“Perception” as a Factor Influencing Self-Medication Among Healthcare Professionals in a Tertiary Hospital in South-South Nigeria

Self-medication, defined as the use of medication without professional consultation, is a common phenomenon worldwide. Healthcare professionals, due to their medical expertise and easy access to drugs, are more likely to engage in self-medication than the general population. While it can provide rapid symptom relief, the practice poses serious risks, including misdiagnosis, drug interactions, antibiotic resistance, and adverse drug reactions [1].

Self-medication in Nigeria is viewed as a major public health concern, shaped by a complex combination of cultural beliefs, the accessibility of healthcare services, and the level of individual health literacy. Cultural beliefs and practices also play a key role in shaping attitudes toward self-medication. In numerous Nigerian communities, there is a longstanding tradition of using herbal remedies and over-the-counter drugs for self-care. Auta et al. [2] pointed out that self-medication is widely accepted culturally, with many individuals preferring to use familiar treatments before seeking professional healthcare [2]. This tendency toward self-care can be linked to a historical dependence on traditional medicine and restricted access to healthcare services, especially in rural regions [2].

Additionally, perceptions of self-medication are often influenced by the shortcomings of the formal healthcare system. Many Nigerians face challenges in accessing healthcare, including high costs, lengthy wait times, and a lack of healthcare professionals. Ayodele’s study highlighted that these obstacles drive people to turn to self-medication as a more convenient alternative [3]. The belief that healthcare providers are frequently inaccessible or unapproachable further fuels the reliance on self-care, prompting individuals to take their health into their own hands [3]. Furthermore, healthcare professionals’ perceptions and attitudes towards self-medication are influenced by a range of elements encompassing professional standards, individual convictions, their beliefs about its effectiveness, perceived risks and benefits, and cultural contexts, which are explored in different studies. While certain professionals might see self-medication as a practical approach for minor ailments, others may raise apprehensions regarding its possible hazards and ethical considerations.

The theory of planned behaviour, which was developed by Icek Ajzen in the late 1980s, is a model widely used for understanding and predicting human behaviour, particularly in the context of health, environmental, and social domains. It suggests that individual behaviour or actions are shaped by three key elements: Attitude towards the behaviour, subjective norms, and perceived behavioural control [4].
A. Attitude towards the behaviour: Attitude represents how someone perceives a behaviour, whether negatively or positively. It is a personal judgment based on the perceived benefits and drawbacks of the action, influenced by one’s belief about its advantages and disadvantages, as well as the evaluations of its outcomes (Sallis et al., 2015) [5].
B. Subjective norms: Subjective norms indicate an individual’s perception of whether significant others endorse the behaviour. [5].
C. Perceived behavioural control: Perceived behaviour control refers to individuals’ perception of their ability to carry out a particular behaviour. This perception is assessed through beliefs about barriers and aids to performing the behaviour, as well the degree of control they feel they have over it [5].

In the study done by Tobin et al. [6], the majority (64.6%) of respondents felt no obligation to consult a doctor when ill and did not perceive themselves to be at any risk of self-medication, while 49.0% thought that self-medication should not be practiced by healthcare workers. In the same study, 53.9% of respondents had a positive attitude towards self-medication, while 46.1% had a negative attitude towards it. Research by Sholabi et al. [7] on the prevalence, knowledge, and perception of self-medication practices among undergraduate healthcare students discovered that approximately half demonstrated good knowledge and perception of self-medication practices, stimulated by the perception of treating minor ailments. A similar finding among undergraduate students is a tertiary institution in Saudi Arabia, where medical students showed a positive attitude towards self-medication.

The inclination to protect a healthy image, privacy concerns, as the discomfort at assuming the patient’s role are some primary motives that can drive healthcare professionals to manage their own health needs [8]. Perception and attitude towards self-medication vary among healthcare professionals. some view it as a practical necessity for minor illnesses, while others consider it a risky practice that should be discouraged [8]. Studies have shown that self-confidence in medical knowledge, workload constraints, and accessibility of medications are key factors driving self-medication among professionals [9]. Despite increasing concerns about the dangers of self-medication, the practice remains prevalent among healthcare professionals. The normalization of self-medication and healthcare professionals can influence public attitudes towards self-medication, further exacerbating irrational drug use which could negatively impact public health [10]. The aim of this study to assess the perceptions of healthcare professionals towards selfmedication, and how do these influence their decisions towards self-medication.

Study site

This study was carried out in a tertiary Hospital, in Bayelsa State, south-south, Nigeria.

Study design

A descriptive cross-sectional design was used in this study.

Sampling technique

purposive sampling technique was used to select study participants.

Data collection

A structured questionnaire prepared in English Language was used as a research tool. The research instrument was certified by the supervisor after a pilot study before the formal distribution to the respondents in the study area.

Data analysis

Data from questionnaires were coded and entered directly into Statistical Package for the Social Sciences (SPSS) version 24.0 software. Descriptive statistics such frequency, percentages and mean values were used to summarize the data and further expressed in tables and charts. Inferential statistics, including Chi-square tests, were applied to determine associations between certain factors and self-medication practice.

Ethical Issues

Ethical approval was obtained from the Research and Ethics Committee of Federal Medical Centre, Yenagoa, Bayelsa State. Informed consent was obtained from all participants before administering the questionnaire. The participants’ responses remained anonymous and confidential.

