RESEARCH ARTICLE

Self-medication practices among adult population attendingcommunity pharmacies in Malaysia: an exploratory study

Mohamed Azmi Hassali • Asrul Akmal Shafie •

Harith Al-Qazaz • Jayabalan Tambyappa •

Subish Palaian • Vidhya Hariraj

Received: 10 December 2010 / Accepted: 11 July 2011 / Published online: 3 August 2011

� Springer Science+Business Media B.V. 2011

Abstract Objective To assess the prevalence of self-

medication among adults in an urban setting and to identify

any factors contributing to self-medication in relation to

consumer characteristics. Setting The study was carried out

in Kuala Lumpur, the capital of Malaysia. Methods A

cross-sectional study using a self administered question-

naire including adults above 21 years old as an exit survey

was conducted in Kuala Lumpur. Main outcome measures

Number of medications taken in a day by participants,

source of medication for the treatment of minor illnesses

among participants, common illnesses chosen for self-

medication by participants, and the sources of information

of participants. Results Of 314 participants, 62.7% had

taken at least one medication in the past week without

prescription and 62.7% believed that over the counter

medicines were just as effective as those prescribed by

doctors. 69.4% would seek a healthcare professional’s

advice before purchasing any medication and 86.9% would

consult a pharmacist prior to buying medication from the

pharmacy. Only 86% checked the expiry dates on medi-

cations and 54.5% reported keeping leftover medication.

Conclusions Self-medication practice is prevalent in Kuala

Lumpur but some practice might be harmful. Education on

appropriate use of self-medication need to be emphasized

in order to ensure quality use of medicines.

Keywords Adults � Medication � Pharmacist �Self-medication

Impact of research findings on practice

• The practice of self-medication is prevalent in Kuala

Lumpur, Malaysia and can be observed at various

socio-demographic levels.

• Data from this study can help policy makers in

Malaysia to develop legislation on self-medication

practices.

Introduction

Self-care is what people do for themselves to establish and

maintain health, and to prevent and deal with illness. It can

also be defined as the selection and use of medicines by

individuals to treat self-recognized illnesses or symptoms

[1, 2]. It is a broad concept that includes health activities

and health-related decision-making including nutrition,

lifestyle, self-medication, hygiene, and socio-economic and

environmental factors. With the advent of global net-

working, information technology, better education, new

discoveries and policy changes, consumers today demand

more alternatives and choice to make informed decisions.

Moreover, there is growing social pressure on people to

lead healthy lifestyles [3]. In Malaysia alone, commercial

gymnasiums, weight loss centers and health supplements

have flourished in the last decade, a development reflective

of a more ‘‘health-conscious’’ society.

Self-medication involves the intermittent or continued

use of a medication prescribed by a physician for chronic

or recurring diseases or symptoms. In practice, it also

M. A. Hassali (&) � A. A. Shafie � J. Tambyappa � S. Palaian

Discipline of Social and Administrative Pharmacy, School of

Pharmaceutical Sciences, Universiti Sains Malaysia, 11800

Minden, Penang, Malaysia

e-mail: azmihassali@usm.my

H. Al-Qazaz � V. Hariraj

Discipline of Clinical Pharmacy, School of Pharmaceutical

Sciences, Universiti Sains Malaysia, 11800 Minden, Penang,

Malaysia

123

Int J Clin Pharm (2011) 33:794–799

DOI 10.1007/s11096-011-9539-5

includes use of the medication by other family members

[1]. With better understanding of disease and health, con-

sumers are now playing an active role in their health care

and take control of their health and self-care initiatives.

The more informed consumers usually have a greater

demand for over-the-counter (OTC) medications through

self-medication [4]. It was estimated that 80% of all

medical symptoms are self-recognized and self-treated

without professional care [3]. Self-medication with the use

of OTC drugs is the most prevalent form of medical care in

the world. It is estimated that over 92% of all consumers

used at least one OTC in the last year, and 55% have used

more than one [3]. The Working Group on Drug Classifi-

cation has defined OTC preparations as a ‘‘pharmaceutical

product, drug, or medicinal specialty whose dispensing or

administration does not require medical authorization, and

it can be used by the consumers under their own initiative

and responsibility in order to prevent, relieve or to treat

minor illnesses’’ [5].

