MILD ANALGESICS TAKING BEHAVIOR AMONG

ACADEMIC STAFFS OF THE COLLEGE PUBLIC

HEALTH AND MEDICAL SCIENCES, JIMMA
UNIVERSITY

By: Hawi Befekadu

A RESEARCH PROPOSAL SUBMITTED TO DEPARTMENT OF

PHARMACY, COLLEGE OF PUBLIC HEALTH AND MEDICAL
SCIENCES, JIMMA UNIVERSITY, FOR PARTIAL FULFILLMENT
OF THE REQUIREMENTS OF BACHELOR DEGREE OF
PHARMACY (B. PHARM)

April, 2012
Jimma, Ethiopia
 MILD ANALGESICS TAKING BEHAVIOR AMONG ACADEMIC
STAFFS OF THE COLLEGE PUBLIC HEALTH AND MEDICAL
SCIENCES, JIMMA UNIVERSITY

By: Hawi Befekadu

Advisor: Jemal Hussien (MSc, B.Pharm; Asst. Professor)

April, 2012
Jimma, Ethiopia
 Proposal Summary

Background: Most pain experienced by the general public is treated without consulting a
health professional. The most frequently self-medicated mild analgesics are Paracetamol and
Ibuprofen.

Objective: To assess the analgesic taking behavior of Academic staffs among the college of
public health and medical science.

Method: A cross sectional study will be conducted from June 15 to 25. A validated data
collection tool self-medication scale for analgesics will be used to assess the analgesic taking
behavior. The compiled data will be subjected for statistical analysis using SPSS version 16.

Result: A result will be presented following analysis using tables and graphs.

Conclusions: conclusion will be made based of the results of the study.

i
 Acknowledgment

I would like to express my deepest gratitude to my advisor Ato Jemal Hussien for his
continuous advice, guide and suggestion as well as for his support during literature review.
Also I would like to thank Abdi Befekadu, my elder brother, for his help during typing and
editing this proposal.

ii
 Table of Contents

Contents

Proposal Summary.................................................................................................................................i
Acknowledgment..................................................................................................................................ii
Table of Contents.................................................................................................................................iii
List of Acronyms...................................................................................................................................v
Operational Definition..........................................................................................................................vi
1. Introduction...................................................................................................................................1
1.1. Background...........................................................................................................................1
1.2. Statement of the problem...........................................................................................................3
1.3. Significance of the study............................................................................................................4
2. Literature review...............................................................................................................................5
3. Objectives.........................................................................................................................................9
3.1. General objective.......................................................................................................................9
3.2. Specific objectives.....................................................................................................................9
4. Participants and methods.................................................................................................................10
4.1. Study area and period...............................................................................................................10
4.2. Study design.............................................................................................................................10
4.3. Population................................................................................................................................10
4.3.1. Source of population.........................................................................................................10
4.3.2. Study population...............................................................................................................10
4.4. Sample size and sampling technique........................................................................................11
4.4.1. Sample size........................................................................................................................11
4.4.2. Sampling technique...........................................................................................................12
4.5. The study variables...............................................................................................................12
4.6. Data collection.........................................................................................................................13
4.6.1. Data collection tool...........................................................................................................13
4.6.2. Data collection process......................................................................................................13
4.7. Data analysis............................................................................................................................13
4.8. Pretest.......................................................................................................................................13

iii
 4.9. Ethical consideration................................................................................................................13
4.10. Limitation of study.................................................................................................................13
Reference............................................................................................................................................14
Questionnaire......................................................................................................................................16

iv
 List of Acronyms

DRPs Drug related problems

GIT Gastro-intestinal tract

NSAIDs Non-steroidal anti-inflammatory drugs

OTC Over the counter

RTIs Respiratory tract infections

SMS Self-medicating scale

WHO Word health organization

v
 Operational Definition

Dose:-The amount of mild analgesic to be taken during mild/severe pain.

Pain:- In this paper, pain refers to the experience of head ache, period

pain,sports injury, migraine and others.

