View
43
Download
0
Category
Tags:
Preview:
DESCRIPTION
The purpose of the research study is to investigate the perception and attitudes of consumers towards self-medication in light of Hofstede’s cultural dimension of uncertainty avoidance. The study had been conducted in Karachi and a sample size of 200 had been utilized for the purpose. Analysis of data obtained from specially designed questionnaire had been fed into statistical software to acquire descriptive statistics together with confirmatory factor loading and correlation matrix analysis. The empirical findings showed that the consumers are risk averse but will be willing to practice self-medication based upon the specific situation they may face in life or due to operational variables which they may be exposed to at any given time e.g. cost of medicine being too high or unavailability of time to wait at a doctor’s clinic. Additionally, the consumer may engage into self-medication based upon good past experience or group influence. Studies in Pakistan have been undertaken on self-medication but not in juxtaposition with any cultural dimension. Future researches on different cultural dimensions of Hofstede vis-à-vis self-medication and for other risk-taking and risk-averse behavior can be conducted in light of this research.
Citation preview
An Investigation into
Consumer Attitudes and Perception towards
Self-Medication in Pakistan in light of the
Cultural Dimension of Uncertainty Avoidance
Submitted by
Khawaja Saleem Ahmed (1058138)
Fatima Haider (1058117)
Yousuf Zahid (1058156)
Asma Zuberi (1058108)
For the course Research Project
EMBA 66 (6)
Submitted to Faryal Salman on Thursday, February 14, 2013
Faculty of Management Sciences, SZABIST
Shaheed Zulfikar Ali Bhutto Institute of Science & Technology (SZABIST) – Karachi
2
Table of Contents
Acknowledgement ........................................................................................................................................ 4
Abstract ......................................................................................................................................................... 5
1. INTRODUCTION ................................................................................................................................ 6
1.1 Background of the Study............................................................................................................... 6
1.2 Problem Statement .............................................................................................................................. 7
1.3 Research Gap ...................................................................................................................................... 8
1.4 Research Objectives ............................................................................................................................ 9
1.5 Research Questions ........................................................................................................................... 10
1.6 Theoretical Framework ..................................................................................................................... 11
1.7 Significance and Scope of the Study ................................................................................................. 12
1.8 Limitations of the Study .................................................................................................................... 13
2. LITERATURE REVIEW ................................................................................................................... 14
2.1 Self-Medication: Definition .............................................................................................................. 14
2.2 Self-Medication: Spread and Frequency ........................................................................................... 14
2.3 Self-Medication: Reasons and Ailments Treated .............................................................................. 15
2.4 Self-Medication: Consumer Behavior .............................................................................................. 15
2.5 Self-Medication: Effect of Population Spread, Income and Literacy ............................................... 16
2.6 Self-Medication: Perception of Risk ................................................................................................. 17
2.7 The National Cultural Dimensions of Hofstede ................................................................................ 18
2.8 Pakistan: The Cultural Dimension of Uncertainty Avoidance .......................................................... 19
2.9 Hofstede: Criticism ........................................................................................................................... 20
3. RESEARCH METHODOLOGY ........................................................................................................ 21
3.1 Research Design ................................................................................................................................ 21
3.1.1 Qualitative Research .................................................................................................................. 21
3.1.1.1 Focus Group ........................................................................................................................... 21
3.1.2 Quantitative Research ................................................................................................................ 23
3.1.2.1 Desk Research ......................................................................................................................... 23
3.1.2.2 Survey and Questionnaire Design ........................................................................................... 23
3
3.2 Sampling Procedure and Design ....................................................................................................... 25
3.2.1 Sampling Frame ......................................................................................................................... 25
3.2.2 Sampling Size and Selection ...................................................................................................... 25
3.3 Field Work for the Survey ................................................................................................................ 27
3.4 Research Hypothesis ......................................................................................................................... 28
4. DATA ANALYSIS ............................................................................................................................. 29
4.1 Reliability Analysis ........................................................................................................................... 29
4.2 Instrument Validity ........................................................................................................................... 31
4.3 Demographics ................................................................................................................................... 32
4.3.1 Frequency Tables ....................................................................................................................... 32
4.3.2 Bar Charts .................................................................................................................................. 35
4.4 Behavioral Analysis .......................................................................................................................... 39
4.5 Confirmatory Factor Analysis ........................................................................................................... 41
4.6 Pearson’s Correlation Matrix ............................................................................................................ 45
4.7 Hypothesis Testing ............................................................................................................................ 46
5. CONCLUSION AND RECOMMENDATIONS .................................................................................... 49
5.1 Conclusion ........................................................................................................................................ 49
5.2 Recommendations ............................................................................................................................. 51
AREAS OF FURTHER STUDY ................................................................................................................ 52
BIBLIOGRAPHY ....................................................................................................................................... 53
APPENDIX ................................................................................................................................................. 57
a. Focus Group Guide ......................................................................................................................... 57
b. Survey Questionnaire ...................................................................................................................... 61
4
Acknowledgement
The authors of the study express a sincere gratitude to Ms. Faryal Salman for providing guidance
throughout the semester and especially on the continuous improvement of data collection and its
compilation.
