Medication and Health Product Use Among Older Thais Adults : Behavioral Insights and Policy Recommendations: A Cross-Sectional Study

Medication and Health Product Use Among Older Thais Adults : Behavioral Insights and Policy Recommendations: A Cross-Sectional Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Medication and Health Product Use Among Older Thais Adults : Behavioral Insights and Policy Recommendations: A Cross-Sectional Study Tharinee Srisaknok, Chanuttha Ploylearmsang, Adisorn Wongkongdech, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6059939/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background : Inappropriate medication and health product use (M&HP) among the elderly: impact health and health care costs. This study examined the behaviors and factors influencing medication and health product selection among elderly individuals in northeastern Thailand. Methods: The Cross-sectional study was conducted among elderly participants residing in northeastern Thailand. Data were collected from 1,461 elderly individuals between March and November 2022. Personal characteristics and M&HP use behaviors were analyzed using descriptive statistics and factors influencing inappropriate M&HP use were analyzed using multiple logistic regression. Results : 78.6% of participants had chronic diseases. When unwell, most sought care from clinics or hospitals. However, 84.46% used products without consulting professionals, and 52.9% relied on recommendations. Only 41.9% sought additional information about medications. Most behaviors were risky. Factors like unemployment and chronic diseases were associated with inappropriate medication use. Conclusion : Thai elderly individuals, particularly those with chronic diseases and unemployed, are at risk of inappropriate medication and health product use due to easy access and lack of skills and assistance in accessing quality information. Our findings offer actionable insights for improving rational medication use and promoting health literacy among aging populations, aligning with global health priorities and those of Israel and similar aging societies. Medication and Health Products use Healthcare-Seeking Behavior Older Adults in Thailand Medication adherence Inappropriate Medication Use Background The world is facing the challenge of a rapidly aging society. As of 2019, there were over one billion elderly individuals globally, a figure expected to rise to 1.4 billion by 2030 and 2.1 billion by 2050 [1]. In Thailand, there are over 12 million older adults, and older adults make up 18% of the total population [2]. A large proportion (18.9%) live in the Northeastern region [3], making it the second-highest in the ASEAN region after Singapore [4]. Specifically, in Thailand, the number of individuals aged 80 and above is projected to increase significantly from 1.5 million in 2017 to 3.5 million over the next 20 years [5]. Additionally, 5% of older people need help to perform basic daily activities [6]. Many elderly individuals have chronic conditions requiring ongoing medical treatment and care. However, reduced cognitive ability, auditory ability, and psychosocial factors can affect their understanding of health literacy [7] and self-care capacity [8]. A recent survey on health status and health literacy of the Thai elderly found that most rated at a fair or poor level for health literacy and exhibited poor health behavior [9]. Similarly, in the northeastern region, most elderly had low health literacy scores on the M&HP usage scale, particularly at the level of critical health literacy [10-11]. The Thai government has developed long-term health care (LTC) system policies [12] for dependent individuals. However, family/social structures have changed, with the average rural household size decreasing to 2.7 members by 2014, driven by social, economic, and environmental changes. These factors have impacted living expenses and lifestyles, leading to a preference for having one or two children, opting not to have children, or marrying to pursue a more independent lifestyle [13]. As rural working-age persons have migrated to the cities for work, this decreased family support has left some elderly individuals to care for themselves. Volunteer caregivers (CG) are also being trained to provide necessary care for dependent individuals' health issues and promote or prevent potential health risks through community and family involvement [14]. The World Health Organization's (WHO) policy emphasizes the appropriate prescription, distribution, sale, and use of medicines that align with patient treatment needs [15]. Thailand has adopted the rational use of medicines policy as a critical national drug strategy, with plans and methods for reforming health literacy and communication. Due to the prevalent practice of self-medicating with drugs purchased from pharmacies without admission [7], particularly among older people, the Thai government aims to promote the "Smart Elderly Citizen" initiative [16]. This initiative focuses on enhancing the elderly's capacity for health literacy, particularly in medicine use, to aid in health care, illness prevention, and complication avoidance, thereby reducing emergency service utilization, medical expenses, and mortality rates. Nearly all elderly Thai face health issues due to physical deterioration and chronic diseases, with about half engaging in improper health-seeking behaviors to maintain or improve their health [9]. Issues with memory and cognitive abilities and the need for proper guidance impede their ability to analyze health information or make informed decisions regarding purchasing or using medications and health products. This problem is exacerbated by misleading advertisements for dietary supplements and the convenience of online purchasing, which sometimes results in consuming harmful products [17]. Consequently, healthcare expenses for households and national health insurance funds have increased, particularly for elderly health services [18], which is of growing significance for the northeastern region of Thailand, which has the highest proportion of elderly individuals [19]. This research aimed to study the behavior of older adults in northeastern Thailand regarding their use of medications and health products and identify factors influencing medication and health product selection among the elderly. By increasing the understanding of the current situation and related factors, this study seeks to identify strategies to prevent future problems. Methods Study design and study site This study used a cross-sectional questionnaire survey design with data obtained through interviews. It surveyed 1,461 older adults (60 years and over) predominantly from rural village settings in Isaan, N-E Thailand, between April 1 and September 30, 2021. The study sites were proportional to the population in each health region from 13 senior schools in N-E Thailand by Multi-stage Random Sampling. Subsequently, specific target areas were selected by purposive sampling: the elderly schools (elderly schools represent an innovative model for promoting lifelong learning and enhancing the quality of life among older adults). These programs are designed to provide education, skill development, and social activities tailored to the interests and needs of the elderly population [18] in each province. The selection considered the number of students in these elderly schools, aiming for at least 1,000 students per province. These schools are located in urban and rural areas, with the majority in rural regions. The number of schools required in each province varied depending on the number of elderly students; for example, Maha Sarakham Province in the 7th Health Region with four schools and a total of 354 students, Loei Province in the 8th Health Region with three schools and a total of 342 students, Nakhon Ratchasima Province in the 9th Health Region with three schools and a total of 478 students., and Sisaket Province in the 10th Health Region with three schools and a total of 287 students. Participants and Recruitment An initial sample size of 1,537 participants was calculated using Cochran's formula (Cochran, 1997) cited in Chow et al. 2008[20], with a confidence level of 95% and a variance value of 8.18 [21]. We increased this by 20% to accommodate anticipated incomplete responses and attrition for 1,922 participants. Participant recruitment criteria were being over 60 years of age, with or without underlying diseases, with full consciousness, able to communicate in Thai, and willing to consent to join the study. Exclusion criteria were hospitalization during the data collection period, acute illness requiring urgent treatment, not being in the target area during the data collection period, and inability to cooperate throughout the study. All participants who were invited and met the inclusion criteria consented to participate in the study. After excluding some participants who did not complete the questionnaire, the total was 1,461. Questionnaire development The researcher developed the Medications and Health Products Usage (M&HP) structured questionnaire. The questionnaire consisted of 12 questions on general demographic data, seven on general health behaviors when ill, and nine on medication and health product usage. Pilot testing for clarity, feasibility, and appropriateness was carried out with 30 additional older participants, and three rounds of re-editing contributed to the final questionnaire format. The content validity of the M&HP questionnaire was assessed using the Rovielli and Hambleton (1977) protocol, and five expert raters gave IOC values greater than 0.5 for all 60 items. Reliability was assessed using Cronbach's alpha reliability coefficient, which produced a coefficient of 0.97. Questionnaire scoring This questionnaire consists of 9 items assessing health behavior related to the use of medications and health products. The rating scale has three levels: Always (3 points), Sometimes (1 point), and Never (0 points) over the past six months. Respondents select only one option per question. Scoring Interpretation: Positive Behaviors (items 1, 2, 3, 5, 7, and 8); always: 3 points; sometimes: 1 point; never: 0 points. Negative Behaviors (items 4, 6, 9, and 10): always: 0 points; sometimes: 1 point and never: 3 points. Average Behavior Score Levels: low = 1.00-1.50; moderate = 1.51-2.50; High = 2.51-3.00. Data collection The Thai government's COVID-19 pandemic lockdown regulations impacted data collection, and the research team was initially unable to collect data on-site with face-to-face interviews as originally planned. Four alternative methods were employed: phone interviews, online surveys, and mailing questionnaires to participants, with additional local field researchers collecting the data. When the COVID-19 situation improved, researchers began on-site face-to-face interviews as initially planned. Consent to participate The purpose of the study, rights to participate, assurances of confidentiality of information, and consent process were explained to all participants verbally by phone, face-to-face, or in written form, depending on the data collection process used. All participants received a small souvenir after data collection