The awareness of the Jordanian population about OTC medications: A cross‐sectional study

Abstract Due to the shortage of literature related to the safe use of over‐the‐counter (OTC) products by patients worldwide, the aim of this study was to evaluate people's knowledge and attitudes regarding the use of OTC products in Jordan. Using an internet‐based questionnaire mainly spread through social media platforms, a descriptive cross‐sectional study was conducted with Jordanian candidates who consume OTC products. A total of 274 OTC product users answered the survey questions. The results showed that analgesics were the most commonly used OTC products among the participants (50.4%). The majority used the OTC products only as needed rather than on a regular basis. Only 42.4% of the participants sought a pharmacist's help in determining the dose of the OTC medicine. Most of the participants were very interested in reading a patient information leaflet (80.3%) and the side effects and contraindications (89.5%). The majority of participants agreed that antibiotics have to be prescribed (68.5%), and anti‐allergy medications should not be used as sleep aid medications (75.0%). About 53.4% thought that OTCs are sometimes enough to treat their health conditions without the need to follow‐up with a physician. A chi‐square analysis showed an association between gender, age, educational level and having a family member in the medical field and OTC products knowledge among Jordanians. Females, for example, were more interested in reading leaflet, checking production and expiry dates, knowing adverse effects, and appropriate storage conditions (P < .001, 0.022, 0.003, 0.007, respectively). We concluded that a good level of knowledge on the use of OTC products among the study population was identified in the present study.


| INTRODUC TI ON
Over-the-counter (OTC) products include nonprescribed medications such as analgesics, cough and cold medicines, and anti-fungal medications. 1,2 OTC medications are considered an important element of health care in Jordan 3 and the use of OTC products has steadily increased in the pharmaceutical market. 4 Since OTC products are dispensed without a prescription, they are perceived by the public as a safer medicine compared to the prescribed ones. [5][6][7] This perception has led patients to diagnose their own health and use inappropriate self-medication. 8 Misuse or abuse of OTC products by overusing a single agent or using too many different drugs to treat serious diseases 9 has led to misdiagnoses, 10,11 masking of serious conditions, 12 addiction and dependency, 13 kidney, liver, or gastric damage, 14 and other health problems. Jordanians use OTC products, and the potential for abuse or misuse does exist. [15][16][17] There are relatively few studies in the literature related to the safe use of OTC products among patients in Jordan. Previous studies in Jordan looked at the extent of OTC medication use and the reasons behind the prevalent use of OTC medications [15][16][17][18] ; however, the recent studies have not evaluated the information about suspected abuse or misuse of OTC medication.

| MATERIAL S AND ME THODS
A descriptive cross-sectional study was conducted in February 2017.
Jordanians were the source population for this study. According to the Internet World State in 2016, 73.6% of Jordanian people used the Internet. The sample size was calculated based on this percentage and was estimated at 269 participants. Patients aged 19 years and above, who used any OTC products and were willing to participate were considered for the study population.
The data were collected using an Internet-based questionnaire after gaining ethical approval (November 1, 2016) from Isra University.
The questionnaire was designed after a review of the relevant literature and written in Arabic. [16][17][18][19][20][21] Two independent faculty members at Isra University reviewed the questionnaire for its content and the questionnaire draft was revised based on their feedback. The survey was generated using "Google Forms" online survey platform. The survey had a cover page explaining the nature and purpose of the study.
An informed consent form was obtained from each participant prior to the data collection. The questionnaire comprised 24 questions and it was divided into two parts: demographic data and questions on the use of OTC products. The latter part of the questionnaire covered three themes: the prevalence and types of OTC products used, the knowledge about the use of OTC products, and the satisfaction with OTC products used. The question and answer types varied from yes or no to drop-down list answers. The survey was piloted among known OTC product users (n = 4). This involved completing the survey using different computers at different locations.
The link to the survey was distributed via Facebook platform which might not obtain the perceptions of people who do not use social media or do not have access or rarely use the internet.
Therefore, the survey was also promoted through other possible data collection strategies (ie, telephone applications such as WhatsApp). To make sure our sample was random, the message containing the link was anonymously spread to different groups of social media users.
The SPSS software (version 21) was used for data analysis.
Continuous data were reported as mean ± SD. The sociodemographic characteristics and descriptive statistics of participants are presented as frequency (percentages). A chi-square test was conducted to explore the association between different categorical variables and OTC medication knowledge and attitudes. A confidence interval of 95% (P < .05) was applied to represent the statistical significance of the results. The level of significance was assigned as 5%.

| Characteristics of the participants
A total number of 274 participants clicked on the link of the survey, but only 238 questionnaires were completely filled and included in the study analysis.

| The use of OTC products
It was found that 23.9% of the participants use OTC products daily, 18.5% use them weekly, 16.4% use them monthly, and only 7.1% use them every 2 weeks. The rest (34.0%) use OTC products only as needed. Analgesics were the most commonly used OTC products among the participants (50.4%) followed by supplements (like vitamins and minerals) and antipyretics. Other categories of OTC products used were cough syrups, anti-acids, nasal drops and sprays to reduce nasal congestion and a runny nose, constipation medications, diarrheal medications, and ophthalmic drops and ointments ( Figure 1). The majority of participants (90.0%), mostly the females (P < .022), showed a great interest in checking the production and expiry dates ( Table 2).

| Information about OTC products
A percentage of 42.4% sought a pharmacist's help to determine the appropriate dose. Others depended on the patient information leaflet, consulted a physician, or depended on their own information, and others asked friends and nurses. Additionally, three quarters of the participants inform their physician about the OTC products they take, even without being asked.

| Patient satisfaction after OTC product use
Participants who claimed that they suffered from side effects as a result of using OTC products were only 11.8% whereas 7.1% were not aware whether they went through any side effects at all.
Additionally, 53.4% of the participants thought that OTC products are sometimes enough in treating their conditions without the need to follow-up with physician while only 29.0% believed that OTC products are satisfying and there is no need to consult a physician (Table 2).

| D ISCUSS I ON
According to our results, the knowledge and attitudes of Jordanians regarding OTC was overall good in most aspects of the study.
Analgesics/antipyretics were the most commonly used self-medications among OTC products, which was in agreement with previous studies. [19][20][21][22] This can be attributed to the common use of such drugs in treating minor and uncomplicated illnesses such as fever, headache, and pain. 23  Our results show that the awareness of our respondents generally, and females particularly, about OTC products was highly associated with checking the expiry dates. This might be because women are known for being the home medical caregiver which is a common pattern in many parts of the world.

A patient information leaflet (PIL) is intended to provide pa-
tients with written information about the medication. Its main purpose is to provide patients with the necessary information about their medication in terms of its administration, precautions, and potential side effects. 34 In our study, gender was highly asso- However, previous reports suggested that many patients taking nonprescription medication do not tend to disclose the use of these medications to their physician. 36 In our study, it was clear that the respondents had some level of awareness in regards to antibiotics being classified as pre-

| CON CLUS IONS
A good level of knowledge about the use of OTC products among the study population was identified in the present study in terms of reading the patient information leaflet, knowing the active ingredients, side effects, and contraindications, and in knowing the misuse/ abuse practices of OTC products. Since a high prevalence of OTC product use is evident, OTC product users should also be encouraged to regularly consult health care providers in the case of lack of knowledge.

D I SCLOS U R E
We declare that there is no conflict of interest.