Original Research

The Journal of School Nursing

2015, Vol. 31(2) 110-116
Self-Medication Among School Students ª The Author(s) 2014
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DOI: 10.1177/1059840514554837
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Mohammed ALBashtawy, PhD, MPH, RN1,

Abdul-Monim Batiha, PhD, RN2, Loai Tawalbeh, PhD, RN3,
Ahmad Tubaishat, PhD, RN3, and Manar AlAzzam, PhD, RN4

Abstract
Self-medication, usually with over-the-counter (OTC) medication, is reported as a community health problem that affects
many people worldwide. Most self-medication practice usually begins with the onset of adolescence. A school-based cross-
sectional study was conducted in Mafraq Governorate, Jordan, using a simple random sampling method to select 6 public
schools from a total of 34 schools. The total sample consisted of 422 school students from Grades 7 through 12. Measures
of central tendency and w2 were used to compare the difference between the categorical variables. The prevalence of
self-medication among the participants was 87.0%. Nearly 75% of self-medication was used for pain relief. The prevalence
of self-medication among school students is very high and increases with age. School nurses and other local health-care work-
ers must coordinate with school principals to disseminate health education campaigns about safe use of medication to provide
awareness and education to school students, parents, and families.

Keywords
school students, school nurse, self-medication, community health, drugs, adolescent health, analgesic use

Introduction high cost of health care services in many poor societies

Self-medication, usually with over-the-counter (OTC) medi-
cation, is a global health problem (Abahussain, Matowe, &
Nicholls, 2005; Silva, Soares, & Muccillo-Baisch, 2012). The
problem is now on the rise in developed and developing coun-
tries (Badiger et al., 2012). Self-medication is defined as the
use and consumption of drugs without a prescription of a pro-
vider or without any medical supervision (Zafar et al., 2008).
This practice includes the use of drugs on one’s own initiative,
the use of old prescriptions to purchase new medications, and
sharing medication with friends, peers, families, and relatives
in their local area (Ruiz, 2010; Zafar et al., 2008).
Adolescence is a crucial period because most self-
medication practice begins usually with the onset of adoles-
cence, often during the middle school years. By the age of
16, nearly all school students have self-medicated. Most
of them reported starting self-medication at 11 to 13 years
of age (Dawood, Mohamed Ibrahim, & Abdullah, 2013; Du
& Knopf, 2009). Younger children and adolescents often take
medication administered by their parents and relatives (Curry
et al., 2006).
Worldwide, many factors such as sociodemographic,
political, economic, and cultural issues have contributed to
the broadening of self-medication habits. These factors are
related to many conditions such as the accessibility and
availability of many types of drugs and medical products
from the community pharmacies and difficult access and
(Pereira, Bucaretchi, Stephan, & Cordeiro, 2007).
Self-medication among school-age students has the
potential to produce harmful effects on the adolescents
as well as the community as all. Parents and school-age
students may have insufficient knowledge about the drugs
that they use, which can lead to a serious problems and
complications (Buck, 2007). Most of them are unaware
of the incorrect self-diagnosis, suitable dose, rout of
administration, potential risks and adverse reactions, drug
interactions, incorrect manner of and risk of dependence
and abuse which may lead to a serious complications and
death. Nowadays, antimicrobial resistance is a rapidly
increasing problem worldwide (Ruiz, 2010). Many signs
1
Faculty of Nursing, Community Health Nursing, Al al-Bayt University,
Al-Mafraq, Jordan
2
Faculty of Nursing, Adult Health Nursing, Philadelphia University,
Amman, Jordan
3
Faculty of Nursing, Adult Health Nursing, Al al-Bayt University, Al-Mafraq,
Jordan
4
Faculty of Nursing, Mental Health Nursing, Al al-Bayt University,
Al-Mafraq, Jordan
Corresponding Author:
Mohammed ALBashtawy, PhD, MPH, RN, Faculty of Nursing, Community
Health Nursing, Al al-Bayt University, Al-Mafraq, 25113, P.O. Box: 130040,
Jordan.
Email: mohammadbash@aabu.edu.jo