Mild analgesic:-Is pain relievers including paracetamol, aspirin, ibuprofen, diclofenac and
related to class of drugs that are widely used to cope with headache, fever and other milder
pain.

Analgesic taking behavior: The tendency to take mild analgesics for relieving pain. In this
study this is defined to be reluctance, don’t think twice and run its course.

vi
 1. Introduction

1.1. Background

To make sure that drugs are being used rationaly the patient needs certain information about
the medication. They should know its name; understand what it is for and how it is meant to
help. They must also know often, weather with food or an empty stomach and for how long
they should know what to do if the medicine does not work as expected or has unwanted
effects (1).

Most illness do not come to the attention of physicians as many of them are either tolerated
or self-medicated self-medication is commonly employed practice with an attempt to
normalize the perceived illness. Self-medication is the obtaining consuming of during
without the advice of physician of either for diagnosis prescription or surveillance of the
treatment (2).

Most pain experienced by the general public is treated without consulting a health
professional. In line with this mild analgesic such as parecetamol and ibuprofen are amongst
the most commonly used over counter (OTC) drugs in the western world (3).

Several studies revealed the presence of different factors that influence self-medication
including patient satisfaction with the health care provider coast of drugs, educational level,
social economic factors, age and gender (4).

The increasing need of analgesic medication will require more and better education of both
the public and profession to avoid the irrational use of drugs. If action is not taken, the
danger of drug interaction and side effect could increase because it is expected since the use
of OTC many not be recorded or reported to the doctor (5).

More over the prolonged use of mild analgesics to treat daily headache can lead to
dependence and consequent rebound headache on withdrawal (6).

1
 Given the prevalence of pain and mild analgesics use and the associated risks even when
used appropriately it is important to understand how people view their risks and benefits.
There is good information on demographic correlates of mild analgesics use (7).

The aim of this study is to fill the current gab in knowledge by examine which beliefs are
associated with the use and over use of mild analgesics among academic staffs of the collage
public health and medical science at Jimma university.

1.2. Statement of the problem

The extent and level of awareness of analgesics use is low among different peoples. Thus list
of major problem with respect to analgesics are:
2
 - Poor awareness regarding the level of responsibility.
- Poor awareness regarding the risk of analgesics use.
- Lack of knowledge or misunderstanding related with analgesics use.

OTC drugs are readily available, there are a number of risks associated with their use
paracetamol is one of the leading causes of drug related poisoning (8). High doses being
particular harmful to the liver, in addition, NSAIDs such as ibuprofen or asprin can lead to
potentially serious side effects, particularly gastrointestinal inflammation and ulceration (9).

The group of medications in highest demand was NSAIDS. This is matter of concern because of
the relationship between the use of NSAIDS and gastrointestinal damage. The incidence of high
digestive hemorrhage is 650 cases per 1,000 inhabitants per year and 40% of these are attributed
to acetylsalicylic acid (10).

Also, one of the risks involved in the regular and unsupervised use of NSAIDs is intestinal
nephritis. It is consider that 11% of all terminal renal insufficiency cases, whose incidence is
about 110 new cases per 1,000,000 are attributed to analgesics (11).During hospitalization 164
patients died (3.2%) and 812 others (16%) had non-fatal cardiac cerebral, renal or GIT ischemic
complications. Among patients received asprin (up to 650mg) within 48 hours often
revascularization, subsequent mortality was 1.3% (40 to 2999 patients) (12).

3
1.3. Significance of the study

The result of this study would contribute to the scientific community and to the public at large in
that:

 It enhances the level of awareness, confidence

 It reveals the level of behavior about the tendencies towards using milder analgesics.

 It will serve as input for concerned bodies.

 It serves as baseline data for researchers (scientific community)

4
 2. Literature review

In a survey of American consumer’s a third of all respondents admitted taking more than
recommended doses of non-prescribed product because they believed that they needed to do so
in order to treat their conditions effectively and 21% said that they rarely or never read the label
on such products (13).

