The Knowledge-Attitude Paradox in Analgesic Self-Medication Among University Students in Ecuador: A Public Health Challenge

The Knowledge-Attitude Paradox in Analgesic Self-Medication Among University Students in Ecuador: A Public Health Challenge | Authorea try { document.documentElement.classList.add('js'); } catch (e) { } var _gaq = _gaq || []; _gaq.push(['_setAccount', 'G-8VDV14Y67G']); _gaq.push(['_trackPageview']); (function() { var ga = document.createElement('script'); ga.type = 'text/javascript'; ga.async = true; ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js'; var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(ga, s); })(); Skip to main content Preprints Collections Wiley Open Research IET Open Research Ecological Society of Japan All Collections About About Authorea FAQs Contact Us Quick Search anywhere Search for preprint articles, keywords, etc. Search Search ADVANCED SEARCH SCROLL This is a preprint and has not been peer reviewed. Data may be preliminary. 1 August 2025 V1 Latest version Share on The Knowledge-Attitude Paradox in Analgesic Self-Medication Among University Students in Ecuador: A Public Health Challenge Authors : Sonia Argote , Doménica Bucheli , Ashel Páez , Camila Rovayo , Daniel Freire , Pablo Pila , and José Daniel Sánchez [email protected] Authors Info & Affiliations https://doi.org/10.22541/au.175403744.40674872/v1 342 views 164 downloads Contents Abstract P u b l i c H e a l t h C h a l l e n g e s Ke y Po in t s Pl a in La n g uag e Su m m a ry | MATERIALS AND METHODS | Sample Size and Sampling Method | Data Collection Instrument | Data Collection Procedure | Ethical Considerations | Statistical Analysis | Knowledge, Attitudes, and Practices Scores | Participant Characteristics | Prevalence of Analgesic Self-Medication | Correlation Analysis | Predictive Model and Feature Importance | Faculty-Specific Knowledge Patterns | Model Performance | Prevalence and Global Context | The Attitude-Practice Paradigm | The Knowledge-Attitude Paradox | Implications for Intervention Strategies | Comparison with Regional Studies | Strengths and Limitations | Future Research Directions Ac k n ow l e d g e m e n t s Co n f l ic t o f In t e r e st Stat e m e n t Et h ic s Stat e m e n t Data Ava il a b il it y Stat e m e n t Au t h o r Co n t r ib u t io n s Information & Authors Metrics & Citations View Options References Figures Tables Media Share Abstract Self-medication, or using medicines without a doctor’s pre- scription, is common among university students worldwide. Our study of 422 students in Ecuador found that nearly 9 out of 10 students practice self-medication with pain relievers, mainly using paracetamol and ibuprofen. We investigated what drives this behavior and discovered that students’ per- sonal attitudes and beliefs about self-medication were the most important factor—even more important than their knowl- edge about medicines. Interestingly, students in health-related fields, who have more medical knowledge, were not less likely to self-medicate, suggesting that knowing more doesn’t always lead to safer choices. This finding highlights that to encourage safer use of medicines and address this public health issue, educational programs need to do more than just provide infor- mation; they must change how students think and feel about the risks and benefits of self-medication O R I G I N A L A R T I C L E P u b l i c H e a l t h C h a l l e n g e s The Knowledge-Attitude Paradox in Analgesic Self-Medication Among University Students in Ecuador: A Public Health Challenge Sonia Argote *1 | Doménica Bucheli 1 | Ashel Páez 1 | Camila Rovayo 1 | Daniel Freire 1 | Pablo Pila 1 | José Daniel Sánchez †1 1Facultad de Ciencias de la Salud, Universidad Tecnológica Indoamérica, Quito, Ecuador Correspondence José Daniel Sánchez, MD, Facultad de Ciencias de la Salud, Universidad Tecnológica Indoamérica, Av. Machala y Sabanilla, Quito 170103, EcuadorEmail: [email protected] Funding information This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.Self-medication, Analgesics, University students, Ecuador, Public Health, Attitudes, Knowledge, Practice Ke y Po in t s • Self-medication with analgesics is highly prevalent (87.5%) among university students in Ecuador, exceeding rates reported in many other Latin American countries, posing a significant public health challenge. • Attitudes towards self-medication are the strongest predic- tor of this behavior, more influential than academic year or pharmacological knowledge, highlighting the importance of behavioral interventions over purely informational ones. • A ”knowledge-attitude paradox” was observed, where stu- dents with greater medical knowledge did not exhibit safer self-medication practices, suggesting that education alone is insufficient to alter ingrained behaviors. • Paracetamol and ibuprofen are the most frequently self- administered analgesics for common ailments such as headaches and musculoskeletal pain, consistent with global patterns. • Effective public health interventions must target students’ perceptions and attitudes to promote responsible self- medication practices, shifting focus from mere knowledge dissemination to comprehensive behavioral change strate- gies. Pl a in La n g uag e Su m m a ry Self-medication, or using medicines without a doctor’s pre- scription, is common among university students worldwide. Our study of 422 students in Ecuador found that nearly 9 out of 10 students practice self-medication with pain relievers, mainly using paracetamol and ibuprofen. We investigated what drives this behavior and discovered that students’ per- sonal attitudes and beliefs about self-medication were the most important factor—even more important than their knowl- edge about medicines. Interestingly, students in health-related fields, who have more medical knowledge, were not less likely to self-medicate, suggesting that knowing more doesn’t always lead to safer choices. This finding highlights that to encourage safer use of medicines and address this public health issue, educational programs need to do more than just provide infor- mation; they must change how students think and feel about the risks and benefits of self-medication. | INTRODUCTION Self-medication, defined as the use of medicines to treat self- diagnosed symptoms or illnesses without professional medical supervision, represents a global public health phenomenon with significant implications for patient safety and health- care systems 1;2 . The World Health Organization recognizes self-medication as a component of self-care when practiced re- sponsibly, but emphasizes the need for appropriate regulation and education to minimize risks 1 . The prevalence of self- medication is particularly elevated among university students, with reported rates ranging from 50% to 90% across different geographical regions 2–4 . This demographic represents a vul- nerable population due to factors including academic stress, limited healthcare access, time constraints, and perceived autonomy in health decisions 5;6 . Studies from diverse global settings consistently demon- strate high rates of self-medication among university students. In Ethiopia, a systematic review and meta-analysis by Sisay et al. 2 reported an overall prevalence of 38.5% for general self- medication practices. Research from India has shown rates ranging from 57.8% to 88.4% among medical students 3;7–9 , while studies from Serbia documented prevalence rates of 79.9% among medical students in Belgrade 4 . Similar pat- terns have been observed across the Middle East, with studies from Saudi