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The Views of the Public on Making Decisions about over the Counter Medications and Their Attitudes towards Evidence of Effectiveness

Aim: This study aimed to determine the public views on making decisions about over the counter drugs and their attitudes towards evidence of their effectiveness. Methodology: The present study includes gathering data from the public using a survey that was adapted from a previous study. This survey was translated from English to Arabic language and was converted to an online form using Google Forms and then the link was sent to be completed by the public. Results: The survey was completed by 102 respondents. Most of the respondents agreed that the most important factors that influence their purchases of medications were the safety of the product (73.53%) and the efficacy of the drug (71.57). Most of the respondents agreed that the main methods of determining the effectiveness of the medication included the previous using of the drug (76.5%) and the physician recommendation to use it by a (75.5%). Only about 49.02% of them agreed that the majority of non-prescription medicines are supported by scientific evidence from drug trials to prove they are effective. Original Research Article Ahmed et al.; JPRI, 33(9): 5-12, 2021; Article no.JPRI.65764 6 Conclusion: This study highlighted positive views and attitudes toward the use of OTC drugs. It is important to increase the awareness of the public about how to use these drugs wisely. Community pharmacists should play a crucial role in optimizing medication use and in patients counseling.


INTRODUCTION
Over the counter medications (also known as nonprescription medications and OTC) are drugs that could be bought without a prescription [1]. They are generally effective and safe when patients follow the directions on the drug label and follow the directions of health care professional [1]. The role of evidence in decision making in relation to these drugs has been controversial. Till now, there has been some debate about their efficacy and also there has been some debate whether their use is supported by scientific evidence or no [2].
A recent systematic review has indicated that there is no good evidence for the efficacy or against the effectiveness of over the counter cough preparations in acute cough [3] and also complementary medicine has been heavily criticized for evidence base lacking [4][5][6]. Another study showed that pharmacists rarely considered evidence when making decisions about over the counter drugs and that safety of the drug was the primary concern for the patients [7].
One of the major problems of using OTC is that the public may be influenced by information received from family and friends that affect their medication selection [8,9]. The public may also have perceptions that these medications are safe and don't cause any harmful effects [10]. Wilcox et al. [11] reported that the individuals who use OTC non-steroidal anti-inflammatory drugs were in general unaware of the potential side-effects of these medications [11]. Other studies found that found that consumers usually had a lack of awareness of the potential interactions of OTC drugs with other drugs [12,13].
There has been limited research conducted about the views of the public on evidence of effectiveness for OTC products. Therefore, the objectives of this study was to determine the public views on making decisions about over the counter drugs and their attitudes towards evidence of their effectiveness.

METHODOLOGY
The present study includes gathering data from the public using a survey to determine their views on making decisions about over the counter drugs and their attitudes towards evidence of effectiveness. The survey was adapted from a previous study that was conducted by Hanna and Hughes in in Northern Ireland [2].
The survey questionnaire contains clear and simple questions that enable the respondents to provide accurate information. This survey was translated from English to Arabic language and after validation, it was converted to an online form using Google Forms and then the link was sent to be completed by the public. The survey was validated by content and face validation and after that it was shared over social media during January 2021.
The public in Saudi Arabia were included in the study. The exclusion criteria include other populations and persons who refuse to participate. Moreover, all of the incomplete surveys were excluded from the study. The data were collected and analyzed by excel software and after that the data were represented by numbers and percentages.