to acknowledge their contribution. Statical analysis Descriptive statistics were used to describe demographic data and levels of health behavior. Pearson's chi-squared test was used to find any association between categorical variables. The binary logistic regression method was used to find significant predictors, and multiple logistic regression was used to test the association between factors. All data were analyzed using RStudio software package version 2022.02.1 +461 "Prairie Trillium" for Windows [22]. Results Social Demographic of Participants The total number of participants was 1,461, with the majority being female and the average age was 68.60 (range 60-87 years). Most participants resided in rural areas, with primary schools having the highest education level. One-third were widowed and received care from family members. Nearly 40% could still engage in agricultural activities, but almost 80% could not generate income. Almost all participants had chronic illnesses. Nearly all participants were either unable to use smartphones or were not proficient in using them to search for information. About 40% received support from personnel for assistance or advice on using medications and health products. (see Table 1). Table 1 : Participants' demographics (N= 1,461). Personal factors Number Percentage 1. Gender Male Female 588 873 40.25 59.75 2. Age (= 5.99), Min= 60 years, Max= 87 years 3. Place of residence 1) urban 2) rural 43 1,556 2.69 97.31 4. Highest education level 1) not exceed grade 6 2) above grade 6 (primary school) 1,373 88 93.98 6.02 5. Marital status 1) Single 2) Living with spouse 3) Divorced or widowed 48 919 494 3.29 62.90 33.81 6. Caregiver 1) do not have caregivers 2) family members 272 1189 18.62 81.38 7. Occupation 1) Farmers 2) Pensionered 3) Unemploying 899 30 532 61.53 2.05 36.41 8. Have enough money 440 27.52 9. Underlying disease 1149 78.64 10. Have a smartphone(s) and can use it to find health information on the internet 1) proficiency 2) not proficiency 3) cannot use 205 605 651 14.03 41.41 44.56 11. Have support from medical personnel to provide help/advice on medications and health product usage. 573 39.22 12. Need greater literacy in the usage of medicines and health products 1331 91.10 Health-seeking behavior data When experiencing illness, nearly 60% of individuals preferred seeking health information from others rather than conducting research. Most opted for treatment from modern medical practitioners at hospitals (45.64%) or clinics (18.89%) rather than exclusively purchasing medications from pharmacies staffed by licensed pharmacists. Over 10% procure medications from village grocery stores based on recommendations from acquaintances with similar symptoms or through media advertisements. Almost half of the individuals use medications more for body nourishment than for treating illnesses (51.27%). They frequently chose dietary supplements independently (52.93%), with the primary reason for selection being recommendations from others (52.65%). (see Table 2). Table 2 : Health care-seeking behaviors of the Thai elderly. (N= 1,461). Personal factors N % When symptoms of illness occur 1. How to Seek Information about Health, medicine, or health products 1) Search for information by her/ himself 2) Often ask others for information 3) Do not seek additional information 2. How to manage and treat illness (multiple answers allowed) 1) Consult a current physician at the hospital 2) Consult a current physician at the clinic 3) Buy medicine from a pharmacy with a pharmacist on duty 4) Buy medicine from a pharmacy (not sure if there is a pharmacist) 5) Buy from a local grocery store 6) Buy from media advertisements such as T.V., radio or online 7) Seek advice/medicine from someone with similar symptoms 8) Have family members arrange it 612 290 559 1404 581 0 95 319 270 311 96 41.89 19.85 38.26 45.64 18.89 0.00 3.09 10.37 8.78 10.11 3.12 3. Receive Health Information about Medicine or Health Products from 1) Healthcare professionals 2) Village health volunteers (VHVs) 3) Community leaders 4) Family members, relatives, siblings 5) Neighbors 6) Television 7) Radio 8) Brochures, books, leaflets, magazines 9) Social media and online platforms such as Line, Facebook or YouTube 1082 599 151 504 239 624 478 147 563 24.66 13.65 3.44 11.49 5.45 14.22 10.90 3.35 12.83 4. Experience in Choosing Medicine and Health Products Without consulting medical personnel 1234 84.46 5. Reasons for choosing medicine or health products 1) Treatment of illness 2) Health maintenance 660 801 48.73 51.27 6. Types of medication or health products used (Multiple answers allowed) 1) Medication 2) Health supplements 3) Medical devices 550 920 268 31.65 52.93 15.42 7. Reasons for Choosing Medicine and Health Products (Multiple answers allowed) 1) Personal decision 2) Recommended by others 3) Given by others 4) Advertising 598 854 50 120 36.87 52.65 3.08 7.40 Health-seeking behaviors on the M&HP were generally at a low level. Almost all aspects of this behavior were rated low. The only aspect that was at a moderate level was seeking advice from doctors or pharmacists when experiencing adverse reactions from medication use. Behaviors rated lowest included "choosing medications with a label indicating the drug registration number," "sharing or forwarding information without verifying its quality," "trying medications recommended by someone with a positive experience," and "checking the advertisement claims before deciding to purchase." These behaviors had average ratings of less than one-third (see Table 3). Table 3 : Usage of Medicine &Health Products behaviors of Thai Elderly (N= 1,461). Always (3 pts.) N (%) Sometime (1 pts.) N (%) Never (0) N (%) ± S.D. Level of M&HP usage 1. Seek information from reliable sources before making a purchase 181 (12.39) 931 (63.72) 349 (23.89) 1.01±0.86 Low 2. Read the drug label before usage 413 (28.27) 763 (52.22) 285 (19.51) 1.37±1.09 Low 3. Verify information from M&HP advertisements before making a purchase 330 (22.59) 431 (29.50) 700 (47.91) 0.97±1.18 Low 4. Consult a doctor or pharmacist promptly if experiencing abnormal symptoms 428 (29.30) 959 (65.64) 74 (5.07) 1.54±0.97 Moderate 5. Share or forward information without verifying quality 180 (12.32) 426 (29.16) 855 (58.52) 0.66±0.98 Low 6. Verify information before deciding to purchase or use medications or products 399 (27.31) 622 (42.57) 440 (30.12) 1.25±1.16 Low 7. Advise others on choosing medications or health products 256 (17.52) 1019 (69.75) 186 (12.73) 1.22±0.88 Low 8. Use M&HP given by others for trial 196 (13.42) 649 (44.42) 616 (42.16) 0.85±0.97 Low 9. Choose medications with a registration number 71 (4.86) 328 (22.45) 1062 (72.69) 0.37±0.72 Low * The score of usage of M&HP behaviors: 'always' (3 points); 'some time' (1 point); 'never' (0 points) * Each item scores 3 points, totaling 30 points * Level of the usage of M&HP behavior 'Low': 1.00-1.50, 'Moderate': 1.51-2.50, and 'High': 2.51-3.00) Factors Affecting to the usage of medications and health products. Table 4: Logistic regression analysis determined factors related to health literacy in medication and health product usage. Univariate analysis revealed risk factors for having a low level of M&HP were being unemployed (OR=1.48, 95% CI:1.10, 1.99, p=0.008) and having underlying disease (OR=1.48, 95% CI: 1.03, 2.12, p=0.033). Factors affecting medication and health product usage were found among persons with underlying disease (OR=1.48, 95% CI: 1.03, 2.12). Table 4 : The analysis of the relationship between factors and the usage of M&HP. (N= 1,461) Factor Low level N(%) Medium-High level N(%) OR crude (95%CI) P value 1. Sex male female 484(82.30) 726(83.20) 104(17.70) 147(16.80) 0.94 (0.71,1.24) 0.673 2. Education background 1) not exceed grade 6 2) above grade 6 1,13(82.40) 79(89.80) 242(17.6) 9(10.20) 0.53 (0.26,1.08) 0.074 3. Marital status 1) Single 2) Divorced or widowed 3) married 39(81.20) 399(80.80) 772(84.00) 9(18.80) 95(19.20) 147(16.00) 0.83(0.39,1.74) 0.80(0.6,1.06) 1 0.613 0.124 4. Occupation 1) Unemployed 2) pensioner 3) agriculturist 457(85.90) 24(80.00) 723(80.40) 75(14.10) 6(20.00) 176(19.60) 1.48(1.10,1.99) 0.97(0.39,2.24) 1 0.008* 0.954 5. Caregiver 1) do not have 2) family members 229(84.20) 981(82.5) 43(15.80) 208(17.50) 1.13(0.79,1.62) 0.506 6. Financial status 1) not enough 2) enough 691(81.68) 519(84.40) 155(18.32) 96(15.60) 1.21(0.92,1.60) 0.175 7. Underlying disease 1) have 2) do not have 939(81.70) 271(86.90) 210(18.30) 41(13.10) 1.48(1.03,2.12) 0.033* 8. Supported by family 1) do not have 2) have 567(82.50) 643(83.1) 120(17.50) 131(16.9) 0.96(0.73,1.26) 0.784 9. Supported by medical personnel 1) do not have 2) have 738(83.10) 472(82.40) 150(16.90) 101(17.60) 1.05(0.8,1.39) 0.716 10. The need to promote literacy in the usage of MD&HP 1) Need 2) do not need 1103(82.90) 107(82.30) 228(17.10) 239(17.70) 1.04(0.65,1.67) 0.871 The results of analyzing many factors at a time (multiple logistic regression; backward stepwise: likelihood ratio) on the usage of M&HP behavior**. Underlying disease (have vs do not have) 1.48 (1.03,2.12) 0.034 *** * Significant (p < 0.05), ** The results of analyzing many factors at a time on the usage of M&HP behavior by multiple logistic regression; backward stepwise: likelihood ratio. ***Wald's test DISCUSSION Our study aligns with several prior research findings: low health literacy contributes to increased illness, healthcare burdens, high treatment costs, and elevated mortality rates [23-24]. Most of our participants, aged between 60 and 69, could manage their daily activities or social engagements and attend activities at elderly schools [6]. However, residing predominantly in rural areas, most had only primary education, and few possessed smartphones with internet access due to poor economic conditions. Most females also lacked experience, health literacy, and skills in using devices to search for health information [5,9,17,25]. Moreover, there was limited awareness of and communication with medical personnel regarding health services, and many could not access health services [26]. Even those with smartphones may accept low-quality information due to a lack of critical judgment and naivety [9,25]. Minor ailments often resulted in self-medication from village shops or pharmacies without consulting pharmacists or reading labels, possibly due to poor eyesight, small print, or lack of understanding [27]. The study explored the factors influencing medication usage behavior, and the presence of chronic illnesses was found to relate significantly to this behavior. Individuals who suffer from illnesses seek various treatment methods to recover or improve their health, often believing these methods to be beneficial and appropriate for their recovery [28]. This tendency was more pronounced in the "senior" elderly with illnesses than in healthy individuals [29]. For instance, elderly individuals aged 80-89 with significant health issues were almost six times more likely to consume dietary supplements compared to those aged 60-69 [30]. This result highlights the increased health concerns and proactive measures older age groups take to manage their health. The study observed that unemployment significantly affects