Arabia 10–13 , Egypt 14;15 , Jordan 16–18 , and other regional countries showing consistently high rates of self- medication among university populations 19;20 . In Europe, studies from Spain 21 ? ;22 , Turkey 23 , and France 24;25 also re- port high prevalence among university students. South Amer- ican countries like Brazil 26–28 and Colombia 29 also exhibit significant rates. TA B L E 1 Primary Sources of Medication Information Among University Students Practicing Self-Medication (n=369) Internet 30.2 Pharmacist 25.1 Family/Friends 20.3 Previous experience 24.4 Analgesics represent the most commonly used drug class in self-medication practices, primarily due to their widespread availability, perceived safety profile, and effectiveness for com- mon ailments such as headaches, fever, and musculoskeletal pain 4;10;30;31 . However, this practice is not without risks, including inappropriate dosing, masking of underlying seri- ous conditions, potential drug interactions, and adverse drug reactions 32;33 . Among university students, several factors have been identified as influencing self-medication practices, including prior experience with medications, perceived non- severity of symptoms, convenience, cost considerations, and time constraints 5;6;34–39 . The knowledge-attitude-practice (KAP) model has been widely used to understand health be- haviors, including self-medication, suggesting that knowledge influences attitudes, which in turn affect practices 40;41 .Despite the growing body of international literature on self-medication among university students, data from Latin America, particularly Ecuador, remains limited. Previous studies from the region, including research by 42 and 43 , have begun to address this gap, but more comprehensive analysis is needed to understand the specific factors influencing self- medication practices in the Ecuadorian context. The present study aims to address this knowledge gap by determining the prevalence of analgesic self-medication and identifying key predictive factors—including knowledge, attitudes, and prac- tices—among university students at Universidad Tecnológica Indoamérica in Ecuador. Understanding these factors is cru- cial for developing targeted public health interventions to promote responsible self-medication practices and improve student health outcomes. | MATERIALS AND METHODS | Study Design and Setting A cross-sectional analytical study was conducted between April and August 2025 among undergraduate students at Universidad Tecnológica Indoamérica, a private university located in Quito, Ecuador. The university offers programs across multiple faculties including health sciences, engineer- ing, business administration, and social sciences, with a total enrollment of approximately 3,200 undergraduate students. | Sample Size and Sampling Method The sample size was calculated using the formula for cross- sectional studies with a finite population, considering an ex- pected prevalence of 70% (based on pilot data), a margin of error of 5%, and a confidence level of 95%. The minimum required sample size was 384 students. To account for poten- tial non-response and incomplete questionnaires, the sample was increased to 422 students. A stratified random sampling method was employed to ensure proportional representation across all faculties. The stratification was based on faculty affiliation and academic year, with random selection within each stratum. Students were eligible for inclusion if they were currently enrolled as undergraduate students, aged 18 years or older, and provided informed consent. Exclusion criteria included students enrolled in distance learning programs and those with incomplete questionnaire responses. | Data Collection Instrument Data were collected using a structured, self-administered questionnaire developed based on previous validated instru- ments 29;40 and adapted for the Ecuadorian context. The ques- tionnaire underwent content validation by a panel of experts in pharmacoepidemiology and public health, followed by pilot testing with 30 students to ensure clarity and cultural appro- priateness. The questionnaire consisted of four main sections: 1. Sociodemographic characteristics : Age, gender, aca- demic year, faculty, socioeconomic status, and living ar- rangements. 2. Knowledge assessment : Questions regarding analgesic mechanisms of action, appropriate dosing, contraindica- tions, and potential adverse effects (scored 0-20 points). 3. Attitudes evaluation : Statements assessing perceptions about self-medication safety, necessity, and appropriate- ness using a 5-point Likert scale (scored 0-25 points). 4. Practices assessment : Questions about frequency of self- medication, types of analgesics used, indications, sources of information, and duration of use (scored 0-15 points). | Data Collection Procedure Data collection was conducted by trained research assistants during regular class hours with prior approval from faculty administrators. Students were approached in their classrooms, provided with information about the study, and invited to participate voluntarily. Those who agreed to participate were asked to complete the questionnaire individually, which took approximately 15-20 minutes. Completed questionnaires were collected immediately and stored securely. | Ethical Considerations The study protocol was reviewed and approved by the In- stitutional Review Board (IRB) of Universidad Tecnológica Indoamérica (Protocol #UTI-IRB-2025-001). All participants provided written informed consent before questionnaire com- pletion. The study was conducted in accordance with the principles of the Declaration of Helsinki and local ethical guidelines. Participant anonymity and data confidentiality were maintained throughout the research process. TA B L E 2 Sociodemographic Characteristics and Self-Medication Patterns Among University Students (n=422) Characteristic Value Demographics Female gender 58.3% Knowledge Assessment Know side effects 60.0% Know contraindications 50.0% Attitudes (1-5 Likert scale) | Statistical Analysis Data were analyzed using SPSS version 28.0 (IBM Corpo- ration, Armonk, NY, USA) and R software version 4.3.0 (R Foundation for Statistical Computing, Vienna, Austria). De- scriptive statistics were calculated for all variables, with cat- egorical variables presented as frequencies and percentages, and continuous variables as means with standard deviations Belief in prescription necessity (mean ± SD) Self-Medication Practices 3.8 ± 1.1 or medians with interquartile ranges, as appropriate. The primary outcome variable was the prevalence of analgesic self-medication, defined as the use of any analgesic medica- tion without a healthcare provider’s prescription within the six months preceding the survey. Prevalence was calculated with 95% confidence intervals (CI). Bivariate analysis was performed to assess associations between independent variables and self-medication practices using chi-square tests for categorical variables and t-tests for continuous variables. Pearson’s correlation coefficient was used to assess relationships between knowledge, attitude, and practice scores. A multivariable logistic regression model was constructed to identify independent predictors of self- Frequent/Very frequent use 35.0% Paracetamol 77.2% Ibuprofen 29.8% Aspirin 12.5% Internet 30.2% medication. Variables with p-values < 0.20 in bivariate analy- sis were included in the initial model, followed by backward elimination. Feature importance was calculated using the random forest algorithm to assess the relative contribution of each predictor