Out of 333 students studying at a large English university campus of these 291 agreed to
participate two thirds treated with mild analgesics. One quarter of those who reported using
analgesics also exceeding the maximum dose the sample as a whole appeared to possess very
little awareness of the harmful effects that mild analgesics can cause (14).

In English university campus frequencies of symptoms reported and of use of analgesics in the
past month of the 291 respondents only, only 20 reported not experiencing at least one of the
following in the last month: headache (n= 227), hangover (n= 180), period pain (n=199), sport
injuries (n=80), migraine (n=14). 199 (73%) reported taking analgesics to relieve these
symptoms (14).

Of 304 undergraduate students, 93% reported having experienced pain in the past month,
studying at carding university unit kingdom. Factor analysis of the SMS revealed three factor
strictures which were named (reluctance, don’t think twice and run its course) ranged from 3 to
15 score and possessed a scale midpoint of 9. Nearly a quarter (24%) of the sample scored above
the midpoint of the ‘don’t think twice’ scale suggesting a strong belief in self-medicating with
analgesics. Result for the ‘reluctance’ scale showed that 80% of students scored above the
midpoint of the scale suggesting a strong belief in waiting to see if the symptoms get worse
before self-indicating. Nearly half of students (43%) scored over the midpoint of the ‘runs its
course’ scale, indicating a belief to prefer to let the body deal with the symptoms naturally (15).

In unit kingdom of the 282 students indicated that they would use analgesics for pain relief they
mean rating of severity of pain for analgesics use was 5.2. Nearly the quarters (213, 74%)
indicated that they had taken an analgesic to relieve a pain experience in the last month. The
most common analgesics taken were parecetamol (17%) or ibuprofen (57%). The total number of
doses taken over the past month ranged from 1 to 112 (15).
5
Of those who experienced pain in the last month, 258(93%) reported trying some form of non-
pharmacological treatment before taking an analgesics and of those who took an analgesics
(208), all expect 17(8%) tried one or more alternative form of pain relief first. These including
resting (79% ), drinking water (64%), using a hot water bottle (38%) having a massage (14%),
using ice (12%), herbal therapy(2%), physiotherapy (1%), osteopathy (0.5%) or other (6%) (15).

At university of Modena, Italy The majority of the patient had positive attitude towards OTC
analysis, which they believed to be more adequate than prescription drugs for acute treatment of
their headache. Their headache characteristic of the 280 patients (233 women and 47 men), 183
(93%) migraine suffers, 14(7%) episodic tension type headache suffers, 39(46%) patients with
chronic tension type headache and 45 (54%) with diagnosis of migraine with inter-paroxysmal
headache (16).

Of the 258 patients using analgesics, 49% thought it was correct to take them only when pain
become intolerable, 43% at the onset of pain and a minority, 8% before the pain actually started.
In fact, an even larger majority, 56% said they actually took the analgesics only when the pain
becomes unbearable, 41% at the onset, and only 3% before onset (16).

A high school in Helsingborg Sweden’ A total of 245 students (99%) took part, 138 females and
107 males. OTC has been used occasionally by 37.7% of the girls and 62.6% of the boys, while
10.9% and 6.5% respectively reported daily use, 39.1% and 15% respectively reported at least
once in month. Analgesics were the most frequently used OTC (17).

Drugs related problems had been experienced by 31.1% of the female and 19.6% of the male
students the most common of which was therapy failure. The finding that one in three girls and
one in five boys in our study had experienced at least one DRP with an OTC was un expected
poor knowledge of drugs and low awareness of the risk involved may be two of the reason (17).

In Sweden most students had experience of more than one non-prescription drug, as the boys
reported a total of 207 and the girls 372. Painkillers were by far the most common paracetamol
accounting for 46.6% and ibuprofen for 27.8%. Reasons behind the choice, a specific OTC drug
had been chosen by student on the recommendation of their parents (56.0%), physicians (11.1%),
pharmacy (7.7%), advertising (9.0%), and friend (5.5%) (17).