A profound appreciation also goes out to all our classmates who had been instrumental in
extending support in their respective organizations for collection of data through the survey
questionnaire.
Special thanks are conveyed to Mr. Asad Subzwari for taking out time and assisting the authors
during coding and data entry of the survey on the software of SPSS 17 and PASW Statistics 18.
5
Abstract
The purpose of the research study is to investigate the perception and attitudes of consumers
towards self-medication in light of Hofstede’s cultural dimension of uncertainty avoidance. The
study had been conducted in Karachi and a sample size of 200 had been utilized for the purpose.
Analysis of data obtained from specially designed questionnaire had been fed into statistical
software to acquire descriptive statistics together with confirmatory factor loading and
correlation matrix analysis. The empirical findings showed that the consumers are risk averse
but will be willing to practice self-medication based upon the specific situation they may face in
life or due to operational variables which they may be exposed to at any given time e.g. cost of
medicine being too high or unavailability of time to wait at a doctor’s clinic. Additionally, the
consumer may engage into self-medication based upon good past experience or group influence.
Studies in Pakistan have been undertaken on self-medication but not in juxtaposition with any
cultural dimension. Future researches on different cultural dimensions of Hofstede vis-à-vis self-
medication and for other risk-taking and risk-averse behavior can be conducted in light of this
research.
6
1. INTRODUCTION
1.1 Background of the Study
The people of Pakistan have been observed to take risks, knowingly and unknowingly, in
every walk of life. The authors in light of their everyday observation have seen countless
people take a risk while undertaking a specific action. These actions arise from an attitude
that the people have created due to a wide range of reasons. Without contemplating on the
reasons as to why people have developed such attitudes, consider the people who take risks
while riding motorcycles without helmets, violating traffic signals on the red light,
attempting to cheat in exams, swimming at the seaside without knowing how to swim,
talking on the cell phone while driving, making an expensive lease-based investment but
without a plan of how future payments will be made, providing children at home with
computer and internet facilities and then not keeping a check and control over their activities,
procrastinating at workplace despite being aware of work deadlines and visiting public places
during times of public unrest and turmoil.
The list of such activities in which an apparent risk-taking behavior is observed is endless but
then risk is a subjective term and what is considered to be a risk for one person may not be so
for another. This is where perceptions of people come into interplay.
The authors of the study have attempted to narrow the focus on the apparent risk-taking
behavior of people in the act of self-medication. Self-medication is not only common in
Pakistan but all over the world as well and it is practiced due to a large number of reasons;
reasons which encourage people to avoid consulting the physician. Regardless of the reasons,
it is a human behavior which requires to be studied in order to determine the factors which
play a role in developing perception and attitudes among people.
7
1.2 Problem Statement
According to the cultural dimension of uncertainty avoidance put forth by Hofstede (geert-
hofstede.com), the people of Pakistan have been found as risk-averse and with a considerably
high uncertainty avoidance index. On the contrary, the act of self-medication as per common
knowledge and based upon general scientific evidence is a risk-taking behavior. This
contradiction is the essence of the problem because on one hand, Pakistanis refrain from
taking risks and on the other, indulge in treatment of ailments through self-medication
without seeking professional advice from doctors.
8
1.3 Research Gap
The research conducted in Pakistan almost thirty years ago (Hofstede & Bond, 1984), had
established the basis of the society as high on uncertainty avoidance but the authors intend to
conduct a study because of some apparent gaps that have been identified in the research.
a) Has the society’s risking-taking attribute changed and evolved over the years?
b) Is the society still risk-averse and had the original research missed out key aspects
which had failed to show the larger picture?
c) Do other cultural dimensions of Hofstede influence or have started to influence the
uncertainty avoidance index of Pakistanis?
d) Is it just a perception or a fact that self-medication is dominantly practiced amongst
the educated people?
e) Is the consumer behavior of self-medication influenced by personality characteristics
of an individual and by formal/informal reference groups?
The research being undertaken will eventually benefit to understand and identify the hidden
reasons of this specific consumer behavior and bring to light possible other aspects besides
Hofstede’s theory when it comes to declaring the Pakistani society as high on uncertainty
avoidance.
9
1.4 Research Objectives
The primary objective of the study is to learn how consumers develop perceptions and form
an attitude towards the act of self-medication and whether consumers take this risk willingly
or unknowingly. At the same time, the study will also assist in the determination and analysis
of reasons behind this act in contrast with the cultural dimension of uncertainty avoidance.