purchasing behavior among the elderly. Whether engaged in income-generating activities or agricultural work [31], employed individuals demonstrated better overall health and work capacity than their unemployed counterparts [32]. In contrast, those who were unemployed exhibited a higher likelihood of experiencing health problems, which subsequently led to an increased reliance on self-care practices and medication use. Self-medication represents a form of health management, reflecting an individual's capacity and autonomy to control and care for one's health. However, this study, along with other related factors, particularly among older adults with chronic illnesses and without caregivers, underscores the need to promote health literacy in medication use. Information often comes from non-health professionals and various media sources, necessitating the safe and informed selection of medicines and health products (M&HP). Therefore, promoting health literacy is crucial to ensure the safe self-selection of M&HP, as improper use can lead to adverse side effects, deterioration in the quality of life of the elderly and their families, and potentially resulting in life-threatening situations. Study strengths This study’s large sample size strongly represents the population of northeastern Thailand. It highlights vital health risks among the elderly, such as high reliance on non-professional advice and low levels of information-seeking about medications, which aligns with findings in similar studies on inappropriate medication use in aging populations [33]. With rising healthcare costs and an increasing elderly population, understanding these inappropriate medication and health product use behaviors is crucial for developing strategies to improve health outcomes and reduce unnecessary healthcare expenses. Study Limitation Due to the COVID-19 outbreak and government prevention measures, the research team faced delays in data collection as physical access to the target areas was restricted. Four alternative methods were implemented to address this: contacting participants by telephone, distributing an online questionnaire, sending the questionnaire by post, and involving local research team members to collect data. Once the situation improved, the team could resume physical data collection in the target areas. CONCLUSION Health literacy, which includes assessing quality and making appropriate decisions regarding the purchase and use of M&HP, reflects an individual's capacity and autonomy in managing their health [34]. Our study highlights that chronic illnesses and unemployment significantly influence M&HP use behavior in our Thai rural elderly sample. Literature reviews indicate that various factors, including age, which increases susceptibility to diseases, the absence of caregivers to assist in accessing quality information amidst persuasive advertising, and the reluctance to seek advice from health professionals, all affect the health status of the elderly. Given the growing elderly population, the accompanying health burden, and high healthcare costs, countries must adapt their health systems to address these emerging challenges. Developing appropriate tools to help the elderly access information and implement quality control systems for media and products is essential [l35]. Ensures consumer protection, particularly for the elderly, promoting their safety and quality of life Declarations Authors' contributions Project Administration, Methodology, Investigation, Writing – Review and editing, Funding Acquisition, and Supervision: RW. Conceptualization, Data Curation, Formal Analysis, Resources, Methodology, Investigation, and Writing – Original Draft: TS, CP. Resources, Validation, Formal Analysis, Visualization, Investigation, Review & Editing: AW, SC. Acknowledgments The authors gratefully acknowledge the participants whose willing contribution made this research possible. We also acknowledge the Village Health Workers, teachers in elderly schools, local research assistants who have facilitated the research process, and Professor John F Smith, who has edited English. Funding This research project was financially supported by Mahasarakham University (No.2821912). Ethical Approval The Human Research Ethics Committee of Mahasarakham University (# 077/2564) reviewed and approved the research proposal on February 18, 2021 . Consent for Publication Not applicable. Participants and Public Involvement Participants and the public were not involved in the design, conduct, reporting, or dissemination of this research. Competing interests No competing interests were disclosed. Provenance and peer review Not commissioned; externally peer-reviewed. Data availability statement The data supporting this study are not available. Due to contains sensitive personal information that cannot be shared publicly due to privacy and confidentiality agreements with the participants. Supplemental material This content is provided by the author(s) and has not been vetted or peer-reviewed by BMJ Publishing Group. The views and recommendations are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims any responsibility for reliance on the content. In cases where translations are included, BMJ does not guarantee their accuracy and is not liable for errors or omissions arising from translation or adaptation. Open access This study is an open-access article distributed following the Creative Commons Attribution Non-Commercial (CC BY-NC4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/. ORCID IDs Ranee Wongkongdechhttp://orcid.org/ 0000-0003-4236-5326 Chanuttha Ploylearmsang http://orcid.org/ 0000-0002-8158-0312 Adisorn Wongkongdechhttp://orcid.org/ 0000-0003-2469-1523 Souksathaphone Chanthamath http://orcid.org/ 0000-0002-0778-8000 Tharinee Srisaknok http://orcid.org 0000-0002-9274-1126 References World Health Organization (2022). Ageing and Health . [cited 2024 Jun 12]. 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The grounded psychometric development and initial validation of the Health Literacy Questionnaire (HLQ). BMC Public Health . 2013;13(1):1-17. Sarapee Putkhong, Orasa Phanpakdee, Pornthip Malatham, & Kaewamatawong, T. Factors related to self-care behavior in drug use and awareness of disease control in elderly people with asthma. Nursing Research and Innovation Journal . 2013;17(3):309-327. (in Thai) Pender NJ, Murdaugh CL, Parsons MA. Health promotion in nursing practice. 2006. Chadakorn Boonsin, Amornsak Pou, Makmai P. Drug use behavior among elderly patients with hypertension in Phetchabun Province. Science and Technology Northern Journal . 2023;2(2):16-28. (in Thai) Pimmasiri Uiwattanakul, Jetanipit Sommat, Wipharat Haichanda. Prevalence and factors associated with the consumption of dietary supplements among the elderly in Chum Phae District, Khon Kaen Province. Journal of Health Sciences and Basic Public Health . 2022;5(2): July-December. (in Thai) National Statistical Office. Survey on employment of the elderly in Thailand 2018. Bangkok: National Statistical Office; 2019. (in Thai) Foundation of Thai Gerontology Research and Development Institute. Situation of the Thai elderly in 2020. Nakhon Pathom: Population Research Institute and Society, Mahidol University; 2021. Sirisuwan, Petcherut & Phimha, Surachai & Banchonhattakit, Pannee. (2022). Influence of active ageing and health literacy on quality of life among elderly persons in northeast Thailand. Health Education Journal . 81. 001789692211093. 10.1177/00178969221109329. Sangduan Ginggeaw NP. The Relationship between Health Literacy and Health Behaviors among Older Adults who have Multi-morbidity. Nursing Journal of the Ministry of Public Health . 2016;25(3):43-54. Tharinee Srisaknok, Chanuttha Ploylearmsang, Ranee Wongkongdech. Why there is a need to promote media literacy in the use of medicines and health products in Thai older adults ?. Stud Health Technol Inform. 2023 ; Jun 29; 305: 208-211. doi: 10.3233/SHTI230464. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6059939","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":417915045,"identity":"f4f4a93d-fab0-43f9-9c2b-61ec07a937a9","order_by":0,"name":"Tharinee Srisaknok","email":"","orcid":"","institution":"Faculty of Pharmacy, Mahasarakham University","correspondingAuthor":false,"prefix":"","firstName":"Tharinee","middleName":"","lastName":"Srisaknok","suffix":""},{"id":417915046,"identity":"38bee226-9e17-4b9f-92cb-d72787c86d85","order_by":1,"name":"Chanuttha Ploylearmsang","email":"","orcid":"","institution":"Faculty of Pharmacy, Mahasarakham University","correspondingAuthor":false,"prefix":"","firstName":"Chanuttha","middleName":"","lastName":"Ploylearmsang","suffix":""},{"id":417915047,"identity":"9a07a80c-ad6c-45f0-83a9-00364d99ce46","order_by":2,"name":"Adisorn Wongkongdech","email":"","orcid":"","institution":"Faculty of Public Health, Mahasarakham University","correspondingAuthor":false,"prefix":"","firstName":"Adisorn","middleName":"","lastName":"Wongkongdech","suffix":""},{"id":417915048,"identity":"056df2af-1f68-43f5-81e4-d18d97d3a8dc","order_by":3,"name":"Souksathaphone Chanthamath","email":"","orcid":"","institution":"Khammouane provincial hospital","correspondingAuthor":false,"prefix":"","firstName":"Souksathaphone","middleName":"","lastName":"Chanthamath","suffix":""},{"id":417915049,"identity":"e8f35efd-cae3-4453-8e38-dd6b67290f23","order_by":4,"name":"Ranee Wongkongdech","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAvUlEQVRIiWNgGAWjYBADOTjLgFgtxjCGBNFaEhuI1mLefvbggw8Mh9PX9p8xYPhRw1BnTkiLzJm8ZMMZDIdzt93IMWDsOcYgYdlAQIsEQ46ZNA/DbaAWHgMG3gagww4Q0sL/xvz3H4bb6Wbnzxgw/iVKi0SOGTMDw+0EswM5BszE2SLxxliyx+C/4bYbaQWHZY5JSG4g7LAcww8/KtLkzc4f3vjwTY0NP0FbIAAaFwdAwTEKRsEoGAWjgAoAANbgOxJVycFRAAAAAElFTkSuQmCC","orcid":"","institution":"Faculty of Medicine, Mahasarakham University","correspondingAuthor":true,"prefix":"","firstName":"Ranee","middleName":"","lastName":"Wongkongdech","suffix":""}],"badges":[],"createdAt":"2025-02-19 02:53:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6059939/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6059939/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":78748960,"identity":"ef661d29-4a20-4df6-afb4-823faaf83718","added_by":"auto","created_at":"2025-03-18 11:17:03","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1090287,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6059939/v1/efad0630-86a5-46fd-9ddc-69f8c02a2195.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Medication and Health Product Use Among Older Thais Adults : Behavioral Insights and Policy Recommendations: A Cross-Sectional Study","fulltext":[{"header":"Background","content":"\u003cp\u003eThe world is facing the challenge of a rapidly aging society. As of 2019, there were over one billion elderly individuals globally, a figure expected to rise to 1.4 billion by 2030 and 2.1 billion by 2050 [1]. In Thailand, there are over 12 million older adults, and older adults make up 18% of the total population [2]. A large proportion\u0026nbsp;(18.9%) live in the Northeastern region [3], making it the second-highest in the ASEAN region after Singapore [4]. Specifically, in Thailand, the number of individuals aged 80 and above is projected to increase significantly from 1.5 million in 2017 to 3.5 million over the next 20 years [5]. Additionally, 5% of older people need help to perform basic daily activities [6].