6
In the city of Valdivia, southern Chile, Of 909 surveyed customers 75% of self-medicate of
these, 31% stated that they commonly self-medicate due to suffering from light symptoms such
as headaches (19%), the common cold (3.3%), sore muscles (6.2%) and bone pains (5.3%). The
most requested medication groups were NSAIDs (33.2%), paracetamol (15.2%), anticoagulants
(4.7%), antiulcer agents (4.1%) and migraine headache analgesics (3.1%)(18).

The main reasons that read need to self-medication were minor symptoms(23%), repeated
symptoms, i.e. patients using the same drug for symptoms already suffered (11%), a fast solution
to the problem (10%) ,and lack of time to see a doctor (9%) other reasons applied to 25% of the
patients. A drug recommendation from a family member had been made to 6.4% and from
friends to 4.1%. The use of prior prescription had a frequency of 46.7%. 7% were influenced by
advertising and 6% said they had received from pharmacy (18).

In city of Amman, Jordan self-medication was common practice among Jordanians (42.5%). The
study of identified in Jordan patients potential reason to self-medicate (n=240), which were
mainly their ailment being minor 111(46.4%), saving the time 90(37.7%), saving physicians
visiting coast 75(31.4%), being afraid to discover a more serious disorder 14(5.9%) and having
no trust in medical doctors 9(3.8%) (19).

The factors that most commonly influenced people’s choice non-prescription were: advice
received from pharmacy staff 41(14.2%), neighbor/friends 61(17.6%) and informal advice by
other health professions such densities or nurse 76(21.9%) and pervious experience 210(60.5%)
(19).

One quarter (23.9%) of the Jordanian admitted to misuse medication against doctor where
130(16%) admitted to under use and 73(9.0%) admitted to over use their drugs the justification
for over use were better control of symptoms (51.7%), need more effect (27.6%) and looking for
faster healing (20.7%) (19).

At university Sains, Malaysia, Amongst 481 female student, 93.1% students stated that they
stored medicine in their rooms, while 340(70.7%) stated that they stopped taking prescribed
medicine without counseling doctor. The prevalence of self-medicate was 389 (80.9%). The
most common reason for self-medication were related to their knowledge of their ailment and its

7
treatment (58.0%), 14.4% thought it saved time and 8.5% motioned that medication given by
provider was not effective (20).

The most common symptoms were Ortorhinolarngology problems (22.5%), followed by

respiratory disease (19.6%), GIT disease (18.1%) and headache /fever (16.8%) commonly used
medicines were analgesics and antipyretics (30.2%), ear, nose and throat drugs (10.8%). GIT
drug (8.5%) anti infections (7.3%) and herbal (3.5%) (20).

At the university of logos, Nigeria headache prevalence was 46.0% and was significantly higher
in women than one men (62.8% vs 34.1% ).prevalence of tension type headache was higher than
that of migraine (male 12.3%, female 19.2%), Migraine was three times more common in
women (10.3% vs 3.2%). A family history of headache was present in 22.0% only 4.6% sought
medical assistance, where as 68.2% took non-prescription drugs mainly simple analgesics
specific drugs for migraine and tension type headache were rarely used (21).

In study done in Addis Ababa, the most frequently reported illness that promoted drug
consumers for self-medication were found to be gastrointestinal disease, headache fever or
respiratory tract infections. The most common reason for self-medication were non seriousness
of the disease and prior experience about the drugs more than 50% of the drug consumers
requested drugs by specifically mention the names of the drugs and one fifth of them by telling
their illness /symptoms. The most frequently requested category of drugs were analgesics/
antipyretic (more than 30%), antimicrobials (more than 25%) and GIT drugs (more than 17%)
(22).

In study done in Jimma town in 2000, out of 152 ill people 27.6% were self-medicated. The most
frequently reported illness was headache (60%). Most of the drugs were obtained from drug
retail outlets (52.2%). The relatively lesser coast (35.7%) was the major reason for self-
medication (23).

8
 3. Objectives

3.1. General objective

 To assess mild analgesic taking behavior among academic staffs of college of public
health and medical sciences, Jimma University.

