|Year : 2014 | Volume
| Issue : 3 | Page : 219-225
Perception about self-medication practices for oral health problems among the general population of Davangere city, Karnataka, India
Department of Public Health Dentistry, Rajarajeswari Dental College and Hospital, Bengaluru, Karnataka, India
|Date of Web Publication||15-Nov-2014|
No. 26, RMV 2nd Main, 1st Cross, Gowdara Colony, Nagashettyhalli, Bengaluru 560 094, Karnataka
Source of Support: None, Conflict of Interest: None
Background: Self-medication is a widely accepted practice in many developing countries. The determining factors of self-medication need to be first understood to develop appropriate medicine information policies and patient-provider education strategies. Keeping this in mind, present survey was conducted with the aim to assess the perception about self-medication practices for oral health problems among the general population of Davangere city, Karnataka, India. Materials and Methods: A cross-sectional field survey was conducted among 440 subjects in Davangere city. Data were collected through a specially designed proforma using a closed-ended, self-administered questionnaire containing 12 questions, in three sections. Results: Response rate of the survey was 100%. Self-medication and nondoctor prescription was found to be obvious and at an alarming rate of 70.9%. Among reasons of self-medication, toothache was the most common one. People of all sociodemographic categories approved self-medication giving reasons of lack of time as a major reason followed by nonseriousness of their condition. Analgesics, herbal remedies were often used for treating their oral health problems. Most of the respondents consulted pharmacist for basic treatment and only decided to approach a dentist if the problem persisted. Majority of respondents were aware of the adverse effect regarding the drug prescribed including expiry date of the medication used. Conclusions: Self-medication for oral health problems prevalence was higher in the population of Davangere city. Pharmacists and family influence played a major role in self-medication for oral health problems.
Keywords: Davangere city, oral problems, pharmacists, self-medication
|How to cite this article:|
Giriraju A. Perception about self-medication practices for oral health problems among the general population of Davangere city, Karnataka, India. J Indian Assoc Public Health Dent 2014;12:219-25
|How to cite this URL:|
Giriraju A. Perception about self-medication practices for oral health problems among the general population of Davangere city, Karnataka, India. J Indian Assoc Public Health Dent [serial online] 2014 [cited 2018 Dec 16];12:219-25. Available from: http://www.jiaphd.org/text.asp?2014/12/3/219/144806
| Introduction|| |
"A desire to take medicine is perhaps the great feature which distinguishes man from animals" - William Osler.  According to WHO, health is defined as the state of complete physical, mental, and social well-being and not merely the absence of diseases or infirmity.  As with all human actions, the decisions regarding health behavior are influenced in part by external stimuli, e.g. a pharmacist advising a patient and also by internal states such as those thoughts and feelings and beliefs. Patients understand their illness within their own conceptual framework, which includes their own beliefs, thoughts, and feelings. They process that information and then make their own decision and act. This is important to know because pharmacists are talking to patients about the drugs they dispense. The dialog that occurs between the patient and health care provider often is telling and listening. Unfortunately, there is not a one-to-one correspondence between telling and knowing and knowing and doing. Patients take information and process it with their own cognitive framework, which is based upon their interpretation of their own experiences and henceforth start doing self-medication.
According to WHO's definition, self-medication is "The selection and use of medicines by individuals to treat self-recognized illnesses or symptoms."  Self-medication is an important part of daily self-care behavior and one of the vital issues under debate in healthcare systems.  Self-medication includes the use of nonprescription drugs and a range of different alternative medicines such as herbal remedies, food supplements, and traditional products. People of all socio-demographic categories practice self-medication.  Internationally, self-medication has been reported as being on the rise.  Medicines for self-medication are often called "nonprescription" or "over-the-counter" (OTC) drugs and is available without a doctor's prescription through pharmacies.
Recent advances in drug research have provided many synthetic medicines for the treatment of disease, leading to a drug explosion. Today, over 7000 drugs and drug combinations are available.  Many of them have been released for general use, and are sold directly to the public as OTC remedies. In some countries, OTC products are also available in supermarkets and other outlets. Medicines that require a doctor's prescription are called prescription products (Rx products). India does not have a list of OTC products.  Market forces are expected to contribute to significant expansion of nonprescription drug use. Consumer behaviors, beliefs, and attitudes provide context to the opportunities and challenges surrounding the selection, use, and monitoring of nonprescription drugs.