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ALBashtawy et al.
and symptoms like itching, bleeding, heartburn, nausea,
vomiting, insomnia, irregular bowel habits, fainting, dizziness,
skin rashes, headaches, general weakness, abdominal discom-
fort, and distension, may occur as side effects of self-
medication. Ultimately, heart failure and death may also occur
as a final complication of self-medication (Pereira et al., 2007;
Ruiz, 2010).
Many studies have reported that self-medication among
adolescents is common (Silva et al., 2012), and the preva-
lence rates are high among adolescents worldwide. In devel-
oping countries, rates of self-medication by adolescents have
been determined to range from 30% to 92%: 76% in Pakistan
(Zafar et al., 2008), 59% in Nepal (Shankar, Partha, & She-
noy, 2002), 66% in Nigeria 66% (Fadare &Tamuno, 2011),
and 92% in Kuwait (Abahussain et al., 2005). The average
rate is 68% in Europe (Bretagne, Richard-Molard, Honnorat,
Caekaert, & Barthélemy, 2006) and 73% in the United States
(Du & Knopf, 2009).
In 2003, self-medication was evaluated in an interna-
tional cross-sectional survey of 123,227 school students
in three age-groups: 11, 13, and 15 years. In all 28 countries
included in the study, analgesic use was higher in girls than
boys, and use of analgesics for headaches increased by age.
Data from the United States revealed that analgesic use was
higher among girl students than among males, while med-
ications for sleeplessness or nervousness were used by 10%
or less among both genders (Hansen, Holstein, Due, & Cur-
rie, 2003). The use of medications for menstrual cycle pain
by adolescent girls has been studied among 76 healthy ado-
lescent girls with moderate to severe dysmenorrheal.
Seventy-three of the adolescent girls (93%) reported taking
at least one medication for menstrual pain. The majority
(91%) of the sample self-medicated (O’Connell, Davis, &
Westhoff, 2006).
In Jordan, only three studies have been conducted during
the previous 10 years that discussed self-medication among
the general population and university students (Shehadeh
et al., 2012; Suaifan et al., 2012; Yousef, Al-Bakri, Bustanji,
& Wazaify, 2008). Thus, there is a need to better understand
this problem among school students in Jordan because the
previous studies reflect the problem of self-medication only
among adult population. Furthermore, the findings of this
study will provide basic information to health-care providers
in the Ministry of Education and Ministry of Health to man-
age the problem of self-medication. Therefore, this study
was conducted to assess self-medication among school
students.
Research Questions 1: What are the prevalence rates of
self-medication among adolescences?
Research Questions 2: What are the sources of informa-
tion regarding self-medication among the school students?
Research Questions 3: What are the factors that lead to
self-medication among the school students?
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111
Method
A school-based cross-sectional study was conducted for a
period of 3 months from March to June 2013. This study was
carried out in Mafraq city, the capital of Mafraq Governor-
ate, Jordan. At the end of 2013, Mafraq city had a population
of nearly 100,000. The number of students attending primary
and secondary school from Grade 7 through Grade 12 in the
city was nearly 18,500. A simple random sampling method
was used to select six public schools (three for boys and
three for girls) containing primary and secondary school stu-
dents from a total of 34 schools in the city. Approval was
also obtained from the district education office at Mafraq
Qasba, and then locally from the principals of each selected
school. Each school selected a suitable day for the data col-
lection. This study was approved by the Ethical Approval
Committee in Al al-Bayt University, Jordan.
Sampling
Adequate sample size was determined for the current study
by using the formula:
n ¼ z2 ð1  aÞ=2  Pð1  PÞ=e2 ;
where n ¼ minimum sample size, z(1  a/2) ¼ is the
confidence level at 95%, p ¼ expected prevalence of
self-medication among school students (0.5%), and e ¼ the
margin of error at 5% (Baheiraei, Hamzehgardeshi, Moham-
madi, Nedjat, & Mohammadi, 2013) . Accordingly, the min-
imum sample size needed for this study was 384 school
students; however, the sample size was increased to 602
school students, to mitigate the cases of withdrawal and the
subjects who did not get permission from their families to
participate in this study.
Procedures
The study procedure took place in the chosen schools. All
the students (602) from Grades 7 to 12 in the selected
schools were invited to participate in this study by giving
them a consent letter for their families. The letter included
a brief description of the study purpose and a copy of ques-
tionnaire. Return of the consent letter signed by the family
indicated acceptance for the student to engage in this study
and then the students were invited to fill the study question-
naire in their classes. All subjects received a full explanation
from the researcher of how to write their responses. From
602 school students invited to participate, 422 (224 boys and
198 girls), gained the consent from their families and com-
pleted the questionnaire (approximately 70% response rate).
Measures
After reviewing the relevant literature regarding self-
medication and OTC medication, a questionnaire was
modified from previous studies (Abahussain et al., 2005; Du
& Knopf, 2009; Sarahroodi & Arzi, 2009; Yousef et al.,
112 The Journal of School Nursing 31(2)

