Self-medication, defined as the use of medicines by individuals to treat self-recognized illnesses or symptoms without professional medical consultation, has emerged as a global public health concern. While some degree of self-care is encouraged for minor ailments, inappropriate or excessive self-medication can lead to serious consequences, including incorrect self-diagnosis, drug interactions, masking of severe diseases, adverse drug reactions, and most alarmingly, the growing menace of antimicrobial resistance. In low- and middle-income countries like India, these risks are amplified by the easy availability of over-the-counter (OTC) drugs, insufficient regulatory enforcement, and widespread public misconceptions regarding medication safety and efficacy.1-3

India, with its pluralistic healthcare system and diverse socio-economic landscape, presents unique challenges in controlling self-medication practices. Cultural beliefs, accessibility to pharmacists without prescriptions, economic constraints, long waiting times at public healthcare facilities, and a growing dependence on online health information contribute to the rising trend of self-directed drug use. Punjab, a northern Indian state with a relatively high literacy rate and mixed urban-rural population distribution, is particularly noteworthy. Despite better educational attainment, a significant portion of the population, especially in rural areas, continues to rely on non-professional sources for health advice and medication, often underestimating the risks involved.4-7

The increasing reliance on self-medication, especially for antibiotics, analgesics, and antipyretics, reflects both gaps in public health infrastructure and a lack of awareness regarding safe drug use. Studies have shown that self-medication is often driven by past experiences, peer recommendations, or information accessed through social media and unverified online platforms. This practice is further compounded by the absence of stringent pharmacy regulations, allowing easy access to prescription medications without medical oversight.8-11

Despite growing concern, there remains a scarcity of region-specific data assessing the knowledge, attitudes, and practices related to self-medication in Punjab. Understanding the public’s perception and behavioral patterns is essential to formulating effective interventions. Therefore, this study aims to evaluate the prevalence, awareness, and socio-demographic determinants of self-medication among the general population of Punjab. By identifying critical knowledge gaps and behavioral drivers, the research seeks to inform targeted public health strategies aimed at promoting rational drug use and reducing the associated health risks.

Study Design

This study was designed as a descriptive, cross-sectional survey to evaluate the prevalence, awareness, and determinants of self-medication practices among the general adult population of Punjab, India. A structured questionnaire was developed and disseminated through Google Forms, allowing the collection of quantitative data from a broad and demographically diverse respondent base across both rural and urban regions of the state.

Study Area and Population

The study was conducted in Punjab, a state in northern India characterized by a heterogeneous population, including a mix of urban centers and rural communities. Participants included residents aged 18 years and above, representing various age groups, educational backgrounds, and occupational categories. The inclusion of both urban and rural populations ensured a comprehensive understanding of self-medication practices across different socio-economic and healthcare accessibility contexts.

Study Duration

Data collection was carried out over a period of three months, from January to March 2025, to allow adequate outreach and response collection from various districts of Punjab.

Sample Size and Sampling Technique

A sample size of 400 participants was targeted based on a standard formula for cross-sectional studies, assuming a 95% confidence level, an estimated 50% prevalence of self-medication practices, and a 5% margin of error. An additional buffer of 10% was included to account for incomplete or invalid responses.

Given the nature of the study, a convenience and purposive sampling technique was employed. The Google Form link was shared widely across social media platforms (WhatsApp, Facebook, Instagram), community WhatsApp groups, university email lists, and other public forums to ensure maximum outreach and participation from various demographics.

Inclusion and Exclusion Criteria

Inclusion Criteria:

• Individuals aged 18 years or older

• Permanent residents of Punjab

• Ability to understand and respond in English, Hindi, or Punjabi

• Provided informed consent and voluntarily participated in the study

Exclusion Criteria:

• Healthcare professionals and students of medicine, pharmacy, or nursing (to avoid biased knowledge levels)

• Individuals under active long-term medical treatment

• Respondents with incomplete or ambiguous responses

Data Collection Tool

The primary tool for data collection was a structured, self-administered online questionnaire developed in Google Forms. The questionnaire was created in consultation with public health experts and pharmacists and was made available in three languages—English, Hindi, and Punjabi—to maximize comprehension and accessibility.

The questionnaire consisted of three main sections:

1. Socio-Demographic Profile: Age, gender, education, occupation, income level, and place of residence (urban or rural).

2. Knowledge and Awareness of Self-Medication: Understanding of common drug types (e.g., antibiotics, painkillers), awareness of side effects, understanding of prescription requirements, and risks such as antibiotic resistance.