Self-medication is common among individuals in many developing countries but not much is known about its determinants, and increasingly self-prescribed medications are obtained and consumed without the advice of the physician. Advertisements on television, newspapers, and other pharmaceutical publications have improved the rate of self-medication.  In economically deprived communities, most episodes of illnesses are treated by self-medication.  Poor diagnostic ability compounded by limited knowledge of appropriate management result in an increase of self-medication and low rate of health care utilization. 
Several personal factors could influence self-medication practices including sex, income, self-care orientation, and medication knowledge.  Serious issues concerned with self-medication are wastage of resources, microbial resistance, adverse drug reactions and drug-drug interactions, prolonged suffering, and drug dependence.  Hence, knowledge on behavioral aspects related to medication use is required to improve and expand the knowledge base on health care seeking behavior. Though self-medication is difficult to eliminate, intervention can be made to discourage the rampant practice. To our best available knowledge, there is no research conducted to reveal the extent of self-medication practice in relation to both general and dental health in Davangere city. Thus, this study was conducted to assess the perception of self-medication related to oral problems among the general population of Davangere city.
To assess the perception about self-medication practices for oral health problems among the general population of Davangere city.
- To know knowledge toward self-medication practices for oral health problems among the general population of Davangere city
- To assess attitude and practices toward self-medication practices for oral health problems among the general population of Davangere city.
| Materials and Methods|| |
A cross-sectional field survey.
The synopsis of the proposed survey was prepared and submitted to the Institutional Review Board, Bapuji Dental College and Hospital, Davangere for Ethical Approval. After the review and scrutiny by the board members, approval was granted to conduct the survey.
Description of the questionnaire
Data were collected using a specially designed proforma. It was a closed-ended, self-administered questionnaire containing 12 questions, in three sections. The questionnaire had provision to take voluntary written informed consents from the participants.
First section of the questionnaire contained information related to demographic details of the survey participants. Second section of the questionnaire contained six questions which were related to the knowledge about self-medication related to oral health problems. Third section of the questionnaire contained six questions which were related to the attitude and practices about self-medication in relation to the oral health problems.
Validation of translated questionnaire
The survey proforma prepared in English was translated to Kannada language (local language) and retranslated to English in order to check the validity of the translation by translation experts (back translation method).
General population of Davangere city aged 18-65 years and who are residing in the Davangere city since 10 years.
Subjects who are illiterate and mentally incapacitated to give a valid response to questions.
Sample size determination
The sample size was calculated scientifically based on the previous survey conducted by Wijesinghe, Jayakody, Seneviratne (prevalence and predictors of self-medication in a selected urban and rural district of Sri Lanka, 2012).  The prevalence of self-medication in that survey was found to be 50%.
Sample size was calculated using the formula:
n = zα × P × q/L2
n = number of subjects required, zα =1.96 ≈ 2;
P = 50% (prevalence of self-medication), q = 1 - P = 50%
L = Allowable error = 10% of P = 5%
n = 400 subjects; nonresponse rate of 10% was expected; therefore final sample size was calculated to be 440 subjects.
Davangere city has been divided into four zones (Northeast, Northwest, Southeast, and Southwest) for administrative purpose. Required permission to conduct the survey was obtained from the Municipal Council Office, Davangere. A map was also obtained from the Municipal Council Office of Davangere, and the city was divided into four zones, in which 110 subjects were randomly selected from each zone.
Scheduling of survey
The time limit set for data collection from participating subjects was 4 months (October 2012 to January 2013). A detailed schedule of the survey was prepared well in advance. Door to door survey was conducted to collect the data from the selected survey participants.