2008) and then revised by academic staff (four colleagues in Table 1. Sociodemographic Characteristics of the Participants.
community health and three pharmacologists). They reevalu-
Variable Number Percentage M (SD)
ated the study purposes, research questions, and study ques-
tionnaire. Moreover, they validated the questionnaire for Gender
face and content component. A pilot study was conducted with Boys 224 53.1
22 of the school children in two schools (one for boys and one Girls 198 46.1
for girls). Accordingly, some questions were added and some Total 422 100.0
Ages by years 16.28 (1.27)
deleted to be consistent with the research questions, after that
13–15 172 40.8
the final draft of the questionnaire was developed. 16–18þ 250 59.2
The study questionnaire (Appendix A) has two parts, con- Grades
taining a total of 11 questions. The first part (five questions) 7 50 11.8
covered the participant’s sociodemographic data including 8 66 15.6
information on school, gender, grade, age, and place of resi- 9 56 13.3
dence. The second part (six questions) comprised questions 10 97 23.0
11 89 21.1
about medication without prescription (self-medication)
12 64 15.2
during the last year, therapeutic category of self-medication
used, types of pain relief that were mostly taken, source Note. M ¼ mean; SD ¼ standard deviation.
of information about medication, factors that lead to self-
medication and reasons for using pain relief medication. problem is too minor and no need to go to the physicians
The participants required 9 to 12 min to complete all the (30.2%; Table 5).
questions, and all of the school students were informed the
importance of completing the questions precisely and hon-
estly with the right to withdraw from the study any time.
Moreover, all questions were completed under the supervi- Discussion
sion of the researcher to encourage the school students to Self-medication and misuse of OTC medication among
be accurate with their answers and to offer clarification on school students is considered alarming public health
any point. dilemma that increases resistance to many categories of
treatment at long run, and can threaten their lives (Du &
Data Analysis Knopf, 2009; Fadare & Tamuno, 2011; Sarahroodi & Arzi,
Data were entered, coded, and analyzed using SPSS (pack- 2009). In this study, the finding revealed that 87% of school
age for the social science) Inc., Chicago, Illinois, software students from Grades 7 to 12 used self-medication during the
version 19. Means, percentage, frequency, standard devia- previous year. Because there is no documented data about
tion (SD), and distribution were computed. w2 was used to the prevalence of self-medication among school children
compare the difference between the categorical variable and in Jordan, it is very difficult to make any comparison at a
p values were considered significant at the level of .05. national level. Moreover, the prevalence of this study is
seems high and needs to taken seriously. This finding was
consistent with previous studies conducted worldwide (Aba-
Results hussain et al., 2005; Hansen et al., 2003; Nicholls, Stevens,
Participants’ ages ranged from 13 to 19 years, with a mean & Albahsain, 2002). On the other hand, this finding is con-
of 16.28 years (SD ¼ 1.27), and their grades were distributed sidered high compared with other studies (Bretagne et al.,
from Grades 7 to 12 (Table 1). 2006; Du & Knopf, 2009; Fadare & Tamuno, 2011; Shankar
The prevalence of self-medication among the participants et al., 2002; Zafar et al., 2008). The prevalence of self-
was 87.0%. Nearly, 75% of self-medication was used for medication among school students is high in Jordan because
pain relief; female students commonly used pain relief med- many types of medication (e.g., antibiotics, analgesics, anti-
ication, dermatology and hair problems medication, weight pyretic, pain killers, vitamins, antihistamines, dermatologi-
gain and obesity conditions more than boys, with statistical cal products, decongestants, and steroids) can be obtained
significance (p value ¼ .018; see Table 2). The prevalence of easily from the community pharmacies, without any physi-
self-medication increased by age from 69.4% among 13- cian prescription. Moreover, no measures have been taken
year-olds to 94.6% among those aged 18þ (Table 3). to address this problem, especially among school students.
Table 4 reveals that the most common sources of medica- The findings also revealed that the prevalence of self-
tion information were taken from the family (36.5%), friends medication increased with age. This was in agreement with
and peer group (35.1%), followed by Internet and TV other studies reported elsewhere (Abahussain et al., 2005;
(32.9%). Moreover, the most common factors that lead to Buck, 2007; Du & Knopf, 2009; Hansen et al., 2003), and
self-medication were previous experience (44.4%), urgency may be explained by school students during adolescence often
of the problem (38.7%), followed by the reason that the trying to achieve independence and establish their own

