Investigation of the relationship between rational drug use and healthy lifestyle behaviours of university students

Abstract

Aim:

the aim of this research is to investigate the relationship between rational drug use and healthy lifestyle behaviours of university students.

Method:

this descriptive and cross-sectional study consisted of 1115 students from a university in the Southeast-East Anatolia Region in the autumn semester of the 2019–2020 academic year. In the collection of data, ‘Student Introduction Form’, ‘The Rational Drug Use Scale’ and ‘The Health-Promoting Lifestyle Profile II’ were used. Ethical approval was obtained from the Batman University Ethics Committee. In addition, necessary legal permissions were obtained from the institution where the study was conducted and from the students. Descriptive statistics, number, percentage, independent t-test, ANOVA test and Spearman’s rank correlation were used in the Statistical Package for Social Science (SPSS) 22.0 package software to analyse the data.

Results:

the average age of the students was 21.31 ± 2.37 years, and their monthly drug expenditure was 142.63 ± 157.200 Turkish Lira. Some 28.1% of them were third-year students, 59% had graduated from Anatolian high school, 59.6% were living with their nuclear family, 49.1% had an equal level of income and expenditure, 7.7% had no chronic disease, and 9% had regular medication. Some 57.8% of them had health insurance. The Health-Promoting Lifestyle Profile II scale mean score of the students was 124.12 ± 21.37 and the Rational Drug Use Scale mean score was 33.65 ± 6.75. A statistically significant difference was found between the students’ class, income, and the total mean scores of the health-promoting lifestyle profile II scale (p < 0.05). A statistically significant difference was found between the school type, family type and income status of the students and the total mean scores of the rational drug use scale (p < 0.05).

Conclusion:

a strong positive correlation was found between rational drug use scale and the health-promoting lifestyle profile II scales.

Keywords

healthy lifestyle behaviours rational drug use health behaviour university student

Introduction

Drug use has increased recently worldwide, as well as in Turkey. There are many reasons for this increase in drug consumption; the most common are inappropriate use of antibiotics, excessive use of injections even though oral formulations are more appropriate, unnecessary use of expensive drugs, use of brand-name drugs instead of generic drugs, prescribing of drugs that do not conform to clinical guidelines, and the non-rational use of drugs that includes self-medication. Non-rational drug use, that is, unnecessary and wrong drug use, is an important health problem globally, especially in developing countries, and it is a habit that may not be easily changed. The World Health Organization (WHO), in Nairobi in 1985, defined rational drug use as the use of ‘medicines suitable for the clinical needs of patients, in doses that meet their personal needs, for a sufficient period of time, at the least cost to themselves and the society (1,2)’. Non-rational drug use causes undesirable consequences for the patient and inefficient use of resources, in addition to risks such as decreasing the effect of treatment, increasing diseases, death, increased treatment cost, and medicine side effects (3).

In a study conducted in Lebanon, although 83.3% of the participants knew that the non-rational use of antibiotics caused antibiotic resistance, 51% stated that they had used non-prescription antibiotics in the last three months (4). Some 26.2% of the patients in a study conducted in Portugal stated that they used non-prescribed antibiotics (5). In our country, 75.5% of the participants of a study conducted in Ankara in 2001 and 57.2% of the participants of a study conducted in Adana in 2013 stated that they used medicines without consulting a doctor, and 80.50% of the participants of a study conducted in Antalya in 2019 stated that they used medicines in accordance with their complaints without consulting a doctor (6 –8). There are three stakeholders in rational drug use (supply, demand, and regulatory and supervisory mechanisms), and all three stakeholders have responsibilities to achieve rational drug use (9). Nurses play an important role in the achievement of rational drug use, as they have a role in the provision of healthcare, establish the closest relationship with patients, are responsible for the preparation and administration of medicines, and follow up the treatment (10).