Administration of questionnaire
WHO informed consent protocol for qualitative studies was adapted to conduct a survey,  the investigator introduced himself to the survey subjects in the local language (Kannada) or English depending on the convenience of the study subjects and administered the questionnaires (Kannada or English language depending on subject's convenience of understanding). The subjects were then instructed to answer the questions in the questionnaire. They were informed to feel free and raise any questions to clarify their doubts. On average, it took 10-12 min for subjects to answer all the questions in the questionnaire. The answered questionnaires were received from the subjects after they finished answering on the same day.
The data obtained in the present survey were compiled and organized systematically. A master table was prepared. Dataset was subdivided and distributed meaningfully in individual tables. Statistical analysis was carried out using SPSS Inc., 233, S. Wacker Dr, 11 th Floor, Chicago, IL 60606-6307.
| Results|| |
The present survey had response rate of 100%. The demographic details of the survey are presented as shown in [Table 1]. About 80% of the population had practice of the self-medication for oral problems and majority had used same prescription as their family [Table 2]. Majority of subjects who practiced self-medication used it for few days till oral health problem subsided [Table 2]. Majority of subjects opined toothache as major triggering factor and lack of time as major reason for practicing self-medication for oral health problems [Table 3] and [Table 4]. Subjects who practiced self-medication used analgesics as the main mode and had temporary relief of pain [Table 5] and [Table 6]. The most common source was the pharmacy shop [Table 7]. Majority of subjects practicing self-medication opined that they would consult pharmacists for self-medication [Table 8] and opined that they would visit the dentist when oral problems persisted even after self-medication [Table 9]. Majority of self-medication users for oral health problems had knowledge of checking expiry date of medications while self-medicating.
|Table 2: Practice of self-medication for oral health-related problems among study population |
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|Table 3: Triggering factors for self-medication among the study population |
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| Discussion|| |
To the author's best knowledge, the present survey is the first of its kind which has tried to assess the perception of the general population toward self-medication related to oral problems in Davangere city, Karnataka, India. There are no studies in Indian scenario which has conducted to-date regarding the present topic.
The survey found the prevalence of self-medication practice to be very high (70.9% of total study participants). The reasons for such high prevalence of such a practice in Davangere city according to authors by seeing the results of present survey may be due to lack of awareness among general population about oral diseases, cost of dental treatments, lack of time, quick relief from symptoms, no family support, lack of knowledge about side effects, and belief in other herbal system of medicines. This result is in line with the results obtained in other studies conducted by many authors globally where the prevalence ranged from about 50% to as high as 75% in relation to general health problems where dental problem was part. In contrary, there are few studies where the prevalence was found to be as low as 26%, which was attributed to the presence of strict regulations by the government on marketing of OTC or without prescription medications. 
The age group of the study population in the survey ranged from 18 to 65 years, and mean age group of the participants was 38.8 years indicating that the majority of the study participants were middle-aged and had practice of self-medication. This finding is in accordance with the study conducted by Shankar et al., Ritu et al. and Sweileh where it was found that middle-aged participants had practice of self-medication when compared to extreme age groups (children or old age individuals). The reason for such trend is due to the fact this age group in the population are the one who are at more stress and workload and also at the same time the working population in the society. ,, This is the age group which is more susceptible to many health problems including oral health problems and tries to adopt self-medication practices due to various factors like lack of money, time, feeling of disease as not serious, familiarity with the diseases and remedy, lack of insurance and also lack of trust on physicians. 
It was found in our survey that practice of self-medication was more among male participants when compared to female participants. This finding is in agreement with many studies conducted by Shankar et al.,  Ritu et al.  and Sweileh.  Furthermore, there are few studies , which showed contrary results where female participants were more involved in self-medication compared to male participants. The main reasons were the fact that in those studies hospital facilities were out of reach especially for female housewives, presence of more health consciousness, due to the low threshold of pain and more fear of dental procedures. 
The finding of the present study showed that among participants who practiced self-medication, toothache was the main reason for administration of self-medication. Comparison could not be made with any other studies as there were no studies which have been done to date exclusively to assess the practice of self-medication in relation to oral problems. Only two studies , could be considered for comparison where dental problem was considered as one of the reason for self-medication along with general health problems.