3.2. Specific objectives

 To determine the frequency of pain experiences

 To determine the tendency of the mild analgesics taking behavior

 To determine the analgesic use pattern.

 To determine the predictors of use mild analgesics

9
 4. Participants and methods

4.1. Study area and period

The study will be conducted among academic staffs of Jimma University College of public
health and medical science. Jimma town, the capital city of Jimma administrative zone, is located
335kms south west of Addis Ababa, the capital city of Ethiopia. The study will be conducted
from May 15 to 25-2011.

4.2. Study design

A cross sectional study will be conducted.

4.3. Population

4.3.1. Source of population

All Academic staffs of the college of public health and medical science (Medical(143),
Pharmacy(68), Dentistry(32), Nurse(77), Health officer(112)) will be considered as source of
population.

4.3.2. Study population

All Academic staffs of the college of public health and medical science involving the following
inclusion criteria will be considered as study population:

 Voluntary participants.

 Available in the office setup.

10
4.4. Sample size and sampling technique

4.4.1. Sample size

The sample size for the study will be determined by using the following formula:

z 2 pq
n=
d2

Where: z= the standard normal value at confidence interval of 95% =1.96

p= Prevalence of self-medication is estimated at 50% q= L-P=0.5

d= Margin of sampling error tolerated

n= Minimum sample size required

Therefore, the sample size is:

( 1.96 )2( 0.5)(0.5)

n= =384
(0.05)2

Having the above information for population greater than 10,000 the minimum sample size will
be 384. In this case total population is 444 from graduating class of college of public health and
medical science. So to determine the sample size, population size correction was done as
follows:

n
r=
n Where: r= correct sample size
1+
N

N= Total academic staffs study population (444)

n= Minimum sample size

384
r= =206
1+384 /444

11
4.4.2. Sampling technique

A two stage sampling technique will be used. First the Academic staff’s samples will be
proportionally assigned to each department. From each department respondents were enrolled
using convenient sampling

S/N Dept No.

1 Epidemiology 13 15
2 HE & Behavioral science 19 21
3 Health Service management 9 9
4 HO 4
5 Pharmacy 25 25
6 Population and Family Health 7 7
7 Anesthesia 6 6
8 Biomedical Science 40 44
9 Dentistry 8 8
10 Ophthalmology 7 7
11 Medical Laboratory and path 72
12 Psychiatry 6
13 Internal Medicine 6-8
14 Pediatrics
15 Surgery
16 Gynecology 3
17

College of public health and medical science academic staffs .

Medicine = 143 Pharmacy = 68 Dentistry = 32 Nurse = 77 Health officer =112

Sample of academic staffs proportionally

66 32 15 36 58
12
The total number of academic staffs enrollment were 206

4.5. The study variables

 Sex

 Age

 Department

 pain experience( last month)

 Mild analgesic use

 Analgesic taking behavior

 Type of mild analgesics

4.6. Data collection

4.6.1. Data collection tool

A structure and validated questioner Self-medication scale (SMS) developed by James and
French, (2008) will be used to collect the data.

4.6.2. Data collection process

The questioner will be distributed (self-administered) to volunteer academic staffs to filled in

their filled questioner will be collected in the following day.

4.7. Data analysis

The collected data was analyzed using computer software SPSS-version 16 and chi-square (x 2)
was applied where applicable to compute different variable.

13
4.8. Pretest

The questions tested in similar study setting before the actual data was collected.

4.9. Ethical consideration

 Permission for data collection will be asked pharmacy department.

 Informed consent and Academic staffs’ was obtained from their departments.

 The aim of the study will be explained to the academic staffs’.

4.10. Limitation of study

 Some respondent were not willing to fill out the questionnaires.

 Some of the questionnaires distributed to academic staffs were not returned back.

 Shortage of time.

Reference

1. WHO/Action programme on essential drug, 1988 essential drugs monitor (7): 19(Col, 3-4).

2. Tefera A, Alemayehu W. Self-medication in three towns of north west Ethiopia, Ethiopia

health facility development, April, 2001, 15(1):25.

