3. Background & Rationale
Self- medication is an important
public health problem, with a
reported prevalence of 0.1% in
northern and western Europe, 21%
in Eastern Europe, 27% in USA and
85.59% in Asia(8)
The prevalence rates of self-
medication and self -care are 31% in
India, 59% in Nepal and 51% in
Pakistan.(3)
3
4. Background & Rationale
Use of Self medication
practice
Increase in Antibiotic
Resistance
Drug resistance
Self-medication practices in urban and rural areas of western India: a cross sectional study
Death (2.9 to 3% death, drug to
drug interaction)
4
5. Background & Rationale
The risks associated with self- medication practice
are :
Incorrect self-diagnosis
Delays in seeking medical advice when needed
Severe adverse reactions
Risk of dependence and abuse,
Use of excessive drug dosage
prolonged duration of use.
Drug resistance and death(3)
5
6. • Mountain region
• Majorities are grass root
population
• No any specialization
hospital
• OPD 59% from health facility in
2016 and 41% of people have
taken self –medication practice
in Rolpa.(15).
• Most of previous studies
mainly focus in urban area
Source: http://www.dho.rolpa.gov.np 1: HMIS data from MoH
Background & Rationale (cont:)
Triveni
-2
Madi
-6
Sukidaha
-3
Thawan
g -5
Sunchhah
ari -5
Runtigadhi-5
6
7. Research Questions
• 1. What is the proportion of self-medication
practice among rural people in Rolpa district
Nepal?
• 2. Are there any associations between
general characteristics, perception of self-
medication, access to health facility, social
support and self- medication practice?
7
8. • To estimate the proportion of self-medication
among rural people of Rolpa district, Nepal
• To describe general characteristics of rural
people such as age, gender, caste, education,
occupation, working hours per day, income,
marital status, religion, decision making role in
treatment of illness, health insurance on self-
medication practice.
Research Objectives
8
9. To assess perception about self-medication
among rural people i.e. perceived benefits and
perceived barriers.
To assess the access of health service i.e.
affordability, availability, accessibility,
accommodation, acceptability among rural
people of Rolpa district, Nepal
Research Objectives (cont:)
9
10. To assess social support i.e. emotional support,
instrumental support, informational support,
appraisal support among rural people of Rolpa
district, Nepal
To analyse the associations between general
characteristics, perception, access related to
health facility, social support and self- medication
among rural people of Rolpa district Nepal
Research Objectives (cont:)
10
11. Hypotheses
• There are associations between general
characteristics i.e. marital status, education level,
religion, caste, occupation, monthly income,
working hours per day, decision making role,
health insurance and self- medication practice.
• There are associations between perception, i.e.
perceive benefits, perceive barriers and self-
medication practice
11
12. Hypotheses
• There are associations between access to
health service i.e. affordability, availability,
accessibility, accommodation, acceptability
and self-medication practice.
• There are associations between social
support i.e. health personnel, family
members, friends, drug sellers and self –
medication practice.
12
13. Independent variable
• General characteristics
• Perception(perceived benefit and perceived barrier)
• Access: affordability, availability, accessibility,
accommodation, acceptability
• Social support: emotional support, instrumental
support, informational support, appraisal
support
• Dependent variable
• Self-medication-practice
Variables of the study
13
15. Operational Definitions
General Characteristics
Age
Sex
Nationality
Monthly allowance
Living condition
Dependent variable
Self –medication practice refers to the respondent’s self-care for health
using non-prescription or over the counter (OTC) drugs of western medicines
as directed by the labelling for the minor ailments or using medicines without
prescription within three months prior to the study.
Independent variable
Age: age of female respondent at the time of interview.
Education: the highest level of education attainment by the
respondent.
Family income: monthly total income of the respondent’s
family.
15
16. Operational Definitions (cont:)
General Characteristics
Age
Sex
Nationality
Monthly allowance
Living condition
• National health insurance refers to the regulatory mechanism o
national health insurance scheme operating by national healt
insurance by ministry of health in Nepal for covering of universa
health coverage and primary health care of each individual in th
family for reducing of pocket money of individual
• Working hours per day is the time period when individual i
engaged in work. It is taken as the time (official hours o
work) and duration of work in hours (also include non
official working time). If student, this is taken as the stud
time and duration.
16
17. Operational Definitions (cont:)
General Characteristics
Age
Sex
Nationality
Monthly allowance
Living condition
• Perception means our recognition and interpretation of sensory
information. Perception also includes how we respond to the
information. We can think of perception as a process where we
take in sensory information from our environment and use that
information in order to interact with our environment. Perception
allows us to take the sensory information in and make it into
something meaningful( Perceived benefits and perceived
barrier)
• perceived benefits refers to one's belief in the efficacy of the advised action to reduce risk or
seriousness of impact. i.e. define action to take; how, where, when; clarify the positive effects to
be expected the form health service health services, health personnel, benefits of self-
medication such as first aid with low cost and time saving.