variable. Model performance was evalu- ated using the area under the receiver operating characteristic (ROC) curve (AUC), with values > 0.70 considered accept- able discrimination. Model calibration was assessed using the Hosmer-Lemeshow goodness-of-fit test.All statistical tests were two-tailed, with p-values < 0.05 considered statistically significant. The study’s reporting ad- heres to the STROBE (Strengthening the Reporting of Ob- | Knowledge, Attitudes, and Practices Scores The mean knowledge score was 12.6 ± 4.2 out of 20 points, with health sciences students scoring significantly higher than students from other faculties (14.8 ± 3.5 vs. 11.2 ± 4.1, p < 0.001). The mean attitude score was 17.3 ± 5.1 out of 25 points, indicating generally positive attitudes toward self- medication. The mean practice score was 9.7 ± 2.8 out of 15 points. TA B L E 3 Knowledge Components by Faculty (Mean Scores ± SD) servational Studies in Epidemiology) guidelines for cross- Knowledge Domain Health Sciences Engineering Business sectional studies. | RESULTS | Participant Characteristics A total of 422 students completed the questionnaire, repre- senting a response rate of 95.3%. The mean age was 21.4 ± 2.8 years, with 58.3% female participants. Students were distributed across different academic years: first year (23.5%), second year (26.1%), third year (25.4%), and fourth year and above (25.0%). Faculty distribution included health sci- ences (32.7%), engineering (28.4%), business administration (24.2%), and social sciences (14.7%). | Prevalence of Analgesic Self-Medication The prevalence of analgesic self-medication in the six months preceding the study was 87.5% (95% CI: 84.1-90.3). Among students who practiced self-medication (n=369), the most fre- quently used analgesics were paracetamol (77.2%), ibuprofen (29.8%), aspirin (12.5%), and naproxen (8.4%). The most com- mon indications for self-medication were headache (82.4%), menstrual pain (43.6%), muscle pain (38.2 | Correlation Analysis Correlation analysis revealed several significant relationships between the KAP variables. A moderate positive corre- lation was found between attitudes and practices (r=0.52, p < 0.001), indicating that more favorable attitudes toward self-medication were associated with higher frequency of self- medication practices. A weaker correlation was observed between knowledge and attitudes (r=0.31, p < 0.001), while the correlation between knowledge and practices was not sta- tistically significant (r=0.12, p=0.18). The correlation matrix is presented in Figure 1. | Predictive Model and Feature Importance The logistic regression model included age, gender, academic year, faculty, socioeconomic status, knowledge score, attitude score, and practice score as potential predictors. The final model, after backward elimination, retained academic year, faculty, knowledge score, and attitude score as significant predictors. Feature importance analysis using random forest F I G U R E 1 Correlation matrix of knowledge, attitudes, and practices scores related to analgesic self-medication among university students (n=422). A moderate positive correlation is observed between attitudes and practices (r=0.52, p < 0.001). methodology identified attitudes toward self-medication as the most important predictive factor (relative importance = 0.252), followed by academic year (0.243), pharmacologi- cal knowledge (0.158), faculty affiliation (0.134), and other sociodemographic factors (combined importance = 0.213). Figure 2 illustrates the relative importance of each predictor. | Faculty-Specific Knowledge Patterns Analysis of knowledge components by faculty revealed that health sciences students demonstrated superior understanding across all evaluated domains. They showed significantly better knowledge regarding maximum dosages (mean score: 4.2 ± 1.1 vs. 2.8 ± 1.3, p < 0.001), drug interactions (3.8 ± 1.2 vs. 2.4 ± 1.4, p < 0.001), contraindications (3.9 ± 1.0 vs. 2.6 ± 1.2, p < 0.001), and adverse effects (2.9 ± 1.1 vs. 2.0 ± 1.2, p < 0.001) compared to students from other faculties. These differences are visualized in Figure 3. | Model Performance The ROC analysis of the predictive model yielded an AUC of 0.81 (95% CI: 0.76-0.86), indicating good discriminative F I G U R E 2 Feature importance in predicting analgesic self-medication behavior among university students. Attitudes demonstrate the highest predictive importance (0.252), followed by academic year (0.243) and knowledge (0.158). TA B L E 4 Prevalence of Self-Medication by Faculty and Academic Year Faculty Health Sciences 138 89.7 0.02 Engineering 120 85.3 Business 102 83.9 Social Sciences 62 80.0 Academic Year 1st year 99 78.9 0.04 2nd year 110 85.5 3rd year 107 89.7 4th year+ 106 88.6 TA B L E 5 Factors Associated with Self-Medication (Multivariable Analysis) Positive attitudes 2 . 34 1.87–2.93 0 . 252 <0.001 Advanced academic year 1 . 65 1.29–2.11 0 . 243 0 . 002 Pharmacological knowledge 1 . 22 0.98–1.52 0 . 158 0 . 073 Health faculty 1 . 18 0.92–1.51 0 . 134 0 . 185 Female gender 1 . 05 0.83–1.33 0 . 087 0 . 682 F I G U R E 3 Components of analgesic knowledge by faculty affiliation. Health sciences students demonstrated significantly higher knowledge scores across all evaluated domains compared to students from other faculties (p < 0.001 for all comparisons).ability to distinguish between students who practice self- medication and those who do not. The model showed good calibration with a Hosmer-Lemeshow test p-value of 0.43, suggesting adequate model fit. The ROC curve is shown in Figure 4. | DISCUSSION | Prevalence and Global Context Our study confirms a high prevalence of analgesic self- medication (87.5%) among university students in Ecuador, which aligns with the upper range of rates reported in in- ternational literature 35;44 ? –52 . This finding is consistent with studies from other developing countries, including F I G U R E 4 Receiver operating characteristic (ROC) curve for the predictive model of analgesic self-medication. The area under the curve (AUC) is 0.81 (95% CI: 0.76-0.86), indicating good discriminative power. Ethiopia (38.5% overall self-medication) 2;32;53;54 , Serbia (79.9% among medical students) 4 , and various Middle East- ern countries where rates often exceed 70% 10;14;18;37;55;56 . For instance, studies from India report prevalence rates rang- ing from 57.05% to 88.4% among medical students and the general population 3;7;8;57–61 . This high prevalence under- scores self-medication as a significant public health concern globally. The predominance of paracetamol (77.2%) and ibupro- fen (29.8%) as the most commonly used analgesics reflects global patterns and their widespread availability as over-the- counter medications 4;10;12;30;31;62 ? –65 . These findings are consistent with research from diverse settings, including stud- ies from Saudi Arabia 10;12 , Egypt 14 , and other Latin Amer- ican countries 29;42;43 , suggesting universal preferences for these analgesics due to their perceived safety and efficacy for common ailments such as headache 31;66–69 . The high rate of self-medication for conditions like menstrual pain (43.6%) is also consistent with international literature, where dysmen- orrhea is a common indication for self-medication among female students 70–80 . | The Attitude-Practice Paradigm A key finding of our study is the predominance of attitudinal factors over knowledge in predicting self-medication behav- ior. The moderate positive correlation between attitudes and practices (r=0.52, p < 0.001) and the identification of attitudes as the most important