In the present survey, participants cited the presence of minor illness as a major reason for taking self-medication in relation to oral health problems followed by other reasons such as lack of time, money, and other religious belief. The following finding in this survey is a pointer showing that the majority of the participants consider dental problems as minor ailments and self-treatable. This kind of thinking according to author may be due to less awareness to dental health among the population, who consider the necessary and correct treatment from oral professionals only when all the remedies have failed to cure or treat the oral disease  Similar results were seen in other studies. ,,,,,,
It was found in our survey that majority of participants used the same prescription of their family members. The present finding may be due to use of self-medication among family members who influence the other members and sometimes also recommend the other family members to use the same prescription used by them as the prescription could have led to relief of symptoms in them,  similar results were seen in other studies conducted. ,,,,, where use of the same prescription was reported for the relief of symptoms.
Majority of the study participants in our survey used self-medication to cure their symptoms for few days. This finding is in line with two studies , where it was found that majority of the participants also consumed self-medication for few days, and there was some relief of symptoms for which self-medication was consumed.
Relief from pain was given as a major response by majority of the respondents who had taken self-medication in relation to their oral health problems. This may be due to the finding that majority of our study participants complained toothache as a major reason for their self-medication. Similar results were seen in some studies. ,, where majority of participants felt that self-medication gave temporary relief from symptoms like pain, saved money, made them independent to take care of themselves and time and also felt self-medication cured their ailments.
In our study, majority of participants who used self-medication used analgesic as the most common form. This finding can be linked with our previous finding which highlighted the presence of toothache among majority of participants who had self-medication. This result is in accordance with some studies ,,,, where use of analgesics was found to be the most common form of self-medication used.
Majority of the participants in our study procured self-medication from pharmacy shop, followed by other places such as hospital pharmacy and herbal homes. This finding was found mainly because majority of drugs used to treat minor illness are available as OTC drugs in many of the pharmacy shops in Davangere city without professional prescription. Also many factors as seen previously like lack of time, cost of dental treatment, fear of dentists, peer and parental influence and ease of approach to pharmacists for their required medication without prescription favored contacting pharmacists at first place for self-medications,  similar results clearly corresponded with other studies ,,,,,,, where pharmacy shops was main place to procure self-medication.
Pharmacists were the main consultants for taking self-medications followed by friends' relatives and mass media in our present study. This showed that majority of the participants heavily relied on the expertise of pharmacists, experience of their friends and relatives and also on the mass media which advertise lot of medications which are easily available as OTC drugs without prescription. Similar results were seen in many studies conducted previously by many authors, where pharmacists were the major consultants for self-medication.
Our survey results showed that the majority of study participants visited dentists if oral symptoms persisted even after the self-medication. The finding can be attributed to the presence of two reputed dental colleges in Davangere city which provides quality care to the population and also to the presence of private dental clinics which are run by very reputed dentists. No comparison could be made as there were no previous studies which tried to assess this component in their study.
Majority of subjects in our survey had the knowledge about expiry date on the medications which they self-medicated. This finding may be due to the fact that majority of study participants in our survey had level of education which made them to read the label instructions on the medication including expiry date Similar finding was seen in studies conducted by Sallam et al.,  Hassali et al.  and Jain et al.,  where it was found that majority of study participants practicing self-medication also had a practice of reading the labels which included expiry date when they purchased self-medication.
| Conclusions|| |
This survey was conducted to review the self-medication and nondoctor prescription for oral health problems among the population in Davangere city. Results showed that self-medication and nondoctor prescription was found to be obvious and at an alarming rate of 70.9%. Among the reasons of self-medication, toothache was the most common one. In this survey, people of all sociodemographic categories approve of self-medication giving reasons of lack of time as a major reason followed by nonseriousness of their condition. In addition to analgesics, herbal remedies were often used for treating their oral health problems. Most of the respondents consulted pharmacist for basic treatment and only decided to approach a dentist if the problem persisted. Fortunately, majority of respondents were aware of the adverse effect regarding the drug prescribed including expiry date of medication used. Self-medication has to be used within the limits of the oral health problems and treated along with proper consultation from a registered pharmacist if possible.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9]