From an economic perspective, the increase in OTC

drugs is driven by consumer demand, healthcare efficiency,

market expansion, generic competition and cost-contain-

ment schemes [6]. Rising healthcare costs and prescription

drug expenditures are the driving forces for government and

health insurance payers to look for new means to contain

healthcare costs [3]. The use of OTC medication helps

(North) Americans save an average of $20 billion annually

in healthcare costs which include the costs of prescription

drugs, doctors’ visits, lost work time, insurance and travel

[4]. An individual may choose to see a doctor, consult a

community pharmacist, start taking a supplement, use

leftover drugs previously purchased or resort to comple-

mentary medicine (non-pharmacological therapies).

Although there are many options available, the key for any

individual embarking on self-medication is to recognize

symptoms, identify conditions suitable for self-medication,

choose the appropriate product, identify any adverse event

and follow the directions as indicated on the label.

It was recommended that self-medication should be

emphasized as a primary component in health care and

more health education programs should be designed to

educate communities on safer practices [7]. To date, there is

a shortage of information about self-medication pattern and

prevalence among consumers in Malaysia. With greater

availability of medicines, there is now a greater risk of

patients self-medicating without direct provider guidance.

Recognizing the prevalence of self-medication and factors

influencing self-medication among consumers will enable

pharmacists to identify the needs of the consumer as well as

to establish professional standards in terms of structured

training to support the needs of pharmacists. It might also

help to educate and improve awareness among consumers

to insure the quality and responsible use of medicines.

Aim of the study

To assess the prevalence of self-medication among adults

in an urban setting and to identify any consumer charac-

teristics that may contribute to self-medication.

Method

Study design and population

This study was a cross-sectional survey using a conve-

nience sampling method. The study was conducted in

Kuala Lumpur, the capital of Malaysia. A pilot-tested self-

administered questionnaire was distributed as an exit sur-

vey from a list of 26 pharmacies selected randomly in

Kuala Lumpur between January and May 2009. A sample

size of 384 participants was determined using the Raosoft

sample size calculator [8] for a population-based study.

Adults in Kuala Lumpur older than 21 who were able to

read and understand either English or Malay were included

in this study. At the end of the study period, 314 subjects

were included in the final analysis. A total of 70 partici-

pants were excluded after data collection because of

incomplete responses to the questionnaire.

Questionnaire development and data management

A questionnaire with two sections (Demographic and Self-

medication Assessment) was developed and used as a data

collection tool. In the demographic section, consumers

were asked to provide their ethnicity, age, gender,

employment, monthly income and level of education.

Section B contained 18 questions about their self-medica-

tion practices, the type and amount of medication used,

source of information, knowledge on adverse effects and

interactions, names and labels of medication and storage.

The questionnaire was based on previous studies and was

validated (face and content) among 20 participants whose

data were not included in this study. Data collection was

carried out by five data collectors in various zones in Kuala

Lumpur by distributing the questionnaire to customers of

selected pharmacies. The data collectors consisted of final-

year pharmacy students who were rigorously trained in

terms of the survey intention and how to contact the par-

ticipants and explore their responses.

Statistical analysis

Data analysis was done with the SPSS version 15.0 (the

software which is officially used at the University Sains

Malaysia). Chi Square test was used to test for associations

Int J Clin Pharm (2011) 33:794–799 795

123

between demographic data and self-medication assessment

questions. Significance was set at P \ 0.05.

Ethical issues

Participation in this survey was voluntary and the partici-

pants were asked to sign a consent form before completing

the survey. No findings which could identify individual

participants were published.

Results

Altogether, 384 adults responded to this study and 314

(81.7%) participants were included in the final analysis.

The socio-demographic characteristics of participants were

presented in Table 1. The majority of participants were

male 170 (54.1%), and 36.9% of patients were between the

ages of 30 and 39. Most were Chinese (144, 48.9%), and

married (181, 57.6%). With regard to educational level,

123 (39.2%) were degree holders and 149 (47.5%) worked

in the private sector and 84 (26.8%) earned more than

RM4000 (*1,150 USD). Out of the final sample, 197

(62.7%) stated that they had taken at least one medication

in the previous week at their own discretion without

prescription.