10
1.5 Research Questions
The core research questions arising as a result from the research objectives and the research
gap are:
a) How do the people in Pakistan perceive risk when it comes to management of health
matters?
b) Despite being a risk-averse nation, why do the people in Pakistan practice self-
medication?
c) Which attributes contribute in forming an attitude towards the specific consumer
behavior of self-medication?
d) If and whether socio-economic factors play a role in motivating people to practice
self-medication?
11
1.6 Theoretical Framework
The practice of self-medicating students has reached a significantly high percentage despite
the fact that the majority of students understand that self-medication practice is incorrect
(Zafar et al., 2008). This means that people take a risk even after knowing the fact that it is a
risk. This postulation has been clarified in the theoretical framework which incorporates the
research hypothesis in light of the uncertainty avoidance index and the different variables.
Figure 1. The theoretical framework
12
1.7 Significance and Scope of the Study
The research study strives to identify reasons by means of which consumers develop an
inclination towards risk-averse or risk-taking behavior in the practice of self-medication
based upon the perceptions that are developed leading to attitude formation.
Findings of the study will possibly pave the way for managerial implications in terms of
identifying ways and means of implementing stringent pharmacy regulations, stabilizing the
cost of medicines and sustaining the quality of health care otherwise a strong probability
exists that consumers will continue to jeopardize individual and family health care through
self-medication practices. Subsequently, tactical measures by all concerned stake holders will
ensure that a larger strategy is formulated which also incorporates the aspect of imparting
awareness on self-medication towards the people.
In order to conduct the research, specific units have been considered and which constitute of
male and female adults hailing from different income groups and belonging to different age
segments. These units are students and working individuals both in terms of profession.
13
1.8 Limitations of the Study
The study is restricted to the research of consumer behavior on self-medication only with a
focus on Karachi that represents the major urban areas of Pakistan. The drawn sample size is
however not sufficient as it may not represent the total population of the city and the other
principle urban hubs of the country.
The other cultural dimensions of Hofstede besides uncertainty avoidance have not been
considered and which may establish an-interplay among all the dimensions in order to
analyze consumer perception and attitude.
An element of bias may also exist in the replies received by the respondents due to individual
perception and attitude towards the personal subject of health care. Other factors that have
not been considered in the study include elements of religion and locus of control by means
of which people govern their lives in Pakistan. Personalities also play a role and which
motivates a person to develop an attitude and behave in a particular manner; this dimension
also has not been taken into consideration.
Based upon the lines of the study undertaken, additional in-depth research is required which
may bring to light hidden variables that act as trigger points when it comes to understanding
consumer behavior and the cultural dimensions of Pakistan.
14
2. LITERATURE REVIEW
2.1 Self-Medication: Definition
The act treating an ailment either for diagnosis or prescription, by purchasing and consuming
medicines without consulting an authorized doctor is called self-medication (Montastruc et
al., 1997) The methods of self-medication are several and include purchase of drugs without
a doctor’s prescription, using old prescriptions to acquire medicines, consuming in-stock
medicines at home or workplace and exchanging, sharing and recommending drugs with
friends, family members and colleagues (Filho et al., 2004).
Self-medication is a widespread international occurrence and it has been around since ages
because human beings have a natural disposition to reduce and eradicate health related issues
with some medicine (Baig, 2012). Self-medication has been recognized at the highest level as
well and the World Health Organization has pronounced the act as one where a person,
during sickness will choose and consume a drug for self-treatment (WHO, 1998).
2.2 Self-Medication: Spread and Frequency
The impulsive use of medicines based upon self-conceived notions and through influencing
references has been a matter of all-round concern (Filho et al., 2004) Self-medication as an
act is spread all over the world and has considerably high rates of occurrence; up to 68% in
European countries (Bretagne et al., 2006). The developing countries have an even higher
rate (Shankar et al., 2002); up to 92% in Kuwait (Abahussain et al., 2005). India has 31%
(Deshpande & Tiwari, 1997) whereas Nepal has a prevalence rate of 59% (Shankar et al.,
2002). In Pakistan, however, just a few undertakings have come to light which elucidate the
spread of self-medication but which have nonetheless confirmed a high rate of 51% spread in
the country (Haider & Thaver, 1995).
15
2.3 Self-Medication: Reasons and Ailments Treated
In a research that had been undertaken among Karachi-based university students, it was
discovered that up to 76% students have engaged in the act of self-medication (Zafar et al.,
2007). The study disclosed a number of reasons based upon which students self-medicate;
most notable among which were the past experience of respondents with similar health
indications (50.1%) and the perception itself of the petty nature of the problem (48.3%).