3. Practices and Attitudes: Frequency and reasons for self-medication, sources of health advice, preferred drug categories, and perceived need for professional consultation.

All questions were multiple-choice or checkbox format to facilitate clarity and ease of response. Before full-scale distribution, the questionnaire was piloted with 30 individuals to ensure clarity, consistency, and face validity. Feedback from the pilot was used to make minor modifications before formal data collection began.

Scoring and Classification

To assess awareness, each correct or safe response was assigned a score of 1, while incorrect or unsafe responses received a score of 0. Total scores were categorized into four levels:

• Very Good Knowledge: ≥80% correct responses

• Good Knowledge: 60%–79% correct responses

• Fair Knowledge: 41%–59% correct responses

• Poor Knowledge:<40% correct responses

This classification enabled identification of subgroups requiring focused educational interventions.

Data Handling and Statistical Analysis

Responses from Google Forms were exported into Microsoft Excel for initial cleaning and organization. The cleaned dataset was then analyzed using IBM SPSS (Version 26.0).

Descriptive statistics (frequencies, percentages, means, and standard deviations) were used to summarize demographic data and self-medication patterns. Chi-square tests were used to explore associations between demographic variables (e.g., age, education, residence) and self-medication awareness or practice. A p-value of <0.05 was considered statistically significant.

Ethical Considerations

Prior to participation, each respondent was presented with a digital informed consent form outlining the purpose of the study, data confidentiality, voluntary participation, and the option to withdraw at any point. Data anonymity and privacy were strictly maintained throughout, and no personally identifiable information was collected.

Table 1 presents the socio-demographic profile of the 400 participants included in the study. The sample comprised a balanced age distribution, with the largest segment (33.0%) aged between 26–35 years, followed by 36–45 years (28.5%), 18–25 years (19.5%), and those aged 46 and above (19.0%). Gender distribution showed a slight predominance of females (53.0%) over males (47.0%). In terms of educational attainment, a majority had either an undergraduate (35.5%) or secondary-level education (34.0%), while only 4.0% reported no formal education. Occupationally, homemakers formed the largest group (23.5%), followed by private sector employees (19.0%) and students (17.0%). The remaining respondents included government employees, self-employed individuals, and others. Notably, 57.0% of participants resided in rural areas, highlighting the importance of addressing healthcare awareness and accessibility across less urbanized regions of Punjab.

Table 1: Socio-Demographic Characteristics of Participants (n = 400)

Table 2 outlines participants’ responses to 10 knowledge-based multiple-choice questions on self-medication. The results reveal a moderately strong awareness across several domains. A high proportion (79.0%) correctly identified the definition of self-medication, and 74.5% recognized the need to consult a doctor if symptoms persist. Awareness was also satisfactory regarding the misuse of painkillers (67.5%) and the importance of reading medication labels (65.5%). However, significant knowledge gaps were evident in more technical areas: only 58.0% understood that antibiotics should not be used without a prescription, and just 49.0% were aware of the risk of antibiotic resistance. The lowest correct response (46.0%) pertained to the pharmacist's role, reflecting confusion between dispensing and prescribing authority. Overall, while participants demonstrated good surface-level awareness, gaps in understanding drug resistance, professional boundaries, and risks of expired medications warrant targeted educational interventions.

Table 2: Knowledge Assessment on Self-Medication (n = 400)

Table 3 provides insights into the self-medication behaviors and related attitudes of the study population. A significant majority (72.5%) reported self-medicating in the past six months, with 33.0% doing so 2–3 times within that period. Analgesics (67.5%) and antibiotics (42.0%) were the most commonly used medications without prescriptions. The primary motivations behind self-medication included cost-saving (41.0%), prior experience with similar symptoms (38.0%), and lack of time to visit a doctor (23.0%). Pharmacists (53.0%) and online platforms (26.0%) were the leading sources of information, while 21.0% relied on advice from family or friends. Positively, 68.5% reported reading drug instructions, and 74.5% stated they would seek a doctor’s consultation if their symptoms did not improve. However, the frequent use of antibiotics and reliance on informal sources suggest ongoing risks of misuse and highlight the urgent need for community-level regulation and public health education.

