The study's findings indicate a moderate to a high level of self-medication practice among university students in Bangladesh, consistent with previous studies (29, 30, 37, 40, 41). Several factors contribute to this practice, including limited access to healthcare services, cost-effectiveness, cultural beliefs, and the convenience of purchasing medications without a prescription from pharmacies and drug stores (42).
The researcher focused on two types of knowledge among university students in Bangladesh: knowledge about medication and knowledge about adverse drug reactions (ADRs). Knowledge about medication was assessed based on medication doses, content, and related aspects, as well as knowledge of different medicine groups. The findings revealed that most students possessed intermediate knowledge about medication, with a relatively higher level of knowledge about medicine groups, consistent with previous studies conducted in different cities (43). This observation could be attributed to the country's heavy marketing efforts of pharmaceutical companies. Surprisingly, most students exhibited only basic knowledge of ADRs. Previous research indicated that students often hold misconceptions, believing that non-severe illnesses cannot lead to serious consequences (44). This knowledge gap regarding the risks associated with self-medication might be one of the reasons for the high prevalence of self-medication among university students in Bangladesh. The limited awareness about ADRs among students could be attributed to the insufficient emphasis on pharmacovigilance in the country.
The structural equation model (SEM) presented in Fig. 1 reveals a positive causal relationship between knowledge about self-medication and adverse drug reactions (ADRs) and the practice of self-medication. Previous research (45–47) supports this by indicating that individuals who engage in self-medication within the last 12 months tend to have a higher level of knowledge about self-medication. Furthermore, the SEM suggests that knowledge about medication indirectly affects self-medication by influencing knowledge about ADRs. Thus, those with greater knowledge about self-medication are likely to possess more knowledge about ADRs and higher self-medication practice. The belief that self-medication is an effective and convenient way to manage minor health problems, coupled with university students' confidence in their medication knowledge (48), may play a role. Additionally, in Bangladesh, the easy availability of over-the-counter medicine and the convenience of storing it (48, 49) make self-medication a preferred choice. Conversely, obtaining prescribed medication is more difficult and inconvenient (48), as observed in this study. Consequently, knowledgeable individuals may opt for the convenient, easily accessible, and quick relief self-medication provides.
Contrasting findings were presented by a study conducted in Portugal (50) found no positive connection between knowledge and the practice of self-medication. Similarly, a study in Nepal (51) revealed that individuals with higher knowledge about medication safety were less likely to engage in self-medication. Additionally, a study in Nigeria (45) showed a negative correlation between knowledge about ADRs and self-medication practices among university students. These findings highlight the complex nature of the relationship between knowledge and self-medication, suggesting that various factors influence it. While university students in Bangladesh continue to engage in self-medication despite understanding the associated risks, others may avoid it due to their awareness of potential consequences. The results of this study indicate that most university students in the country have a positive attitude towards self-medication and adverse drug reactions (ADRs). Previous studies on general university and medical students have also shown that most of them hold a positive attitude toward self-medication (17, 27, 41, 44, 49, 52). However, some studies suggest that students generally have a negative attitude toward self-medication (43, 52, 53) and are cautious about recommending self-medication to friends and family members (54). These studies further suggest that students may develop this mindset due to increased awareness about medications and ADRs during their time in university (25, 43).
Moonajilin et al. (13) found that, on average, only 26.3% of Bangladeshi people seek healthcare facilities for treatment, indicating a significant shortage in healthcare infrastructure. This shortage could be a prominent reason for the positive attitude towards self-medication and ADRs. Additionally, cultural and traditional beliefs have been identified as influential factors in shaping attitudes towards self-medication (42, 55), and the cultural and traditional beliefs in Bangladesh may have played a significant role in this context. Moreover, the present study has shown that students have limited knowledge about ADRs and their potential risks, which could contribute to these unique findings. This study reinforces the consistent finding from previous studies (25, 41, 50) that individuals with a positive attitude towards self-medication and adverse drug reactions (ADRs) tend to engage in self-medication more frequently. In contrast, those with a negative attitude are less inclined to do so. Among university students, except for some instances presented by James (25), a positive attitude towards self-medication is a common factor (48, 56). The SEM (Fig. 1) used in this study also confirms that a positive attitude towards self-medication has the strongest influence on the actual practice (β= -0.34; p-value < 0.001) encouraging the use of various medicine groups, treating different diseases through self-medication, and increasing the frequency of self-medication.