The analysis within the demographics of this population

showed that the age of the participants were associated

significantly (P \ 0.05) with self-medication in our sam-

ple, as all those above 60 years of age (13, 100%) and 36

(85.7%) participants between 50 and 59 years old were

found to self-medicate (Table 1). Of the total number of

participants, 163 (51.9%) were taking at least one medicine

daily, 143 (45.5%) were taking vitamins and 87 (27.7%)

consumed herbal or traditional supplements (Table 2). In

addition to that, 121 (38.5%) participants were suffering

from a medical condition that required regular medication.

Most participants obtained medication from either phar-

macies (n = 162, 51.6%) or clinics (n = 89, 28.3%).

The most common therapeutic groups of self-medicated

drugs were cough and cold preparations (n = 210, 66.9%)

followed by pain medication (n = 183, 57.6%), diarrhea

(n = 138, 43.9%), allergy and/or rashes (n = 111, 35.4%),

constipation (n = 105, 33.4%), weight loss (n = 84,

26.8%) and heartburn (n = 79, 25.2%). In this survey, 218

participants (69.4%) would consult healthcare profession-

als before purchasing any medication whereas 106 (33.8%)

would refer to a friend or family member. Only 29 (9.2%)

sourced information from the internet and 22 (7.0%) relied

on advertisements (Table 2). It was found that 273 (86.9%)

would consult a pharmacist before buying any medication

and 197 (62.7%) of the total participants believed that

Table 1 Demographic characteristics of participants and last week

self medication

Variable Total (%) Last week self medication

Yes; 197 (62.7%) No; 117 (37.3%)

Gender

Male 170 (54.1) 104 (61.2%) 66 (38.8%)

Female 144 (45.9) 93 (64.6%) 51 (35.4%)

Age groups

21–29 45 (14.3) 18 (40.0%) 27 (60.0%)

30–39 116 (36.9) 73 (62.9%) 43 (37.1%)

40–49 98 (31.2) 57 (58.2%) 41 (41.8%)

50–59 42 (13.4) 36 (85.7%) 6 (14.3%)

C60 13 (4.1) 13 (100.0%) 0 (0.0%)

Race

Malay 123 (39.2) 81 (65.9%) 42 (34.1%)

Chinese 144 (48.9) 88 (61.1%) 56 (38.9%)

Indian 29 (9.2) 18 (62.1%) 11 (37.9%)

Others 18 (5.7) 10 (55.6%) 8 (44.4%)

Marital status

Single 133 (42.4) 78 (58.6%) 55 (41.4%)

Married 181 (57.6) 119 (65.7%) 62 (34.3%)

No of children

None 150 (47.8) 10 (66.7%) 5 (33.3%)

1 15 (4.8) 36 (63.2%) 21 (36.8%)

2 57 (18.2) 41 (64.1%) 23 (35.9%)

3 64 (20.4) 19 (76.0%) 6 (24.0%)

4 25 (8.0) 2 (66.7%) 1 (33.3%)

5 3 (1.0) 89 (59.3%) 61 (40.7%)

Education

None 4 (1.3) 3 (75.0%) 1 (25.0%)

Primary 4 (1.3) 3 (75.0%) 1 (25.0%)

Secondary 93 (29.6) 64 (68.8%) 29 (31.2%)

Diploma 61 (19.4) 37 (60.7%) 24 (39.3%)

Degree 123 (39.2) 71 (57.7%) 52 (42.3%)

Masters/PhD 29 (9.2) 19 (65.5%) 10 (34.5%)

Employment

None 32 (10.2) 13 (40.6%) 19 (59.4%)

Government 56 (17.8) 37 (66.1%) 19 (33.9%)

Non government 149 (47.5) 95 (63.8%) 54 (36.2%)

Self-employed 60 (19.1) 39 (65.0%) 21 (35.0%)

Housewife 17 (5.4) 13 (76.5%) 4 (23.5%)

Monthly income (RM)

None 32 (10.2) 13 (40.6%) 19 (59.4%)

\1,000 14 (4.5) 9 (64.3%) 5 (35.7%)

1,000–1,999 43 (13.7) 27 (62.8%) 16 (37.2%)

2,000–2,999 72 (22.9) 47 (65.3%) 25 (34.7%)

3,000–3,999 69 (22.0) 43 (62.3%) 26 (37.7%)

C4,000 84 (26.8) 58 (69.0%) 26 (31.0%)

Health insurance

Yes 224 (71.3) 133 (59.4%) 91 (40.6%)

No 90 (28.7) 64 (71.1%) 26 (28.9%)

796 Int J Clin Pharm (2011) 33:794–799

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over-the-counter medicines are as effective as those pre-

scribed by the doctor (Table 3).