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ALBashtawy et al. 113

Table 2. Prevalence of Self-Medication Use Among Adolescents by Type of Medication and Gender.

Prevalence Boys (n ¼ 224) Girls (n ¼ 198)

Therapeutic category of self-medicationa n (%) n (%) n (%) w2 (p Value)

All self-medication 367 (87.0) 197 (87.9) 170 (85.9) 0.4 (.563)
Pain relief 321 (76.1) 160 (71.4) 161 (81.3) 5.64* (.018)
Respiratory 55 (13.0) 26 (11.6) 29 (14.6) 0.86 (.386)
Gastrointestinal 28 (6.6) 13 (5.8) 15 (7.6) 0.53 (.558)
Dermatology and hair problems 61 (14.5) 18 (8.0) 43 (21.7) 15.9* (<.001)
Antiallergy 72 (17.1) 40 (17.9) 32 (16.2) 0.2 (.698)
Nutritional supplements and vitamins 39 (9.2) 20 (8.9) 19 (9.6) 0.06 (.86)
Sleep disorders 52 (12.3) 24 (10.7) 28 (14.1) 1.1 (.302)
Weight gain and obesity 27 (6.4) 7 (3.1) 20 (10.1) 8.54* (.005)
Others 16 (3.8) 9 (4.0) 7 (3.5) 0.07 (.791)
Note. N ¼ 422.
a
More than one response.

Table 3. Prevalence of Self-Medicated By Age. The use pattern of pain relief medication may be
Age Prevalence 2
w (p Value)
explained by gender differences related to perceived need;
girls used medication to relief menstrual discomfort and
13 69.4 30.75 (.002) boys are physically more active and susceptible to many
14 78.6 injures and strains (Abahussain et al., 2005; Fadare &
15 88.9 Tamuno, 2011). Furthermore, female students used derma-
16 91.1
tology medications, hair problem medications, weight gain
17 92.0
18þ 94.6 and obesity medication more than boys, thus suggesting in
this sample that girls may be often more directed to their
Table 4. Sources of Information Regarding Self-Medication. appearance (ALBashtawy, 2012; Lian et al., 2010).
In this study, nearly one third of the school students stated
Sourcesa Number Percentage that the most common sources of medication information were
taken from the family, friends, and peers group. This is in agree-
Family 154 36.5
School curricula 95 22.5 ment with previous studies (Abahussain et al., 2005). In 2001,
Friends and peer groups 148 35.1 Sloand and Vessey surveyed 86 adolescents between 10 and 14
Neighbors 43 10.2 years of age about their medication use. Eighty-eight percent of
Internet and TV 139 32.9 the adolescents (aged between 10 and 14 years) stated that they
Books, news papers, and magazines 33 7.8 had access to medicine in their household without medical pre-
Other sources 46 10.9 scription, while 36% took medicine independently (Sloand &
Note. N ¼ 422. Vessey, 2001). On the other hand, a study of 650 adolescents
a
More than one response. between 6 and 18 years with recurrent migraines or tension
headaches found that only 14% of them were self-medicating
Table 5. Factors That Lead to Self-Medication. without telling their parents (Mitka, 2004).
The major factors that led to self-medication in this study
Factora Number Percentage
were the previous experience of school students, which meant
Previous experience 163 44.4 that they selected the medication based on their past experi-
Cost of consultation 37 10.1 ences with similar signs and symptoms or with similar com-
Lack of time for consultation? 45 12.3 plaints and diseases suffered by them or their relatives
Problem is too minor 111 30.2 (Yousef et al., 2008), followed by the urgency of the problem.
Urgency of problem 142 38.7
The general culture of taking medications without pre-
Other factors 29 7.9
scription emphasizes the importance of training of phar-
Note. N ¼ 367. macists and implementing and controlling the needed
a
More than one response. legislations and policies to assess pharmacists’ awareness
of giving medication without physician prescription to treat
identity. Furthermore, becoming more aware of their health acute and chronic diseases. Health education programs spon-
needs, adolescents share their information with other friends sored by Ministry of Health and Ministry of Education are
and peer groups regarding use of drugs (Abahussain et al., needed to educate the target population in the community
2005; ALBashtawy, 2012; Lian et al., 2010). and schools. Furthermore, school health nurses and other

