|Year : 2021 | Volume
| Issue : 1 | Page : 70-77
Knowledge, attitude, practice, and cost assessment of over the counter drugs in female athletes in Pune city, India
Siddhi Agrawal1, Revati Wable1, Florence Benison1, Shalu Mathew1, Atmaram Pawar2, Prasanna R Deshpande1
1 Department of Clinical Pharmacy, Poona College of Pharmacy, Bharati Vidyapeeth (Deemed to be) University, Pune, Maharashtra, India
2 Department of Pharmaceutics, Poona College of Pharmacy, Bharati Vidyapeeth (Deemed to be) University, Pune, Maharashtra, India
|Date of Submission||27-Feb-2020|
|Date of Decision||15-May-2020|
|Date of Acceptance||18-Nov-2020|
|Date of Web Publication||2-Feb-2021|
Prasanna R Deshpande
Department of Clinical Pharmacy, Poona College of Pharmacy, Bharati Vidyapeeth (Deemed to be) University, Pune, Maharashtra
Source of Support: None, Conflict of Interest: None
BACKGROUND: Over-the-counter (OTC) medications are accessible medications convenient for consumers available in community pharmacies and other retail outlets without a prescription. When it comes to the use of OTC medications in sports, the primary use is to treat pain and inflammation. Athletes may also take medicines to treat specific medical conditions or common illnesses such as cold, congestion, cough, allergies, and skin infections.
METHODS: It was a prospective, observational, multi-centered study conducted among female athletes at various sites in Pune. The study was conducted for duration of 6 months. A questionnaire was developed and distributed. Chi-square and Pearson correlation coefficient tests were used for the assessment of P value. P < 0.05 was considered to be statistically significant.
RESULTS: In this study, a total of 324 questionnaires were distributed, of which 300 participants returned with completed questionnaires, i.e., with a response rate of 92.59%. Majority, i.e., 49.34% of participants, belonged to the age group of 21–25 years. The average KAPC score was found to be 11.93 (for knowledge), 8.42 (for attitude), 10 (for practice), and 2.41 (for cost) out of 20, 17, 23, and 3, respectively. The overall assessment of the KAPC score was found to be good, i.e., “58.24%.” The P values calculated were only significant for weight versus attitude (0.000984) and weight versus practice (0.000431).
CONCLUSION: The athletes had good knowledge and good cost management approach however; they showed poor attitude and poor practice regarding OTC medications.
Keywords: Athletes, India, knowledge, attitude, practice, cost, over the counter, Pune
|How to cite this article:|
Agrawal S, Wable R, Benison F, Mathew S, Pawar A, Deshpande PR. Knowledge, attitude, practice, and cost assessment of over the counter drugs in female athletes in Pune city, India. Int J Health Allied Sci 2021;10:70-7
|How to cite this URL:|
Agrawal S, Wable R, Benison F, Mathew S, Pawar A, Deshpande PR. Knowledge, attitude, practice, and cost assessment of over the counter drugs in female athletes in Pune city, India. Int J Health Allied Sci [serial online] 2021 [cited 2021 Mar 8];10:70-7. Available from: https://www.ijhas.in/text.asp?2021/10/1/70/308590
| Introduction|| |
Over-the-counter (OTC) medications, also called as nonprescription medications can be bought without a prescription. They are safe and effective when taken as directed on the label. It is used by the people for treating a perceived or real health problem without consulting a physician. Self-medication is on the rise in India due to the various reasons connected to demographic factors, changing consumer lifestyles, government policies, and strategies of the pharmaceutical industry. A study showed that the use of OTC medications is twice as that of prescribed medications because of its affordability and accessibility. The incidence of self-medication in India is slightly less, which is 76% as compared to the United States, which is 81%.
The anatomy and physiology of females are different than that of males. Furthermore, females are found to use supplements more frequently associated with reasons of health, recovery, and replacing an inadequate diet. Perhaps athletes also at times jeopardise their health by using inappropriate over the counter (OTC) medications. Wrong dose/frequency can lead to adverse effects or interactions of medicine, thus increasing their health-related cost. Therefore, self-diagnosis does more harm than good. Hence, the objective of the study was to assess knowledge, attitude, practice, and cost (KAPC) of OTC drugs in female athletes.
| Methodology|| |
First of all, approval was obtained from institutional review committee. This was a prospective, observational, multi-centered study conducted for duration of 6 months (from October 2018 to March 2019). The patients under inclusion criteria were female athletes above the age of 16 in Pune city. The study was carried out at seven different sites, including sports department of institutes (5), sports ground (1), and sports club (1) in Pune city.