Discussion

The results of this study showed self-medication practices

were prevalent in various age groups, gender, financial

status and education levels. Some 62.7% had taken medi-

cation in the previous week. This was low compared with a

study carried out in the United States [9] where 81% had

taken at least one medication in the preceding week and

those of Mitsi et al. [10], who reported a high use of non-

prescribed antibiotics (74.6%) in a Greek urban population.

The prevalence is higher, however, than that in other

studies conducted in Jordan (42.5%) by Yousef et al. [11]

and Suleman et al. [12] in Southwest Ethiopia (39.2%). The

findings from the basic analysis of self-medication related

data reflect the accessibility of medicines in Kuala Lumpur

where a pharmacy or a clinic can be found in every housing

area.

Interestingly, more than half of the participants

explained that pharmacies are their main source of self-

medication. Those who obtained medicines from the

pharmacy indicated that the high cost of doctors’ visits,

long waiting time at hospitals and the availability of

affordable drugs could have led to alternative ways to

source medication for their minor illnesses. This was

reflected in the WHO paper on self-medication [1] and a

study in Ethiopia by Suleman et al. [12]. The results were

comparable to other findings for types of medicines used

for self-medication. The participants’ responses with

regard to pharmacist consultation and effectiveness of OTC

medications were comparable to the results of a study

performed by the British Market Research Bureau [13]

which revealed findings of 86 and 67% respectively for

pharmacist consultation and effectiveness of OTC medi-

cation. This, however, is in contrast to a study conducted

Table 2 Self medication related data distribution

Question Yes No

1. Have you taken any medication in the

past week by your own decision?

197 (62.7) 117 (37.3)

2. Where do you obtain your medication from?

(a) Pharmacy 162 (51.6) 152 (48.4)

(b) Hospital 40 (12.7) 244 (77.7)

(c) Clinic 89 (28.3) 106 (33.8)

(d) Others 23 (7.3) 291 (92.7)

3. Do you take any vitamins? 143 (45.5) 171 (54.5)

4. Do you take any herbal/traditional

supplements?

87 (27.7) 227 (72.3)

5. How many types of medicine do you take in a day?

(1) None 75 (23.9)

(2) \2 163 (51.9)

(3) 2–5 51 (16.2)

(4) 5–10 23 (7.3)

(5) [10 2 (0.6)

6. Will you choose to buy your own medication for the following

conditions:

(a) Pain 183 (57.6) 133 (42.4)

(b) Cough/cold 210 (66.9) 104 (33.1)

(c) Allergy/rashes 111 (35.4) 203 (64.6)

(d) Heartburn 79 (25.2) 235 (74.5)

(e) Diarrhea 138 (43.9) 176 (56.1)

(f) Constipation 105 (33.4) 209 (66.6)

(g) Weight loss 84 (26.8) 230 (73.2)

7. Do you suffer from any medical

conditions (i.e. diabetes, high bloodpressure, asthma etc.) that require regular

medication?

121 (38.5) 193 (61.5)

8. Where do you source information before purchasing any

medication?

(1) Healthcare professional 218 (69.4) 96 (30.6)

(2) Friend/family member 106 (33.8) 208 (66.2)

(3) Internet 29 (9.2) 285 (90.8)

(4) Advertisement 22 (7.0) 292 (93.0)

Table 3 Answers to questions on awareness of adverse drug reactions, drug interactions and self-medication practices

Questions Yes n (%) No n (%)

Do you believe that over-the-counter medicines are as effective as those prescribed by the doctor? 197 (62.7) 117 (37.3)

Would you consult a pharmacist before buying any medication from the pharmacy? 273 (86.9) 41 (13.1)

Are you aware that certain medication/supplement may cause an adverse drug reaction? 278 (88.5) 36 (11.5)

Are you aware that certain medication/supplement can interact with food or other medication? 61 (19.4) 253 (80.6)

Do you inform your doctor/pharmacist you are taking other medications/supplements? 188 (59.9) 126 (40.1)

Do you read the label that comes with your medication? 282 (89.8) 32 (10.2)

Do you know the name of your medications? 248 (79.0) 66 (21.0)

Do you check the expiry date on your medications before and after purchasing? 270 (86.0) 44 (14.0)

Do you carry your medications with you regularly? 138 (43.9) 176 (56.1)

Do you keep leftover medication? 171 (54.5) 143 (45.5)

Int J Clin Pharm (2011) 33:794–799 797

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by Chui et al. [14] that showed that more than half of the

participants never consulted a pharmacist on how to man-

age minor ailments.

