Introduction

Self-medication, if practiced rationally, allows people to manage minor ailments on their own and access drugs without obtaining a prescription from or visiting a health professional. This saves time used in visiting health facilities when people experience minor ailments and enables health professionals to focus on more severe issues [1]. Self-medication is the act of treating oneself with medication or other remedies without the guidance or prescription of a healthcare professional. This can involve using over-thecounter drugs, herbal supplements, or prescription medications obtained without a doctor’s approval or supervision [2]. This can involve purchasing over-the-counter drugs, herbal supplements, or other treatments, or using prescription medications obtained from sources other than a doctor or pharmacist. Self-medication is part of the concept of self-care, along with non-drug selftreatment, social support in illness, and first aid in everyday life. Self-medication allows individuals to play an active role in the management of their own health [2]. Although the practice enables people to be involved in their own healthcare and provides relief from minor symptoms or conditions, for it to be practiced safely, people must be able to accurately recognize symptoms, choose the most appropriate medications, and determine the appropriate dosage and dosage schedule, all while considering their medical history, contraindications, and possible side effects of the drugs [2,3]. If appropriately practiced, self-medication has the potential to reduce national healthcare expenditure and help reduce the costs of community-funded healthcare programs. Individuals are afforded convenience to attend to their own health concerns and have the opportunity to be educated on certain health issues. However, this may create the misconception that there is a drug treatment available for every health condition [4]. Additionally, relying solely on self-medication may lead individuals to delay seeking care from healthcare professionals, as they might falsely believe they have enough knowledge to treat their condition on their own. It is important to recognize the limitations of self-medication and to seek appropriate medical guidance when necessary. Globally, the prevalence of self-medication ranges between 11.2–93.7%, depending on the target population and country [5]. In developing countries, most people treat themselves by self-medicating. The prevalence of self-medication in developing countries ranges between 12.7–95%, which raises concerns regarding irrational use of medicines. Most medicines are dispensed in these countries without medical prescription or proper monitoring (up to 80% of all drugs purchased), and this is attributed to shortages of available healthcare services or healthcare services with trained healthcare workers being somewhat expensive [6,7]. Ghana faces several challenges with its healthcare system that affect the access to and quality of the healthcare services delivered. The country’s National Health Insurance Scheme (NHIS) only financially protects 35% of the country’s population. Thus, healthcare costs remain high and are considered to be out of the financial reach of most Ghanaians. Out-of-pocket expenditure also remains high (53% in 2018) and can force people into poverty [8]. According to Agblevor, Missodey [9], consumers directly demand 82.5% of the drugs bought in urban chemical shops in Ghana. In rural areas, 78% of the drugs bought are directly demanded while only 1.5% are purchased using a prescription. The potential risks of self-medication include incorrect self-diagnosis, delays in seeking medical advice when needed, infrequent but severe adverse reactions, dangerous drug interactions, incorrect manner of administration, incorrect dosage, incorrect choice of therapy, masking of a severe disease, and risk of dependence and abuse [10]. Among health professionals, inappropriate self-medication can have effect on efficiency and productivity. It may risk the lives of not only those practicing but also those around them [11]. For health professionals, this will also put the lives of the patients they manage at risk. Limited literature on the prevalence and practice of self-medication among health professionals makes it difficult to determine what factors are associated with the practice of self-medication among health professionals. Therefore, this study aimed to determine the prevalence of and factors associated with self-medication among health professionals at Cape Coast Teaching Hospital, Ghana, and help policymakers control self-medication in Ghanaian hospitals by facilitating informed decision-making.

Methods and Materials

The cross-sectional study was conducted among the staff of Cape Coast Teaching Hospital, Ghana from September 2022 to October 2022. The data was collected through an online survey. Proportionate sampling was used, and the sample size of 346 staff was determined using Cochran’s formula (n = (Z2 P(1-P))/d2). Participation in the study was voluntary and anonymous, and the data obtained is kept confidential. The study was reviewed and approved by the Ethical Review Committee of the Cape Coast Teaching Hospital, Ghana. The questionnaire used in this study was adapted from previous studies on the prevalence and determinants of self-medication practice among selected households in Addis Ababa [7]. The questions were further reviewed and refined by experts in the medical and pharmacy professions to ensure accuracy and appropriateness for this study. The questionnaire encompassed information regarding the respondent’s educational level, job category, monthly income, health insurance status, and perceived severity of the condition for which they self-medicated. Covariates such as age, gender, religion, place of residence, and marital status, which are known risk factors for self-medication, were also included. The collected data was analysed using Jamovi version 2.2.5. The collected data was analysed and summarized using descriptive and inferential statistics. The results were presented in tables, and graphs. Multivariable logistic regression analyses were used to determine factors that influence self-medication. Associations were considered significant when the p-value was less than 0.05. In this study, self-medication was defined as the act of choosing and using medications or drugs alleged to treat, manage, and/or prevent a disease or health condition without a doctor’s prescription. The recall period used in the study was one year prior to the study. 