\u003c/p\u003e\n\u003cp\u003eMany elderly individuals have chronic conditions requiring ongoing medical treatment and care. However, reduced cognitive ability, auditory ability, and psychosocial factors can affect their understanding of health literacy [7] and self-care capacity [8]. A recent survey on health status and health literacy of the Thai elderly found that most rated at a fair or poor level for health literacy and exhibited poor health behavior [9]. Similarly, in the northeastern region, most elderly had low health literacy scores on the M\u0026amp;HP usage scale, particularly at the level of critical health literacy [10-11]. The Thai government has developed long-term health care (LTC) system policies [12] for dependent individuals. However, family/social structures have changed, with the average rural household size decreasing to 2.7 members by 2014, driven by social, economic, and environmental changes. These factors have impacted living expenses and lifestyles, leading to a preference for having one or two children, opting not to have children, or marrying to pursue a more independent lifestyle [13]. As rural working-age persons have migrated to the cities for work, this decreased family support has left some elderly individuals to care for themselves. Volunteer caregivers (CG) are also being trained to provide necessary care for dependent individuals\u0026apos; health issues and promote or prevent potential health risks through community and family involvement [14].\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;The World Health Organization\u0026apos;s (WHO) policy emphasizes the appropriate prescription, distribution, sale, and use of medicines that align with patient treatment needs [15]. Thailand has adopted the rational use of medicines policy as a critical national drug strategy, with plans and methods for reforming health literacy and communication. Due to the prevalent practice of self-medicating with drugs purchased from pharmacies without admission\u003csup\u003e\u0026nbsp;\u003c/sup\u003e[7], particularly among older people, the Thai government aims to promote the \u0026quot;Smart Elderly Citizen\u0026quot; initiative [16]. This initiative focuses on enhancing the elderly\u0026apos;s capacity for health literacy, particularly in medicine use, to aid in health care, illness prevention, and complication avoidance, thereby reducing emergency service utilization, medical expenses, and mortality rates.\u003c/p\u003e\n\u003cp\u003eNearly all elderly Thai face health issues due to physical deterioration and chronic diseases, with about half engaging in improper health-seeking behaviors to maintain or improve their health [9]. Issues with memory and cognitive abilities and the need for proper guidance impede their ability to analyze health information or make informed decisions regarding purchasing or using medications and health products. This problem is exacerbated by misleading advertisements for dietary supplements and the convenience of online purchasing, which sometimes results in consuming harmful products\u003csup\u003e\u0026nbsp;\u003c/sup\u003e[17]. Consequently, healthcare expenses for households and national health insurance funds have increased, particularly for elderly health services\u003csup\u003e\u0026nbsp;\u003c/sup\u003e[18], which is of growing significance for the northeastern region of Thailand, which has the highest proportion of elderly individuals [19].\u003c/p\u003e\n\u003cp\u003eThis research aimed to study the behavior of older adults in northeastern Thailand regarding their use of medications and health products and identify factors influencing medication and health product selection among the elderly. By increasing the understanding of the current situation and related factors, this study seeks to identify strategies to prevent future problems.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy design and study site\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study used a cross-sectional questionnaire survey design with data obtained through interviews. It surveyed 1,461 older adults (60 years and over) predominantly from rural village settings in Isaan, N-E Thailand, between April 1 and September 30, 2021.\u003c/p\u003e\n\u003cp\u003eThe study sites were proportional to the population in each health region from 13 senior schools in N-E Thailand by Multi-stage Random Sampling. Subsequently, specific target areas were selected by purposive sampling: the elderly schools (elderly schools represent an innovative model for promoting lifelong learning and enhancing the quality of life among older adults). These programs are designed to provide education, skill development, and social activities tailored to the interests and needs of the elderly population [18] in each province. The selection considered the number of students in these elderly schools, aiming for at least 1,000 students per province. These schools are located in urban and rural areas, with the majority in rural regions.\u003c/p\u003e\n\u003cp\u003eThe number of schools required in each province varied depending on the number of elderly students; for example, Maha Sarakham Province in the 7th Health Region with four schools and a total of 354 students, Loei Province in the 8th Health Region with three schools and a total of 342 students, Nakhon Ratchasima Province in the 9th Health Region with three schools and a total of 478 students., and Sisaket Province in the 10th Health Region with three schools and a total of 287 students.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eParticipants and Recruitment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAn initial sample size of 1,537 participants was calculated using Cochran's formula (Cochran, 1997) cited in Chow et al. 2008[20], with a confidence level of 95% and a variance value of 8.18 [21]. We increased this by 20% to accommodate anticipated incomplete responses and attrition for 1,922 participants. Participant recruitment criteria were being over 60 years of age, with or without underlying diseases, with full consciousness, able to communicate in Thai, and willing to consent to join the study. Exclusion criteria were hospitalization during the data collection period, acute illness requiring urgent treatment, not being in the target area during the data collection period, and inability to cooperate throughout the study.\u003c/p\u003e\n\u003cp\u003eAll participants who were invited and met the inclusion criteria consented to participate in the study. After excluding some participants who did not complete the questionnaire, the total was 1,461.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eQuestionnaire development\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe researcher developed the Medications and Health Products Usage (M\u0026amp;HP) structured questionnaire. The questionnaire consisted of 12 questions on general demographic data, seven on general health behaviors when ill, and nine on medication and health product usage.\u003c/p\u003e\n\u003cp\u003ePilot testing for clarity, feasibility, and appropriateness was carried out with 30 additional older participants, and three rounds of re-editing contributed to the final questionnaire format. The content validity of the M\u0026amp;HP questionnaire was assessed using the Rovielli and Hambleton (1977) protocol, and five expert raters gave IOC values greater than 0.5 for all 60 items. Reliability was assessed using Cronbach's alpha reliability coefficient, which produced a coefficient of 0.97.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eQuestionnaire scoring\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis questionnaire consists of 9 items assessing health behavior related to the use of medications and health products. The rating scale has three levels: Always (3 points), Sometimes (1 point), and Never (0 points) over the past six months. Respondents select only one option per question. Scoring Interpretation: Positive Behaviors (items 1, 2, 3, 5, 7, and 8); always: 3 points; sometimes: 1 point; never: 0 points. Negative Behaviors (items 4, 6, 9, and 10): always: 0 points; sometimes: 1 point and never: 3 points. Average Behavior Score Levels: low = 1.00-1.50; moderate = 1.51-2.50; High = 2.51-3.00.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Thai government's COVID-19 pandemic lockdown regulations impacted data collection, and the research team was initially unable to collect data on-site with face-to-face interviews as originally planned. Four alternative methods were employed: phone interviews, online surveys, and mailing questionnaires to participants, with additional local field researchers collecting the data. When the COVID-19 situation improved, researchers began on-site face-to-face interviews as initially planned.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe purpose of the study, rights to participate, assurances of confidentiality of information, and consent process were explained to all participants verbally by phone, face-to-face, or in written form, depending on the data collection process used. All participants received a small souvenir after data collection to acknowledge their contribution.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDescriptive statistics were used to describe demographic data and levels of health behavior. Pearson's chi-squared test was used to find any association between categorical variables. The binary logistic regression method was used to find significant predictors, and multiple logistic regression was used to test the association between factors. All data were analyzed using RStudio software package version 2022.02.1 +461 \"Prairie Trillium\" for Windows [22].\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eSocial Demographic of Participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe total number of participants was 1,461, with the majority being female and the average age was 68.60 (range 60-87 years). Most participants resided in rural areas, with primary schools having the highest education level. One-third were widowed and received care from family members. Nearly 40% could still engage in agricultural activities, but almost 80% could not generate income. Almost all participants had chronic illnesses. Nearly all participants were either unable to use smartphones or were not proficient in using them to search for information. About 40% received support from personnel for assistance or advice on using medications and health products. (see Table 1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1\u003c/strong\u003e: Participants\u0026apos; demographics (N= 1,461).\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 440px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePersonal factors\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 440px;\"\u003e\n \u003cp\u003e1.