Table 3: Self-Medication Practices and Attitudes among Participants (n = 400)

Table 4 summarizes participants’ overall knowledge scores based on their responses to the 10 assessment questions. A substantial proportion demonstrated strong awareness, with 28.0% scoring in the “Very Good” category (≥80% correct) and another 37.0% falling under “Good” (60–79%). However, 23.5% of participants had only a “Fair” understanding (41–59%), and 11.5% showed “Poor” knowledge (<40%), indicating significant educational gaps. These results emphasize the importance of reinforcing awareness about safe medication practices and the risks associated with self-treatment, especially targeting those with limited understanding to minimize unsafe health behaviors.

Table 4: Knowledge Score Classification among Participants (n = 400)

Table 5 explores the association between knowledge scores and socio-demographic factors. A statistically significant correlation was observed with age group (p = 0.004), education level (p < 0.001), and residence (p =

0.016). Younger age groups (especially 26–35) and participants with higher education (undergraduate and postgraduate) had notably higher proportions in the “Very Good” and “Good” knowledge categories. Conversely, individuals aged 46 and above, rural residents, and those with no formal education were more likely to score “Fair” or “Poor.” Gender and occupation did not show statistically significant associations with knowledge level. These findings highlight the importance of tailored educational strategies focusing on older, rural, and less-educated populations to bridge the awareness gap and promote responsible medication behavior.

Table 5: Association between Knowledge Score and Socio-Demographic Variables (n = 400)

Table 6 examines the association between self-medication practices and socio-demographic variables among the 400 participants. A statistically significant association was observed with age (p = 0.008), where the 26–35

age group exhibited the highest prevalence of self-medication (81.8%), followed by the 36–45 group (73.7%), while only 60.5% of those aged 46 and above reported self-medicating. Education level was also significantly associated (p < 0.001), with higher self-medication rates among participants holding undergraduate (81.7%) and postgraduate (75.9%) degrees, compared to those with no formal education (50.0%). Place of residence emerged as another key factor (p = 0.006), with urban residents self-medicating more (80.2%) than their rural counterparts (66.7%), possibly due to greater access to pharmacies and digital health information. However, no significant associations were found between self-medication and gender (p = 0.412) or occupation (p = 0.763), indicating that these factors did not influence the practice notably. These findings highlight that younger, urban, and more educated individuals are significantly more likely to engage in self-medication, underlining the need for targeted awareness efforts in these specific groups.

Table 6: Association between Self-Medication Practice and Socio-Demographic Variables (n = 400)

This study aimed to assess the prevalence, knowledge, and determinants of self-medication practices among the general population of Punjab using a structured, cross-sectional approach. The findings reveal that self-medication is a highly prevalent behavior, influenced by a range of socio-demographic factors, including age, education level, and place of residence. Despite moderate levels of awareness in certain areas, considerable knowledge gaps persist regarding the safe use of medications—particularly antibiotics—indicating the need for targeted public health interventions.

The prevalence of self-medication in this study was notably high, with 72.5% of participants reporting self-medication within the last six months. This is consistent with previous studies conducted in other regions of India, where self-medication rates have ranged from 60% to 80%. 3,8,12,13The most commonly used drug categories included analgesics (67.5%), antibiotics (42.0%), and antipyretics (31.5%), aligning with national and global trends that highlight widespread non-prescription use of these medicines (WHO, 2015). The frequent use of antibiotics without medical oversight is particularly concerning, as it contributes directly to the global health crisis of antimicrobial resistance (AMR). This misuse often stems from the misconception that antibiotics are a cure-all for common infections, including viral illnesses, for which they are ineffective.

The study found that the primary motivations for self-medication were economic convenience (41.0%), prior experience with illness (38.0%), and the perception that symptoms were minor or non-serious (33.0%). These findings support the idea that self-medication is not merely a knowledge-based decision, but one strongly shaped by access, affordability, and individual health-seeking behaviors. Interestingly, pharmacists (53.0%) were the most commonly cited source of drug information, followed by online sources and family members. This suggests that in the absence of accessible and affordable medical consultations, people tend to rely on semi-professional or informal channels for advice. While pharmacists play a crucial role in healthcare delivery, the lack of regulation and oversight in community pharmacy practices in India can lead to significant risks when dispensing medications without prescriptions.14,15

The knowledge assessment revealed a mixed picture. While a majority of participants could correctly identify basic concepts—such as the definition of self-medication (79.0%) and the appropriate course of action when symptoms persist (74.5%)—there were striking gaps in understanding critical issues like antibiotic resistance (49.0%), the pharmacist’s role (46.0%), and the risks of expired medications (54.5%). Overall, only 28.0% of participants demonstrated “Very Good” knowledge, and 35.0% had Fair or Poor knowledge, highlighting a substantial deficit in public awareness regarding the dangers of inappropriate self-medication. These results are concerning and indicate that mere literacy or educational attainment may not translate into safe health practices unless complemented by structured public education campaigns and community engagement.