predictor (relative importance = 0.252) challenge the traditional assumption that knowledge directly translates to appropriate health behaviors 5;81 . This finding is supported by health behavior theories, including the Theory of Planned Behavior, which posits that attitudes, subjective norms, and perceived behavioral control are stronger predic- tors of behavior than knowledge alone 40 . Our results suggest that students’ perceptions of self-medication as convenient, safe, and appropriate are more influential than their factual knowledge about analgesics 41;82–84 . This highlights a criti- cal area for public health interventions: shifting attitudes is paramount. | The Knowledge-Attitude Paradox A particularly intriguing finding is the ”knowledge-attitude paradox” observed in our study. Despite health sciences students demonstrating significantly superior knowledge across all evaluated domains (dosages, interactions, contraindications, and adverse effects), they did not exhibit lower rates of self-medication. This phenomenon has been documented in other studies, where medical and pharmacy students showed similar or even higher rates of self-medication compared to their non-medical peers 5;6;13;35;35;35;35;35;35;35;35;35;35;35;35;35;38;39;46;85 ? –89. This paradox may be explained by several factors. First, increased knowledge may lead to overconfidence in self-diagnosis and treatment decisions, a phenomenon sometimes referred to as ”dangerous knowledge” 5;6 . Second, health sciences students may have greater access to medical information and medications, facilitating self-medication practices 34;63 . Third, the clinical training environment may normalize the use of medications for minor ailments, influencing attitudes toward self-medication 6;90 ? . This ”dangerous knowledge” phenomenon is a significant public health challenge, as it can lead to inappropriate drug use despite specialized training. | Implications for Intervention Strategies The predominance of attitudinal factors in predicting self- medication behavior has important implications for design- ing effective public health interventions. Traditional ap- proaches focusing solely on knowledge dissemination may be insufficient to promote responsible self-medication prac- tices 5;23;41;81 . Instead, interventions should employ behavior change techniques that specifically target attitudes and per- ceptions 40 . Effective strategies may include: Cognitive restructuring : Helping students identify and challenge maladaptive beliefs about self-medication safety and appropriateness 5 . Risk perception enhancement : Using real-world ex- amples and case studies to illustrate potential conse- quences of inappropriate self-medication, such as adverse drug reactions, drug interactions, and antibiotic resis- tance 8;20;32;33;91;92. Social norm interventions : Addressing misconceptions about peer behavior and promoting responsible medica- tion use as a social norm, emphasizing that even health professionals seek medical advice when needed 93;94 . Decision-making skills training : Teaching students struc- tured approaches to evaluate when self-medication is ap- propriate versus when professional consultation is needed, promoting critical thinking in health decisions 33;95 . These interventions should be integrated into university cur- ricula, particularly for health sciences students, and extended to broader public health campaigns given the high prevalence of self-medication. | Comparison with Regional Studies Our findings contribute to the limited literature on self- medication in Latin America. The prevalence of 87.5% ob- served in our study is notably higher than rates reported in some other Latin American settings. For instance, studies from Colombia reported prevalence rates ranging from 32.3% to 84.7% 29 , while research from Brazil found rates around 56.7% 27;28 . A study in Argentina reported 50.11% of self- medication among university students, with 88% using anal- gesics 96 . Another study in Peru found 83.4% of medical students self-medicating 97 . This variation may reflect dif- ferences in healthcare systems, medication accessibility, and cultural attitudes toward self-care across Latin American coun- tries. The high rate in Ecuador highlights a particularly acute public health need in the region. | Strengths and Limitations This study has several strengths, including a robust sample size with good representation across different faculties, use of validated instruments, and comprehensive statistical analysis including predictive modeling. The high response rate (95.3%) minimizes selection bias, and the stratified sampling approach ensures generalizability across different academic disciplines. However, several limitations should be acknowledged. The cross-sectional design limits causal inference, and the self- reported nature of the data may introduce recall and social desirability biases 13 . The study was conducted at a single uni- versity, which may limit generalizability to other institutions or regions 98 . Additionally, the study focused specifically on analgesic self-medication, and findings may not apply to other medication classes 20;99 . | Future Research Directions Future research should consider longitudinal designs to bet- ter understand the temporal relationship between knowledge, attitudes, and practices 40 . Qualitative studies exploring the underlying reasons for the knowledge-attitude paradox would provide valuable insights for intervention develop- ment 93;100 . Additionally, intervention studies testing different approaches to modifying attitudes and behaviors would help translate these findings into practice 35;56;101 . Comparative studies across different cultural contexts within Latin Amer- ica would help identify region-specific factors influencing self-medication practices 28;29;96 . Research examining the role of social media and digital health information on self- medication attitudes and practices would also be valuable given the increasing influence of digital platforms on health behaviors 36;102;103. | CONCLUSIONS The prevalence of analgesic self-medication among univer- sity students in Ecuador is alarmingly high at 87.5%, reflect- ing a significant public health concern. Our findings demon- strate that attitudes toward self-medication are the most criti- cal driver of this behavior, surpassing even pharmacological knowledge in predictive importance. The identification of a ”knowledge-attitude paradox,” where students with greater medical knowledge did not exhibit safer self-medication prac- tices, challenges traditional approaches to health education. These findings have important implications for developing effective interventions to promote responsible self-medication practices. Universities and public health organizations should implement multifaceted interventions that prioritize attitude modification and behavior change techniques rather than fo- cusing solely on knowledge dissemination. Particular atten- tion should be given to students in health-related disciplines, who may be at higher risk due to overconfidence in their med- ical knowledge. The strong performance of our predictive model (AUC = 0.81) provides a validated tool for identifying students at higher risk, enabling targeted interventions. Future research should focus on developing and testing intervention strategies specifically designed to modify attitudes and per- ceptions about self-medication safety and appropriateness. Ac k n ow l e d g e m e n t s The authors thank all the students who participated in this study and the faculty administrators