Ailments for which the students practiced self-medication included headaches (72.4%), fever
(55.2%) and common cold (65.5%). Accordingly, the respondents consumed medicines for
relief and which fell into the category of painkillers (88.3%), fever relieving medicines
(65.1%), anti-allergics (44.1%) and antibiotics (35.2%). These drugs had been mostly
purchased from pharmacies (64.6%) or/and consumed from available medicines stored at
home (64.4%) or acquired from class mates and friends (9.7%). It had also been reported in
the study that more than one-third (43.3%) students who had approached a physician had
later modified the dosage of the prescribed medicine on their own accord.
2.4 Self-Medication: Consumer Behavior
Self-medication is practiced by students in all academic disciplines and its commonness is
more or less equal among medical and non-medical students (Zafar et al., 2007).
Traditionally, it is assumed that non-medical students do not engage in the practice of self-
medication in comparison with medical students due to the possession of limited knowledge
of medicines but the research findings proved otherwise. In contrast, another research shows
an exceptionally higher rate of self-medication among medical students and professionals
(James et al, 2006).
16
A study that had been carried out on women and specifically mothers in Pakistan brought to
light that positive past experience (61.3%) with drugs had been the primary reason for self-
medication (Haider & Thaver, 1995) Such consumer attitudes are developed through
perception that is reinforced by gaining good experience through repeated acts of self-
medication but it is negative in outlook and identifies that people, despite being educated
remain ignorant of possible problems that may arise through self-medication.
2.5 Self-Medication: Effect of Population Spread, Income and Literacy
Self-medication in Pakistan is practiced more in the urban as compared to rural areas and that
its prevalence ratio goes up with the gradual increase in literacy levels (Baig, 2012). The
households in urban and rural areas together constitute 64.2% in terms of presence of
contemporary medicines at home with urban household leading within the percentage
(Hussain et al., 2011).
Results from a research puts skilled labor over unskilled labor (by 21%) when it comes to
practicing self-medication (Baig, 2012). The research also showed that respondents (76.6%)
earning a monthly income of above Rs. 10,000 self-medicated more than those (57.2%) with
a monthly income of less than Rs. 10,000 per month.
Another study presented interesting facts which proved the common knowledge that illiterate
people abide by basic rules more than literate people; rules that govern specific situations in
life. The results of the study revealed that literate people have a greater tendency to self-
medicate in comparison with illiterates (Klemenc-Ketis et al., 2010; Henry et al., 2006).
17
2.6 Self-Medication: Perception of Risk
A research study discovered that in Pakistan, a very low proportion of university students
consult a physician for ailments and that the reason for not consulting a doctor includes a
number of factors besides the issue of cost of treatment. The study shows that the risk and
hazard perception of the students towards self-medication is considered as inconsequential
(Mumtaz et al., 2006).
According to the Australian Council for Safety and Quality in Health Care, the specific
consumer behavior of borrowing and sharing of medicines prescribed by physicians is
recognized as a risk factor by the health and medical field stakeholders exclusively in
medication errors which subsequently result in adverse drug events (Runciman et al., 2003).
This specific patient behavior negatively affects the quality use of medicine (Bolton et al.,
2002) and that there is a risk of underestimating the impact of this behavior on the incidence
of adverse drug events which include drug-drug interactions, poisoning and the development
of antibiotic resistant strains of pathogens (Ellis, 2009).
In another study conducted at two medical and two non-medical universities, it was
discovered that the frequency of self-medication had been as high as 76 percent (Zafar et al.,
2008). Within the research it had been noted that 87.4% of the respondents were aware of the
risks to health through self-medication. The respondents had accepted the fact that self-
medication is harmful and this shows the aspect of absence of knowledge. A similar result
had also come to light in a research carried out in Turkey where it was found out, that despite
majority of the students (89%) understood the reason of consulting a doctor before
consuming antibiotics, 45% nonetheless continued the practice of self-medication (Buke et
al., 2005).
18
2.7 The National Cultural Dimensions of Hofstede
Despite being common in all segments of society, the factors which encourage a person to
indulge in self-medication are still not clear and the risks arising from this practice continue
to bring forth serious dangers to health (Baig, 2012). The awareness of health and its
management in contemporary times by ordinary people is a result of the difference between
culture and language, and the socioeconomic ranks together with the capacity of a person to
comprehend and act on a doctor’s advice which depends upon cultural beliefs on the broad
subject of health (Shaw et al., 2008).
In a study conducted in United States of America, it was found that African-Americans
consume medicines for symptoms like headaches, nosebleeds and hallucinations by taking
decisions based upon culturally-informed experiences (Schoenberg and Drew, 2002). There
is a definite influence of cultural dimensions on the behavior of a person at the time of an
illness and upon the subsequent consumption of drugs (Deschepper et al., 2008).