Non-rational use of drugs in patients with illnesses both negatively affects their health and causes financial damage and a decrease in drug stocks. In order to prevent these damages and negative consequences, individuals and society should know the importance of their own health, choose a healthy lifestyle, and make this permanent for their lifetime (11). Health promotion can only be successful by people regulating and controlling their own health and achieving their full health potential. In order to achieve this goal, risk behaviours such as smoking, alcohol and drug use, nutritional behaviour, physical activity, violent behaviour, sexual behaviour, unhealthy weight control, communication problems with family and stress management should be avoided (12). This research was conducted in order to investigate the relationship between rational drug use and healthy lifestyle behaviours of university students.

Method

This descriptive and cross-sectional study consisted of 1115 students from a university in the Southeast-East Anatolia Region in the autumn semester of the 2019–2020 academic year. The population of the study consists of 12,399 university students enrolled during the 2019–2020 academic year. The sampling of the study was determined to be 996 with 95% reliability intervals, 0.05 error, 0.25 effect size and 0.95 representation of the population. In the collection of data, a ‘Student Introduction Form’, the ‘Rational Drug Use Scale (RDU)’ and the ‘Health-Promoting Lifestyle Profile II (HPLP II)’ were used.

The RDU scale, developed by Demirtaş et al., is a 3-point Likert-type scale with a single sub-dimension and consists of 21 items. In the scale, ‘0’ stands for ‘I do not know’, ‘1’ for ‘no’ and ‘2’ for ‘yes’. The lowest score on the scale is 0, the highest total score is 42, and rational drug knowledge levels increase as the total score increases. The cut-point value of the scale was calculated as 34 points, and it was found that people who scored 35 points or more had rational drug knowledge. Items 2, 5, 6, 9, 10, 13, 15, 16, 17, 19, 20 are the opposite proposition and are scored the opposite. In the validity and reliability study of the scale, Cronbach’s alpha value was found to be 0.789, and the Cronbach’s alpha value was 0.842 in our study (13).

The HPLP II was first developed in 1987 by Pender et al. who made the valid reliability of the scale, Walker et al. made the valid reliability of the scale. Only this reference has been written here, since Pınar et al.(14). The HPLP II scale is a 4-point Likert-type scale with 52 items and includes options of ‘never’, ‘sometimes’, ‘often’ and ‘regularly’. The scale consists of six sub-dimensions under the headings of ‘health responsibility’, ‘physical activity’, ‘nutrition’, ‘spiritual development’, ‘interpersonal relationships’ and ‘stress management’. The lowest total score was 52 and the highest total score was 208. As the total score increases, the student is also considered to have more healthy lifestyle behaviours. In the validity and reliability study of the scale, Cronbach’s alpha value was found to be 0.92, and the Cronbach’s alpha value was 0.919 in our study (14).

Ethical approval was obtained from the Batman University Ethics Committee (26.11.2019, decision 2019/7.7). In addition, necessary legal permissions were obtained from the institution where the study was conducted and from the students.

The statistical analysis of the data was performed using the IBM SPSS (Statistical Package for Social Science) 22.0 statistics programme. It was found that the data showed a normal distribution in the examination performed with the Kolmogorov–Smirnow test before the analysis. Descriptive statistical methods (number, percentage, min–max values, mean and standard deviation) were used in the evaluation of the data in the personal information form. In the data analysis, the independent t-test, ANOVA and Spearman’s rank correlation were performed. Sociodemographic data and scale total score averages to compare t and ANOVA tests were used. Spearman’s rank correlation test was used to determine the relationship between RDU and HPLP II scale. Bonferroni test was used to determine the difference in multiple comparisons.

Results

The average age of the students was 21.31 ± 2.37 years, and their monthly drug expenditure was 142.63 ± 157.20 Turkish lira. Students reported that 28.0% of them were third-year students, 59% of them had graduated from Anatolian high school, 59.6% of them were living with their nuclear family, 49.1% of them had an equal level of income and expenditure, 7.7% of them had no chronic disease, 9% of them had regular medication, and 57.8% of them had health insurance (Table 1).