• Perceived barrier refers to the one's opinion of the tangible and psychological costs of the
advised action. i.e. Identify and reduce barriers through reassurance, incentives, assistance like
potential negative consequences of side -effects of drugs, drug interaction, increased resistance
of pathogens and over dose effects:
17
18. Operational Definitions (cont:)
General Characteristics
Age
Sex
Nationality
Monthly allowance
Living condition
• Access to health service means way of approaching, reaching
or entering a place, as the right or opportunity to reach, use or
visit in terms of affordability, availability, accessibility,
accommodation, and acceptability of health service.
• 1.Affordability is determined by how the provider’s charges
relate to the client’s ability and willingness to pay for services.
• 2. Availability measures the extent to which the provider has the
requisite resources, such as personnel and technology, to meet
the needs of the client.
• 3.Accessibility refers to geographic accessibility, which is
determined by how easily the client can physically reach the
provider’s location.
18
19. Operational Definitions (cont:)
General Characteristics
Age
Sex
Nationality
Monthly allowance
Living condition
• 4.Accommodation reflects the extent to which the provider’s
operation is organized in ways that meet the constraints and
preferences of the client. Of greatest concern are hours of
operation, how telephone communications are handled, and the
client’s ability to receive care without prior appointments
• 5.Acceptability captures the extent to which the client is
comfortable with the more immutable characteristics of the
provider, and vice versa. These characteristics include ethnicity
of the provider (and of the client), as well as the diagnosis and
type of coverage of the client
19
20. General Characteristics
Age
Sex
Nationality
Monthly allowance
Living condition
Social support means supports from health personnel, family,
friends and drug seller for self-medication practice in terms of
information on drugs, mental, financial and material supports i.e.
modern medicine.
1)Emotional support is associated with sharing life experiences. It
involves the provision of empathy, love, trust and caring.
2)Instrumental support involves the provision of tangible aid and
services that directly assist a person in need. It is provided by close
friends, colleagues and neighbours.
Operational Definitions (cont:)
20
21. General Characteristics
Age
Sex
Nationality
Monthly allowance
Living condition
3)Informational support involves the provision of
advice, suggestions, and information that a
person can use to address problems.
4)Appraisal support involves the provision of
information that is useful for self-evaluation
purposes: constructive feedback, affirmation
and social comparison
Operational Definitions (cont:)
21
22. Usefulness of the study
• Self-medication is becoming an increasingly important
area within healthcare.
• It moves patients towards greater independence in
making decisions about management of minor illnesses,
thereby promoting empowerment.
• Self-medication skills increases access to medication and
may contribute to reducing prescribed drug costs
associated with risks of misdiagnosis, use of excessive
drug dosage, prolonged duration of use, drug interaction
and poly pharmacy.
22
23. 1. https//www.who.org.int.self-medication 2018
Definition of Self-medication
• Self-medication is defined as “the use of drugs
to treat self-diagnosed disorders or
symptoms, or the intermittent or continued
use of a previously prescribed drug for chronic
or recurrent disease or symptoms”(10) World
Health Organization(WHO) Knowledge –
positive association
Literature Review (cont:)
23
24. Theory and concept on perception :
Gibson's theory, King theory and Health belief model
The HBM was developed in the 1950s by social psychologists in the
U.S. Public Health Service
• perceived susceptibility , perceived severity (perceived
threats ,
• Perceived benefits refers to belief in efficacy of the advised action
to reduce risk or seriousness of impact. It is applicable in terms of
define action to take: how, where, when; clarify the positive effects to be
expected
• Perceived barriers is a belief about the tangible and psychological
costs of the advised action The potential negative aspects of a
particular health action
Literature Review (cont:)
24
25. Theory and concept of access to health service
Access is defined as a way of approaching, reaching or entering a place, as the
right or opportunity to reach, use or visit.(29)
• Penchasky and Thomas 1. Affordability is determined by how the provider’s
charges relate to the client’s ability and willingness to pay for services.
•
• 2. Availability measures the extent to which the provider has the requisite resources,
such as personnel and technology, to meet the needs of the client.
• 3.Accessibility refers to geographic accessibility, which is determined by how easily
the client can physically reach the provider’s location.
• 4.Accommodation reflects the extent to which the provider’s operation is organized in
ways that meet the constraints and preferences of the client. Of greatest concern are
hours of operation, how telephone communications are handled, and the client’s
ability to receive care without prior appointments.