The scrutiny of differences in culture is carried out by a number of different models and from
which the most-well renowned is Hofstede’s National Cultural Dimensions. Hofstede defines
culture as “the collective programming of the mind that distinguishes the members of one
human group from another” (Hofstede & Bond, 1984). Based upon moderating variables
such as education, the following of people of each other will increase the possibilities of
perceiving the social environment and sharing of a subjective culture all from the same or a
similar window (Hofstede & Bond, 1984).
19
2.8 Pakistan: The Cultural Dimension of Uncertainty Avoidance
Hofstede has labeled the people of Pakistan as risk averse in the cultural dimension of
uncertainty avoidance (geert-hofstede.com). With a score of 70, Pakistan is categorized as
high in uncertainty avoidance or where people have a high preference for avoiding
uncertainty. “It means that Pakistanis adhere to specific codes of belief; are intolerant of
unorthodox behavior and ideas; have an emotional need for rules; give importance to time;
have an urge to work hard; resist innovation at times; observe punctuality as a norm and
individual motivation is driven by security” (geert-hofstede.com). In other words, on the
uncertainty avoidance index, the people of Pakistan feel threatened by unknown, ambiguous,
uncertain or unstructured situations.
According to Hofstede, the people in Pakistan possess an emotional need for rules even if
these rules do not seem to work (geert-hofstede.com). On the other hand, rules and
regulations exist in Pakistan to govern the functioning of a pharmacy but in Karachi alone, all
kinds of drugs are available at a chemist without prescription. This fact proves Hofstede’s
point but the medicines at these pharmacies are being sold because there are customers who
will purchase them. It is a two-way intentional violation of the governing rule for a pharmacy
to function (Strum et al., 1997).
However, in a study on the cultural diversity in Pakistan (Shah & Amjad, 2011), the results
showed that the Pakistani society by and large does not feel threatened by uncertainty,
unknown, ambiguous or unstructured situations. From the study, it is interesting to note that
the findings on uncertainty avoidance index are amidst terrorist attacks, political instability
and increasing stagflation in Pakistan, and calls for more research into this phenomenon
(Shah & Amjad, 2011).
20
2.9 Hofstede: Criticism
Hofstede’s cultural dimensions have been criticized as not being a valid instrument to
determine cultural differences because of the almost thirty years that have lapsed since 1984
and the study is far too obsolete and could not be implemented in contemporary times of fast
evolving environment, convergence and globalization (Shariq et al., 2011). A number of
researchers have put forth compelling argument against Hofstede. The argument includes
Hofstede’s variables varying in sensitivity from one culture to another (Schwartz, 1999); the
original study by Hofstede had been based on an assessment of individuals and then applied
in large on the overall community, which skewed the results (Dorfman & Howell, 1988);
culture is not necessarily bounded by national borders therefore entire nations cannot be the
valid unit of analysis (McSweeney, 2000); Hofstede’s research had been conducted on the
data collected from one company in different countries and a the findings of one company in
each country could not be implemented on the entire nation to determine cultural dimensions.
(Graves, 1986; Olie, 1995);
Therefore, the purpose of this study is to learn how consumers develop perceptions and form
an attitude towards the act of self-medication and whether consumers take this risk willingly
or unknowingly. This study also undertakes to discover the behavior of consumers in
Pakistan; their level of awareness and the factors which trigger the specific act of self-
medication.
21
3. RESEARCH METHODOLOGY
3.1 Research Design
The development of the study is based on applied research with an approach encompassing
cross-sectional and snap-shot research parameters.
Quantitative and qualitative research methodologies have been implemented in order to
explain the contradiction in actual consumer behavior towards the risk-bearing act of self-
medication and the risk-averse label suggested on the people of Pakistan in light of the
cultural dimension of uncertainty avoidance as formulated by Hofstede.
The research design for the study will subsequently assist in bringing forth an analysis that
will allow suggesting logical recommendations.
3.1.1 Qualitative Research
3.1.1.1 Focus Group
The focus group analysis had been designed and implemented in order to assess the
perception and attitude of the three identified respondent clusters viz., students, households
and corporate professionals.
A focus group is used as a tool to manage, conduct, write and record the feedback received
from a specific group of people who are selected as per pre-defined criteria. The focus group
participants are managed by a moderator who asks questions and probes deeper to obtain a
true understanding of the replies provided by the participants (Prince and Davies, 2001). For
the undertaken research, a focus group had been conducted to obtain a better understanding
of opinions and attitudes of consumer behavior towards the act of self-medication in light of
the underlying cultural dimension variable. The discussion guide for the focus group
consisted of unstructured questions according to the information needed to extract responses
through a conversation.
22
The sample size for the focus group constituted of seven individuals and which represented
educated and different socio-economic classes specifically hailing from the clusters of
corporate sector, household and students. The overall age group was between 20-35 years
with average house hold income of Rs. 100,000 per month.
