JFOA Journal

Introduction

Self-assessed general health (SAH) also known as self-rated health (SRA) or self-perceived health (SPH), based on a simple question such as “In general, how would you assess your health?” is one of the most frequently employed health measures in social science re-search. It has been used to examine the relationship between health and a wide range of social and economic factors, including income [1], education [2], socioeconomic status [3], retirement [4] and early life experiences [5]. Owing to limited space for health questions, SAH is often the only consistently collected measure of health in general population surveys, particularly across waves of longitudinal surveys. Therefore, it is often the sole measure used in many analyses of the determinants and consequences of health [6]. The main advantage of using SAH is that it is probably the most feasible and inclusive measure of health status, as its comprehensive nature allows it to capture elements of health that more guided questions cannot [7]. But, at the same time, it provides little guidance to researchers as to what individuals are thinking of when they assess their general health status. When an individual reports that their health is “poor”, is it because they are in pain, depressed, have limited mobility, or something else entirely? Similarly, what does a report of “excellent” mean? Does it signify the absence of illness or the presence of vigor? No doubt, reports are driven by several underlying factors; however, given the popularity of SAH and its unique ability to predict a number of health outcomes [8,9], it’s important we thoroughly understand its structure.

Self-medication (SM) and Self-medication of Antibiotics (SMA) are a global phenomenon that has been receiving considerable attention within the healthcare systems worldwide [10]. According to the World Health Organization (WHO), selfmedication is defined as one element of self-care and represents the selection and use of medicines by individuals to treat selfrecognized illnesses or symptoms without the guidance of physician for either diagnosis, treatment, or supervision of the treatment [11-14]. The practice of self-diagnosis and SMA by the patients themselves is widespread [15]. According to the World Health Organization (WHO), sub-optimal prescribing practices such as inadequate dosing, incomplete treatment courses and indiscriminate drug use arising due to SM have contributed to the emergence and spread of antimicrobial resistance and emergence of multi-drug resistant pathogens [16].

The existing literature provides important information on the breadth of health factors that are likely to be associated with SAH or SM. A growing literature shows that respondents tend to evaluate their health and drug prescription differently according to several non-health characteristics, including age, gender, education, culture, and personality [17], and failure to account for these factors may bias the estimated associations between health dimensions and SAH or SM. However, it is difficult to draw strong conclusions as to which health factors are most strongly reflected in SAH or SM. Although qualitative studies allow an unrestricted range of health factors to be explored, they rely on respondents being consciously aware of what factors were most important to them when assessing their own health and are restricted to small sample sizes. Quantitative studies have the advantage of much larger sample sizes and the ability to use multiple regression to investigate the relative importance of health factors in assessing one’s health.

SAH and SM practices among the general population remains poorly studied. Most of the studies concerning SAH or SM have focused on specific age groups, sex groups, or patient groups. Studies reporting among the general population are very few. Relative to SAH, some indicators provide direct evidence to the health status of individuals, including previous and current diseases (diagnosed by physicians), and clinical parameters measured in the hospital; these have been termed as “actual” or “objective” health. Some health-related factors, such as demographic characteristics, health history, life habit, life stress and work strain, are closely associated with objective health.

The present study would be implemented to estimate the prevalence of SAH and SM and to look for their association with socio-demographic characteristics in parents. Very few studies were conducted at the community level in Greece to assess the magnitude of SRH [18] and SM practices [19,20]. Studies of such nature will provide useful insight on the reasons for which population resort to this practice and might help policy makers and regulatory authorities to streamline the process of drug regulation, updating the list of essential medicines, and safety issues of over-the-counter drugs. Therefore, the current study was conducted to assess and describe the knowledge, attitudes/ perceptions, and behaviors/practices on SRH and SM and to characterize the critical risk factors influencing SRH and SM behavior among young parents of children in primary schools in Patras, Greece.

Materials and Methods Design

A questionnaire-based cross-sectional study was performed. The study was conducted by administering the questionnaire to young parents. The University Institutional Ethical Review Committee of UPAT (10/2018) issued permission to conduct the study. Since the study did not require any clinical intervention and the participants’ involvement in the study was clearly below minimal risk, all participants gave informed either verbal or written consent.

