Understanding the decision factors and decision-making styles of selecting and using over-the counter medications to treat common minor ailments among young adults

Abstract

Introduction: The prevalence of inappropriate use of over-the-counter (OTC) medication is 20-50%. Young adults are at a unique developmental and transitional life stage that makes them vulnerable to inappropriate use of OTC when they select and use OTC to treat common minor ailments (CMAs). To design an intervention to support young adults to make OTC decisions, it is important to understand the decision-making process of the end-user to tailor the components of the intervention to meet their needs. Objectives: To explore the OTC selection and use decision-making process among U.S. young adults, including investigating factors involved in OTC decisions, the decision-making steps, and the interplay among decision factors, decision-making styles (DMSs), and inappropriate use of OTC. Methods: A scoping review was conducted to identify a comprehensive list of factors involved in OTC selection and use decisions among adults in the U.S. (Aim 1). Semi-structured interviews with young adults were conducted to elucidate the decision-making process of selecting and using OTC to treat CMAs (Aim 2). A cross-sectional study was conducted to assess the association between DMSs, decisional factors, and inappropriate use of OTC to treat CMAs among young adults via online survey (Aim 3). Results: This project found that multiple levels (individual, interpersonal, environmental, and drug-related) of factors were involved in the OTC medication decision-making process. The common OTC decision factors were symptoms, availability and effectiveness of the OTC medications in all adults and in young adults. Personal experience was a more commonly used information resource, preceding the drug fact label (DFL), Internet, professional healthcare providers, and others. The rate of inappropriate selection of OTC was 49.4%, and the rate of inappropriate use of OTC (i.e., Naproxen) was 79.4% in the hypothetical scenario. The previous use of an anti-cough OTC for common cold was associated with higher odds of inappropriate selection of OTC (i.e., selecting anti-cough active ingredient to treat a health condition without cough). DFL was used by some young adults, and they selected different numbers of sections on the DFL to read. Reading Directions, Purpose and Uses, and Warnings were associated with higher odds of correctly answering the OTC use questions. Reading Active Ingredients was associated with lower odds of correctly answering the Indication question. Further, rational decision-making style (RDMS) score was positively correlated with reading information on the DFL and time spent processing information. Intuitive decision-making style (IDMS) score was negatively correlated with time spent processing information. RDMS score was negatively, and IDMS score was positively associated with the inappropriate use of OTC. Conclusion: The inappropriate selection and use of OTC was prevalent, which emphasized the need to employ additional interventions to support young adults making OTC decisions. Insights into decision-making factors can guide the design of future intervention features and functions, ensuring they address the most commonly considered influences. RDMS prevented, and IDMS promoted the inappropriate use of OTC. Thus, future interventions should activate and support RDMS to prevent the inappropriate use of OTC among young adults. Previous experience of using anti-cough OTC medication might increase the risk of selecting the anti-cough OTC for the common cold without cough symptoms. Therefore, professional consultation and other interventions are essential to help young adults select appropriate OTC medications.