The major findings which came forth elucidated that the participants have practiced self-
medication due to five main reasons viz., (a.) time constraints (b.) avoiding the queue time at
a clinic/hospital (c.) non-accessibility to a qualified physician (d.) negligence of doctors in
terms of imparting service as per general perception (d.) non-availability of quality doctors at
the time when treatment of an ailment had been required.
According to participants’ perspective, self-medication is a risk towards health by which
various negative consequences can occur and which often leads to serious complications in
the form of side effects and even causing death.
The participants opined that factors exist which can motivate an individual to take a
calculated or blind risk in terms of self-medication and in life in general. These factors
interplay with an individual’s personality based upon aspects of recognition in society, a
powerful external locus of control and group influence. The participants also disclosed that
they will avoid an uncertain situation as and where logically possible.
The focus group findings disclosed that homogeneity in approach existed among the three
respondent clusters towards the act of self-medication. Accordingly, the outcome of the focus
group determined the constructs for the quantitative survey.
23
3.1.2 Quantitative Research
3.1.2.1 Desk Research
Research in Pakistan has been undertaken in the past on self-medication but not in light of
the cultural dimension of uncertainty avoidance. With regard to the act of self-medication,
consumer behavior including consumer knowledge, perception and attitude has either not
been measured in depth or has been missed out altogether. A thorough study of different
literature has been conducted to develop an understanding of the consumer behavior in this
study and to ascertain if the Pakistani people are genuinely risk averse as declared by
Hofstede. Secondary data has been collected from different data bases of trustworthy and
genuine research journals of medicine, consumer behavior, psychology and sociology.
3.1.2.2 Survey and Questionnaire Design
In terms of applied research, a self-monitored questionnaire based survey has been deployed
in light of a cross-sectional study in Karachi.
The survey has been designed to measure the consumer perception and attitude in terms of
behavioral intention, uncertainty avoidance, perceived risk and risk aversive behavior
towards self-medication. The questionnaire has been designed to provide simplicity,
understandability and comprehensiveness for the respondent and for the ease in post survey
proceedings.
The structure of the statements in the survey had been supported by the likert scale had been
developed to determine the strength of opinion of the respondents. The scale had been
balanced in terms of favorable and unfavorable responses and was non-comparative in
nature.
24
According to the conceptual model of the undertaken research, uncertainty avoidance serves
as the independent variable and the consumer attitude and behavior as the dependent
variables. The underlying operational elements of medicine cost, waiting time for treatment,
consumer’s awareness, external legal environment, consumer’s locus of control and
physician’s service quality shaped up the questionnaire statements and which also included
constructs to ascertain the influence of reference groups on consumer behavior.
In the questionnaire, specific constructs also carried the rank-order scale to measure ailments
most commonly treated through self-medication the situations which encourage a consumer
to opt for self-medication. The profile of the respondent had also been developed based upon
scales requesting for data pertaining to gender, age group, education, employment status and
household income.
25
3.2 Sampling Procedure and Design
3.2.1 Sampling Frame
The focus group findings brought to light that there is no significant difference in opinion
among the three clusters of corporate, household and student representatives. Therefore, the
sample of respondents had been chosen from the corporate sector and university students.
Homogeneity within these clusters may exist but the respondent background within the
clusters will lead to heterogeneity due to diversity in income and age groups, corporate
position, marital status and gender.
For the respondents, the city of Karachi had been selected because of its universal influence
on other cities of Pakistan and thereby it would depict an appropriate representation of the
major urban areas.
3.2.2 Sampling Size and Selection
The sample size constituted of 200 educated respondents residing in different localities of
Karachi. The principle criterion for selecting the sample was based on probability of
stratified random sampling. This is type of sampling technique is where every individual has
an equal and known chance of being selected (Sekaran, 2000).
The respondents had been selected on a chance-basis from the population of those available
at the point of contact at the time of approach. At the private firms and university, the contact
persons had been advised to pre-qualify the respondents on behalf of the authors vis-à-vis
willingness of the respondents to participate neutrally in the survey and by considering the
ability of a respondent to comprehend the importance of the research survey and articulate
the replies accordingly.
26
The respondents from the students’ cluster had been approached in the BBA and MBA
programs of Shaheed Zulfiqar Ali Bhutto Institute of Science and Technology whereas the
working professionals (as respondents) had been approached in a number of private
companies which included MCB, HBL, Habib Metro, Bayer, Habib Public School, AKUH,
Multinet and Ibrahim Fibers.
27
3.3 Field Work for the Survey
The authors of the study had approached the private firms in two teams by contacting the
resource individuals and obtaining necessary permission. It took 16 days from first contact
till the receipt of completed survey forms. Research quality had been assured by maintaining
a Chinese wall (wikipedia.org) during all communication to ensure that the element of bias is
kept at the lowest possible level.
28
3.4 Research Hypothesis
The study puts forth specific hypothesis for empirical testing in light of the research
objectives and with the help of secondary data and insights from focus group.