Results

Sociodemographic characteristics of the participants

Out of the initial 346 participants, 277 responded to the study. After data cleaning, 271 participants remained for analysis. Table 1 provides an overview of the sociodemographic characteristics of the study’s participants. Among the 271 participants, 53.9% were between the ages of 30 and 39, 37.3% were below 30 years old, and 8.8% were 40 years old and above. In terms of gender, 61.6% of the participants were female and 38.4% were male. In terms of educational level, 46.5% of the participants had a Bachelor’s degree, 38% had a diploma-level tertiary education, and 1.5% had a basic-level education (primary to secondary/high school). With regard to marital status, 56.5% of the participants were single, 42.8% were married, and 0.70% were in other forms of relationships. The majority of participants (91.1%) were Christians, while 6.3% identified as Muslims, and 2.6% belonged to other religions. In relation to residence, 75.6% of the participants lived within a 10-minute drive away from the hospital, while 12.9% lived further away. Among the participants, nurses and midwives accounted for 49.8% of the sample, administrative staff comprised 24%, and medical doctors made up 11.1%. In terms of work experience, 59% of the participants had 5 years or less of experience, while 10.3% had more than 10 years of experience. Concerning monthly income, 67.5% earned between 2000–3999 cedis ($169.84-$339.59), 18.8% earned below 2000 cedis ($169.84), and 13.7% earned 4000 cedis or above (>$339.67). Over half of the participants (56.8%) had 1 to 3 dependents, while 16.2% had no dependents. In terms of annual healthcare expenditure, 33.6% spent between 100–499 cedis, while 17.3% spent 2000 cedis or above (≥ $169.84). The majority of participants (91.9%) had an active NHIS subscription, and 22.5% had additional medical coverage in addition to the NHIS.

Table 1: Sociodemographic characteristics of the participants.

Prevalence of self-medication

Figure 1 illustrates the self-medication behaviour among the participants. According to Figure 1, out of the total participants, 219 (81%) had engaged in self-medication within the 12 months preceding the study. Among those who self-medicated (219 participants), 160 (73.1%) did so one to three times during that period, while 13 (5.9%) self-medicated 10 times or more. Among the participants who self-medicated, 120 (54.8%) self-medicated due to their familiarity with the disease and drug used, 34 (15.5%) cited emergency reasons, and 23 (10.5%) mentioned poor services offered at the hospital as their motivation. Only 0.9% of participants reported self-medicating because they were too far from the hospital. Additionally, 94 (42.9%) of the participants obtained information for medication from health professionals, 60 (27.4%) used prescriptions from previous treatments, and 49 (22.4%) relied on their own expertise to self-medicate. The majority of  participants (205, 93.6%) obtained their medication from pharmacies or drug stores.

Figure 1: Showing self-medication behaviour among participants in the past 12 months. [ ] represents variables.

Differences in self-medication practice among participants according to predisposing, enabling, and health need factors

Table 2 displays the differences in self-medication practice based on predisposing, enabling, and health need factors among participants. The prevalence rate of self-medication among participants was 81%. In terms of predisposing factors, educational level and occupation did not show significant association with self-medication prevalence (p-values = 0.835 and 0.409, respectively). The practice of self-medication was higher among participants with Masters’ degrees (84%) and lowest among participants with a diplomalevel education (69.2%). The prevalence was 83.7% among nurses and midwives, 83.3% among medical doctors, and 73.8% among administrative staff. With regards to enabling factors, participants’ income and health insurance status did not exhibit significant association with self-medication prevalence (p-values = 0.138 and 0.315, respectively). The prevalence of self-medication was 89.2% among staff who earned 4000 cedis and above per month, and 72.5% among staff who earned below 2000 cedis per month. Regarding health need factors, participants’ perceived health and severity of health needs were significantly associated with self-medication practice (p-value < 0.001 for each). The prevalence of self-medication was higher among participants with health needs (88.3%) compared to those with no health needs (53.4%), and higher among participants who perceived their health needs to be mild (93.3%) compared to the other groups. The prevalence was 76.7% among participants who perceived their health needs to be severe and 53.4% for participants who perceived their overall health to be good. Religion and perceived safety were also significantly associated with self-medication among the participants (p-value = 0.029 and < 0.001, respectively).

Table 2: Differences in self-medication practice according to predisposing, enabling, and health need factors.

Factors influencing self-medication among participants

Table 3 presents the factors that influence self-medication among participants. In the bivariate logistic regression analysis, only the perceived severity of health need was found to significantly influence self-medication among health professionals. The odds of selfmedicating were higher for participants with mild, moderate, and severe health needs compared with those in good health (OR = 12.07, 95% CI, 4.79 – 30.42; OR = 5.38, 95% CI, 2.37 – 12.22; OR = 2.86, 95% CI, 1.06 – 7.71, respectively). When adjusted for covariates, the odds were even higher among participants with mild, moderate, and severe health needs compared with those in good health (aOR = 18.68, 95% CI, 5.76 – 60.62; aOR = 10.35, 95% CI, 3.36 – 31.88; aOR = 4.91, 95% CI, 1.28 – 18.83, respectively).

Table 3: Factors influencing self-medication among participants.

Discussion