Over-the-counter (OTC) medications are an integral part of modern healthcare systems, offering individuals the convenience of self-care and the ability to manage minor health issues without the need for a prescription. These medications, which include pain relievers, antacids, cold remedies, and vitamins, are widely used for their accessibility and affordability. While OTC drugs can significantly improve health outcomes by providing quick and cost-effective relief, their misuse or overuse poses substantial public health risks. Inappropriate self-medication, failure to follow recommended dosages, and interactions with prescription medications can lead to adverse effects, masking of serious illnesses, and increased healthcare costs.[1-4]

Public knowledge and attitudes toward OTC medications play a critical role in determining their appropriate use. Despite the growing reliance on self-medication, studies worldwide indicate that many individuals lack adequate knowledge about the safe and effective use of OTC drugs. Common misconceptions include the belief that OTC medications are entirely risk-free, leading to practices such as exceeding recommended dosages or using them for prolonged periods without medical supervision. These behaviors can result in complications, including drug dependency, organ damage, or the exacerbation of underlying conditions.[4-8]

Shimla, the capital of Himachal Pradesh, provides a unique setting to study public attitudes and knowledge of OTC medications. The region's diverse demographic profile, including rural and urban populations, varying education levels, and differing access to healthcare facilities, influences medication practices. Urban residents may have better access to pharmacies and information about OTC drugs, while rural populations may rely on informal sources for medication, increasing the risk of misuse. Additionally, cultural beliefs and limited healthcare access in some areas can drive self-medication practices, compounding public health concerns.

Understanding the knowledge, attitudes, and practices of Shimla residents regarding OTC medications is essential for developing targeted public health interventions. Factors such as education, income, and exposure to healthcare systems significantly influence medication behaviors, shaping the risks and benefits associated with OTC drug use. Previous research suggests that tailored awareness campaigns can bridge knowledge gaps, encouraging responsible self-care while minimizing health risks.

This study aims to evaluate the attitudes and knowledge of Shimla residents about OTC medications, identify gaps in understanding, and explore the socio-demographic factors influencing self-medication practices. By providing evidence-based insights, this research seeks to inform public health strategies, promoting the safe and effective use of OTC drugs and empowering individuals to make informed healthcare decisions.

Aims and Objectives

Aims:
To assess the attitudes, knowledge, and practices of Shimla residents regarding over-the-counter (OTC) medications, with a focus on understanding gaps in knowledge and exploring the socio-demographic factors influencing self-medication behaviors. This study aims to provide actionable insights for the development of targeted public health interventions to promote the safe and effective use of OTC drugs.

Objectives:

• To evaluate the level of public awareness regarding the appropriate use of OTC medications, including dosage, indications, and potential risks.

• To analyze common misconceptions and unsafe practices related to OTC drug use, such as prolonged usage, self-diagnosis, and combining OTC drugs with prescription medications.

• To assess the sources of information residents rely on for OTC drug use, such as pharmacists, advertisements, or informal advice, and their role in shaping practices.

• To provide evidence-based recommendations for public health education campaigns aimed at improving awareness and fostering responsible self-medication practices.

Research Approach: This was a descriptive cross-sectional study aimed at assessing public attitudes, knowledge, and practices related to over-the-counter (OTC) medications among residents of Shimla.

Research Design: A community-based cross-sectional survey design was employed to capture a snapshot of public knowledge and behaviors regarding OTC medication use.

Study Area: The study was conducted in Shimla, Himachal Pradesh, encompassing both urban and rural regions to ensure diverse representation. This region's socio-economic and geographic diversity provided a comprehensive context for evaluating public attitudes toward OTC medications.

Study Duration:The study was carried out over three months, from August 2024 to October 2024.

Study Population: The target population included adults aged 18 years and above who had been residents of Shimla for at least one year. Participants were recruited from urban and rural areas to ensure a representative sample reflecting the district’s demographic and socio-economic diversity.

Sample Size: Using a 95% confidence level, a 50% estimated awareness level regarding OTC medication use, and a 5% margin of error, a sample size of 400 participants was determined. An additional 5% was included to account for non-responses, ensuring robust data collection.

Study Tool: A structured questionnaire was developed and pre-tested for clarity, reliability, and cultural relevance. The questionnaire was divided into two sections:

Socio-Demographic Information: Included variables such as age, gender, education, occupation, income, and area of residence (urban/rural).

OTC Medication Awareness and Practices: Consisted of 20 structured questions addressing:

• Knowledge of common OTC medications and their indications.