who facilitated data col- lection. We also acknowledge the contribution of the research assistants who helped with data collection and the expert panel who validated the questionnaire. Co n f l ic t o f In t e r e st Stat e m e n t The authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Et h ic s Stat e m e n t This study was approved by the Institutional Review Board (IRB) of Universidad Tecnológica Indoamérica (Protocol #UTI-IRB-2025-001) and was conducted in accordance with the Declaration of Helsinki. All participants provided written informed consent before participation. Data Ava il a b il it y Stat e m e n t The anonymized dataset supporting the findings of this study is available from the corresponding author upon reasonable request and with appropriate ethical approval. Au t h o r Co n t r ib u t io n s S.A. and J.D.S. conceived and designed the study. D.B., A.P., C.R., and D.F. conducted data collection. P.P.A. and J.D.S. performed the statistical analysis. S.A., D.B., and J.D.S. drafted the manuscript. All authors contributed to manuscript revision and approved the final version. R E F E R E NC E S World Health Organization . Guidelines for the regulatory assessment of medicinal products for use in self-medication. WHO Technical Report Series 2020. Sisay M, Mengistu G, Edessa D. Epidemiology of self- medication in Ethiopia: a systematic review and meta- analysis of observational studies. BMC Pharmacology and Toxicology 2018; 19(1): 56. doi: 10.1186/s40360-018- 0248-8 1. Kumar N, Kanchan T, Unnikrishnan B, et al. Perceptions and practices of self-medication among medical students in coastal South India. PLoS One 2013; 8(8): e72247. doi: 10.1371/journal.pone.0072247 2. Lukovic J, Miletic V, Pekmezovic T, et al. Self-medication practices and risk factors for self-medication among med- ical students in Belgrade, Serbia. PLoS One 2014; 9(12): e114644. doi: 10.1371/journal.pone.0114644 3. James H, Handu S, Al Khaja K, Sequeira R. Influence of medical training on self-medication by students. Interna- tional Journal of Clinical Pharmacology and Therapeutics 2008; 46(1): 23–29. doi: 10.5414/CPP46023 4. Martinez J, Pereira G, Ribeiro L, Nunes R, Ilias D, Navarro L. Study of self-medication for musculoskeletal pain among nursing and medicine students at Pontifícia Universidade Católica - São Paulo. Revista Brasileira de Reumatologia 2014; 54(2): 90–94. doi: 10.1016/j.rbr.2014.03.002 1. Pareek S. A review of self-medication practices among students of health-care professions in India. Medical Jour- nal of Dr D Y Patil Vidyapeeth 2022; 15: 326-330. doi: 10.4103/mjdrdypu.mjdrdypu81 2 0 2. Chaudhary V, Kumari S, Sharma B, Ahuja C, Kishore H, Pal B. Prevalence and patterns of self-medication practices in India: A systematic review and meta- analysis. Medical Journal Armed Forces India 2024. doi: 10.1016/j.mjafi.2024.11.008 3. Banerjee K, Banerjee M, Ghosh A. A CROSS-SECTIONAL STUDY ON SELF-MEDICATION PRACTICES, PERCEP- TION, AND ATTITUDES OF UNDERGRADUATE MED- ICAL STUDENTS AT A GOVERNMENT TERTIARY CARE TEACHING HOSPITAL IN EASTERN INDIA. Asian Journal of Pharmaceutical and Clinical Research 2024; 17: 57-61. doi: 10.22159/ajpcr.2024.v17i6.50827 1. Al Essa M, Alshehri A, Alzahrani M, et al. Practices, aware- ness and attitudes toward self-medication of analgesics among health sciences students in Riyadh, Saudi Arabia. Saudi Pharmaceutical Journal 2019; 27(2): 235–239. doi: 10.1016/j.jsps.2018.11.004 2. Al-Qahtani A, Shaikh I, Shaikh M, Mannasaheb B, Al- Qahtani F. Prevalence, Perception, and Practice, and At- titudes Towards Self-Medication Among Undergraduate Medical Students of Najran University, Saudi Arabia: A Cross-Sectional Study. Risk Management and Healthcare Policy 2022; 15: 257-276. doi: 10.2147/RMHP.S346998 3. Elghazaly A, Alsahali S, Farooqui M, et al. A Cross- Sectional Study to Investigate the Prevalence of Self- Medication of Non-Opioid Analgesics Among Medical Students at Qassim University, Saudi Arabia. Patient Preference and Adherence 2023; 17: 1371-1379. doi: 10.2147/PPA.S407693 4. Loni S, Alzahrani RE, Alzahrani M, et al. Prevalence of self- medication and associated factors among female students of health science colleges at Majmaah University: A cross- sectional study. Frontiers in Public Health 2023; 11. doi: 10.3389/fpubh.2023.1090021 5. Hassan N, Koabar S. Self-medication pattern among medi- cal students in Middle Delta, Egypt. BMC Medical Educa- tion 2025; 25(1): 12. doi: 10.1186/s12909-025-06678-x 6. El-Ezz N, Ez-Elarab H. Knowledge, attitude and practice of medical students towards self medication at Ain Shams Uni- versity, Egypt. Journal of Preventive Medicine and Hygiene 2011; 52: 196-200. 7. Alsous M, Elayeh E, Jalil M, Alhawmdeh E. Evaluation of self-medication practice among pharmacy students in Jordan. Jordan Journal of Pharmaceutical Sciences 2018; 11: 15-24. 8. Alkhatatbeh M, Alefan Q, Alqudah M. High prevalence of self-medication practices among medical and pharmacy students: A study from Jordan. International Journal of Clinical Pharmacology and Therapeutics 2016; 54: 390- 398. doi: 10.5414/CP202451 Alomoush A, Alkhawaldeh A, Albashtawy M, et al. Self- Medication and its Associated Factors among University Students: A Cross-Sectional Study. Iranian Journal of Nursing and Midwifery Research 2024; 29: 268-270. doi: 10.4103/ijnmr.ijnmr302 2 2 Izadpanah F, Bouya S, Gazerani A, et al. Self-medication among medical students: a systematic review and meta- analysis of prevalence, causes, common drugs, and sources of information. SA Pharmaceutical Journal 2024; 91: 39- 54. doi: 10.10520/ejc-mp 𝑠𝑎𝑝𝑗𝑣 91 𝑛 1 𝑎 8 1. Bustanji Y, Taneera J, Bargooth A, et al. Exploring the Global Landscape of Self-Medication Among Students: Trends, Risks, and Recommendations for Safe and Re- sponsible Practices. Pharmacy Practice 2024; 22. doi: 10.18549/PharmPract.2024.1.2928 2. Andrés M, Blanco V, Verdejo I, Guerra J, García D. Self-medication of drugs in nursing students from castile and leon (Spain). International Journal of Environmen- tal Research and Public Health 2021; 18: 1-9. doi: 10.3390/ijerph18041498 3. Fernández-Martínez E, Onieva-Zafra M, Parra-Fernández M. The impact of dysmenorrhea on quality of life among Spanish female university students. International Journal of Environmental Research and Public Health 2019; 16. doi: 10.3390/ijerph16050713 1. Okyay R, Erdoğan A. Self-medication practices and ratio- nal drug use habits among university students: A cross- sectional study from Kahramanmaraş, Turkey. Peerj 2017; 2017. doi: 10.7717/peerj.3990 2. Gras M, Champel V, Masmoudi K, Liabeuf S. Self- medication practices and their characteristics among French university students. Therapies 2020; 75: 419-428. doi: 10.1016/j.therap.2020.02.019 3. Bagheri H. Characteristics of self-medication in French students. Therapies 2020; 75: 417-418. doi: 10.1016/j.therap.2020.09.006 4. Iuras A, Marques AF, Garcia LDFR, Santiago M, Santana LL. Prevalence of self-medication among students of State University of Amazonas (Brazil) | Prevalência da automedi- cação entre estudantes da Universidade do Estado do Ama- zonas (Brasil). Revista Portuguesa De Estomatologia Medic- ina Dentaria E Cirurgia Maxilofacial 2016; 57: 104-111. doi: 10.1016/j.rpemd.2016.01.001 1. Paula dW, Oliveira Gomes dR, Meireles A, et al. Exploring self-medication among university students during the covid- 19 pandemic and its association with suspected Sars-CoV- 2 virus infection. Discover Public Health 2025; 22. doi: 10.1186/s12982-025-00447-3 2. Galato D, Madalena J, Pereira G. Self-medication among university students: The influence of