-

Patient-Reported Outcomes
Contents lists available at sciencedirect.com
Journal homepage: www.elsevier.com/locate/vhri

Community Attitudes and Habits Toward Over-The-Counter Drugs: Results

of a Study Conducted in Thessaloniki, Greece
Panagiotis-Nikolaos Lalagkas, MPharm,* Georgios Poulentzas, MPharm,* Anna Takaviti, MPharm, Zaklin Toursidou, MPharm,
Theodora Tatsiou, MPharm, Dimitra Hadjipavlou-Litina, PhD, Björn Wettermark, PhD, Christos Kontogiorgis, PhD,
Theodoros Constantinides, PhD

A B S T R A C T

Objectives: To determine the frequency of use, sources of information, and selection criteria of Greek residents regarding over-
the-counter (OTC) drugs, as well as their opinion about their dispensing in nonpharmacy settings.
Methods: This was a survey study in which an anonymous cross-sectional questionnaire was used to assess the knowledge,
habits, and attitudes about OTC drugs. Data were collected from March 2017 to July 2017 in Thessaloniki, the second largest
city in Greece. Logistic regression was used to investigate significant factors that affect the participants’ behavior.
Results: A total of 782 participants completed the questionnaire. The population had a mean (SD) age of 46 (17) years and
55.1% were females. About one-third (32.5%) of the participants used nonsteroidal anti-inflammatory drugs more than once
per week. OTC drugs acting on the gastrointestinal tract were used to a lower extent (13.2%). The majority (84%) of the
respondents consult a healthcare professional about the information on OTC drugs. Furthermore, when not sure about
which OTC drug to use, 510 participants (65.6%) valued their physician’s advice, whereas 480 participants (60.2%) valued
their pharmacist’s advice. Most participants (61.2%) were negatively inclined toward the purchase of OTC drugs in
nonpharmacy settings, with younger participants being more receptive to out-of-pharmacy OTC drug purchase than older
ones (odds ratio 2.20; 95% confidence interval 1.37-3.54).
Conclusions: Healthcare professionals play an important role in providing people information on their selection of OTC drugs.
This could be the main reason why participants prefer to buy OTC drugs from community pharmacies rather than retail shops.

Keywords: drug utilization, OTC medicines, role of community pharmacy, self-treatment.

VALUE HEALTH REG ISSUES. 2022; 28:38–45

Introduction healthcare expenditure.1 In contrast, self-medication needs to be

Self-medication is an element of healthcare that allows pa-
tients to have the most responsibility in the management
and treatment of their minor ailments.1 The most common way of
self-medication is pharmaceutical products that do not require
physicians’ prescription, called nonprescription medicines or over-
the-counter (OTC) drugs.2 These play a crucial role in primary
healthcare and include a wide variety of products.3
Due to different national legislations and healthcare standards,
pharmaceutical products distributed as OTC significantly differ
from country to country. Some of the most widely used OTC drugs
are nonsteroidal anti-inflammatory drugs (NSAIDs) (analgesics,
antipyretics, and anti-inflammatory agents) and paracetamol, as
well as drugs acting on the gastrointestinal tract (GIT) and drugs
for dermatological use.4-7 Their use may offer the following
benefits for all stakeholders: patient empowerment, greater
involvement of pharmacists in healthcare, and reduction of public
approached with caution given that there may be risks, such as
the potential for abuse or misuse, masking of symptoms con-
cerning severe health conditions, and drug-drug interactions.8
As reported by many studies, OTC drugs are widely used9-11
especially by the elderly.4 This high prevalence of use is also
demonstrated by a 2003 study, which showed that OTC drugs
account for 18% of the global pharmaceutical market.12 Even more
people are using OTC drugs today,10 a trend which is likely to
continue,13 because of patients’ continuous wish for greater
control over their own health management and the constant
switch of prescription drugs to OTC.14
Although OTC drug use is crucial for public health, there has
only been a limited number of studies addressing this subject in
Greece.15-19 Most of them focused on the prevalence of the use of
OTC drugs among consumers or drug categories branded as OTC in
the country. None of those studies has dove into patients’ attitudes
(sources of information, selection criteria) and habits toward OTC

*Panagiotis-Nikolaos Lalagkas and Georgios Poulentzas contributed equally to the manuscript.