\u0026nbsp;Gender\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Male\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Female\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e588\u003c/p\u003e\n \u003cp\u003e873\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e40.25\u003c/p\u003e\n \u003cp\u003e59.75\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 624px;\"\u003e\n \u003cp\u003e2. Age \u0026nbsp;(= 5.99), Min= 60 years, Max= 87 years\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 440px;\"\u003e\n \u003cp\u003e3.\u0026nbsp;Place of residence\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 1) urban\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 2) rural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003cp\u003e1,556\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2.69\u003c/p\u003e\n \u003cp\u003e97.31\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 440px;\"\u003e\n \u003cp\u003e4.\u0026nbsp;Highest education level\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 1) not exceed grade 6\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 2) above grade 6 (primary school)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1,373\u003c/p\u003e\n \u003cp\u003e88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e93.98\u003c/p\u003e\n \u003cp\u003e6.02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 440px;\"\u003e\n \u003cp\u003e5. Marital status\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 1) Single\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 2) Living with spouse\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 3) Divorced or widowed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003cp\u003e919\u003c/p\u003e\n \u003cp\u003e494\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e3.29\u003c/p\u003e\n \u003cp\u003e62.90\u003c/p\u003e\n \u003cp\u003e33.81\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 440px;\"\u003e\n \u003cp\u003e6. Caregiver\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 1) do not have caregivers\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 2) family members\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e272\u003c/p\u003e\n \u003cp\u003e1189\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e18.62\u003c/p\u003e\n \u003cp\u003e81.38\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 440px;\"\u003e\n \u003cp\u003e7. Occupation\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 1) Farmers\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 2) Pensionered\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 3) Unemploying\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e899\u003c/p\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003cp\u003e532\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e61.53\u003c/p\u003e\n \u003cp\u003e2.05\u003c/p\u003e\n \u003cp\u003e36.41\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 440px;\"\u003e\n \u003cp\u003e8. Have enough money\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e440\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e27.52\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 440px;\"\u003e\n \u003cp\u003e9.\u0026nbsp;Underlying disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e1149\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e78.64\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 440px;\"\u003e\n \u003cp\u003e10. Have a smartphone(s) and can use it to find health information on the internet \u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;1) proficiency\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;2) not proficiency\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;3) cannot use\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e205\u003c/p\u003e\n \u003cp\u003e605\u003c/p\u003e\n \u003cp\u003e651\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e14.03\u003c/p\u003e\n \u003cp\u003e41.41\u003c/p\u003e\n \u003cp\u003e44.56\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 440px;\"\u003e\n \u003cp\u003e11. Have support from medical personnel to provide help/advice on medications and health product usage.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e573\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e39.22\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 440px;\"\u003e\n \u003cp\u003e12. Need greater literacy in the usage of medicines and health products\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e1331\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e91.10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eHealth-seeking behavior data\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWhen experiencing illness, nearly 60% of individuals preferred seeking health information from others rather than conducting research. Most opted for treatment from modern medical practitioners at hospitals (45.64%) or clinics (18.89%) rather than exclusively purchasing medications from pharmacies staffed by licensed pharmacists. Over 10% procure medications from village grocery stores based on recommendations from acquaintances with similar symptoms or through media advertisements. Almost half of the individuals use medications more for body nourishment than for treating illnesses (51.27%). They frequently chose dietary supplements independently (52.93%), with the primary reason for selection being recommendations from others (52.65%). (see Table 2).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2\u003c/strong\u003e: Health care-seeking behaviors of the Thai elderly. (N= 1,461).\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"631\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 527px;\"\u003e\n \u003cp\u003ePersonal factors\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 527px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWhen symptoms of illness occur\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;1. How to Seek Information about Health, medicine, or health products\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e1) Search for information by her/ himself\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2) Often ask others for information\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e3) Do not seek additional information\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e2. How to manage and treat illness (multiple answers allowed) \u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e1) Consult a current physician at the hospital \u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2) Consult a current physician at the clinic\u003c/p\u003e\n \u003cp\u003e3) Buy medicine from a pharmacy with a pharmacist on duty\u003c/p\u003e\n \u003cp\u003e4) Buy medicine from a pharmacy (not sure if there is a pharmacist)\u003c/p\u003e\n \u003cp\u003e5) Buy from a local grocery store \u0026nbsp;\u003c/p\u003e\n \u003cp\u003e6) Buy from media advertisements such as T.V., radio or online\u003c/p\u003e\n \u003cp\u003e7) Seek advice/medicine from someone with similar symptoms\u003c/p\u003e\n \u003cp\u003e8) Have family members arrange it\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e612\u003c/p\u003e\n \u003cp\u003e290\u003c/p\u003e\n \u003cp\u003e559\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1404\u003c/p\u003e\n \u003cp\u003e581\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e95\u003c/p\u003e\n \u003cp\u003e319\u003c/p\u003e\n \u003cp\u003e270\u003c/p\u003e\n \u003cp\u003e311\u003c/p\u003e\n \u003cp\u003e96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e41.89\u003c/p\u003e\n \u003cp\u003e19.85\u003c/p\u003e\n \u003cp\u003e38.26\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e45.64\u003c/p\u003e\n \u003cp\u003e18.89\u003c/p\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003cp\u003e3.09\u003c/p\u003e\n \u003cp\u003e10.37\u003c/p\u003e\n \u003cp\u003e8.78\u003c/p\u003e\n \u003cp\u003e10.11\u003c/p\u003e\n \u003cp\u003e3.12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 527px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e3. Receive Health Information about Medicine or Health Products from\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e1) Healthcare professionals \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2) Village health volunteers (VHVs)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e3) Community leaders\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e4) Family members, relatives, siblings\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e5) Neighbors\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e6) Television\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e7) Radio \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e8) Brochures, books, leaflets, magazines\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e9) Social media and online platforms such as Line, Facebook or YouTube\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1082\u003c/p\u003e\n \u003cp\u003e599\u003c/p\u003e\n \u003cp\u003e151\u003c/p\u003e\n \u003cp\u003e504\u003c/p\u003e\n \u003cp\u003e239\u003c/p\u003e\n \u003cp\u003e624\u003c/p\u003e\n \u003cp\u003e478\u003c/p\u003e\n \u003cp\u003e147\u003c/p\u003e\n \u003cp\u003e563\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e24.66\u003c/p\u003e\n \u003cp\u003e13.65\u003c/p\u003e\n \u003cp\u003e3.44\u003c/p\u003e\n \u003cp\u003e11.49\u003c/p\u003e\n \u003cp\u003e5.45\u003c/p\u003e\n \u003cp\u003e14.22\u003c/p\u003e\n \u003cp\u003e10.90\u003c/p\u003e\n \u003cp\u003e3.35\u003c/p\u003e\n \u003cp\u003e12.83\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 527px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e4. Experience in Choosing Medicine and Health Products Without consulting medical personnel\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e1234\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e84.46\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 527px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e5. Reasons for choosing medicine or health products\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e1) Treatment of illness \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2) Health maintenance \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e660\u003c/p\u003e\n \u003cp\u003e801\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e48.73\u003c/p\u003e\n \u003cp\u003e51.27\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 527px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e6. Types of medication or health products used\u0026nbsp;\u003c/strong\u003e(Multiple answers allowed)\u003c/p\u003e\n \u003cp\u003e1) Medication\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2) Health supplements\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e3) Medical devices\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e550\u003c/p\u003e\n \u003cp\u003e920\u003c/p\u003e\n \u003cp\u003e268\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e31.65\u003c/p\u003e\n \u003cp\u003e52.93\u003c/p\u003e\n \u003cp\u003e15.42\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 527px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e7. Reasons for Choosing Medicine and Health Products\u0026nbsp;\u003c/strong\u003e(Multiple answers allowed)\u003c/p\u003e\n \u003cp\u003e1) Personal decision\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2) Recommended by others\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e3) Given by others\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e4) Advertising\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e598\u003c/p\u003e\n \u003cp\u003e854\u003c/p\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003cp\u003e120\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e36.87\u003c/p\u003e\n \u003cp\u003e52.65\u003c/p\u003e\n \u003cp\u003e3.08\u003c/p\u003e\n \u003cp\u003e7.40\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eHealth-seeking behaviors on the M\u0026amp;HP were generally at a low level. Almost all aspects of this behavior were rated low. The only aspect that was at a moderate level was seeking advice from doctors or pharmacists when experiencing adverse reactions from medication use. Behaviors rated lowest included \u0026quot;choosing medications with a label indicating the drug registration number,\u0026quot; \u0026quot;sharing or forwarding information without verifying its quality,\u0026quot; \u0026quot;trying medications recommended by someone with a positive experience,\u0026quot; and \u0026quot;checking the advertisement claims before deciding to purchase.