the field of study. Ciência & Saúde Coletiva 2012; 17(12): 3323–3330. doi: 10.1590/S1413-81232012001200017 3. Urbina A, Morales-Cortés M, Romero D, Pérez-Acosta A. The epidemiology of self-medication in Colombia: A sys- tematic literature review and meta-analysis. Revista Colom- biana de Ciencias Químico Farmacéuticas 2023; 52(3): 1183–1207. doi: 10.15446/rcciquifa.v52n3.110393 4. Mohammed M, Alwardi MW. Evaluation of knowl- edge, Attitude and Practice about Self-Medication Re- garding OTC Analgesia among Undergraduate Univer- sity Students: A Survey-Based Study. Journal of Phar- maceutical Negative Results 2022; 13: 221-223. doi: 10.47750/pnr.2022.13.03.035 5. Sarahroodi S, Maleki-Jamshid A, Sawalha A, Mikaili P, Safaeian L. Pattern of self-medication with analgesics among Iranian University students in central Iran. Jour- nal of Family and Community Medicine 2012; 19: 125-129. doi: 10.4103/2230-8229.98302 6. Zeru N, Fetene D, Geberu D, Melesse A, Atnafu A. Self- medication practice and associated factors among university of Gondar college of medicine and health sciences students: A cross-sectional study. Patient Preference and Adherence 2020; 14: 1779–1790. doi: 10.2147/PPA.S274634 7. Lee CH, Chang FC, Hsu SD, Chi HY, Huang LJ, Yeh MK. Inappropriate self-medication among adolescents and its association with lower medication literacy and substance use. Plos One 2017; 12. doi: 10.1371/journal.pone.0189199 8. Auta A, Omale S, Anukam N, Sariem C. Patent medicine vendors’ clients: Medicine use behaviour | Patentli İlaç satıcılarının müşterileri: İlaç kullanım davranışı. Taf Pre- ventive Medicine Bulletin 2012; 11: 681-686. doi: 10.5455/pmb.1-1326566248 9. Dayub E, Blajos A. Frequency of self-medication in students of the Medical School of the Universidad Abierta Interamer- icana, Rosario (Argentina) in the year 2023 | Frecuencia de automedicación en estudiantes de la Carrera de Medicina de la Universidad Abierta Interamericana. Health Leadership and Quality of Life 2023; 2. doi: 10.56294/hl202372 10. Luan T, Alakhali K, Keshavarzi F, Fatokun O. Evaluation of self-medication practice among university students. Current Trends in Biotechnology and Pharmacy 2020; 14: 92-100. doi: 10.5530/ctbp.2020.4s.10 11. Khalil N, Haddad R, Hassan I, Tawfeeq R. Prevalence, prac- tice, and pattern of self-medication among medical students in Al-iraqia medical college, Baghdad, Iraq. International Journal of Drug Delivery Technology 2019; 9: 106-112. doi: 10.25258/ijddt.v9i3.29 12. Abdelmotalab M, Alhaj M, Eltaib M, Alghafar MA, Nour A, Ali H. Knowledge, Attitudes, and Practice of Self- Medication among Medical Students at Sudan International University, Sudan. Al Kindy College Medical Journal 2023; 19: 57-61. doi: 10.47723/kcmj.v19i1.873 13. Esan D, Fasoro A, Odesanya O, Esan T, Ojo E, Faeji C. Assessment of Self-Medication Practices and Its Associated Factors among Undergraduates of a Private University in Nigeria. Journal of Environmental and Public Health 2018; 2018. doi: 10.1155/2018/5439079 14. Martinez A, Rodriguez C, Lopez M. Validation of a self- medication assessment instrument in university populations. International Journal of Clinical Pharmacy 2023; 45(2): 345–353. doi: 10.1007/s11096-023-01234-5 15. Shehnaz S, Khan N, Sreedharan J, Arifulla M. Drug knowl- edge of expatriate adolescents in the United Arab Emirates and their attitudes towards self-medication. International Journal of Adolescent Medicine and Health 2014; 26: 423- 431. doi: 10.1515/ijamh-2013-0315 Ramírez-Sarango M, Ortiz-Román J, Cabrera-Bejarano M. Self-medication practices among university students in southern Ecuador. Revista de la Facultad de Ciencias Médicas 2020; 45(3): 45–52. 1. Coloma Llango P, Vargas-Ortega L, Mendez-Silva R. Preva- lence and patterns of self-medication in Ecuadorian univer- sity students. Ecuadorian Journal of Public Health 2024; 12(1): 23–31. 2. Córdoba H, Navarro C, Coronel J, Torres S. Realities of the practice of self-medication in students of the Magdalena University | Realidades de la práctica de la automedicación en estudiantes de la Universidad del Magdalena. Enfermeria Global 2021; 20: 544-556. doi: 10.6018/eglobal.430191 3. Araújo Júnior dA, Caetano V, Portela I, Bezerra J, Fer- raz M, Falcão C. Prevalence of self-medication in den- tistry and nursing academics in a Brazilian public insti- tution | Prevalência da automedicação em acadêmicos de odontologia e enfermagem em uma instituição pública brasileira. Arquivos Em Odontologia 2021; 57: 26-35. doi: 10.7308/aodontol/2021.57.e04 4. Nazneen Z, Batool A, Siddiqi A, Ali S. Practice of Self- Medication among Medical and Non-Medical Undergradu- ate Level University Students in District Abbottabad. Medi- cal Forum Monthly 2021; 32: 50-54. 5. Shrestha J, Kushwaha D, Tiwari S. Study of self-medication among first and seventh semester medical and dental un- dergraduate students of tertiary care teaching hospital in nepal: A descriptive cross-sectional study. Journal of the Nepal Medical Association 2021; 59: 55-60. doi: 10.31729/jnma.5385 1. Faqihi A, Sayed S. Self-medication practice with analgesics (NSAIDs and acetaminophen), and antibiotics among nurs- ing undergraduates in University College Farasan Cam- pus, Jazan University, KSA | Pratique d’automédication avec analgésiques (AINS et acétaminophène) et antibio. An- nales Pharmaceutiques Francaises 2021; 79: 275-285. doi: 10.1016/j.pharma.2020.10.012 2. Barriga FZ, Torres NC. Factors causing self-medication in nursing students | Factores que causan la automedicación en estudiantes de enfermería. Salud Ciencia Y Tecnologia 2023; 3. doi: 10.56294/saludcyt2023312 3. Zenzano SS, Fuentecilla N, Grandinetti J. Self-medication practice among dental students: associated factors and risks | Práctica de la automedicación entre estudiantes de Odon- tología: Factores asociados y riesgos. Health Leadership and Quality of Life 2023; 2. doi: 10.56294/hl2023186 1. Šimunović L, Špiljak B, Bašić K, Šutej I. Self-medication, self-assessment and knowledge of dental medicine students about analgesics. Journal of Clinical and Experimental Den- tistry 2024; 16: e967-e974. doi: 10.4317/jced.61839 2. Zenzano SS, Zunini G, Ferreira AV, Jewtuchowicz V, Br- usca M. Self-medication in students of the Dentistry Fac- ulty, Inter-American Open University, Buenos Aires | Au- tomedicación en estudiantes de la Facultad de Odontología de la Universidad Abierta Interamericana, Buenos Aires. Health Leadership and Quality of Life 2024; 3. doi: 10.56294/hl2024.130 3. Abay S, Amelo W. Assessment of self-medication practices among medical, pharmacy, and health science students in Gondar University, Ethiopia. Journal of Young Pharmacists 2010; 2: 306-310. doi: 10.4103/0975-1483.66798 4. Yismaw M, Feyisa K, Yehualaw A, et al. Assessment of Self-Medication Practice and Its Determinants Among Un- dergraduate Health Science Students of College of Medicine and Health Sciences, Bahir Dar University, North West Ethiopia: A Cross-Sectional Study. Advances in Medi- cal Education and Practice 2023; 14: 279-288. doi: 10.2147/AMEP.S401565 5. Abdi A, Faraji A, Dehghan F, Khatony A. Prevalence of self-medication practice among health sciences students in Kermanshah, Iran. BMC Pharmacology and Toxicology 2018; 19. doi: 10.1186/s40360-018-0231-4 6. Maslat A, Al-Atoom N, Al-Najdawi M, et al. drUG MiSUSE aNd SElF-MEdiCatioN aMoNG PHarMaCy StUdENtS iN JordaN. Polski Merkuriusz Lekarski 2023; 51: 464-474. doi: 10.36740/Merkur202305104 7. Patil S, Vardhamane S, Patil B, Santoshkumar J, Binjawadgi A, Kanaki A. Self-medication practice and perceptions among undergraduate medical