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114 The Journal of School Nursing 31(2)

local health-care workers must coordinate with school prin- 3-Age by years:
cipals to disseminate health education campaigns about safe 4-Grade:
use of medication to provide awareness and education to 5-Place of residence:
school students, parents, and families.
Part 2: Self-medication data
Limitations 6-I used medication without prescription (self-medica-
tion) during the last year?
A limitation for this study is related to varying ages and 1: Yes 2: No
grades of the participating school students; some of them may If your answer is yes please answer the questions from no 7
not understand or gave the actual answers. Moreover, the use to 11.
of self-reported questionnaire regarding self-medication may
not reflect the real and actual habits, sources, and factors that 7-I used self-medication to:
related to this unsafe habit. Moreover, some school students 1-Pain relief
fear revealing such information related to self-medication. 2-Respiratory conditions
3-Dermatology conditions
Implication to School Health 4-Gastrointestinal conditions
The results of this study are particularly important for 5-Anti allergy conditions
nurses, physicians, health educators, school managers, 6-Nutrition supplements and vitamins
teachers, and policy makers in both the Ministry of Health 7-Anxiety and sleeping disorders conditions
and Ministry of Education. By assessing and evaluating 8-Hair products conditions
self-medication of OTC medication among school students, 9-Weight gain and obesity
strategies could be implemented to promote the health of 10-Birth control bills conditions
school students. Globally, better communication between 11-Other mentions it . . . . . . . . . . . . . . . . . .
nurses from different countries is useful to share updated
information and researche regarding safe use of medication 8-My source of information regarding self-medication
to fulfill the role of school nurse. was/were
School nurses can play an essential role in health assess- 1-School curricula
ment, including obtaining the health history of students and 2-Mother
their families regarding self-medication and performing a 3-Father
physical assessment regarding signs and symptoms of unsafe 4-Sisters and brothers
use of medications among school students. The nurse can 5-Friends and peer group
educate students and their families by provision of health 6-Neighbors
education activities targeted at the whole community regard- 7-Books, news papers, and magazines
ing the dangerous of self-medication. 8-Internet and TV
9-Other sources, mention it . . . . . . . . . . . . . . . . . .
Conclusion
9-My common factors that lead to self-medicated was/
The prevalence of self-medication among school students in were:
Mafraq Governorate is very high and increases with age. 1-Previous experience
Furthermore, risky practices toward medications need to 2-Lack of time
be improved. This highlights the importance of training 3-Cheaper source of treatment
pharmacists and implementing and controlling the needed 4-Urgent of the problem
legislation and policies of giving medication without physi- 5-Problem seeming to be trivial
cians’ prescriptions. Moreover, health education programs 6-Other reason, mention it . . . . . . . . . . . . . . . . . .
sponsored by Ministry of Health and Ministry of Education
are needed to educate the community and schools and imple- 10-I used these self-prescribed medications during the
ment the safe use of medication in the school curriculum. last year with the frequency:
1-Pain killer
Appendix A 1-Once a time 2-Two to three times
3-Every few months 4-Every few weeks
Assessment of Self-Medication Among School
5-Weekly 6-Daily
Students, Jordan 2-Anti pyretic
Part 1: Sociodemographic data 1-Once a time 2-Two to three times
1-School: 3-Every few months 4-Every few weeks
2-Gender: 1-Male 2-Female 5-Weekly 6-Daily

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ALBashtawy et al. 115

3-Antiboitics Dawood, O. T., Mohamed Ibrahim, M. I., & Abdullah, A. C.