Risk is perceived by self-medicating people in individual capacities and which leads the
people to be either risk-averse or risk-takers. As a result, the people may be high or low on
the uncertainty avoidance index which reflects on the specific (positive or negative) attitudes
that are developed and which will eventually initiate or avoid the consumer behavior towards
self-medication.
The following hypotheses were generated:
a. H0: The behavioral intention is significantly correlated to uncertainty avoidance
H1: The behavioral intention is not significantly correlated to uncertainty avoidance
b. H0: The behavioral intention is significantly correlated to perceived risk
H1: The behavioral intention is not significantly correlated to perceived risk
c. H0: The behavioral intention is significantly correlated to risk aversive behavior
H1: The behavioral intention is not significantly correlated to risk aversive behavior
d. H0: The uncertainty avoidance is significantly correlated to perceived risk
H1: The uncertainty avoidance is not significantly correlated to perceived risk
e. H0: The uncertainty avoidance is significantly correlated to risk aversive behavior
H1: Uncertainty avoidance is not significantly correlated to risk aversive behavior
f. H0: The perceived risk is significantly correlated to risk aversive behavior
H1: The perceived risk is not significantly correlated to risk aversive behavior
29
4. DATA ANALYSIS
The data collected from field survey of the study had been analyzed by means of four
specific tests through SPSS 17 and PASW Statistics 18 software. The tests included the
reliability analysis, instrument validity, factor analysis and correlation matrix. Subsequently,
the hypothesis put forth will be concluded.
4.1 Reliability Analysis
The internal consistency of a test is expressed between 0 and 1 (Cronbach, 1951). The
internal consistency measures the statements under each of the variables with respect to
reliability i.e. if the constructs are reliable enough to measure what is intended to be
measured.
As the credibility estimate increases, the fraction of the test score which may be derived from
a mistake should decrease (Nunnally and Bernstein, 1994). The Cronbach is a measurement
of the credibility of a result and locates and assigns errors at specific respondent instead of on
the researcher (Tavakol and Dennick, 2011).
The four constructs of the research study presented acceptable reliability figures of 0.5 and
greater Cronbach’s alpha and depicted in the tables on the following page.
30
Behavioral Intention
Cronbach's Alpha Cronbach's Alpha Based on Standardized Items N of Items
.775 .775 12
Uncertainty Avoidance
Cronbach's Alpha Cronbach's Alpha Based on Standardized Items N of Items
.643 .646 5
Perceived Risk
Cronbach's Alpha Cronbach's Alpha Based on Standardized Items N of Items
.813 .818 5
Risk Aversive Behavior
Cronbach's Alpha Cronbach's Alpha Based on Standardized Items N of Items
.824 .825 7
31
4.2 Instrument Validity
The instrument for conducting research has to be checked for validity before implementation.
The questionnaire deployed for the research had been replicated from that administered on
self-medication with antibiotics from an international study (plosone.org). For the specific
requirement of the research, the authors customized the original questionnaire to
accommodate the four constructs of behavioral intention, uncertainty avoidance, perceived
risk and risk aversive behavior. These constructs cumulatively accentuate the different
research studies undertaken in Pakistan and internationally on self-medication, risk aversive
behavior, cultural dimension of uncertainty avoidance, and consumer behavior. Face validity
had also been acquired from course advisor to the extent that the said constructs and scales
will amicably fulfill the purpose of measuring the needful.
32
4.3 Demographics
The survey questionnaire constituted of items related to identify the basic demographic
structure of the respondents. Six basic demographic dimensions had been used in the survey
instrument, viz. (a) gender (b) marital status (c) age group (d) education (e) employment
status (f) household income.
