Study setting, design, and period
Institutional based cross-sectional study was employed to assess knowledge, attitude and associated factors towards self-medication among health professionals at University of Gondar Comprehensive Specialized Hospital, northwest Ethiopia, which is located 728 Km away from Addis Ababa, the capital city of Ethiopia. University of Gondar Comprehensive Specialized Hospital is a teaching Hospital which acts as a referral center for the nearby General Hospitals. It provides referral services for over 5 million inhabitants in the northwest region of Ethiopia. The data collection period was from June to August, 2019.
Population
We used all University of Gondar Comprehensive Specialized Hospital Health professionals working in different departments of the Hospital. The study population was all University of Gondar Comprehensive Specialized Hospital Health professionals working in different departments of the Hospital who were present at the time of data collection.
Inclusion and exclusion criteria
All Health Professionals working in University of Gondar Comprehensive Specialized Hospital were included. Health Professionals who were severely ill during the data collection period were excluded.
Sample size calculation and sampling technique
The sample size (n) was calculated using single population proportion formula with the assumptions of the proportion =0.5 (no previous study in Ethiopia), 95% uncertainty interval, and margin of error (d) = 5%. After adding non response rate of 10%, the final sample size was 423. Simple random sampling technique was used for selection of Health Professionals to be included in the study.
Data collection procedure
We used semi-structured, pretested self-administered questionnaire to collect the required data after preparing the questionnaire by reviewing different literatures (2, 4, 27). The questionnaire consisted of different items regarding Sociodemographic characteristics, self-medication practice related questions, knowledge related questions and attitude related questions. Four BSc Nurses were recruited to distribute and return the questionnaire and facilitate the collection process.
Variables of the study
Dependent variable: Self-medication practice
Independent variables: Sex, age in years, marital status, educational level, work experience, working setting, Profession, working hours per week, work stress , knowledge and attitude towards self-medication.
Operational definition
Knowledge: Respondents were asked twenty two knowledge questions about whether they know antimicrobial resistance, they know self-medication mean, they know medication administration requires basic knowledge about drug action, they know changing of time when taking the drug has hazard, they know antihypertensive drugs could not be discontinued when blood pressure returns to the normal range, they know over use of paracetamol will cause liver toxicity, they know antacid should be chewed before swallowed, they know improper use of medication can result antimicrobial resistance, they know not taking full dose of the medication do have an effect, they know self-medication can mask signs and symptoms, they know drug use during pregnancy should care, they know all medications have its own adverse effects, they know taking medicine with food, drink, tea, or alcohol can interfere with the effect of medicine, they know antibiotics often side effect such as diarrhea, they know antibiotics cause negative effects on body’s own bacterial flora, they know to terminate the therapy immediately if one feels better after only partially antibiotics, they know bacteria can become resistance to antibiotics, they know people can become resistance to antibiotics, they know antibiotics use for animals can reduce possibility of effective antibiotics treatment for humans, they know antibiotics resistance can spread from animals to humans and they know antibiotics resistance can spread from person to person. . Study participants who scored mean and above of the questions were considered as having good knowledge.
Attitude: Respondents were asked thirteen attitude questions whether they strongly disagree, disagree, agree and strongly agree about self-medication is part of self-care, pharmacists are good source of information for minor medical problems, the course of medicine should be complete although the symptoms subside, health care workers have good ability to treat symptoms ,self-medication is acceptable for health care workers, self-medication would be harmful if taken with without proper knowledge of drug and disease, medical license would be essential for better administration of drugs, the course of medication should be complete although the symptoms subside, they should be careful with non-prescribed over the counter medicine, health care workers should check the accompanied medication leaflets, self-medication is not acceptable at all and it would be harmful, left over antibiotics can be saved for personal future use and left over antibiotics should be taken back to the pharmacy. Study participants who scored mean and above of the questions were considered as having positive attitude.
Statistical analysis
Epi-info 7.1 was used for data entry and then exported into SPSS version 20 for computing, recoding, and statistical analysis. Mean with standard deviation (SD), and frequency with percent were computed to descriptive results of the study. Logistic regression was used to explain the relationship between knowledge and Attitude with the independent variables. Bivariable analysis was executed to determine crude association between knowledge and Attitude with each independent variable. Independent variables with a p-value of < 0.2 were selected for multivariable logistic regression. A variable with a p-value of ≤ 0.05 with 95% uncertainty interval was treated as significant factor for knowledge and Attitude of self-medication.
Data quality control
Quality control was considered starting from questionnaire design until the analysis process. It was pretested and facilitators were trained about the purpose of study and ethical issues in the process of data filling. Pretest was done among 20 health professionals outside of the study area and we amended the questionnaire based on difficulties we face during pretest.
Reliability
We computed Cronbach’s alpha to test internal consistency of the tool which was used to assessing knowledge and attitude of health professionals towards self-medication practice. The result showed that the alpha coefficient is 0.702 for knowledge and 0.655 for attitude which are acceptable according to Malley (28).