\u0026quot; These behaviors had average ratings of less than one-third (see Table 3).\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3\u003c/strong\u003e: Usage of Medicine \u0026amp;Health Products behaviors of Thai Elderly (N= 1,461).\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"604\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003eAlways (3 pts.)\u003c/p\u003e\n \u003cp\u003eN (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003eSometime\u003c/p\u003e\n \u003cp\u003e(1\u0026nbsp;pts.)\u003c/p\u003e\n \u003cp\u003eN (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003eNever\u003c/p\u003e\n \u003cp\u003e(0)\u003c/p\u003e\n \u003cp\u003eN (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003e\u0026plusmn;\u003c/p\u003e\n \u003cp\u003eS.D.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003eLevel of M\u0026amp;HP usage\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e1. Seek information from reliable sources before\u0026nbsp;making a purchase\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e181\u003c/p\u003e\n \u003cp\u003e(12.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e931\u003c/p\u003e\n \u003cp\u003e(63.72)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e349\u003c/p\u003e\n \u003cp\u003e(23.89)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003e1.01\u0026plusmn;0.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003eLow\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e2. Read\u0026nbsp;the drug label before usage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e413\u003c/p\u003e\n \u003cp\u003e(28.27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e763\u003c/p\u003e\n \u003cp\u003e(52.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e285\u003c/p\u003e\n \u003cp\u003e(19.51)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003e1.37\u0026plusmn;1.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003eLow\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 208px;\"\u003e\n \u003cp\u003e3. Verify information from\u0026nbsp;M\u0026amp;HP\u0026nbsp;advertisements before\u0026nbsp;making a purchase\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e330\u003c/p\u003e\n \u003cp\u003e(22.59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e431\u003c/p\u003e\n \u003cp\u003e(29.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e700\u003c/p\u003e\n \u003cp\u003e(47.91)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003e0.97\u0026plusmn;1.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003eLow\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 208px;\"\u003e\n \u003cp\u003e4. Consult a doctor or pharmacist promptly if experiencing abnormal symptoms\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e428\u003c/p\u003e\n \u003cp\u003e(29.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e959\u003c/p\u003e\n \u003cp\u003e(65.64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e74\u003c/p\u003e\n \u003cp\u003e(5.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003e1.54\u0026plusmn;0.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003eModerate\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 208px;\"\u003e\n \u003cp\u003e5. Share or forward information without verifying quality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e180\u003c/p\u003e\n \u003cp\u003e(12.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e426\u003c/p\u003e\n \u003cp\u003e(29.16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e855\u003c/p\u003e\n \u003cp\u003e(58.52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003e0.66\u0026plusmn;0.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003eLow\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 208px;\"\u003e\n \u003cp\u003e6. Verify information before deciding to purchase or use medications or products\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e399\u003c/p\u003e\n \u003cp\u003e(27.31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e622\u003c/p\u003e\n \u003cp\u003e(42.57)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e440\u003c/p\u003e\n \u003cp\u003e(30.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003e1.25\u0026plusmn;1.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003eLow\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 208px;\"\u003e\n \u003cp\u003e7. \u0026nbsp;Advise others on choosing medications or health products\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e256\u003c/p\u003e\n \u003cp\u003e(17.52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e1019\u003c/p\u003e\n \u003cp\u003e(69.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e186\u003c/p\u003e\n \u003cp\u003e(12.73)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003e1.22\u0026plusmn;0.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003eLow\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 208px;\"\u003e\n \u003cp\u003e8. Use\u0026nbsp;M\u0026amp;HP\u0026nbsp;given by others for trial\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e196\u003c/p\u003e\n \u003cp\u003e(13.42)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e649\u003c/p\u003e\n \u003cp\u003e(44.42)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e616\u003c/p\u003e\n \u003cp\u003e(42.16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003e0.85\u0026plusmn;0.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003eLow\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 208px;\"\u003e\n \u003cp\u003e9. Choose medications with a registration number\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e71\u003c/p\u003e\n \u003cp\u003e(4.86)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e328\u003c/p\u003e\n \u003cp\u003e(22.45)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e1062\u003c/p\u003e\n \u003cp\u003e(72.69)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003e0.37\u0026plusmn;0.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003eLow\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e* The score of usage of M\u0026amp;HP behaviors: \u0026apos;always\u0026apos; (3 points); \u0026apos;some time\u0026apos; (1 point); \u0026apos;never\u0026apos; (0 points)\u003c/p\u003e\n\u003cp\u003e* Each item scores 3 points, totaling 30 points\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e* Level of the usage of M\u0026amp;HP behavior \u0026apos;Low\u0026apos;: 1.00-1.50, \u0026apos;Moderate\u0026apos;: 1.51-2.50, and \u0026apos;High\u0026apos;: 2.51-3.00)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFactors Affecting to the usage of medications and health products.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 4: Logistic regression analysis determined factors related to health literacy in medication and health product usage. Univariate analysis revealed risk factors for having a low level of M\u0026amp;HP were being unemployed (OR=1.48, 95% CI:1.10, 1.99, p=0.008) and having underlying disease (OR=1.48, 95% CI: 1.03, 2.12, p=0.033).\u003c/p\u003e\n\u003cp\u003eFactors affecting medication and health product usage were found among persons with underlying disease (OR=1.48, 95% CI: 1.03, 2.12).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4\u003c/strong\u003e: The analysis of the relationship between factors and the usage of M\u0026amp;HP. (N= 1,461)\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"614\" style=\"margin-right: calc(-2%); width: 102%;\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 36.1005%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFactor\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.1749%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLow level \u0026nbsp; N(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.942%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMedium-High level N(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9566%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOR\u003csub\u003e\u0026nbsp;crude\u003c/sub\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(95%CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36.1005%;\"\u003e\n \u003cp\u003e1. Sex\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; male\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; female\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.1749%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e484(82.30)\u003c/p\u003e\n \u003cp\u003e726(83.20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.942%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e104(17.70)\u003c/p\u003e\n \u003cp\u003e147(16.80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9566%;\"\u003e\n \u003cp\u003e0.94\u003c/p\u003e\n \u003cp\u003e(0.71,1.24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.673\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36.1005%;\"\u003e\n \u003cp\u003e2. Education background\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 1) not exceed grade 6\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 2) above grade 6\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.1749%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1,13(82.40)\u003c/p\u003e\n \u003cp\u003e79(89.80)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.942%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e242(17.6)\u003c/p\u003e\n \u003cp\u003e9(10.20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9566%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.53\u003c/p\u003e\n \u003cp\u003e(0.26,1.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.074\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36.1005%;\"\u003e\n \u003cp\u003e3. Marital status\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 1) Single\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 2) Divorced or widowed\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 3) married\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.1749%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e39(81.20)\u003c/p\u003e\n \u003cp\u003e399(80.80)\u003c/p\u003e\n \u003cp\u003e772(84.00)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.942%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e9(18.80)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;95(19.20)\u003c/p\u003e\n \u003cp\u003e147(16.