2212-1099/$36.00 - see front matter ª 2021 ISPOR–The International Society for Pharmacoeconomics and Outcomes Research, Inc. Published by Elsevier Inc.

drugs or the public’s opinion on the planned reform regarding OTC
drug dispensing through nonpharmacy channels—a practice
currently not allowed by the Greek law. Studies regarding OTC
drugs in Greece are of even greater interest because of the
increased revenue in the OTC market in southern European
countries compared with northern ones.13
This study aimed to assess the Greek citizens’ habits and atti-
tudes to OTC drugs as well as their opinion on purchasing them in
retail shops. Secondary objectives of the research group were to
estimate the frequency of use for the most common OTC drugs
and evaluate the public’s knowledge about them.
Methods
Study Design and Setting
This was a cross-sectional survey study, carried out in
Thessaloniki, the second largest city of Greece, with a population
of about 1 million citizens. The study was carried out from March
2017 to July 2017.
Data Collection
Customers of community pharmacies all over Thessaloniki
were asked to fill in the questionnaire in printed format, a pro-
cedure that required about 20 minutes. A member of the research
group was present to inform participants about the study, answer
any questions and address potential misunderstandings. Phar-
macies were officially invited to participate in the study as places
of recruitment. From those who positively responded to this call,
we selected a number of pharmacies to ensure that recruiting
places would be equally distributed in the 3 regions of interest
(eastern, central, and western Thessaloniki). A total of 15 (15 of
1175 in the municipality of Thessaloniki) pharmacies were
selected, 5 from each 1 of Thessaloniki’s geographic regions. Par-
ticipants were recruited during both the morning and evening
working hours of the pharmacies. All customers who entered the
community pharmacy while a member of the research group was
there were asked to voluntarily participate in the survey unless
they had already participated. Responses were recorded in a
standardized way and then coded appropriately in a format
convenient for data analysis.
Ethics Approval and Consent to Participate
All procedures performed involving human participants were
in accordance with the ethical standards of the institutional and
national research committee and with the 1964 Helsinki decla-
ration and its later amendments or comparable ethical standards.
The research group obtained the pharmacists’ consent to recruit
participants in the respective community pharmacies. The whole
procedure was explained to the participants, who could partici-
pate anonymously and voluntarily. The local ethics and scientific
committee informed the research group that no approval was
needed given that no sensitive or personal information was
collected.
Sample Size and Eligibility Criteria
The sample size was calculated using the online tool “sample
size calculator” developed by Raosoft (Raosoft, Inc, Seattle, WA).20
All study participants were adults ($18 years old). People illiterate
in Greek, mentally incapable, or unwilling to participate were
excluded from this study.
PATIENT-REPORTED OUTCOMES 39
Questionnaire
The questionnaire was developed by the research group after
looking at relevant literature and while keeping under consider-
ation the characteristics of the healthcare system and the situation
around community pharmacies in Greece. It was primarily
evaluated in a group of 50 people, who provided feedback on
potentially confusing or leading questions. After the suggested
modifications were implemented, recruitment of the study sample
began. The questionnaire was divided into 5 parts. Part A con-
tained questions about participants’ characteristics: sex, age, area
of residence, and education level. A short definition of OTC drugs
was then provided to avoid participants from misunderstanding
the study’s scope.
Part B consisted of just 1 question regarding participants’
knowledge on which drugs were dispensed as OTC and which
ones as prescription medicines. For this purpose, 14 drug cate-
gories were provided by name (nasal decongestants, laxatives,
cough medication, analgesics, antipyretics, anti-inflammatory
drugs, skin antifungals, antibiotics, contraceptives, steroids/an-
drogens, antidiabetic drugs, cholesterol medication, anxiolytics,
and antihistamines) on a list, and respondents were asked to
select those that they considered being dispensed as OTC drugs.
The drug categories were classified by the researchers as OTC
drugs or prescription drugs based on the majority of the relevant
drugs (eg, although some cough medications require a prescrip-
tion, they were classified as OTC given that the majority of them
were available as OTC). Participants were asked to respond to this
question in the same way. The inclusion of prescription drugs in
this question seemed relevant given that, for a person to claim to
have a good level of knowledge around OTC drugs, they also
needed to distinguish which drugs require a prescription. Partic-
ipants’ knowledge level was evaluated as high if they correctly
classified 10 or more categories; moderate if they correctly
classified 5 to 9 categories; and low if they correctly classified 4
categories or less.
Part C aimed to assess how frequently participants used 2
common OTC drugs: NSAIDs and drugs acting on the GIT. The
options that could be selected were “never/very rarely,”
“approximately once per month,” and “approximately once per
week.”
Questions of part D concerning information about the appro-
priate use, dosage, and side effects of OTC drugs, as well as the
criteria for choosing an OTC drug. The potential choices to the
question regarding the information sources were the following:
physician, pharmacist, internet/social media, patient information
leaflet, friends/family, and advertisements. The potential choices to
the question on the selection criteria were the following: package
illustration, advertisements, price, ease of use, physician’s recom-
mendation, pharmacist’s recommendation, and friends/family.
Participants were able to select 1 or more options in these
questions.
Finally, questions on part E were about whether participants
would purchase OTC drugs in nonpharmacy settings and the
reason(s) for their choice. Additionally, it contained 2 additional
questions regarding potential factors that could increase OTC
drugs’ abuse/misuse: low price and dispensing in retail shops.
Data Analysis
Participants’ characteristics and all variables were analyzed
using descriptive statistics and are presented as proportions.
Simple logistic regression was used to investigate associations
between participants’ characteristics and their attitudes and
habits concerning OTC drugs. Independent variables were
40 VALUE IN HEALTH REGIONAL ISSUES MARCH 2022