The instrument of this study constituted of KAPC-OTC Questionnaire (English and Marathi), which comprised patient demographic details (participants initial, age, height, weight) and Questions on KAPC on OTC medicines.
Sample size for the study
Convenience sampling method was used for deciding the sample size for the study.
Development of questionnaire
The study was commenced by developing a questionnaire through literature review (12),,,,,,,,,,,, expert opinions, and group discussions. The domains for the questions were shortlisted referring above journals and articles regarding OTC medications. The questionnaire for this study had four parts, i.e., KAPC; and these were assessed separately.
Validation of the questionnaire
The developed questionnaire was then validated by showing the draft to our fellow workers for determining errors on pilot basis (n = 5) and they were asked to check the content, ease to fill, grammar, and flow of the questions. Then, questionnaire was then translated to Marathi. Approvals from the respective sites were obtained.
Participants were selected in accordance with the inclusion criteria. Detailed information regarding the study objectives was explained to the participants and consents were taken, thereby ascertaining their willingness to participate in the study. The questionnaires were distributed and then procured for demographic details and KAPC of OTC drugs. The collected data were entered into MS Excel and the assessment of KAPC was done using the scoring method. Finally, the analysis of data was carried out using the appropriate statistical method.
The scoring for all questions was given as per [Table 1] except the ones with multiple answers. For “multiple answers-questions,” i.e., the check box type questions, the total number of options were considered as the highest score. These include Knowledge Q.1, Attitude Q.2 and 4, and Practice Q.1 and 2 as shown in [Table 6] with the highest score of 8, 5, 4, 8, and 6, respectively.
Calculation of the average cost spent on over-the-counter
The average cost a female athlete spent on her OTC medications per month was calculated in the following manner; the median for every option was calculated (e.g., median for 0–100 was found to be 50). The median was then multiplied with the number of responses of the respective option and a value was obtained (e.g., 232 responses were obtained for the option 0–100, hence 50 × 232) as shown in [Table 2]. For calculation purpose the higher limit was considered as 2000. In this manner, the values for each response were calculated. The sum of all these values was then divided by the number of participants (300) to get the resultant average cost spent by the participants on OTC drugs as shown in [Table 3].
Calculation of overall knowledge, attitude, practice and cost score
The average percentage of KAPC was found to be 59.65%, 49.53%, 43.47%, and 80.33%, respectively. For calculating the overall KAPC score, all four average percentage were added and divided by four [59.65 + 49.53 + 43.47 + 80.330/4] = 58.24%.
The margin of error for the sample size was calculated according to the Raosoft sample size Calculator (using the calculator available on www.raosoft.com). The association between different parameters were established by Pearson co-relation co-efficient test (using the calculator available on www.socscistatistics.com)  and Chi square test (using the calculator available on www.mathsisfun.com) . The associations were established between KAPC versus age, height, and weight. P values were calculated by respective online calculators.
| Results|| |
In this study, a total of 324 questionnaires were distributed, of which 300 participants returned with completed questionnaires; therefore, the response rate was found to be 92.60%. For the sample size of 300, the margin of error was found to be 5.62% according to the Raosoft sample size calculator, considering parameters such as confidence level, response distribution as 95% and 50%, respectively.
Demographic parameters for this study are depicted in [Figure 1]. Most practiced sports observed in our study were cricket, kho-kho, badminton, football , throwball and athletic sports.
Check box type question
For these types of questions, the accurate choice was all the available options. Being check box type, the responses obtained were more than the sample size (n = 300) as one participant ticked more than one response.
Overall score for knowledge, attitude, practice, and cost
The overall assessment of responses was calculated as good (>50%) and poor (<50%). Based on this analysis, female athletes were found to have good knowledge and cost management approach, as shown in [Table 1] and [Table 2], respectively. On the contrary, they showed poor attitude and practice toward OTC drugs, as shown in [Table 3] and [Table 4], respectively.