• Awareness of risks associated with improper use, such as side effects, dependency, and interactions with other drugs.

• Attitudes toward self-medication and reliance on OTC drugs for minor illnesses.

• Sources of information on OTC medications, including pharmacists, advertisements, and informal advice.

• Identification of barriers to safe OTC drug use, such as lack of information or healthcare access.

Each correct response was awarded one point, and total scores were categorized as:

• Very Good (>80%): 16–20 points.

• Good (60–79%): 12–15 points.

• Fair (41–59%): 8–11 points.

• Poor (<40%):<8 points.

Data Collection:

• Data were collected using a Google Forms-based survey distributed via WhatsApp, Facebook, and Instagram to maximize reach.

• Convenience sampling was employed, and responses were collected until the target sample size of 400 was achieved.

Data Analysis:

• Data were organized and cleaned using Microsoft Excel.

• Statistical analysis was performed using Epi Info V7 software, including:

• Frequency and percentage distribution for socio-demographic variables.

• Descriptive statistics for awareness scores.

Ethical Considerations:

• Participation was voluntary, with informed consent obtained from all respondents.

• Confidentiality and anonymity of participants were strictly maintained, with no identifying information recorded.

• The study adhered to ethical guidelines for human research, and participants were informed of their right to withdraw at any time

The study evaluated public awareness, attitudes, and practices regarding over-the-counter (OTC) medications among Shimla residents. A total of 400 participants contributed data, providing insights into the socio-demographic diversity and varying levels of knowledge related to OTC medication use.

Participants were evenly distributed by gender, with slightly more females (52.00%). Most respondents were in the 26–35 (33.75%) and 36–45 (30.00%) age groups. Education levels varied, with 34.00% holding undergraduate degrees, and rural residents accounted for the majority (56.25%), reflecting Shimla's demographic landscape.

Table 2: Awareness and Practices Regarding OTC Medications

Participants showed varied awareness levels regarding OTC medications. While 74.50% understood the risks of misuse, knowledge about proper storage (74.00%) and expiration (77.50%) was higher. However, misconceptions persisted, such as low awareness of herbal supplements not being OTC drugs (49.00%) and incorrect understanding of the OTC acronym (44.50%).

Most participants scored in the "Good" (38.50%) and "Fair" (33.00%) categories, reflecting moderate awareness. Only 22.00% demonstrated comprehensive knowledge ("Very Good"), while 6.50% scored poorly, highlighting gaps in understanding that require targeted educational efforts.

These results underline significant gaps in public knowledge and practices related to OTC medication use, emphasizing the need for robust public health interventions to address misconceptions and promote safer practices.

Figure-1: Distribution of Knowledge Scores on OTC Medications

This study provides a comprehensive evaluation of public awareness, attitudes, and practices regarding over-the-counter (OTC) medications among residents of Shimla. The findings highlight a mix of foundational knowledge and critical gaps, emphasizing the urgent need for targeted public health interventions to improve the safe use of OTC drugs. By identifying socio-demographic influences and misconceptions, this research offers actionable insights to inform community-specific health promotion initiatives.

The socio-demographic profile of participants revealed key factors influencing awareness and practices regarding OTC medications. The balanced gender distribution (48.00% male and 52.00% female) suggests the importance of targeting both genders equally in educational campaigns. A significant portion of participants fell within the 26–35 (33.75%) and 36–45 (30.00%) age groups, indicating that working-age individuals may be the primary users of OTC medications due to their accessibility and convenience. Younger adults (18–25) demonstrated relatively limited awareness, highlighting the need for early preventive education, particularly in schools and colleges.

Educational attainment played a crucial role in shaping knowledge levels. Participants with undergraduate (34.00%) and postgraduate (10.75%) degrees demonstrated better awareness of safe practices compared to those with no formal education (6.00%). This underscores the necessity of tailoring educational campaigns for less-educated populations, focusing on simplified messaging to bridge knowledge gaps. Furthermore, rural residents (56.25%) exhibited lower awareness levels compared to their urban counterparts, reflecting disparities in access to healthcare services, information dissemination, and pharmacist consultations. Addressing these rural-urban gaps through community outreach programs is essential for equitable healthcare education.

The study revealed encouraging levels of awareness about certain aspects of OTC medication use. A majority of participants (74.50%) recognized the risks associated with misuse, and 71.50% understood the importance of consulting a doctor before using OTC drugs for chronic conditions. Additionally, 77.50% were aware of drug expiration, reflecting a foundational understanding of safety measures.