• 5.Acceptability captures the extent to which the client is comfortable with the more
Literature Review (cont:)
25
26. Theory and concept on social support
House 1981 “Social support is associated with how networking helps
people cope with stressful events. Emotional support, instrumental
support, Informational support and appraisal support
Relevant research findings
• In Ethiopia showed The prevalence of self-medication practice was
26.6%. Previous medication use (AOR) = 4.20, 95% CI (2.70-6.53)
• Patients with drug therapy were found to be 3.3 times more
likely to adhere to medication than those who did not
(adjusted odds ratio of 3.29, 95% CI was 1.42 to 7.62, p =
0.006).(38)
Literature Review (cont:)
26
27. MATERIAL AND METHODS
Study Design A cross-sectional descriptive study
Study Site Rural area, Rolpa Nepal
Study Population 18 to 70 years’ old who living
in rural area
Triveni -2
Madi-6
Sukidaha -3
Thawang -5
Sunchhahari -5
Runtigadhi-5
27
28. Inclusion & Exclusion Criteria
Inclusion criteria
• Age between 18 to 70 years
• Stay in rural Rolpa for at least 3 months
• Household head will be the major respondent of the
study
• People who are willing to participate in the study
Exclusion criteria
• People under any treatment by health facilities
• Those who could not communicate verbally
28
30. Sampling Procedure
Sampling method Stratified probability random sampling
Rolpa district
Median ward =27 Small ward=21
Runtigadhi-5
Madi -6 Thawang-5
105 105 105
Total sample size=631
Triveni -2
Sukidaha-3 Sunchhari-5
105 105 105
Big ward =14
Stratified Probability proportional sampling
Simple random sampling
Systematic simple random sampling
30
31. Research Instrument
Structured questionnaires includes 5 parts
• General characteristics
• Perception of self-medication practice
• Access to health service
• Social support
• Self Medication Practice
• Translate from English to Nepali
31
32. Validity and Reliability
Validity
• Consistent with operational definitions
• Consult with advisors and experts
Reliability
• At least 30 Pretest will be done
• Revise according to need
• Test by Cronbach’s coefficient of alpha.
32
33. Data Collection
• Getting approval from ethics committee,
MU and NHRC Nepal
• Contact and explain to local authority.
• Conduct training to 4 interviewers.
• Inform consent from every respondent.
• Keep confidentiality.
• Interview will last about 30 minutes
33
34. Data Analysis
Data verification
•Check for consistency and missing information
•Coding and data entry
Statistical Analysis
•Descriptive statistics
— Frequency, %,mean & SD for all independent variables
• Inferential statistics
—Bi-variate analysis using Chi square test (α - 0.05) for
association between dependent and each independent
variables
—Afterwards multiple logistic regression analysis will be used to
determine the association between independent and dependent
variables. P-Values of less than 0.05 will be considered as
statistically significant.
34
35. Measurement & Scoring system
General characteristic
• Continuous scale for age, family income
• Nominal scale for religion
• Ordinal scale for # of children and # of desire children
• Perception, access and social support: Likert Scale will be
use for measurement . If the question will be positive, the answer will
be “Strongly disagree =1”, “Disagree=2”, “Neutral=3”, “Agree=4”,
“Strongly agree=5” and if the question will be negative the score will be
reversed.
35
36. Measurement & Scoring system
Variables Total possible
scores
Cut off points
Poor Moderate Good
Perceptions
related to self-
medication
practice
15-75 15-45 46-60 61-75
Perceived
Benefits
9-45 9-27 28-36 37-45
Perceived Barrier 6-30 6-18 19-24 25-30
Access related to
health service
20-100 20-60 61-80 81-100
Affordability to
health service
3-15 3-9 10-12 13-15
Availability to
health service
4-20 4-12 13-16 17-20
Accessibility to
health service
5-25 5-15 16-20 21-25
Accommodation
to health service
3-15 3-9 10-12 13-15
Acceptability to
health service
5-25 5-15 16-20 21-25 36
37. Measurement & Scoring system
Variables Total possible
scores
Cut off points
Poor Moderate Good
Social support
related to
health service
16-80 16-48 49-64 65-80
Emotional
support to
health service
5-25 5-15 16-20 21-25
Instrumental
support to
health service
3-15 3-9 10-12 13-15
Informational
support to
health service
5-25 5-15 16-20 21-25
Appraisal
support to
health service
3-15 3-9 10-12 13-15
37
38. Ethical Consideration
• Getting approval from ethics committee, MU ethical board
and NHRC Nepal
• Inform to respondents about objectives, methods,
and contents.
• Participation is completely voluntarily
• Allow to quit or withdraw anytime.
• Name is not recorded
• Questionnaires will be coded and sealed in envelope.
• Kept strictly confidential.
38