In addition to this, the overall KAPC assessment among the female athletes was found to be good, i.e., “58.24%” as shown in [Figure 2].
|Figure 2: Overall knowledge, attitude, practice, and cost score assessment|
Click here to view
The average cost spent by the participants in our study was found to be 132 INR
P-value for this study was calculated according to Pearson co-relation co-efficient calculator were only significant for weight versus attitude (0.000984) and weight versus practice (0.000431), i.e., <0.05, as shown in [Table 6].
| Discussion|| |
To the best of our knowledge, this is the first study in the country assessing the KAPC, i.e., KAPC of OTC drugs exclusively in female athletes.
Sample size used in our study was “300”. Other studies like Sankdia et al. (n = 139), Paul et al. (n = 100), Aishwaryalakshmi et al. (n = 89), Sharma et al. (n = 110), Chen et al. (n = 250), and Cybulski et al. (n = 170) used a lower sample size, while studies such as Manohar et al. (n = 465) Ramia et al. (n = 921), Pileggi et al. (n = 728), and Almalak et al. (n = 1596) used a greater sample size as compared to our study, i.e., >300.
Age is an important factor in research as it helps in generalizing the results to a population of particular age group. Studies such as Sankdia et al. and Sharma et al. were conducted among young adults (18–35 years), whereas studies such as Chen et al., Ramia et al., and Pileggi et al. were conducted in middle-aged adults (36–55 years) and studies such as Paul et al. and Cybulski et al. were conducted among older adults (older than 55 years). Conversely, the participants of the current study majorly belonged to 21–25 years of age, i.e., in other words, our study was conducted among young adults (18–35 years).
Another important factor of research is the study population, as to which is the target population for the study. The studies like Sankdia et al., Manohar et al., and Almalak et al. included students as their study population; while studies like Aishwaryalakshmi et al., Sharma et al., and Cybulski et al. considered the general population for their study. Other studies like Paul et al. and Chen et al. included geriatrics and faculty members as their study population, respectively. On the contrary, the current study focused on the female athletes as the study participants.
OTC drugs can be used for indications such as cough/cold, fever, pain, and headache. Headache and pain were found to be the most commonly used indications for OTC in studies like Sankdia et al. (78%), Paul et al. (58%), Manohar et al. (57%), Sharma et al. (82.7%), Chen et al., Pileggi et al. (95%), and Almalak et al. (80%). In contrast to this, our study resulted in cough/cold (78.33%) being the most common indication for the use of OTC drugs. OTC drugs can be used for indications such as cough/cold, fever, pain, and headache. Headache and pain were found to be the most commonly used indications for OTC in studies like Sankdia et al. (78%), Paul et al. (58%), Manohar et al. (57%), Sharma et al. (82.7%), Pileggi et al. (95%), and Almalak et al. (80%). In contrast to this, our study resulted in cough/cold (78.33%) being the most common indication for the use of OTC drugs.
OTC drugs are generally considered to be safe but are sometimes associated with side effects; hence, knowledge about the same is necessary. Studies like Sankdia et al. (75%), Sharma et al. (84.5%), Ramia et al. (2.1%), and Almalak et al. (62.96%) showed keen knowledge regarding the side effects of OTC drugs. On the contrary, in our study, 51.33% of participants showed good knowledge about the side effects of OTC's.
When OTC drugs are purchased, the reason for consumption should always be known. Ramia et al. study showed that 54.8% of the study participants knew the reason behind their consumption. Whereas in our study, 63.33% of participants were occasionally aware about the reason for their OTC consumption.
The overall knowledge regarding the indication, reason, side effects, etc., with the use of OTC is important. Various studies such as Ramia et al. (56%), Almalak et al. (81%), and Sharma et al. (54%) showed poor, moderate, and good knowledge, respectively. While the participants of the current study showed good knowledge (score: 59.65%).