Table 1. Participants’ demographic characteristics. Evaluating Participants’ Knowledge About Drugs’ OTC/
Prescription Status
Participants Number Percentage (%) Almost two-thirds (64.8%) of the participants knew which drug
Overall 920 categories were branded as OTC and which would require a pre-
Respondents 782 85 scription, whereas 34.4% had moderate knowledge and 0.8% had a
low level of knowledge (Table 2).
The drug category correctly classified by most participants was
Sex Number Percentage (%) antidiabetic drugs (96.4% correct answers), followed by
Male 351 44.9 cholesterol-lowering drugs (94% correct answers), and anxiolytics
Female 431 55.1 (92.8% correct answers). In contrast, drug categories with the
lowest rates of correct answers were topical antifungals (30.5%
correct answers), anti-inflammatory drugs (38.6% correct an-
Age, y Mean 6 SD
swers), and laxatives (48.1% correct answers). Information about
Participants 45.75 6 17.15 the other drug categories is presented in Figure 1A and B.
Males 46.77 6 17.77 A total of 24.3% of the participants demonstrated a high overall
knowledge level of the 7 categories classified as OTC (6-7 correct
Females 44.91 6 16.61
answers), whereas 52.9% had moderate knowledge level (3-5
Age groups, y Number Percentage (%) correct answers), and 22.8% had low knowledge level (0-2 correct
answers). The corresponding figures for the 7 categories classified
18-29 153 19.6 as prescription drugs were 76.2%, 20.3%, and 3.6%, respectively
30-39 123 15.7 (Table 2).
40-49 183 23.4
50-59 145 18.6 OTC Drug Frequency of Use
60-69 95 12.2 About one-fifth (18.9%) of the participants claimed that they
701 82 10.5 never or very rarely use NSAIDs, whereas 48.6% use NSAIDs once
per month and 32.5% use them once per week. A total of 37.7%
Education level (years of Number Percentage responded that they never or very rarely use OTC drugs acting on
education) (%) the GIT, 13.2% used them once per month, and 49.1% used them
once per week.
Elementary school graduate (9 y) 115 14.8
High school graduate (12 y) 215 27.6
Information Sources and Selection Criteria for OTC Drugs
Higher educational institute 357 45.8
(university) or technological The most popular sources of information about the appropriate
educational institute graduate use, dosage, and side effects of OTC drugs were pharmacists
(16-17 y) (chosen by 53.8% of the participants), physicians (52%), and the
MSc degree or higher 92 11.8 patient information leaflet (27.5%) (Fig. 2). The vast majority (84%)
MSc indicates Master of Science. of the participants consult, among other information sources, at
least 1 scientific source (pharmacist, physician, or patient infor-
mation leaflet). Simple logistic regression was performed to
evaluate the potential effect demographic factors (sex, age,
sex (male, female), age (young participants [18-34 years educational level, and area of residence) had on the preference of
old], middle-aged participants [35-64 years old], and elderly information sources about OTC drugs. Patient information leaflets
participants [$65 years old]), educational level (high education were selected by younger participants (18-34 years old) than
level [higher educational institute–university/technological elderly participants ($65 years old) (OR 2.92; 95% CI 1.65-5.18),
educational institute graduates or higher], low educational level but it was a less popular choice among low educational level
[secondary education graduates]), and region of residence participants when compared with high educational level partici-
(Western Thessaloniki, Central Thessaloniki, and Eastern pants (OR 0.58; 95% CI 0.42-0.81). Additionally, information on
Thessaloniki). Dependent variables were dichotomous, which is OTC drugs from friends and family was a less preferred option by
the reason logistic regression was selected as the preferred middle-aged participants (35-64 years old) than elderly
analysis method. Results are presented as odds ratios (ORs) with participants ($65 years old) (OR 0.38; 95% CI 0.19-0.76). No
95% confidence intervals (CIs). All analyses were performed further associations between demographic factors and choice of
with the IBM SPSS statistical software version 15.0 (SPSS Inc, information source proved to be statistically significant.
Chicago, IL). Most of the respondents claimed they selected OTC drugs
based on advice from a physician (65.6%) or pharmacist (60.2%).
The third most common choice was friends/family, as chosen by
Results
22.3% of the participants. The proportion of participants
choosing other options is presented in Figure 3. When per-
Demographic Characteristics of the Participants
forming simple logistic regression to evaluate the effect of de-
In this study, 920 unique individuals were invited to fill in the mographic factors on what affected participants’ choice of OTC
questionnaire, out of which, 782 (85%) agreed to participate. drug, some interesting associations occurred (Fig. 4). Women
Almost half of the participants (44.9%) were male, with a mean were more likely to select that they were influenced by a phar-
age of 46 6 17 years. A majority of the participants (57.6%) had a macist’s recommendation (OR 1.47; 95% CI 1.10-1.97) and less
high educational level (higher educational institute–university/ likely influenced by the drug package illustration (OR 0.38; 95%
technological educational institute graduates or higher) (Table 1). CI 0.18-0.81) than men. Product price was selected as an
 PATIENT-REPORTED OUTCOMES 41