1-Once a time 2-Two to three times (2013). Children’s knowledge and beliefs about medicines.
3-Every few months 4-Every few weeks Journal of Child Health Care. Advance online publication.
5-Weekly 6-daily doi:10.1177/1367493513496911
4-Antiallergies Du, Y., & Knopf, H. (2009). Self-medication among children and
1-Once a time 2-Two to three times adolescents in Germany: Results of the National Health Survey
3-Every few months 4-Every few weeks for Children and Adolescents (KiGGS). British Journal of Clin-
5-Weekly 6-Daily ical Pharmacology, 68, 599–608.
Fadare, J., & Tamuno, I. (2011). Antibiotic self-medication among
11-I used pain relief medication mostly for: university medical undergraduates in Northern Nigeria. Journal
1-Headache 2-Backache of Public Health and Epidemiology, 3, 217–220.
3-Desmonerria 4-Other mention it . . . . . . . . . . . . Hansen, E. H., Holstein, B. E., Due, P., & Currie, C. E. (2003).
International survey of self-reported medicine use among ado-
Thank you very much lescents. Annals of Pharmacotherapy, 37, 361–366.
Lian, C., Phing, T., Chat, C., Shin, B., Baharuddin, L., & Jalil, Z.
Acknowledgments (2010). Oral health knowledge, attitude and practice among
The authors would like to acknowledge the directorate of secondary school students in Kuching, Sarawak. Archives of
Mafraq Qasba Education Office along with school principals, teach- Orofacial Sciences, 5, 9–16.
ers, parents, and all school students who participated in this study. Mitka, M. (2004). When teens self-treat headaches, OTC drug mis-
use is frequent result. Journal of the American Medical Associ-
Declaration of Conflicting Interests ation, 292, 424–425.
Nicholls, P., Stevens, R., & Albahsain, N. (2002). Medication
The author(s) declared no potential conflicts of interest with respect
to the research, authorship, and/or publication of this article. used by Saudi girls. Saudi Pharmaceutical Journal, 10,
126–132.
O’Connell, K., Davis, A. R., & Westhoff, C. (2006). Self-
Funding
treatment patterns among adolescent girls with dysmenorrhea.
The author(s) received no financial support for the research, Journal of Pediatric and Adolescent Gynecology, 19,
authorship, and/or publication of this article. 285–289.
Pereira, F. S., Bucaretchi, F., Stephan, C., & Cordeiro, R. (2007).
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Author Biographies
Mohammed ALBashtawy, PhD, MPH, RN, is Associate Professor
and Vice Dean at the Faculty of Nursing, Community Health and Men-
tal Health Nursing Department, Al al-Bayt University, Al-Mafraq,
Jordan.
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The Journal of School Nursing 31(2)
Abdul-Monim Batiha, PhD, RN, is Assistant Professor at the
Faculty of Nursing, Adult Health Nursing, Philadelphia University,
Amman, Jordan.
Loai Tawalbeh, PhD, RN, is Assistant Professor and Chair of
Adult Health Nursing Department at the Faculty of Nursing,
Adult Health Nursing, Al al-Bayt University, Al-Mafraq,
Jordan.
Ahmad Tubaishat, PhD, RN, is Assistant Professor at the Faculty
of Nursing, Adult Health Nursing Department, Al al-Bayt Univer-
sity, Al-Mafraq, Jordan.
Manar AlAzzam, PhD, RN, is Assistant Professor and Chair of
Community Health and Mental Health Nursing Department at the
Faculty of Nursing, Mental Health Nursing, Al al-Bayt University,
Al-Mafraq, Jordan.