3. Blenkinshopp A, Band C. Over the counter medication, London: British medical

association: 2005. ISBN 0-954 8965-2-1.

4. Figueiras A, Caameno F, Gestal-Ostero JJ. Socio-demographic factors related to self-

medication in Spain. Eur J epidemiol, 2000;16:19-26.

5. Solomn W, Abebe G/mariam. Self-medication in Jimma town, Eth. journal of health

development, August 2003;17(2):111-115.

6. Steiner TJ, Fontebasso M. Headache. BMJ 2002; 325:881-6.

14
7. Porteous T, Bond C, Hannaford P, Sinclair H. How and why is non-prescription analgesics
used in Scotland? fam pract 2005; 22:78-85.

8. Hawton k, simkin s, Deeks J, Johnston A, waters k, et al. UK legislation on analgesic packs:

before and after study of long-t term effects on poisonings. BMJ 2004:329:1076-80.

9. Abbott FV, Fraser MI, Use and abuse of over the counter analgesic agents. J psychiatry
Neuro sci 1993;23:13-34.

10. Sam Alley WE, Griffin MR. The risks and costs of upper gastro intestinal disease attributable
to NSAIDS. gastroenterology clin North AM. 1996;25:373-96.

11. Richy F, Bruyere O, Ethgen O, Rabenda V, Bourenot G, Audran M, etal . Time dependent
risk of gastrointestinal complications induced by NSAIDS : a consensus statement using a
meta-analytic approach. Ann rhueum dis. 2004; 63:759-66.

12. Negl J. Med, Vol. 347, No. 17. October 24, 2002 www. Nejm.Org.

13. Americans at risk from self-medication, survey reveals. Am J Health syst pharm
1997;54:2664-46.

14. French DP, James Dh. Reasons for the use of mild analgesics among English students. Pharm
world sc; 2008:30(1):79-85.

15. French DH, James Dh. The development of the self-medicating scale ascale to measure
people’s beliefs about self-medication. Pharm world science 2008; 30: 794-800.

16. Ferrari A, Stefani M, stemieri S, Bertolotti M, stemeiri E. Analgesic drug taking: beliefs and
behavior among headache patients, headache 1997;37:88-94.

17. Westerlund M, Branstad JD and Westerlund T. Medicine taking behavior and drug related
problems in adolescents of a Swedish high school. pharm world sc: 2008;30:343-350.

18. Fuentes Albarran K, Villa Zapta L. Analisis and quantification of self-medication patterns of
customers in community pharmacies in southern chile. Pharm World sci(2008)30: 963-68.

15
19. Yousef AM, Al-Bakri AG, Bustanj Y. Wazaify M. Self –medication pattern in Amman,
Jordan. pharm world SC; 2008;30:24-30.

20. Ali SE, Ibrahim MIM Palain S. Medication storage and self-medication behavior amongst
Female students in Malaysia, pharmacy practice 2010; Vol.8 No. 4.

21. Ojini Fl, Okubade Jo Un, Danesi MA. Prevalence and clinical characteristics of headache in
medical students of the university of logos, Nigeria, Cephalgial April 2009;29(4): 472-77.

22. Tenaw A, Tsige GM. A prospective study on self-medication practices and consumers drug
knowledge in Addis Ababa. Eth. Journal of health development. February 2004;14(1): 1-10

23. Solomon W, Abebe GM . Self-Medication in Jimma town.Eth Journal of health

development . August 2003 ; 17 (2) : 111 -115.

Questionnaire

Instructions: This questionnaire is designed to determine the pattern of mild analgesics use
among Jimma university academic staffs and thus you are kindly requested to freely and
genuinely express your opinion and respond to the questions below. Your response is made
anonymous and thus you are not expected to write your name. Your response will be kept
confidential.

