45 years old29. Thus, it is believed that greater internet
access will lead to an increase in the tendency to seek health information
online.
In this
study, it was also found that trust in healthcare services is a protective
factor against self-medication. In this regard, a study in Bogotá observed that
13,8 % of the general population reported not seeking healthcare services due
to lack of trust in doctors and/or medications30, while in Peru, a
study found that the main reason for self-medication was the belief that people
"already know what doctors prescribe"31 for their problems,
related to the belief that doctors prescribe the same treatments.
Finally,
it is worth mentioning that this study was conducted during the COVID-19
lockdown, which likely restricted student participation to just 13 % of the
total population of the faculty. It should also be noted that self-medication
was defined over a three-month period in this study, which may have led to some
overestimation of prevalence. Additionally, the self-selection of participants
may have contributed to a higher prevalence, as students familiar with these
practices may have been more willing to participate.
Conclusions
In
conclusion, this study found a high prevalence of self-medication (89,4 %)
among students in a Colombian health sciences faculty. The factors associated
with this practice were family history of self-medication, being in advanced
semesters, and presenting symptoms such as sore throat or diarrhea.
Additionally, factors that decreased the likelihood of self-medication included
1) trust in healthcare providers and 2) being female. There is a need for
educational interventions, both at the population and institutional levels, to
identify risky practices without losing the benefits of self-medication, particularly
for professionals who are trained in the responsible use of medications.
Funding
This
study was self-funded and has no conflicts of interest.
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http://www.scielo.org.pe/scielo.php?script=sci_arttext&pid=S1018-130X2001000400004&lng=es&nrm=iso&tlng=es