Table 2. Participants’ knowledge level of OTC status.

General knowledge Knowledge about OTC drug Knowledge about prescription drug
categories categories
Correct answers Percentage (%) Correct answers Percentage (%) Correct answers Percentage (%)
(max. 14) (max. 7) (max. 7)
0-4 0.8 0-2 22.8 0-2 3.6
5-9 34.4 3-5 52.9 3-5 20.3
10-14 64.8 6-7 24.3 6-7 76.2
max. indicates maximum; OTC, over-the-counter.

important selection criterion by more middle-aged participants
(35-64 years old) than elderly participants ($65 years old) (OR
1.81; 95% CI 1.12-2.92). Additionally, a larger number of young
participants (18-34 years old) selected that recommendations
from friends and family were important when choosing an OTC
drug when compared with elderly participants ($65 years old)
(OR 1.71; 95% CI 1.17-2.49). Lastly, advertisements proved to be a
more popular selection criterion among low educational level
participants in comparison with those with high educational
levels (OR 1.81; 95% CI 1.15-2.85). No further associations be-
tween demographic factors and choice of information source
proved to be statistically significant.

Figure 1. Presentation of the percentage of participants that correctly classified each of the drug groups as either (A) OTC drugs or (B)
prescription drugs.

A OTC drugs

Nasal decongestants

Antipyretics

Analgesics

Cough medication

Laxatives

Anti-inflammatory drugs

Skin antifungals

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

B Prescription drugs

Contraceptives

Antihistamines

Antibiotics

Steroids/Androgens

Anxiolytics

Cholesterol medication

Antidiabetic drugs

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

OTC indicates over-the-counter.

42 VALUE IN HEALTH REGIONAL ISSUES MARCH 2022

Figure 2. Presentation of participants’ choice for information sources on the right use, dosage, and side effects of OTC drugs.

100.0%

80.0%

60.0%
53.8% 52.0%

40.0%
27.5%

20.0%
9.1% 7.1%
1.0%
0.0%
Pharmacist Physician Patient Friends/Family Internet/ Advertisements
information Social
leaflet Media

OTC indicates over-the-counter.

Purchase of OTC Drugs From Nonpharmacy Settings comparison with elderly participants ($65 years old) (OR 2.20;
95% CI 1.37-3.54). Associations between other demographic fac-
Almost two-thirds (61.2%) of the participants declared
tors and the choice of purchase of OTC drugs from nonpharmacy
unwilling to purchase OTC drugs from nonpharmacy settings,
settings did not prove to be statistically significant.
whereas 37.1% responded positively to this question. The
The majority (69.6%) of the participants were worried that the
remaining participants (1.7%) selected the option of “I do not
excessive use of OTC drugs would increase when purchased from
know/I do not care.” The most common reason why participants
retail shops, whereas 14.5% did not agree, and 15.9% answered