Analysis of associations between knowledge levels and socio-demographic variables (Table 5) revealed statistically significant correlations with age (p = 0.004), education (p < 0.001), and residence (p = 0.016). Participants aged 26–35 years and those with higher education levels (undergraduate and postgraduate degrees) were significantly more likely to have higher knowledge scores. This aligns with previous literature suggesting that younger, educated individuals may have more exposure to health information, whether through formal education or online sources. Urban participants also scored higher, possibly due to better access to digital resources, health infrastructure, and awareness campaigns. However, no significant associations were found with gender or occupation, suggesting that self-medication knowledge is relatively gender-neutral and not necessarily profession-dependent.

A similar pattern was observed in Table 6, which assessed the association between socio-demographic factors and actual self-medication behavior. Again, age, education, and residence showed statistically significant associations. Individuals in the 26–35 age group had the highest prevalence of self-medication (81.8%), possibly due to a combination of higher health literacy and busier lifestyles that reduce time for formal consultations. Similarly, those with higher educational qualifications reported higher self-medication, reflecting both increased confidence and, potentially, a greater tendency to bypass professional consultation. Urban dwellers were significantly more likely to self-medicate than rural residents (80.2% vs. 66.7%), highlighting the role of urban access to OTC medications and informal sources like online platforms. These associations underscore the complex interplay between knowledge and behavior—having more knowledge may empower individuals to self-medicate, but it doesn’t always guarantee safe or appropriate choices.

Importantly, while gender and occupation did not show significant associations with either knowledge or practice, they should not be overlooked in public health programming. Both groups could be influenced indirectly through culturally relevant campaigns and better pharmacy regulation. Furthermore, the finding that nearly one-third of respondents do not read medication instructions, and 25.5% do not seek medical help after failed self-treatment, suggests the persistence of risky behaviors that can have serious health consequences.

Taken together, these findings point to a pressing need for multifaceted interventions. Public health authorities must invest in community-based awareness programs, especially targeting rural areas and less-educated populations. Efforts should include clear messaging about the dangers of antibiotic misuse, the risks of unsupervised drug intake, and the importance of professional medical guidance. Equally important is the strengthening of regulatory oversight, ensuring that pharmacies do not dispense prescription drugs without proper authorization. Collaboration with pharmacists could also be harnessed positively by involving them in health education initiatives, turning them into frontline educators rather than just medicine dispensers.13-16

Limitations

Despite the strengths of this study, certain limitations must be acknowledged. Firstly, the data collection was conducted via a self-administered Google Form, which may introduce self-selection and response bias, as individuals with internet access and interest in health topics were more likely to participate. This may limit the generalizability of findings to populations with lower digital literacy or limited internet access. Secondly, the use of convenience and purposive sampling rather than randomized selection may reduce the representativeness of the sample. Thirdly, the cross-sectional nature of the study captures only a snapshot of knowledge and behavior at one point in time and cannot establish causality. Additionally, the exclusion of healthcare professionals—although necessary to avoid skewed knowledge levels—may have limited comparisons across subgroups. Finally, self-reported practices are inherently subject to recall and social desirability bias, potentially affecting the accuracy of responses regarding medication use.

This study highlights the high prevalence of self-medication among the general population of Punjab and underscores the critical influence of socio-demographic factors such as age, education, and urban residence on both knowledge and practice. While many participants demonstrated basic awareness of medication safety, notable gaps persist—particularly concerning antibiotic misuse, pharmacist roles, and risks of expired drugs. The findings suggest that increased education and accessibility to health information do not always translate to safe medication practices. Targeted public health interventions, community education programs, and stricter pharmacy regulations are urgently needed to promote rational drug use and mitigate the risks associated with unsupervised self-treatment. By identifying vulnerable demographic segments and understanding their behavior, this study provides a valuable foundation for developing localized strategies to improve medication literacy and healthcare outcomes in the region.

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