However, significant gaps were identified in other areas. Only 49.00% of participants correctly understood that herbal supplements are not considered OTC drugs, and just 44.50% accurately defined the OTC acronym. These misconceptions can lead to inappropriate use of medications, posing health risks. Moreover, only 44.50% recognized improper storage as a critical safety concern, indicating the need for awareness campaigns addressing the importance of proper handling and storage of medications.[9,10]

Self-diagnosis and self-medication emerged as significant issues, with 65.50% of participants acknowledging that self-diagnosis is unsafe. While this indicates some level of understanding, it also reflects a need for further education on the risks of unsupervised drug use. Additionally, although 63.50% agreed that pharmacists are reliable sources of advice, gaps in healthcare access, particularly in rural areas, may limit the ability of residents to seek professional guidance.

The study underscores the need to strengthen preventive knowledge and promote safer health-seeking behaviors. While most participants recognized the importance of consulting healthcare professionals, there were notable deficiencies in understanding the broader implications of inappropriate OTC medication use. For example, only 46.50% understood the need for strict dosage adherence, and just 44.50% were aware of improper disposal practices, which can contribute to environmental hazards and public health risks.

Public health campaigns should focus on fostering a deeper understanding of these issues, emphasizing the importance of adhering to prescribed dosages, consulting professionals, and safely disposing of unused medications. Efforts should also address misconceptions about the effectiveness of OTC drugs for conditions like viral infections, as 50.50% of participants incorrectly believed OTC drugs could be effective against such illnesses. This highlights the need for targeted messaging about the proper indications for OTC medication use.

The distribution of knowledge scores revealed that only 22.00% of participants demonstrated comprehensive understanding ("Very Good"), while the majority fell into the "Good" (38.50%) and "Fair" (33.00%) categories. Alarmingly, 6.50% scored poorly, reflecting significant knowledge gaps among a subset of the population. These findings highlight the importance of prioritizing underserved groups, particularly rural residents and those with lower educational attainment, in public health initiatives.[11,12]

Specific gaps, such as misconceptions about drug interactions, improper storage, and self-medication, should be prioritized in educational efforts. Tailored campaigns using accessible formats, such as visual aids, community workshops, and healthcare worker-led sessions, can help improve understanding and encourage safer practices.[13,14]

The findings of this study have significant implications for public health strategies in Shimla and similar regions. First, mass awareness campaigns emphasizing the safe use of OTC medications are crucial. These campaigns should focus on dispelling misconceptions, such as the effectiveness of OTC drugs for viral infections and the safety of self-diagnosis, while promoting adherence to proper usage guidelines.

Second, addressing rural-urban disparities is essential for equitable healthcare education. Simplified and culturally sensitive materials, including posters, pamphlets, and community radio messages, can help bridge literacy gaps and ensure broader dissemination of health information. Collaboration with local healthcare providers, pharmacists, and community leaders can further enhance outreach and engagement.

Third, integrating OTC medication education into existing healthcare programs, such as those focused on chronic diseases or maternal and child health, could amplify the impact of these efforts. Encouraging pharmacists to educate consumers during drug purchases and establishing community collection points for expired or unused medications can promote safe practices.

Finally, leveraging digital platforms for health education, particularly in urban areas with higher internet penetration, could reach a wider audience. Online campaigns focusing on FAQs about OTC medications and interactive sessions with healthcare professionals could further enhance public understanding.

Strengths and Limitations

The strengths of this study include its representative sample, capturing diverse socio-demographic perspectives from both urban and rural areas, and its comprehensive evaluation of OTC medication awareness. However, reliance on online data collection may have excluded individuals without internet access, potentially underrepresenting older and rural populations. Future research should incorporate in-person surveys and qualitative methods, such as focus group discussions, to gain deeper insights into cultural and behavioral factors influencing OTC medication use.

This study highlights critical gaps in public awareness and practices regarding OTC medication use among Shimla residents. While foundational knowledge exists, misconceptions about self-medication, drug interactions, and improper storage persist, particularly among rural and less-educated populations. Targeted educational campaigns, community outreach, and pharmacist-led interventions are essential to promote responsible OTC medication use. By addressing these gaps, public health initiatives can reduce the risks associated with improper OTC drug practices, ultimately enhancing health outcomes and fostering safer healthcare behaviors in the region.

The authors declare that they have no conflict of interest

No funding sources

The study was approved by theJawaharlal Nehru Medical College, Aligarh Muslim University(AMU).

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