did not prefer to purchase OTC drugs from nonpharmacy settings
that they did not know or they did not care. When asked if they
was the need for the pharmacist’s advice (chosen by 63.4% of the
think that the lower price of OTC drugs would be associated with
participants who answered “No”), followed by doubts around
an increase in misuse/abuse, most of the participants (55.8%)
storage conditions (30.5%), and habit of purchasing them from a
answered negatively, 26.1% answered “Yes,” whereas 18.1%
pharmacy (30.5%). In contrast, for participants who claimed they
selected the option “I do not know/I do not care.”
were willing to purchase OTC drugs from retail shops, the most
popular reason was lack of time (chosen by 62.1%), whereas a
sense of safety because of the previous consultation with a Discussion
healthcare professional (44.3%) and potentially lower price (26.2%)
came next. A larger number of younger participants (18-34 years In this study, we assessed the habits, attitudes, and opinions on
old) stated willing to buy OTC drugs from nonpharmacy settings in OTC drugs among Greek citizens residing in the urban area of

Figure 3. Presentation of participants’ choice for criteria of OTC drug selection.

100.0%

80.0%
65.6%
60.2%
60.0%

40.0%
22.3% 18.7%
20.0% 17.1%
10.9%
4.0%
0.0%
e

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OTC indicates over-the-counter.

 PATIENT-REPORTED OUTCOMES 43

Figure 4. The effect of participants’ characteristics on attitudes regarding OTC drugs (information sources, selection criteria, and
willingness to purchase OTC drugs in nonpharmacy settings). *High educational level: Higher educational institute or technological
educational institute graduate or higher; Low educational level: Completed secondary education. †Associations between the above
attitudes (dependent variables) and the independent variables (sex, age, educational level, and region of residence) that did not prove to
be statistically significant are not presented in the above figure.

CHARACTERISTICS CRUDE OR (95% CI)

Information sources
Patient information leaflet
Young ( 18-34 years) 2.92 (1.65-5.18)
Elderly (>65 years) Reference
Low educational level 0.58 (0.42-0.81)
High educational level Reference
Friends/family
Middle-aged (35-64 years) 0.38 (0.19-0.76)
Elderly (>65 years) Reference
Selection criteria
Pharmacist recommendation
Female 1.47 (1.1-1.97)
Male Reference
Package illustration
Female 0.38 (0.18-0.81)
Male Reference
Price
Middle-aged (35-64 years) 1.81 (1.12-2.92)
Elderly (>65 years) Reference
Friends/family
Young ( 18-34 years) 1.71 (1.17-2.49)
Elderly (>65 years) Reference
Advertisements
Low educational level 1.81 (1.15-2.85)
High educational level Reference
Purchase of OTC from non-pharmacy settings
Young ( 18-34 years) 2.2 (1.37-3.54)
Elderly (>65 years) Reference

0 1 2 3 4 5 6

CI indicates confidence interval; OR, odds ratio; OTC, over-the-counter.