Table 1.

Descriptive characteristics of university students (n = 1115).

Characteristics	n	%
Age
17–19 years	217	19.5
20–22 years	639	57.3
23 and more years	259	23.2
Grade
1.	286	25.7
2.	293	26.3
3.	313	28.0
4.	223	20.0
School type
Anatolian High School	658	59.0
Sciences High School	112	10.0
Imam Hatip High School	180	16.1
Vocational and Technical High School	225	20.0
Family type
Nuclear	665	59.6
Extended	394	35.3
Fragmented	56	5.1
Income
Poor	372	33.4
Middle	547	49.1
High	196	17.6
Presence of chronic illness
Yes	86	7.7
No	1029	92.3
Drug use regularly
Yes	100	9.0
No	1015	91.0
Healthcare insurance
Yes	644	57.8
No	471	42.2
Annual drug expenditure
0–100 TL	691	62.0
101–200 TL	199	17.8
201–300 TL	104	9.3
300 and more	121	10.9

The HPLP II scale minimum–maximum score, total score and the mean of the total score of the RDU scale are provided in Table 2. When we examine Table 2, the health responsibility subscale mean score is 20.74 ± 4.61, physical activity is 17.62 ± 4.71, nutrition is 20.22 ± 4.39, spiritual value is 23.08 ± 4.93, interpersonal relationships is 22.86 ± 4.65, stress management is 18.85 ± 3.99, the mean of the total score the HPLP II scale was found to be 124.12 ± 21.37, and the mean of the total score of the RDU scale was 33.65 ± 6.75 (Table 2).

Table 2.

Descriptive statistics of the HPLP II total score, the sub-scales and RDU.

		Mean ± SD	Min–Max
HPLP II sub-scales	Health responsibility	20.74 ± 4.61	9–36
	Physical activity	17.62 ± 4.71	8–32
	Nutrition	20.22 ± 4.39	9–36
	Spiritual development	23.08 ± 4.93	9–36
	Interpersonal relations	22.86 ± 4.65	9–36
	Stress management	18.85 ± 3.99	8–32
HPLP II scale*		124.12 ± 21.37	52–208
RDU scale		33.65 ± 6.75	0–42

Total of sub-scales.

The demographic characteristics of the students and the HPLP II and RDU scale mean scores are provided in Table 3. A statistically significant difference was found between students’ age, class, income status, presence of chronic disease and health insurance and the HPLP II scale mean score (p < 0.05). The HPLP II scale mean scores are higher as students get older. According to the Bonferroni test, the significant difference results in the age of university students were found in the 17–19 years and 20–22 years, the 17–19 years and 23 and more years students (F = 4.353, p < 0.05). Based on the Bonferroni test, the significant difference results in the academic year of university students were found in the first and second, the first and third, the first and fourth year students (F = 3.836, p < 0.05). The findings showed that the significance determined by the Bonferroni test originated from the student group whose income level was higher than their low and middle income peers (F = 3.46, p < 0.05). Students with chronic diseases have a higher health lifestyle scale mean score than students without chronic diseases (t = 1.95, p < 0.05). HPLP II scale mean score is higher for the students who have health insurance compared with students without health insurance (t = 2.53, p < 0.05) (Table 3).

Table 3.

Comparison of the mean scores obtained by the students regarding demographic characteristics.