Research tool

The research tool was developed previously by the research team. The absence of such tools led to the development and validation of a new tool by the research team which was used in this study [20]. Summarizing, the questionnaire included three parts. Part 1 with sociodemographic data, part 2 included information about the SRH and part 3 with questions on the parents’ knowledge and attitudes towards SRH and SM, practice and reasoning of SM.

The survey was provided to young parents in two formats, either as a printed version or through an online platform. The researchers utilized the printed version to conduct in-person interviews with parents in schools, while the online version was shared with social groups Responses were recorded using a Likert scale format: strongly disagree, disagree, agree, and strongly agree.

The survey tool has been reviewed by the researchers for content, clarity, relevance, and intelligibility of the questions [20]. A pilot test of 30 participants was used to assess the questionnaire’s validity, Cronbach’s alpha was used to estimate the reliability of the responses. Concerning the pilot study, the Cronbach’s alpha was 0.82 for knowledge, 0.70 for attitude, and 0.7 for practice, indicating good internal consistency.

Study population

The study sample was determined based on the findings of Ramazani, et al. and calculated using a sample size formula for estimating a proportion. With a desired 95% confidence interval and 0.05 accuracy, the initial estimated sample size was 400 parents, ac-counting for a potential 10% loss. To account for the prevalence rates of self-assessed health (SAH) and SelfMedication (SM) practices, which were found to be 55.9%, and to achieve a relative precision of 10%, the minimum required sample size was recalculated to be 500. Considering a non-response rate of 10%, the final minimum sample size was determined to be 550. Probability proportional to size sampling was employed to select the subjects from all public primary schools of Patras. Stratified random sampling was utilized, using the schools as the sampling class. The percentage of parents selected from each school was determined based on the respective number of parents participated in Parent Association. To facilitate this process, a list of parents in each school was initially obtained and encoded. Overall, the study employed a combination of sample size calculations, probability proportional to size sampling, and stratified random sampling to ensure an adequate and representative sample for the investigation.

Data collection

Having obtained permission from the ethical committee, the researchers contacted the parent association of primary schools to ask for a parent mail list. Also, the research team, has visited the schools, several times. Parents were clearly explained to the participants and the confidentiality of all questionnaire responses was reassured. Participants were informed that they could withdraw from the study at any point. Incomplete or duplicate responses were excluded. In-person interview data were collected by 2 trained researchers (JV and IC).

Statistical Analysis

Descriptive statistics were employed to summarize the recorded variables. This involved calculating measures such as median and interquartile range to provide an overview of the distribution of each quantitative variable and relative frequencies for qualitative variables. The coefficient of correlation was calculated to assess the relationship between quantitative variables, and the Chi-square test of homogeneity was used to examine whether two subgroups within the population shared the same distribution of a single categorical variable [21]. Comparison among multilevel categorical variables was conducted with Chi-square test or Fisher exact test where p-values were computed by Monte Carlo simulation, using 2000 permutations to obtain a robust assessment of statistical significance [22]. Internal consistency was assessed using Cronbach’s alpha and omega coefficient [23]. In all analyses, a p-value less than 0.05 was considered statistically significant. 95% Confidence intervals were calculated via bootstrapping (with 5000 permutations). All answers were recorded in an Excel spreadsheet (Microsoft Office) and statistical analysis was conducted with R Studio (RStudio: Integrated Development for R. RStudio, PBC, Boston, MA, URL http://www.rstudio.com/).

Results Descriptive statistics

Considering SAH and SM as significant issues in the general population (Montgomery et al 2011), we aimed to determine the prevalence, knowledge’s, attitudes, practices and risk factors of SAH and SM in parents from primary schools, in Patras, Greece.

Cronbach’s alpha, 95% confidence intervals, omega hierarchical, omega H asymptomatic and omega total coefficients within “child-unwell behavior”, “quality of life”, “self-medication (for all)”, “self-medication (child, condition)”, “self-medication (child, kind)”, “self-medication (own, kind)”, and “self-rated health” are presented in Table 1.

Table 1: Cronbach’s alpha, 95% confidence intervals, omega hierarchical, omega H asymptomatic and omega total.

The total number of parents who answered the questionnaires (printed and electronic) was 567, however 6 were excluded from the current statistical analysis, because of logistic errors emerged or because of missing data. In our statistical analysis, 560 subjects were utilized and all demographic and descriptive data are presented in Table 2.

Table 2: Descriptive statistics.