Thessaloniki, the second largest city in Greece. Results highlight
the major role of healthcare professionals (pharmacists and
physicians), both as sources of information about the proper use,
dosage, and side effects of OTC drugs and as trusted consultants
when it comes to selecting a certain OTC drug. The importance of
healthcare professionals, especially pharmacists, on OTC drugs is
also confirmed by the participants’ reluctance to purchase them in
nonpharmacy settings.
Participants exhibited a high level of knowledge regarding
which drug categories are dispensed as OTC or require a pre-
scription. There is still confusion for certain categories (eg, oral
contraceptives, laxatives), in which many participants opted for
the incorrect choice. Especially in the case of oral contraceptives,
which require a physician’s prescription in Greece, the confusion
is reasonable, because they are dispensed as OTC in many other
countries, a practice supported by the scientific community.21
Worldwide, NSAIDs and drugs acting on the GIT are 2 of the
most commonly used OTC drug classes.4-7 According to an Italian
study that took place in pharmacies, among 724 different OTC
drugs purchased, the majority comprised NSAIDs, paracetamol,
and drugs for the GIT.7 This is the reason why we asked specifically
about these drug classes. There is a number of studies exploring
OTC drugs’ frequency of use by patients, with their results
suggesting that a range of 23.8% to 46.3% of the participants use
OTC drugs once a week, findings that are in agreement with the
ones from the current study.7,9-11
Lots of studies highlight the importance of healthcare pro-
fessionals as the source of information on the right use, dosage,
and side effects of OTC drugs.5,10,22 In fact, a study conducted in
the health sectors of 6 Coop large superstores located in northern,
central, and southern Italy states that the information sources
patients mostly prefer are physicians and pharmacists.22 The
current study’s results also suggest that participants prefer phar-
macists and physicians as sources of information, whereas patient
information leaflets, friends/family, internet/social media, and
advertisements were less popular options.22 This is confirmed by
Raynor et al,23 stating that people prefer individualized informa-
tion coming from an expert rather than general statutory
information coming from a leaflet or an advertisement.
Most of the participants claimed that the key factor driving their
selection of OTC drugs was a recommendation from a physician or a
pharmacist. Results of a study conducted in pharmacy customers in
Estonia agree with the above, that healthcare professionals’
recommendation is the most crucial factor when it comes to the
selection of a drug.24 In contrast, a study in Australia suggests that
other factors, such as effectiveness, safety, and cost play a more
important role than healthcare professionals’ advice.5 These
different results imply that further research on this field is needed.
Notably, a large portion of the participants, about 10%, select OTC
drugs influenced by advertisements—a risky habit because they
convey both intentional and unintentional messages.2
In this study, most respondents were reluctant to buy their
OTC drugs in retail shops. Such a reform has been implemented in
other countries, such as Australia,3 Sweden,10,11 Serbia,4 and
Italy,22 where studies have reported that, despite the availability of
OTC drugs in nonpharmacy settings, consumers still prefer to
purchase them from pharmacies.4,11,25 This is justified by the fact
that patients tend to seek out pharmacists’ advice on the use of
OTC drugs for the treatment of minor health conditions.5 The
current study also highlights the significance of pharmacists’ role
to patients on the subject of OTC drugs, since about two-thirds of
the participants declared that they would not purchase OTC drugs
from retail shops if they become available. Additionally, many
participants are afraid that dispensing of OTC drugs in retail shops
would increase their irrational use, which is reasonable as they
believe that pharmacists provide the useful and necessary advice.5
This concern was validated by an Australian study that reports a
decrease in the appropriate OTC drug use because of their
44 VALUE IN HEALTH REGIONAL ISSUES
availability in nonpharmacy settings.26 Moreover, a study con-
ducted in Sweden showed that there was an increased intoxica-
tion of paracetamol associated with the availability of paracetamol