Characteristics	HPLP II Mean ± SD	RDU Mean ± SD
Age
°17–19 years¹	120.41 ± 21.73	33.08 ± 6.45
°20–22 years²	124.69 ± 21.54	34.20 ± 6.72
°23 and more years³	125.82 ± 20.33	32.76 ± 6.98
Sig. (2-tailed)	F = 4.353 p = 0.01 1 < 2, 1 < 3*	F = 5.20 p = 0.006 1 < 2, 3 < 2*
Grade
°1.	120.59 ± 22.77	33.12 ± 7.01
°2.	124.46 ± 21.09	33.45 ± 6.60
°3.	125.71 ± 20.89	33.79 ± 6.43
°4.	126.26 ± 20.19	34.39 ± 7.00
Sig. (2-tailed)	F = 3.836 p = 0.01 1 < 2, 3, 4*	F = 1.59** p = 0.19
School type
°Anatolian High School¹	124.53 ± 21.77	34.24 ± 6.64
°Sciences High School²	121.92 ± 19.70	31.83 ± 8.44
°Imam Hatip High School³	123.22 ± 18.54	33.41 ± 6.72
°Vocational and Technical High School⁴	124.94 ± 21.37	32.78 ± 6.62
Sig. (2-tailed)	F = 0.66** p = 0.57 4	F = 5.45 p = 0.001 2 < 1, 3 < 1, 4 < 1*
Family type
°Nuclear ¹	124.52 ± 21.63	34.82 ± 6.20
°Extended²	122.04 ± 21.44	32.20 ± 6.90
°Fragmented³	128.65 ± 16.71	29.96 ± 8.56
Sig. (2-tailed)	F = 0.64** p = 0.57	F = 5.45 p = 0.001 3 < 1, 3 < 2, 2 < 1***
Income
°Poor¹	123.01 ± 22.79	33.07 ± 7.06
°Middle²	123.59 ± 20.11	34.24 ± 6.53
°High³	127.71 ± 21.85	33.10 ± 6.63
Sig. (2-tailed)	F = 3.46** p = 0.03 3 < 1, 2	F = 4.16** p = 0.01 3 < 2, 1 < 3
Presence of chronic illness
°Yes	127.76 ± 17.56	34.61 ± 6.57
°No	123.82 ± 21.64	33.57 ± 6.76
Sig. (2-tailed)	t = 1.95* p = 0.05	t = 1.40* p = 0.17
Drug use regularly
°Yes	126.47 ± 22.56	33.86 ± 6.64
°No	123.89 ± 21.64	33.63 ± 6.76
Sig. (2-tailed)	t = 1.15* p = 0.25	t = 0.317* p = 0.74
Health insurance
°Yes	125.56 ± 20.33	35.03 ± 6.04
°No	122.16 ± 22.58	31.03 ± 6.04
Sig. (2-tailed)	t = 2.53* p = 0.009	t = 8.18* p = 0.001
Annual drug expenditure
°0–100 TL¹	123.73 ± 21.29	34.41 ± 6.45
°101–200 TL²	124.87 ± 21.07	33.37 ± 6.57
°201–300 TL³	122.51 ± 20.95	31.26 ± 7.12
°300 and more⁴	126.57 ± 22.67	31.78 ± 7.12
Sig. (2-tailed)	F = 0.887** p = 0.44	F = 10.68** p = 0.001 4 < 1, 4 < 2, 2 < 3

Independent t-test.

ANOVA.

***

Bonferroni test.

A statistically significant difference was found between the students’ age, type of school they graduated from, family type, income status, health insurance and annual drug expenditures and RDU scale scores (p < 0.05). Students in the 20–22 age group have higher mean scores on the RDU scale than students in the other age group (F = 5.20, p < 0.05). Anatolian high school graduates have higher mean scores on RDU than other high school graduates (F = 5.45, p < 0.05). Students with nuclear families have higher mean scores on RDU than other family types (F = 5.45, p < 0.05). Students with health insurance have higher mean scores on the RDU scale than students without health insurance (t = 8.18, p < 0.05). Students with an annual drug expenditure of 0–100 Turkish lira have higher mean scores on the RDU than students with other expenditures (F = 10.68, p < 0.05) (Table 3).

A strong positive correlation was found between RDU scales and HLB II scale (r = 0.955, p = 0.001).