Furthermore, the study reveals that the attitude toward self-medication indirectly impacts the practice by influencing the attitude toward adverse drug reactions (ADRs). This suggests that individuals who perceive self-medication as acceptable also subconsciously acknowledge the potential negative consequences, despite recognizing its effectiveness. It can be attributed to self-medication as a convenient and cost-effective option to get quick relief from minor health issues (42, 50). Additionally, from a psychological perspective, one can argue that university students, being mature and knowledgeable individuals, possess optimism while accepting the reality of self-medication. This acknowledgment demonstrates their understanding that their choices can have both positive and negative outcomes, and they are willing to accept the responsibility that comes with it. This study highlights the widespread perception among students that self-medication is highly convenient. They report that buying and storing medicine in Bangladesh is easy, consistent with previous studies (42, 57, 58) conducted in Bangladesh and other countries (54, 59, 60). Those over-the-counter (OTC) medications are commonly used for self-medication. Students also emphasize that self-medication saves time and offers quick relief, which has consistently emerged as primary motivation for self-medication in previous studies (7, 61, 62). Additionally, the convenience of self-medication in Bangladesh is attributed to the knowledge gained from previous prescriptions and the online availability of medical information. These factors have also been reported as key drivers of self-medication (48, 52, 57).
The structural equation model (SEM) shows a significant positive causal relationship between the convenience of self-medication (β = 0.23; p-value < .001) and its practice. As the convenience of self-medication increases, so does its prevalence. This finding is consistent with earlier studies (25, 27, 28, 37–40) highlighting the positive influence of easy access to self-medication on its practice.
One possible explanation for the convenience of self-medication is the proliferation of health-related resources on the internet. This enables individuals to independently research symptoms, diagnoses, and potential treatments, leading to a sense of autonomy and confidence in making health decisions without consulting a healthcare professional. Additionally, easy access to medical information allows students to become more knowledgeable about common ailments, symptoms, and treatments, thereby reinforcing the practice of self-medication (48, 52, 57).
This study highlights the significant inconvenience half of the students face when accessing prescribed medicine in Bangladesh, shedding light on the challenges associated with healthcare services in the country. The reasons identified by the study, including distance to government healthcare centers, unavailability of pharmacies, high cost of private medical care, and inadequate health call centers, are all significant barriers to accessing healthcare services. Previous studies conducted in Bangladesh (57, 58) have also reported difficulties obtaining advice from healthcare professionals, further exacerbating the problem. This situation can be directly attributed to the low healthcare budget in Bangladesh, which is one of the lowest in South Asia, accounting for only 5.4% of the total GDP (14). The study reveals a positive causal relationship between the physical inconvenience of obtaining prescribed medication and the practice of self-medication, as indicated by the structural equation model (SEM) analysis (β = 0.25; p-value < .001). Consequently, the practice of self-medication among university students increases with the growing inconvenience of accessing prescribed medication. These findings align with previous research (42, 48, 49, 54, 55) that has identified difficulties in obtaining proper treatment as a significant contributing factor to the practice of self-medication. Earlier, this study stated that students with a higher level of medication knowledge resort to self-medication may be due to the significant inconvenience associated with obtaining prescribed medication. This inconvenience can also be attributed to the accepting attitude of students towards the potential negative consequences that may arise due to self-medication. Students in Bangladesh may prefer to avoid the hassle of seeking health professionals' suggestions, which contributes to this phenomenon.
Policy Recommendations
Despite existing regulations and healthcare facilities, effective and evidence-based guidelines are needed to improve self-medication practices. While self-medication can be beneficial if appropriately directed, but specific actions are needed.
To strengthen prescribed medication practices, standardized guidelines should be developed, covering dosage recommendations, regimen instructions, and considerations for potential adverse effects. Healthcare providers should undergo continuous education on evidence-based medicine and patient safety, with mechanisms in place to monitor and evaluate adherence to guidelines.
Enhancing the quantity and accessibility of prescribed medication requires collaboration between governments, healthcare providers, and pharmaceutical companies. Measures include ensuring an adequate supply of medications, reducing costs through bulk purchasing agreements and promoting generics, and improving accessibility through pharmacy networks, home delivery, and telemedicine.
Improving government medical services entails increased funding for infrastructure, equipment, and staff capacity. Reducing waiting times and implementing electronic health record systems can enhance patient satisfaction and care coordination.
Educating the public is vital. Public awareness campaigns should highlight self-medication risks, while collaboration with educational institutions and healthcare providers can deliver targeted programs on proper medication usage. Leveraging communication channels is essential to disseminate accurate information and discourage self-medication.
Strengthening regulation and enforcement involves monitoring and controlling the availability and sales of over-the-counter medications, deterring unauthorized prescription sales, and raising awareness of legal and health consequences.