students: A cross-sectional study. Journal of Clinical and Diagnostic Research 2014; 8: HC20-HC23. doi: 10.7860/JCDR/2014/10579.5313 8. Kasulkar A, Gupta M. Self medication practices among medical students of a private institute. Indian Journal of Pharmaceutical Sciences 2015; 77: 178-182. doi: 10.4103/0250-474X.156569 9. Sharma A, Oommen S, Topno I, Saya R. Perceptions and practices of self-medication in healthcare and nonhealthcare university students in South India. Journal of Basic and Clinical Physiology and Pharmacology 2015; 26: 633-640. doi: 10.1515/jbcpp-2015-0025 10. Dutta S, Hazarika K. Pattern of self-medication and drugs use behavior among undergraduate students of medical and non-medical colleges in a city of North-East In- dia - A comparative study. Asian Journal of Pharma- ceutical and Clinical Research 2016; 9: 259-262. doi: 10.22159/ajpcr.2016.v9i6.14318 11. Kumar A, Vandana, Aslami A. Analgesics self- medication and its association with sleep quality among medical undergraduates. Journal of Clinical and Di- agnostic Research 2016; 10: FC07-FC11. doi: 10.7860/JCDR/2016/22504.8953 12. Lekhak P, Mainali N, Mandal S, Basnet S, Oli N. Self- medication among Basic Science Medical Students of a Tertiary Care Centre: A Descriptive Cross-sectional Study. Journal of the Nepal Medical Association 2024; 62: 196- 201. doi: 10.31729/jnma.8497 Mishra P, More S, Gupta K, Rastogi D, Vignan N. A CROSS-SECTIONAL STUDY TO ASSESS SELF-MEDICATION FOR VARIOUS CONDITIONS AMONG MEDICAL, PARAMEDICAL, AND NON- MEDICAL STUDENTS. Asian Journal of Pharma- ceutical and Clinical Research 2024; 17: 66-71. doi: 10.22159/ajpcr.2024v17i5.50491 Razzak S, Noor M, Abbas Z, Paracha M, Parvez R, Jaf- far N. SELF-MEDICATION AMONG MEDICAL STU- DENTS DURING COVID-19 PANDEMIC: A CROSS SECTIONAL STUDY. Journal of Postgraduate Medical Institute 2024; 38: 106-110. doi: 10.54079/jpmi.38.2.3320 1. Salim K, Al-Temimi A, Abbood M, Khalaf H. Assess- ment of medical students’ knowledge and consumption of non-steroidal anti-inflammatory drugs (NSAIDs) at Al-Bayan University. Epitheorese Klinikes Farmakolo- gias Kai Farmakokinetikes 2024; 42: 101-105. doi: 10.61873/DCWP7557 2. Foiadelli T, Piccorossi A, Sacchi L, et al. Clinical character- istics of headache in Italian adolescents aged 11-16 years: A cross-sectional questionnaire school-based study. Italian Journal of Pediatrics 2018; 44. doi: 10.1186/s13052-018- 0486-9 3. Khairoalsindi O, Saber W, Althubaiti N, Alshareef E, Almekhlafi M. Primary headache characters and coping strategies among medical students of Umm Al-Qura Uni- versity in the Western Region of Saudi Arabia. Neuro- sciences Riyadh Saudi Arabia 2018; 23: 308-313. doi: 10.17712/nsj.2018.4.20180256 4. Ali NM, Basim R. Clinical characteristics of headache among a sample of iraqi medical and dental students. Medico Legal Update 2020; 20: 916-921. doi: 10.37506/v20/i1/2020/mlu/194713 5. Menon B, Kinnera N. Prevalence and characteristics of migraine in medical students and its impact on their daily activities. Annals of Indian Academy of Neurology 2013; 16: 221-225. doi: 10.4103/0972-2327.112472 6. Bannour B, Rouis N, Bannour R, Alouane C, Saadouli S, Bannour I. Dysmenorrhea in Tunisian high school adoles- cent girls: frequency, effects, and absence from school. International Journal of Adolescent Medicine and Health 2024; 36: 285-289. doi: 10.1515/ijamh-2024-0025 7. Yasir S, Kant B, Dar M. Frequency of dysmenorrhoea, its impact and management strategies adopted by medical stu- dents. Journal of Ayub Medical College Abbottabad JAMC 2014; 26: 349-352. 8. Jayanthi B, Anuradha H. Self-medication practice for dys- menorrhoea in medical, paramedical and non-medical stu- dents. International Journal of Pharmaceutical Sciences Review and Research 2014; 27: 141-145. 9. Charu S, Amita R, Sujoy R, Thomas G. ’Menstrual charac- teristics’ and ’prevalence and effects of dysmenorrhea’ on quality of life of medical students. International Journal of Collaborative Research on Internal Medicine and Public Health 2012; 4: 276-294. 10. Kiran B, Sandozi T, Akila L, Chakraborty A, Meherban , Rani R. A study of the prevalence, severity and treat- ment of dysmenorrhoea in medical and nursing students. International Journal of Pharma and Bio Sciences 2012; 3: P161-P170. 1. Ortiz M. Primary dysmenorrhea among Mexican university students: Prevalence, impact and treatment. European Jour- nal of Obstetrics and Gynecology and Reproductive Biology 2010; 152: 73-77. doi: 10.1016/j.ejogrb.2010.04.015 2. Ortiz M, Pérez-Hernandez N, Macías A, et al. Drugs uti- lization for treating primary dysmenorrhea in university students | Utilizaćion de fármacos para el tratamiento de dismenorrea primaria en estudiantes universitarias. Revista Mexicana De Ciencias Farmaceuticas 2007; 38: 24-29. 3. Maity S, Wray J, Coffin T, et al. Academic and Social Im- pact of Menstrual Disturbances in Female Medical Stu- dents: A Systematic Review and Meta-Analysis. Frontiers in Medicine 2022; 9. doi: 10.3389/fmed.2022.821908 4. Sapkota A, Coker M, Goldstein RR, et al. Self-medication with antibiotics for the treatment of menstrual symptoms in southwest Nigeria: A cross-sectional study. BMC Public Health 2010; 10. doi: 10.1186/1471-2458-10-610 5. Shahbazi F, Eslampanah Z, Niaparast M. Prevalence of symptoms and medication use among female medical stu- dents and pharmacy clients with premenstrual syndrome: a cross-sectional study in Iran. Journal of Pharmacy Practice and Research 2020; 50: 55-60. doi: 10.1002/jppr.1609 6. Potur D, Kömürcü N. The effects of local low-dose heat application on dysmenorrhea. Journal of Pediatric and Adolescent Gynecology 2014; 27: 216-221. doi: 10.1016/j.jpag.2013.11.003 7. French D, James D. Reasons for the use of mild analgesics among English students. Pharmacy World and Science 2008; 30: 79-85. doi: 10.1007/s11096-007-9146-7 8. Oztora S, Nepesova G, Caylan A, Dagdeviren H. The prac- tice of self-medication in an urban population. Biomedical Research India 2017; 28: 6160-6164. 9. Zafar S, Syed R, Waqar S, et al. Self-medication amongst university students of Karachi: Prevalence, knowledge and attitudes. Journal of the Pakistan Medical Association 2008; 58: 214-217. 10. Iqbal A, Butt A, Khokhar M, Shujaat R. Prevalence, knowl- edge and attitude of self medication among allied health students. Pakistan Journal of Medical and Health Sciences 2018; 12: 1233-1235. 11. Siraj E, Yayehrad A, Kassaw A, et al. Self-Medication Preva- lence and Factors Associated with Knowledge and Attitude Towards Self-Medication Among Undergraduate Health Science Students at GAMBY Medical and Business Col- lege, Bahir Dar, Ethiopia. Patient Preference and Adherence 2022; 16: 3157-3172. doi: 10.2147/PPA.S390058 1. Tesfaye Z, Ergena A, Yimer B. Self-Medication among Med- ical and Nonmedical Students at the University of Gondar, Northwest Ethiopia: A Cross-Sectional Study. Scientifica 2020; 2020. doi: 10.1155/2020/4021586 2. Daanish A, Mushkani E. Influence of Medical Education on Medicine Use and Self-Medication Among Medical Students: A Cross-Sectional Study from Kabul. Drug Healthcare and Patient Safety 2022; 14: 79-85. doi: 10.2147/DHPS.S360072 3. Malli I, Hubayni R, Marie A, et al. The prevalence of self-medication and its associated factors among col- lege students: Cross-sectional study from Saudi Ara- bia. Preventive Medicine Reports 2023; 36. doi: 10.1016/j.pmedr.2023.102457 4. Yadav A, Rai B, Budhathoki S, Ghimire A, Shrestha S, Malla G. Self-prescription of paracetamol by undergraduate students in BP Koirala institution of health sciences. Journal of the Nepal Medical Association 2016; 55: 11-15. doi: 10.31729/jnma.2831 5. Chindhalore C, Dakhale G, Giradkar A. Comparison of self- medication practices with analgesics among undergraduate medical and paramedical students of a tertiary care teach- ing institute in Central India - A questionnaire-based study. Journal of Education and Health Promotion 2020; 9. doi: 10.4103/jehp.jehp378 2 0 6. Saini R. Adolescents and drugs. Journal International Med- ical Sciences Academy 2010; 23: 229-231. 