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9566%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.83(0.39,1.74)\u003c/p\u003e\n \u003cp\u003e0.80(0.6,1.06)\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.613\u003c/p\u003e\n \u003cp\u003e0.124\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36.1005%;\"\u003e\n \u003cp\u003e4.\u0026nbsp;Occupation\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 1) Unemployed\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 2) pensioner\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 3) agriculturist\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.1749%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e457(85.90)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e24(80.00)\u003c/p\u003e\n \u003cp\u003e723(80.40)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.942%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e75(14.10)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e6(20.00)\u003c/p\u003e\n \u003cp\u003e176(19.60)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9566%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.48(1.10,1.99)\u003c/p\u003e\n \u003cp\u003e0.97(0.39,2.24)\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.008*\u003c/p\u003e\n \u003cp\u003e0.954\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36.1005%;\"\u003e\n \u003cp\u003e5. Caregiver\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 1) do not have\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 2) family members\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.1749%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e229(84.20)\u003c/p\u003e\n \u003cp\u003e981(82.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.942%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e43(15.80)\u003c/p\u003e\n \u003cp\u003e208(17.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9566%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.13(0.79,1.62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.506\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36.1005%;\"\u003e\n \u003cp\u003e6. Financial status\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 1) not enough\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 2) enough\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.1749%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e691(81.68)\u003c/p\u003e\n \u003cp\u003e519(84.40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.942%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e155(18.32)\u003c/p\u003e\n \u003cp\u003e96(15.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9566%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.21(0.92,1.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.175\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36.1005%;\"\u003e\n \u003cp\u003e7. Underlying disease\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 1) have \u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 2) do not have\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.1749%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e939(81.70)\u003c/p\u003e\n \u003cp\u003e271(86.90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.942%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e210(18.30)\u003c/p\u003e\n \u003cp\u003e41(13.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9566%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.48(1.03,2.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.033*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36.1005%;\"\u003e\n \u003cp\u003e8. Supported by family \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 1) do not have\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 2) have\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.1749%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e567(82.50)\u003c/p\u003e\n \u003cp\u003e643(83.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.942%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e120(17.50)\u003c/p\u003e\n \u003cp\u003e131(16.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9566%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.96(0.73,1.26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.784\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36.1005%;\"\u003e\n \u003cp\u003e9. Supported by medical personnel\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 1) do not have\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 2) have\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.1749%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e738(83.10)\u003c/p\u003e\n \u003cp\u003e472(82.40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.942%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e150(16.90) 101(17.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9566%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.05(0.8,1.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.716\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36.1005%;\"\u003e\n \u003cp\u003e10. The need to promote literacy in the usage of MD\u0026amp;HP\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 1) Need\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 2) do not need\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.1749%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1103(82.90)\u003c/p\u003e\n \u003cp\u003e107(82.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.942%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e228(17.10)\u003c/p\u003e\n \u003cp\u003e239(17.70)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9566%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.04(0.65,1.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.871\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 614px;\"\u003e\n \u003cp\u003eThe results of analyzing many factors at a time (multiple logistic regression; backward stepwise: likelihood\u0026nbsp;ratio) on the usage of M\u0026amp;HP behavior**.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36.1005%;\"\u003e\n \u003cp\u003eUnderlying disease (have \u003cem\u003evs\u003c/em\u003e do not have)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.1749%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.942%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.9566%;\"\u003e\n \u003cp\u003e1.48 (1.03,2.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.034 ***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e* Significant (p \u0026lt; 0.05),\u003c/p\u003e\n\u003cp\u003e** The results of analyzing many factors at a time on the usage of M\u0026amp;HP behavior by multiple logistic regression; backward stepwise: likelihood ratio.\u003c/p\u003e\n\u003cp\u003e***Wald\u0026apos;s test\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eOur study aligns with several prior research findings: low health literacy contributes to increased illness, healthcare burdens, high treatment costs, and elevated mortality rates [23-24]. Most of our participants, aged between 60 and 69, could manage their daily activities or social engagements and attend activities at elderly schools [6]. However, residing predominantly in rural areas, most had only primary education, and few possessed smartphones with internet access due to poor economic conditions. Most females also lacked experience, health literacy, and skills in using devices to search for health information [5,9,17,25]. Moreover, there was limited awareness of and communication with medical personnel regarding health services, and many could not access health services [26]. Even those with smartphones may accept low-quality information due to a lack of critical judgment and naivety [9,25]. Minor ailments often resulted in self-medication from village shops or pharmacies without consulting pharmacists or reading labels, possibly due to poor eyesight, small print, or lack of understanding [27].\u003c/p\u003e\n\u003cp\u003eThe study explored the factors influencing medication usage behavior, and the presence of chronic illnesses was found to relate significantly to this behavior. Individuals who suffer from illnesses seek various treatment methods to recover or improve their health, often believing these methods to be beneficial and appropriate for their recovery [28]. This tendency was more pronounced in the \"senior\" elderly with illnesses than in healthy individuals [29].\u003c/p\u003e\n\u003cp\u003eFor instance, elderly individuals aged 80-89 with significant health issues were almost six times more likely to consume dietary supplements compared to those aged 60-69 [30]. This result highlights the increased health concerns and proactive measures older age groups take to manage their health.\u003c/p\u003e\n\u003cp\u003eThe study observed that unemployment significantly affects purchasing behavior among the elderly. Whether engaged in income-generating activities or agricultural work [31], employed individuals demonstrated better overall health and work capacity than their unemployed counterparts [32]. In contrast, those who were unemployed exhibited a higher likelihood of experiencing health problems, which subsequently led to an increased reliance on self-care practices and medication use.\u003c/p\u003e\n\u003cp\u003eSelf-medication represents a form of health management, reflecting an individual's capacity and autonomy to control and care for one's health. However, this study, along with other related factors, particularly among older adults with chronic illnesses and without caregivers, underscores the need to promote health literacy in medication use. Information often comes from non-health professionals and various media sources, necessitating the safe and informed selection of medicines and health products (M\u0026amp;HP). Therefore, promoting health literacy is crucial to ensure the safe self-selection of M\u0026amp;HP, as improper use can lead to adverse side effects, deterioration in the quality of life of the elderly and their families, and potentially resulting in life-threatening situations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy strengths\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study’s large sample size strongly represents the population of northeastern Thailand. It highlights vital health risks among the elderly, such as high reliance on non-professional advice and low levels of information-seeking about medications, which aligns with findings in similar studies on inappropriate medication use in aging populations [33]. With rising healthcare costs and an increasing elderly population, understanding these inappropriate medication and health product use behaviors is crucial for developing strategies to improve health outcomes and reduce unnecessary healthcare expenses.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy Limitation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDue to the COVID-19 outbreak and government prevention measures, the research team faced delays in data collection as physical access to the target areas was restricted. Four alternative methods were implemented to address this: contacting participants by telephone, distributing an online questionnaire, sending the questionnaire by post, and involving local research team members to collect data. Once the situation improved, the team could resume physical data collection in the target areas.