Demography of study participants

From the results obtained, two hundred and eighty-five healthcare professionals completed the questionnaires. Ninetyseven (34.0%) were male while 66.0% were female healthcare professionals. The modal age group was the age interval 40-49 years with 94 participants (33.0%); while less than a tenth were in the 5th decade of life (7.7%). The mean age of all participants was 36.7 years, with a standard deviation of 8.4 years. One hundred and thirty-four healthcare professionals (47.0%) who participated were Nurses, 116 participants were Medical Doctors (40.7%), and 35 participants were pharmacists (12.3%). Eighty-six (30.2%), sixty-seven (23.5%) and eighty-one participants (28.4%), have spent 0-5 years, 6-10 years and 11-15 years respectively as years of experience among healthcare participants in the study as shown in table 1.

Table 1: Sociodemographic characteristics of healthcare professionals.

Perception of self-medication among healthcare professionals

Responses to questions investigating perceptions of selfmedication among healthcare professionals: The responses of healthcare professionals to questions investigating the perception of self-medication are shown in Table 2. Two hundred and eighty-one participants (98.6%) believe that self-medication is a common habit among healthcare professionals; however, about a quarter (24.2%) think that self-medication is a positive practice (Table 2). Concerning safety, about a third of participants (34.4%) believe that self-medication is ‘somewhat safe’ while a quarter think it is somewhat unsafe. One hundred and seventyfive healthcare professionals responded that the risk associated with self-medication is moderate (61.4%), but only about half of the participants (149-52.2%) believe that the awareness of risk associated with self-medication among healthcare professionals is adequate.

Table 2:Responses to Statements investigating perception of self-medication among health care professionals.

Ninety-nine healthcare professionals (34.7%) were categorized as having a good perception of self-medication in the study, and 186 participants (65.3%) were classified as having a poor perception of self-medication Figure 1.

Figure 1:The perception of self-medication among healthcare Professionals.

Association perception and practice of self-medication among healthcare professionals

Table 3 shows that the perception of self-medication was significantly associated (χ2=7.48; p-0.006) with the practice of self-medication. A significantly higher proportion of healthcare professionals who had poor perception (84.4% Vs 70.7%) than those with good perception practiced self-medication.

Table 3:Association perception and practice of self-medication among healthcare professionals.

Determinants of self-medication among healthcare professionals

Healthcare professionals with a poor perception of selfmedication are two times more likely to self-medicate (aOR=2.90; p-0.002) than those with a good perception of self-medication (Table 4).

The respondents included Nurses (47.0%), Doctors (40.7%), and Pharmacist (12.3%). The study also revealed that the majority of the healthcare professionals were between the ages of 40 and 49 years. Also, the majority of respondents were married and had a working experience of 0-5 years, while half of the respondents earned between N200,000 and 399,000. According to the Oxford Learner’s dictionary, “perception” is defined as the ability to understand the true nature of something”. In other words, this refers to cognitive perception, which involves the mental process of interpreting and understanding the deeper meaning or the essence of something beyond just sensory input. This implies that a good perception indicates an accurate, informed, and constructive understanding or interpretation of something. Whereas a poor perception suggests inaccurate, uninformed, or negative understanding or interpretation.

In this study, responses to questions asked, perception of selfmedication (Table 2) was categorized into their “good perception” or “poor perception”. The poor perception category included responses such as: self-medication is a positive practice, somewhat safe, very safe, with low risk associated with it, as well as those who had a neutral opinion. On the other hand, the good perception category included responses such as: Self-medication is a negative practice, unsafe, somewhat and very unsafe, with a moderate to high risk associated with it. The result revealed that 65.3% of respondents had a poor perception of self-medication, while 34.7% of respondents had a good perception of self-medication. Also, the result from Table 2 showed that 86% of healthcare professionals perceived the risk associated with self-medication as moderate to high risk (good perception/understanding), yet a significant portion still engaged in it. This aligns with studies by Mohammed et al. [11], where over two-thirds of health professionals practiced self-medication despite acknowledging the negative consequences. This could be attributed to professional confidence in managing their health despite the acknowledged risks. Also, it could be that healthcare professionals may feel confident in their ability to selfmedicate safely due to their training and knowledge [12,13]. On the other hand, findings from a study carried out on pregnant women attending antenatal clinics in Nigeria perceived self-medication as risky and showed that they were less likely to engage in it [14]. This contrast may be due to the perceived vulnerability during pregnancy, which leads to more cautious behaviour compared to the general self-assuredness of healthcare professionals. However, if there are perceived barriers or challenges in managing their health through self-medication, they may be less likely to selfmedicate [13].

Furthermore, it is important to note that responsible selfmedication is the key. The concept of responsible self-medication has garnered increasing attention in recent years, especially within the context of healthcare systems that are either overstretched or difficult to access for many people. Responsible self-medication, when practiced correctly, can alleviate some of the burden on healthcare systems, allowing professionals to focus on more serious or complicated health cases [15]. Healthcare professionals with a poor perception of self-medication are two times more likely to selfmedicate (aOR=2.90; p-0.002) than those with a good perception of self-medication (Table 4). This may be due to an interplay of cognitive dissonance, normative beliefs, convenience, and risk assessment. Despite recognizing the potential risks, healthcare professionals may often justify self-medication by relying on their medical knowledge and experience, leading to a rationalization of the behaviour. This internal conflict, combined with a belief in their ability to manage adverse effects, reinforces the practice.

Table 4:Determinants of self-medication among healthcare professionals.

In conclusion, this study highlights the paradox of selfmedication among healthcare professionals. While many recognize its risks, they continue to practice it. Although self-medication is viewed positively by some, concerns about antimicrobial resistance, ethical concerns, and improper drug use remain.

In addressing the issues associated with self-medication, there is a need for a combination of regulatory reforms, institutional policies, and awareness campaigns to promote responsible medication practices among healthcare professionals.

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