In general, factors influencing decisions for self-medi-

cation include one’s past experience and social knowledge;

real or perceived symptom states; advertising and promo-

tion; and the lay referral network [6]. The overall sources

of information show that self-medication practices among

adults in this survey are not influenced by advertisements

or the internet but could probably be attributed to past

experience of using medication or interaction with a doctor

or pharmacist.

Among the respondents surveyed in this study, 88.5%

were aware of adverse drug reactions (ADR). This per-

centage is much higher than that reported in other coun-

tries. Suleman et al. [12] revealed findings that more than

80% of their participants had no idea of the potentially

dangerous effects of medicines without the advice of health

professionals.

The high community awareness of ADR could be har-

nessed as a potential source of pharmaco-vigilance moni-

toring in the country. In Malaysia, adverse drug reactions

are reported to the National Pharmaceutical Control

Bureau, where a committee, namely the Malaysian

Adverse Drug Reaction Committee appointed by the Drug

Control Authority monitors the safety profiles of drugs

registered in Malaysia [15]. Awareness that certain medi-

cations or supplements can interact with food or other

medication was low, however (19.4%). Potential risks

arose because a considerable proportion of participants

were also taking vitamins and herbal supplements. A study

by Indermitte et al. [16] in Basel, Switzerland demon-

strated that of 1,183 customers, 116 (26.7%) regular cus-

tomers were exposed to potential drug interactions within

their prescribed drugs and in 28 (6.5%) multiple (C2)

potential drug interactions were found. Lack of awareness

of drug interaction could pose health hazards in terms of

adverse reactions and prolonged suffering owing to unin-

tended or unrecognized interaction, as described by

Kaufman et al. [9]. Hence, appropriate self-medication or

informed decisions of consumers to self medicate is

crucial.

The health authorities of Malaysia have carried out

nationwide campaigns to educate the public on knowing

their medications. Results revealed that a high percentage

of participants read their medication labels (282, 89.8%)

and 248 (79%) knew the name of their medications.

Awareness of brand names and generic names, however,

was not assessed in this survey. A salient finding in this

study is that 270 (86%) of respondents checked expiry

dates on medications before and after purchase, 138

(43.9%) carried them regularly and, surprisingly, a large

number admitted to keeping leftover medication (171,

54.5%). Most of these respondents had a tertiary education

background. Responses to these statements may reflect

self-medication practices as consumers could reuse the

medication for future conditions. This is similar to a find-

ing by Abosede [7], which showed that more literates kept

and used leftover drugs. Among the issues of concern with

regard to this practice are deterioration of the quality of

drugs, resistance of antimicrobials and treatment failures.

These issues could be addressed by pharmacists through

implementation of pharmaceutical care in community

pharmacies to alleviate the problem [12].

Limitations

This study had several limitations that may affect its gen-

eralization. Convenience sampling and self-reported

information do not rule out selection bias, the possibility of

socially desirable responses, and probable variation in data

collection, and hence may not reflect the actual behavior

and/or practice of adults. Future studies may reveal dif-

ferent prevalences in other urban or rural settings. A sound

comparison with other studies was difficult owing to the

unique characteristics of each population, different

healthcare systems, methodologies used and small sample

size.

Conclusions

Overall, the practice of self-medication is prevalent in

Kuala Lumpur, Malaysia and could be observed at various

socio-demographic levels of the community. The study

revealed that 62.7% of participants believed that OTC

medicines were just as effective as those prescribed by the

doctor and 69.4% would seek a healthcare professional’s

advice before purchasing any medication. Lack of aware-

ness about the interaction of medications or supplements

with other food or medication was identified. Although a

large number of adults from a tertiary background knew the

name of the medications taken, read the labels and

informed the doctor and/or pharmacist that they were tak-

ing other medications or supplements, education on the

appropriate use of medication should still be emphasized at

all levels.

Acknowledgments The authors wish to thank all the participants

who provided their valuable responses in answering to the

questionnaire.

Funding None.

Conflicts of interest None.

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123

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