RESULTS AND DISCUSSION
The survey was completed by 102 respondents. Most of the respondents were less than 30 years old (86.28%) and most of them were students (71.57%).
Factors that influence non-prescription medicines purchases are shown in Table 2. Most of the respondents agreed that the most important factors that influence their purchases of medications were the safety of the product (73.53%) and the efficacy of the drug (71.57) followed by the familiarity with the drug (63.73%). Table 3 shows the Views of the public on methods of determining drug effectiveness. Most of the respondents agreed that the main methods of determining the effectiveness of the medication included the previous using of the drug (76.5%) and the physician recommendation to use it (75.5%). Table 4 shows the statements that are related to scientific evidence of effectiveness for prescription only and non-prescription medicines. Most of the respondents agreed that the majority of medicines that are only available on prescription are supported by scientific evidence from drug trials to prove they are effective (70.59%). Only about 49.02% of them agreed that the majority of non-prescription medicines are supported by scientific evidence from drug trials to prove they are effective. Moreover, more than 67% agreed that it is wrong for nonprescription medicines which lack evidence of effectiveness from drug trials to be on sale to the public and about 64.71% said that it is more important to have scientific evidence from drug trials for medicines that are only available on prescription than non-prescription medicines. Table 5 shows statements relating to buying nonprescription medicines and whether evidence of effectiveness influenced the decision. Only 24.51% of the respondents agreed that evidence of effectiveness from drug trials isn't important to me when I'm choosing a non-prescription medicine.
About 21.57% of them agreed that it is up to people to decide for themselves what nonprescription medicine they want, even if there is no scientific evidence for it and about 15.69% of them agreed that they will buy whatever nonprescription medicine they want, regardless of what a pharmacist recommends for them.  The present study showed that the main factors that influence the respondents' purchases of non-prescription medications were the safety of the product and the efficacy of the drug and the familiarity with the drug. Similarly, Hanna and Hughes stated that the main factor that influence the purchases of non-prescription drugs was efficacy of the drug (95.9%) followed by the familiarity with the drug (79.1%) and the safety of the drug (77.8%) [2]. Similar findings also were reported in a global study covering several countries by Proprietary Association of Great Britain [14]. Tesfamariam et al. [15] stated that over the counter medications are believed to be relatively safe but their incorrect use could have serious implications [15]. Previous studies also reported that despite the fact that usually, OTC drugs are used incorrectly and causing several adverse events, their use is increasing [16][17][18].
Most of the respondents in the present study said that the main methods of determining the effectiveness of the medication were the previous use of the drug and the physician recommendation to use it. Hanna and Hughes stated that the public determine the effectiveness mainly by previous use (99.7%) [2]. Moreover, Similar to the results of the present study, Hanna and Hughes reported that most of the respondents in their study agreed with statement "the majority of medicines that are only available on prescription are supported by scientific evidence of effectiveness" (86.0%) and about 57.9% of them agreed with the statement "the majority of non-prescription medicines are supported by scientific evidence of effectiveness) [2]. One of the main problems is the availability of a large number of OTC drugs that were not evaluated and available in markets. Food and Drug Administration (FDA) reported that because there are over 300,000 marketed OTC drug products; FDA reviews the active ingredients and the labeling of over 80 therapeutic classes of drugs [19].  [2].
The inappropriate use of over the counter drugs is common. In the present study a high percentage of the respondents said that they are willing to try these drugs if there was no scientific evidence from drug trials to say that the non-prescription medicine was effective, but it wouldn't cause me harm. Lessenger and Feinberg reported that the abuse of over-thecounter medications is a national issue [20]. Moreover, Aronson stated that nowadays over the counter drugs are much more widely available than ever before [21]. Conca and Worthen reported that factors that may contribute to inappropriate nonprescription drug use include public perception that these medications are without safety concerns, and the ease of procurement [22].

CONCLUSION
The present study highlighted positive views and attitudes toward the use of OTC medicines among the respondents but still there are some concerns that should be corrected such as their knowledge and views toward OTC drugs safety. It is important to increase the awareness of the public about how to use these medications wisely and about the safety concerns of inappropriate use by making targeted educational programs such as lectures and workshops. Community pharmacists should play a crucial role in optimizing medication use; they should counsel the patients about the efficacy and safety of OTC drugs.

As
per international standard or university standard, Participants' written consent has been collected and preserved by the authors.

ETHICAL APPROVAL
It is not applicable.

ACKNOWLEDGEMENT
"This Publication was supported by the Deanship of Scientific Research at Prince Sattam bin Abdulaziz University"