Discussion

This study, which was conducted to determine the RDU status and HPLP II of university students, determined that the total score average of the students on the RDU scale was 33.65 ± 6.75, the total score average of the HPLP II scale was 124.12 ± 21.37, and that there was a strong positive relationship between rational drug use and healthy lifestyle behaviours.

University students’ knowledge regarding the RDU was evaluated with the RDU scale developed in 2018. In this scale, the cut-off value was identified as 34 points, and it was reported that those who scored 35 and above from the questionnaire had knowledge regarding rational drug use (13). It was determined that 53.9% of the participants scored 35 points or more. When studies on rational drug use are examined, it is seen that education and age are variables that positively affect rational drug use. Bian et al. (15) determined that those under the age of 30 and with a high level of education have more knowledge regarding rational drug use and more appropriate drug use behaviours than elderly individuals (15). This situation has been associated with the lower education level of older individuals than younger individuals. Jamhour et al. (4) found that self-medication consumption was associated with lower education level and stopping use of antibiotics at inappropriate times (4). Similarly, the studies of Ekambi et al. (16) and Mouhieddine et al. (17) found a positive relationship between education level and non-rational drug use. Studies conducted with university students regarding rational drug use show that students studying health-related fields have more information about RDU (18,19). However, this situation differs in studies involving all university students. In the study conducted by Okyay and Erdoğan with students who do not study in health-related departments, the prevalence of self-medication without a doctor’s prescription was found to be 63.4%. It has been stated that this rate is higher than the rate for the general public (20 –22). In this study, it was observed that as the grade level increases, the score from the RDU scale increases, and accordingly fourth-grade students get the highest score. It is thought that missing information is minimized by ongoing education and the increase of information every year.

In our study, it was determined that individuals with a fragmented family had lower RDU scores than individuals with nuclear and extended families. The WHO drew attention to the determinations of the causes of non-rational drug use and the planning of interventions for these reasons. Considering the difficulties faced by individuals with a fragmented family structure, it is recommended that individuals in this situation should be informed and monitored by healthcare centres more sensitively. Rational drug use is one of the healthy lifestyle behaviours that should be strongly implemented in order to prevent health problems that can result in death, and to reduce the burden placed on the national economy (23).

The prevalence of chronic diseases worldwide has seen a dramatic increase. The relationship between chronic diseases and unhealthy lifestyle behaviours is known. Therefore, the views and attitudes of young people about HPLP II are of great importance in terms of creating foresight for the coming years. In determining the healthy lifestyle behaviours of university students, the mean HPLP II scale score was 135.38 ± 15.21 in the study conducted by Mehri et al. (24), 123.8 ± 19.8 in Alzahrani et al. (25), 118.41 ± 20.90 in Hacıhasanoğlu et al. (26), 133.20 ± 20.59 in Köseoğlu-Örnek, and in Kürklü (27) it was 135.38 ± 15.21. In this study, the mean of total score of HPLP II was 124.12 ± 21.37, and was found to be consistent with the other studies conducted. When the data on HPLP II sub-dimensions were examined, it was determined that the participants had the highest score of 22.86 ± 4.65 on interpersonal relations and the lowest score on physical activity with 17.62 ± 4.71. In studies using the HPLP II scale, it is seen that physical activity is generally the sub-dimension with the lowest mean score. Considering the increasing number of overweight individuals around the world, it can be said that the failure of young to devote enough time to physical activity and to adopt it as a lifestyle is among the reasons for the failure in the fight against obesity.

In our study, a high positive correlation was found between rational drug use and healthy lifestyle behaviours in university students. This situation is seen as promising in the adoption of rational drug use among healthy lifestyle behaviours and in the realization of rational drug use in the coming years.

Footnotes

Ethical approval

The ethical committee approval dated 26.11.2019 and numbered 2019/7.7 was obtained from the Ethics Committee of Batman University.

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Ercan Çinar

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