in retail shops and resulted in reregulation, with restrictions of
paracetamol tablets to be sold only at pharmacies.27 Despite that,
younger people are more positive toward buying OTC drugs from
retailers—an indication that, in some years from now, the Greek
society might be more receptive to.
Pharmacists in the community setting are the ideal healthcare
professionals to consult citizens regarding OTC drugs.1 This
approach is a first step toward creating a nonformal collaboration
with the physicians in which the pharmacists can take the burden
of treating minor ailments off the physicians.28 Moreover, phar-
macists can keep an eye on potential misuse or abuse of OTC
drugs, or even signs of potential masking of symptoms given that
they are healthcare professionals themselves. It is also important
that citizens consider pharmacists a trusted source of information
and appreciate their advice, especially when it comes to OTC
drugs.1 Therefore, one can conclude that community pharmacists
are a cornerstone of self-medication and can substantially
contribute to its growth while also limiting its risks.
Our study presents some strengths and, despite the research
group’s efforts, there are also some limitations as well. Starting
with the strengths, the response rate was very high (85%) and the
sample size was decent and considered sufficient for the type of
analysis carried out. In contrast, going into the study’s limitations,
it was carried out in an urban area of Greece; thus, results may not
be indicative of rural regions. Additionally, a large portion of the
participants seems to have a high level of education. This in-
troduces a potential response bias to this survey, which is a
common limitation of survey studies.29 Finally, participants were
recruited in pharmacies only, but given that OTC drugs were not
available in retail shops at the time of recruitment, community
pharmacies were the most appropriate place for this survey.
Conclusions
The participants of this survey preferred to receive information
and recommendations about OTC drugs from healthcare pro-
fessionals and were negative to the idea of purchasing OTC drugs
from nonpharmacy settings. These 2 findings largely highlight the
importance of both community pharmacies and physicians in OTC
drug consumption. Community pharmacies, in particular, should be
the primary way to increase citizens’ health literacy on OTC drugs in
an attempt to reduce the risks that accompany their use.
Article and Author Information
Accepted for Publication: July 21, 2021
Published Online: November 17, 2021
doi: https://doi.org/10.1016/j.vhri.2021.07.012
Author Affiliations: Laboratory of Hygiene and Environmental Protection,
Department of Medicine, Democritus University of Thrace, Alexandroup-
olis, Greece (Lalagkas, Poulentzas, Kontogiorgis, Constantinides); Division
of Pharmaceutical Chemistry, Department of Pharmacy, Aristotle Univer-
sity of Thessaloniki, Greece (Takaviti, Toursidou, Tatsiou, Hadjipavlou-
Litina); Department of Pharmacy, Disciplinary Domain of Medicine and
Pharmacy, Uppsala University, Uppsala, Sweden (Wettermark).
Correspondence: Christos Kontogiorgis, PhD, Laboratory of Hygiene and
Environmental Protection, Department of Medicine, Democritus University
MARCH 2022
of Thrace, Campus (Dragana) Bldg 5, Alexandroupolis, Greece GR-68100.
Email: ckontogi@med.duth.gr
Author Contributions: Concept and design: Takaviti, Toursidou, Konto-
giorgis, Constantinides
Acquisition of data: Lalagkas, Takaviti, Toursidou
Analysis and interpretation of data: Lalagkas, Poulentzas, Takaviti, Toursi-
dou, Tatsiou, Kontogiorgis
Drafting of the manuscript: Lalagkas, Poulentzas, Tatsiou, Hadjipavlou-
Litina, Wettermark, Kontogiorgis, Constantinides
Critical revision of the paper for important intellectual content: Hadjipavlou-
Litina, Wettermark, Kontogiorgis, Constantinides
Statistical analysis: Lalagkas, Poulentzas, Tatsiou, Kontogiorgis
Supervision: Hadjipavlou-Litina, Wettermark, Kontogiorgis, Constantinides
Conflict of Interest Disclosures: The authors reported no conflicts of
interest.
Funding/Support: The authors received no financial support for this
research.
Acknowledgment: The authors thank the people from the School of
Medicine, Democritus University of Thrace, who assisted in completing this
project; and the administrators and owners of the community pharmacies
where the recruitment took place.
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