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eHealth literacy, which includes assessing quality and making appropriate decisions regarding the purchase and use of M\u0026amp;HP, reflects an individual\u0026apos;s capacity and autonomy in managing their health [34]. Our study highlights that chronic illnesses and unemployment significantly influence M\u0026amp;HP use behavior in our Thai rural elderly sample. Literature reviews indicate that various factors, including age, which increases susceptibility to diseases, the absence of caregivers to assist in accessing quality information amidst persuasive advertising, and the reluctance to seek advice from health professionals, all affect the health status of the elderly.\u003c/p\u003e\n\u003cp\u003eGiven the growing elderly population, the accompanying health burden, and high healthcare costs, countries must adapt their health systems to address these emerging challenges. Developing appropriate tools to help the elderly access information and implement quality control systems for media and products is essential [l35]. Ensures consumer protection, particularly for the elderly, promoting their safety and quality of life\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e Project Administration, Methodology, Investigation, Writing \u0026ndash; Review and editing, Funding Acquisition, and Supervision: RW. Conceptualization, Data Curation, Formal Analysis, Resources, Methodology, Investigation, and Writing \u0026ndash; Original Draft: TS, CP. Resources, Validation, Formal Analysis, Visualization, Investigation, Review \u0026amp; Editing: AW, SC.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u0026nbsp;\u003c/strong\u003eThe authors gratefully acknowledge the participants whose willing contribution made this research possible. We also acknowledge the Village Health Workers, teachers in elderly schools, local research assistants who have facilitated the research process, and Professor John F Smith, who has edited English.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e This research project was financially supported by Mahasarakham University (No.2821912).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Human Research Ethics Committee of Mahasarakham University (# 077/2564) reviewed and approved the research proposal on February 18, 2021\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publication\u0026nbsp;\u003c/strong\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eParticipants and Public Involvement\u0026nbsp;\u003c/strong\u003e Participants and the public were not involved in the design, conduct, reporting, or dissemination of this research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u0026nbsp; No competing interests were disclosed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eProvenance and peer review\u003c/strong\u003e Not commissioned; externally peer-reviewed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statement\u0026nbsp;\u003c/strong\u003e The data supporting this study are not available. Due to contains sensitive personal information that cannot be shared publicly due to privacy and confidentiality agreements with the participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSupplemental material\u003c/strong\u003e This content is provided by the author(s) and has not been vetted or peer-reviewed by BMJ Publishing Group. The views and recommendations are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims any responsibility for reliance on the content. In cases where translations are included, BMJ does not guarantee their accuracy and is not liable for errors or omissions arising from translation or adaptation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOpen access\u003c/strong\u003e This study is an open-access article distributed following the Creative Commons Attribution Non-Commercial (CC BY-NC4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eORCID IDs\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRanee Wongkongdechhttp://orcid.org/\u0026nbsp;0000-0003-4236-5326\u003c/p\u003e\n\u003cp\u003eChanuttha Ploylearmsang http://orcid.org/ 0000-0002-8158-0312\u003c/p\u003e\n\u003cp\u003eAdisorn Wongkongdechhttp://orcid.org/ 0000-0003-2469-1523\u003c/p\u003e\n\u003cp\u003eSouksathaphone Chanthamath http://orcid.org/ 0000-0002-0778-8000\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTharinee Srisaknok \u0026nbsp;http://orcid.org 0000-0002-9274-1126\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWorld Health Organization (2022). \u003cem\u003eAgeing and Health\u003c/em\u003e. [cited 2024 Jun 12]. Available from: https://www.who.int/news-room/fact-sheets/detail/ageing-and-health \u003c/li\u003e\n\u003cli\u003eDevelopment of Thai Gerontology Research and Development Institute. 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Department of Older Persons; 2016.Available from: https://ebooks.m-society.go.th/ebooks/detail/220. (in Thai)\u003c/li\u003e\n\u003cli\u003eRStudio Builds. [cited 2021 Oct 1]. Available from: https://dailies.rstudio.com/version/2022.02.1+461/ \u003c/li\u003e\n\u003cli\u003eChow SC, Shao, J., \u0026amp; Wang, H. . Sample size calculations in clinical research. New York: Marcel Dekker; 2008.\u003c/li\u003e\n\u003cli\u003eYaowaluck Meebunmak1* JI, Kannika Kijnopakieat1, Phenchamart Khamthana1and Nongnaphat Rungnoe. Health Literacy among Older Adults in a Semi-Urban Community in Ratchaburi Province. \u003cem\u003eThe Southern College Network Journal of Nursing Public Health\u003c/em\u003e; 2019;6:129-41.\u003c/li\u003e\n\u003cli\u003eS\u0026oslash;rensen, K., Van den Broucke, S., Fullam, J., Doyle, G., Pelikan, J., Slonska, Z., \u0026amp; Brand, H. Health literacy and public health: a systematic review and integration of definitions and models. \u003cem\u003eBMC Public Health\u003c/em\u003e. 2012;12(1):1-13.\u003c/li\u003e\n\u003cli\u003eSudore, R. L., Yaffe, K., Satterfield, S., Harris, T. B., Mehta, K. M., Simonsick, E. M., ... \u0026amp; Rubin, S. M. Limited literacy and mortality in the elderly. \u003cem\u003eJournal of General Internal Medicine\u003c/em\u003e. 2006;21(8):806-812.\u003c/li\u003e\n\u003cli\u003eSuramitmaitri, B. A study of health literacy intelligence and operational situations to promote the health intelligence of the Thai people, to support the entry into the ASEAN community. Bangkok: Devawongse Varopakarn Institute of Foreign Affairs, Ministry of Foreign Affairs; 2013. (In Thai).\u003c/li\u003e\n\u003cli\u003eOsborne, R. H., Batterham, R. W., Elsworth, G. R., Hawkins, M., \u0026amp; Buchbinder, R. The grounded psychometric development and initial validation of the Health Literacy Questionnaire (HLQ). \u003cem\u003eBMC Public Health\u003c/em\u003e. 2013;13(1):1-17.\u003c/li\u003e\n\u003cli\u003eSarapee Putkhong, Orasa Phanpakdee, Pornthip Malatham, \u0026amp; Kaewamatawong, T. Factors related to self-care behavior in drug use and awareness of disease control in elderly people with asthma. \u003cem\u003eNursing Research and Innovation Journal\u003c/em\u003e. 2013;17(3):309-327. (in Thai)\u003c/li\u003e\n\u003cli\u003ePender NJ, Murdaugh CL, Parsons MA. Health promotion in nursing practice. 2006.\u003c/li\u003e\n\u003cli\u003eChadakorn Boonsin, Amornsak Pou, Makmai P. Drug use behavior among elderly patients with hypertension in Phetchabun Province. \u003cem\u003eScience and Technology Northern Journal\u003c/em\u003e. 2023;2(2):16-28. (in Thai)\u003c/li\u003e\n\u003cli\u003ePimmasiri Uiwattanakul, Jetanipit Sommat, Wipharat Haichanda. 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Influence of active ageing and health literacy on quality of life among elderly persons in northeast Thailand. \u003cem\u003eHealth Education Journal\u003c/em\u003e. 81. 001789692211093. 10.1177/00178969221109329.\u003c/li\u003e\n\u003cli\u003eSangduan Ginggeaw NP. The Relationship between Health Literacy and Health Behaviors among Older Adults who have Multi-morbidity. \u003cem\u003eNursing Journal of the Ministry of Public Health\u003c/em\u003e. 2016;25(3):43-54.\u003c/li\u003e\n\u003cli\u003eTharinee Srisaknok, Chanuttha Ploylearmsang, Ranee Wongkongdech. Why there is a need to promote media literacy in the use of medicines and health products in Thai older adults\u003cem\u003e?.\u003cspan dir=\"RTL\"\u003e \u003c/span\u003e\u003c/em\u003e\u003cem\u003eStud Health Technol Inform. 2023\u003c/em\u003e; Jun 29; 305: 208-211. doi: 10.3233/SHTI230464.\u003c/li\u003e\n\u003c/ol\u003e\n"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Medication and Health Products use, Healthcare-Seeking Behavior, Older Adults in Thailand, Medication adherence, Inappropriate Medication Use","lastPublishedDoi":"10.21203/rs.3.rs-6059939/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6059939/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: Inappropriate medication and health product use (M\u0026amp;HP) among the elderly: impact health and health care costs. This study examined the behaviors and factors influencing medication and health product selection among elderly individuals in northeastern Thailand.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003eThe Cross-sectional study was conducted among elderly participants residing in northeastern Thailand.\u003cstrong\u003e \u003c/strong\u003eData were collected from 1,461 elderly individuals between March and November 2022. Personal characteristics and M\u0026amp;HP use behaviors were analyzed using descriptive statistics and factors influencing inappropriate M\u0026amp;HP use were analyzed using multiple logistic regression.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: 78.6% of participants had chronic diseases. When unwell, most sought care from clinics or hospitals. However, 84.46% used products without consulting professionals, and 52.9% relied on recommendations. Only 41.9% sought additional information about medications. Most behaviors were risky. Factors like unemployment and chronic diseases were associated with inappropriate medication use.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: Thai elderly individuals, particularly those with chronic diseases and unemployed, are at risk of inappropriate medication and health product use due to easy access and lack of skills and assistance in accessing quality information. Our findings offer actionable insights for improving rational medication use and promoting health literacy among aging populations, aligning with global health priorities and those of Israel and similar aging societies.\u003c/p\u003e","manuscriptTitle":"Medication and Health Product Use Among Older Thais Adults : Behavioral Insights and Policy Recommendations: A Cross-Sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-02-21 07:22:57","doi":"10.21203/rs.3.rs-6059939/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f5e3d5b2-918f-4515-88a5-6e5a99e452e9","owner":[],"postedDate":"February 21st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-03-18T11:08:56+00:00","versionOfRecord":[],"versionCreatedAt":"2025-02-21 07:22:57","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6059939","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6059939","identity":"rs-6059939","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}