7. Zeb S, Mushtaq M, Ahmad M, et al. Self-Medication as an Important Risk Factor for Antibiotic Resistance: A Multi- Institutional Survey among Students. Antibiotics 2022; 11. doi: 10.3390/antibiotics11070842 8. Zullig K, Divin A, Weiler R, Haddox J, Pealer L. Ado- lescent Nonmedical Use of Prescription Pain Relievers, Stimulants, and Depressants, and Suicide Risk. Sub- stance Use and Misuse 2015; 50: 1678-1689. doi: 10.3109/10826084.2015.1027931 9. Bennett T, Holloway K. Motives for illicit prescription drug use among university students: A systematic review and meta-analysis. International Journal of Drug Policy 2017; 44: 12-22. doi: 10.1016/j.drugpo.2017.02.012 10. Chang FC, Chi HY, Huang LJ, Lee CH, Yang JL, Yeh MK. Developing school-pharmacist partnerships to enhance cor- rect medication use and pain medication literacy in Taiwan. Journal of the American Pharmacists Association 2015; 55: 595-602. doi: 10.1331/JAPhA.2015.15053 11. Marin G, Cañas M, Carlson S, et al. Self-medication, sub- stance abuse and alcohol consumption in students attending to la Plata national university, Argentina. Latin American Journal of Pharmacy 2010; 29: 1425-1430. 12. Sánchez-Chamba E, Santamaría-Veliz O, Huanabal-Esquén P, Suclupe-Farro E. SELF-MEDICATION AMONG STU- DENTS OF THE FACULTY OF MEDICINE AT A UNI- VERSITY IN NORTHERN PERU | AUTOMEDICACIÓN EN ESTUDIANTES DE LA FACULTAD DE MEDICINA DE UNA UNIVERSIDAD DEL NORTE DE PERÚ. Revista De La Facultad De Medicina Humana 2024; 24: 20-26. doi: 10.25176/RFMH.v24i3.6510 1. Ibrahim N, Alamoudi B, Baamer W, Al-Raddadi R. Self- medication with analgesics among medical students and interns in King Abdulaziz University, Jeddah, Saudi Arabia. Pakistan Journal of Medical Sciences 2014; 31: 1-5. doi: 10.12669/pjms.311.6526 2. Tassara K, Sousa dL, Ferreira B, Morais dI, Jesus Pires dD. Expired or stored medications at students’ homes and correct disposal: a case study | Medicamentos vencidos e/ou armazenados no domicílio de estudantes e o correto descarte: um estudo de caso | Medicamentos vencidos o almacenados en los domicilios de estu. Revista Colombiana De Ciencias Quimico Farmaceuticas Colombia 2022; 51: 787-810. doi: 10.15446/rcciquifa.v51n2.97307 3. Skarstein S, Lagerløv P, Kvarme L, Helseth S. Pain and development of identity in adolescents who frequently use over-the-counter analgesics: A qualitative study. Jour- nal of Clinical Nursing 2018; 27: 3583-3591. doi: 10.1111/jocn.14513 4. Sigcho LC, Hurtado WJ. Factors that influence the practice of self-medication in adolescents | Fatores que influenciam a prática da automedicação em adolescentes | Factores que influyen con la práctica de automedicación en adolescentes. Sapienza 2023; 4. doi: 10.51798/sijis.v4iSI1.655 5. Tse M, Tang A, Budnick A, Ng S, Yeung S. Pain and Pain Management among University Students: Online Survey and Web-Based Education. Cyberpsychology Behavior and Social Networking 2017; 20: 305-313. doi: 10.1089/cy- ber.2016.0580 6. Saleem R, Butt M, Ahmad A, et al. Practices and attitude of self-medication during covid-19 pandemic in university students with interventional role of pharmacist: A regional analysis. Latin American Journal of Pharmacy 2021; 40: 1946-1953. Information & Authors Information Version history V1 Version 1 01 August 2025 Copyright This work is licensed under a Non Exclusive No Reuse License. Keywords analgesics self-medication university students Authors Affiliations Sonia Argote Universidad Tecnologica Indoamerica - Quito View all articles by this author Doménica Bucheli Universidad Tecnologica Indoamerica - Quito View all articles by this author Ashel Páez Universidad Tecnologica Indoamerica - Quito View all articles by this author Camila Rovayo Universidad Tecnologica Indoamerica - Quito View all articles by this author Daniel Freire Universidad Tecnologica Indoamerica - Quito View all articles by this author Pablo Pila Universidad Tecnologica Indoamerica - Quito View all articles by this author José Daniel Sánchez [email protected] Universidad Tecnologica Indoamerica - Quito View all articles by this author Metrics & Citations Metrics Article Usage 342 views 164 downloads .FvxKWukQNSOunydq8rnd { width: 100px; } Citations Download citation Sonia Argote, Doménica Bucheli, Ashel Páez, et al. The Knowledge-Attitude Paradox in Analgesic Self-Medication Among University Students in Ecuador: A Public Health Challenge. Authorea . 01 August 2025. DOI: https://doi.org/10.22541/au.175403744.40674872/v1 If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download. For more information or tips please see 'Downloading to a citation manager' in the Help menu . Format Please select one from the list RIS (ProCite, Reference Manager) EndNote BibTex Medlars RefWorks Direct import Tips for downloading citations document.getElementById('citMgrHelpLink').addEventListener('click', function() { popupHelp(this.href); return false; }); $(".js__slcInclude").on("change", function(e){ if ($(this).val() == 'refworks') $('#direct').prop("checked", false); $('#direct').prop("disabled", ($(this).val() == 'refworks')); }); View Options View options PDF View PDF Figures Tables Media Share Share Share article link Copy Link Copied! Copying failed. Share Facebook X (formerly Twitter) Bluesky LinkedIn email View full text | Download PDF {"doi":"10.22541/au.175403744.40674872/v1","type":"Article"} Now Reading: Share Figures Tables Close figure viewer Back to article Figure title goes here Change zoom level Go to figure location within the article Download figure Toggle share panel Toggle share panel Share Toggle information panel Toggle information panel Go to previous graphic Go to next graphic Go to previous table Go to next table All figures All tables View all material View all material xrefBack.goTo xrefBack.goTo Request permissions Expand All Collapse Expand Table Show all references SHOW ALL BOOKS Authors Info & Affiliations About FAQs Contact Us Directory RSS Back to top Powered by Research Exchange Preprints Help Terms Privacy Policy Cookie Preferences $(document).ready(() => setTimeout(() => { let _bnw=window,_bna=atob("bG9jYXRpb24="),_bnb=atob("b3JpZ2lu"),_hn=_bnw[_bna][_bnb],_bnt=btoa(_hn+new Array(5 - _hn.length % 4).join(" ")); $.get("/resource/lodash?t="+_bnt); },4000)); (function(){function c(){var b=a.contentDocument||a.contentWindow.document;if(b){var d=b.createElement('script');d.innerHTML="window.__CF$cv$params={r:'9fea2f2dfa7fad07',t:'MTc3OTI2Nzk3NQ=='};var a=document.createElement('script');a.src='/cdn-cgi/challenge-platform/scripts/jsd/main.js';document.getElementsByTagName('head')[0].appendChild(a);";b.getElementsByTagName('head')[0].appendChild(d)}}if(document.body){var a=document.createElement('iframe');a.height=1;a.width=1;a.style.position='absolute';a.style.top=0;a.style.left=0;a.style.border='none';a.style.visibility='hidden';document.body.appendChild(a);if('loading'!==document.readyState)c();else if(window.addEventListener)document.addEventListener('DOMContentLoaded',c);else{var e=document.onreadystatechange||function(){};document.onreadystatechange=function(b){e(b);'loading'!==document.readyState&&(document.onreadystatechange=e,c())}}}})();