The choice of OTC drugs during its purchase depends on several factors such as cost, brand, efficacy, popularity, and experience. Cost and brand were the major factors for the purchase of OTC drugs by participants of Pileggi et al. (2.1%) and Manohar et al. (44%) studies. On the other hand, the participants of Sharma et al. study made a choice for OTC drugs due to its like low cost (9.1%), easy accessibility (27.3%), safety and tolerability (18.2%), and majority because it is a time-saving option (45.5%). In contrast to this, the participants of our study chose OTC drugs based on their past experience (41.33%).
After purchasing and before consuming the OTC drugs, patients should read the label for the instruction and other information regarding its use. In the studies like Cybulski et al., Pileggi et al., Almalak et al., and Manohar et al.; 55.29%, 76.3%, 79.9%, and 25% of participants, respectively, prefer reading the label for the drug; whereas 30.59%, 23.7%, 20.1%, and 75% of participants do not prefer reading the label, respectively. On the other hand, in studies like Chen et al. and Ramia et al. the participants did not bother reading the label. On the contrary, in our almost all the participants, i.e., 94.27%, prefer reading the label.
OTC drugs can sometimes cause side effects, which when experienced requires to be corrected within time by taking appropriate action. The participants of Sharma et al. study on experiencing side effects resulted in immediately discontinuing the drug (94.5%), and some lowered the dose (5.5%). Conversely, in our study, 67.33% of participants consulted the physician or pharmacist on experiencing side effects.
The overall attitude regarding considerations while purchasing OTC drugs, reading the label, action when side effect occurs, etc., with the use of OTCs is important. The participants of studies like Pileggi et al. and Sankdia et al. showed a positive attitude where as those of Chen et al. study showed an irresponsible attitude. In contrast to this, participants of our study showed poor attitude (49.53%).
The selection of OTC drugs is usually influenced by physicians, pharmacists, advertisements, nurses, experience, family, friends, etc., Physicians were the main influences in studies like Sharma et al. (27.3%), Chen et al. (38%), Cybulski et al. (45.88%), and Pileggi et al. (56.7%). Pharmacists were the secondary influence in studies like Sharma et al. (55.5%), Chen et al. (18%), Cybulski et al. (48.24%), Sankdia et al. (15%), and Pileggi et al. (27%). Friends were the influences for studies such as Sharma et al. (8.2%), and Cybulski et al. (24.71%). In our study, the top three influences were physicians (54%), pharmacists (45.66%), and past experience (27.66%).
OTC consumption requires knowledge about its use, which can be obtained by seeking advice from qualified professionals (viz. doctor, pharmacist, etc.). In the study of Cybulski et al., 24.71% of participants always took advice and 17.65% of participants often took advice for OTC use. Whereas in our study, 63.33% of participants occasionally took advice for OTC use.
The overall practice regarding the selection of OTC drugs, seeking advice, when to discontinue the use etc., with the use of OTC drugs is important. In Sharma et al. study 53% and 47% participants resulted in having fair and good practice, respectively. Conversely, the participants of our study seem to have poor practice with the use of OTC drugs.
The study was not disease-specific, so results were multifaceted. The current study only addresses the female athletes KAPC of OTC drugs only from the urban area, so future studies can address the same issue with a more diverse sample. Furthermore, the current study has not addressed the association of medical complications with the use of OTC medication. Of 324, 24 did not complete the questionnaire and this affected our result up to some extent.
Question 4 in attitude (approach when side effects occur) was a check box type of question. However the respondents who checked all four options were very few (n = 2), which might have affected our average attitude score.
The questionnaire of our study was not a standard questionnaire, it was a self made one, this might have limited our results in terms of psychometric analysis.
| Conclusion|| |
To the best of our knowledge, this is one of the rare studies assessing the KAPC of OTC drugs in female athletes. We concluded that the athletes had good knowledge and good cost management approach nonetheless; they revealed poor attitude and poor practice regarding OTC medications.
The average cost spent by the participants for OTC drugs was found to be ₹141.27 per month. 50% of them stated that OTC are not costing high on their pocket. Parents are the main source through which participants purchased their OTC drugs.
The overall KAPC score assessment was found to be good, i.e., “58.24%.”
Ours was an exclusive and informative study involving the KAPC of female athletes. Community pharmacists can play a significant role in guiding and providing proper education to patients.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]