I. Socio-Demographic characteristics [5 Questions]

1.1 Department_____________

1.2 Age_________________

1.3 Sex: Male______ Female________

1.4 Religion:

a. Muslim c. Orthodox

16
 b. Protestant d. Others(specify)_________

1.5 Ethnicity

c. Oromo c Tigrai d. Gurage

d. Amhara e. Others(Specify)____________

II. Pain experience, mild analgesics use and Reason for use [13 questions]

(Please use  on the your response item)

2.1/ Have you experienced any of the following pain in last month?

a. Headache c. Sports in jury d. Period- pain

b. Hangover e. Back pain f. Migraine

g. Other (please specify)_______________________________

2.2/ How severe would your symptom need to be for you to use painkillers?

A. Not sever c. very severe

B. mild d. Never use painkillers

2.3/ Would you try any thing else to relieve your symptoms before using a painkillers?

a, Rest c. Herbal therapy (e.g., tea, Coffee, etc)

b, hot water bottle d, drink of water or soft drinks)

e. others please specify___________________________________________________

2.4/ How often would you take pain killers for the symptoms you experienced?

a, always c, usually

b, some times d, never

17
2.5/ Which analgesics pain killer (s) did you take?

a, Ibuprofen C, Asprin

b, Paractamol D, Diclofenac

e, Others (please specify)_____________________________________________________

2.6/ What are your possible reasons to choose the analgesic in Q #5?

a. Well tolerable b. reduced side effect

c. Cheap d. Produce fast action

e. Others (please specify)_____________________________________________________

2.7/ In your view, what is the most preferred and demanded analgesics to relieve your pain?

a. Asprin b. Paracetamol c. Diclofenac

d. Ibuprofen e. Others (specify)_______________________________________________

2.8./For your preferred (chosen) analgesic in Q(5):

a. What dose did/do you take at a time (once) (Please indicate both name and dose)?
________________________________________________________________________

b. What number of doses of the analgesic did (do) you take in the past month? __________

c. For how many days did you take the analgesic? ___________________

2.. Do you know or aware that some analgesics have risk(s)?

A. Yes B. No

2.10/ If yes to Q7, which of following risk(s) are potential risks of analgesics?

18
 a. Gastrointestinal damage

b. Interstitial nephritis

c. Others (please specify)_______________________________________________

2.11/ Did you have any experience of taking mild analgesics in over overdose?

a, Yes b, No

2.12/ If you yes, what is/are your reason (s) [multiple answers are possible.

a. Better control of symptoms

b. Need more effect

c. Looking for faster healing

d. Others (specify)_______________________________________________________

2.13/ From where do you get or access for mild analgesics?

A. Friends B. Pharmacy

C. Clinic d. Others (specify) ________________________________

III. Exploratory factor analysis [ questions]

The following items are designed to assess the analgesic taking behavior (Please use  on the
your response item)

I ‘Reluctance: a preference to self-medicate according to the severity of the symptoms

3.1. I take tables only I am in a lot of pain

a. Strongly agree b. Agree c. Uncertain

d. Disagree e. Strongly disagree

19
3.2. I only something if it is really bad?

a. Strongly agree b. Agree c. Uncertain

d. Disagree e. Strongly disagree

3.3. Only take pain killers when its absolutely necessary.

a. Strongly agree b. Agree c. Uncertain

d. Disagree e. Strongly disagree

II. ‘Don’t think twice: a high tendency to self medicate

3.4.I always take something if I am in pain

a. Strongly agree b. agree c. Uncertain

d. Disagree e. Strongly disagree

3.5. If I am in pain I need a medication to fix it.

a. Strongly agree b. agree c. Uncertain

d. Disagree e. Strongly disagree

3.6 .I don’t hesitate to take pain killers

a. Strongly agree b. agree c. Uncertain

d. Disagree e. Strongly disagree

III. ‘Run its course’: a preference for the body to cope with minor ailments

naturally

3.7. I prefer to let my body fight it?

a. Strongly agree b. agree c. Uncertain

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 d. Disagree e. Strongly disagree

3.8. I do nothing just let it pass

a. Strongly agree b. agree c. Uncertain

d. Disagree e. Strongly disagree

3.. I try ignore it and get on with it.

a. Strongly agree b. agree c. Uncertain

d. Disagree e. Strongly disagree

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