4.3.1 Frequency Tables
Gender
Frequency Percent Valid Percent Cumulative Percent
Valid Male 132 66.0 66.0 66.0
Female 67 33.5 33.5 99.5
3 1 .5 .5 100.0
Total 200 100.0 100.0
Marital Status
Frequency Percent Valid Percent Cumulative Percent
Valid Single 135 67.5 67.5 67.5
Married 65 32.5 32.5 100.0
Total 200 100.0 100.0
33
Age Group
Frequency Percent Valid Percent Cumulative Percent
Valid 18-20 25 12.5 12.5 12.5
21-26 93 46.5 46.5 59.0
27-32 48 24.0 24.0 83.0
33-38 21 10.5 10.5 93.5
39-34 9 4.5 4.5 98.0
45-50 3 1.5 1.5 99.5
50-55 1 .5 .5 100.0
Total 200 100.0 100.0
Education
Frequency Percent Valid Percent Cumulative Percent
Valid undergraduate 37 18.5 18.5 18.5
Graduate 87 43.5 43.5 62.0
Post Graduate 76 38.0 38.0 100.0
Total 200 100.0 100.0
34
Employment Status
Frequency Percent Valid Percent Cumulative Percent
Valid employed 96 48.0 48.0 48.0
self employed 18 9.0 9.0 57.0
unemployed 85 42.5 42.5 99.5
5 1 .5 .5 100.0
Total 200 100.0 100.0
Household Income
Frequency Percent Valid Percent Cumulative Percent
Valid 0 5 2.5 2.5 2.5
Rs. 50k-74k 47 23.5 23.5 26.0
75k-99k 46 23.0 23.0 49.0
100k-124k 60 30.0 30.0 79.0
125k-149k 12 6.0 6.0 85.0
150k+ 30 15.0 15.0 100.0
Total 200 100.0 100.0
35
4.3.2 Bar Charts
36
37
38
4.3.3 Findings
The demographic results of the study presented 66% male and 33% female respondents and
out of the total sample size 67.5% were married and 32.5% single. Majority of the
respondents i.e. 46.5% hailed from the age group of 21-26 years, followed by 27-32 years
group at 24%. Age groups of 33-38 and up to 20 years old represented 10.5% and 12.5%
respectively. With regard to education, 43.5% respondents were graduates, 38% post-
graduates and 18.5% undergraduates. Nearly half the respondents were employed at 48%.
The unemployment percentage was 42.5% and the reason for this high ratio was the fact that
close to a hundred respondents had been students in their final semester. On the household
income front, diverse readings came to light. Most notable was the 15% representation from
the Rs. 150,000 plus income bracket. Rs. 50,000-74,000, Rs. 75,000-99,000 and Rs. 100,000-
124,000 per month household income groups were represented by 23.5%, 23% and 30%
respectively.
39
4.4 Behavioral Analysis
The research had also incorporated two specific items to identify the behavior of respondents
in terms of self-medication i.e. the situations under which they are motivated to self-
medicated and the ailments for which they engage into this practice.
The empirical findings brought to light that 19% of the respondents practice self-medication
in order to save the fee of a doctor. Another 21% self-medicate to avoid the waiting time at a
doctor’s clinic or a health-care facility. The lack of trust on the competency and quality of a
doctor constituted 10% whereas the most significant reason stood out as the easy of
availability of medicines at a chemist without having to show a doctor’s prescription at 29%.
A notable 21% of the respondents engage into self-medication because going over to the
doctor is considered as a hassle.
Legend: B1: Save doctor’s fee B2: Avoid waiting at the doctor’s clinic
B3: Lack of trust on doctor B4: Ease of availability of medicines
B5: Hassle going to the doctor
40
The other questions asked from respondents regarding the ailments for which they usually
self-medicate presented the fact that for perceived to-be minor ailments, self-medication
practice is high among consumers whereas for ailments which are perceived to be serious or
complex in nature, the practice of self-medication is considerably low.
The most common ailments for which consumers self-medicate include cold (18%),
headaches (13%), cough and sore throat (11% each), nasal congestion (10%) and ordinary
fever (9%).
For serious ailments, the percentages were low which show the behavioral trend that
consumers will prefer to visit a doctor. Lack of sleep, depression, nausea and diarrhea had
represented less than 10% each.
41
4.5 Confirmatory Factor Analysis
Reducing from a large to an achievable choice of factors is factor analysis (Zikmund, 2002).
In factor analysis, all variables are grouped together in order to display the capability of
individual items to depict a specific construct. For all the four constructs i.e. behavioral
intention, uncertainty avoidance, perceived risk and risk aversive behavior; factor analysis
had been conducted separately.
The Kaisr-Meyer-Olkin (KMO) measures the adequacy of the sample and presents an index
(between 0 and 1) of the proportion of variants among the variables that might be common
variant. A KMO close to 1.0 indicates a factor analysis and if it is less than 0.5 then it is not
appropriate (Dr. Komata). KMO identifies the specific item which has to be discarded in
factor loading.
The final solution had been constructed and based upon the criteria that each factor must
possess a minimum of three item loadings greater than 0.3 and that any item loading on more
than one factor subject to acquiring the final solution, will be placed only in the factor on
which it loads most highly.
Since the data is based upon perceptions therefore for the constructs of behavioral intention,
uncertainty avoidance, perceived risk and risk aversive behavior, the score of 0.3 as the
baseline against each variable of the construct has been considered. This has been done due
to the reason that perceptions cannot be accurate. A score of 0.5 on the other hand would
have been considered if the findings had been healthier.
The following tables present the communalities derived from factor analysis.
42
Behavioral Intention
Initial Extraction
If I am cured by a medicine through self-medication then I will not visit a doctor 1.000 .624
I take advice for self-medication from the chemist 1.000 .400
Based upon my past experience with medicines, I self-medicate on my own 1.000 .653
I use medicines based upon the references provided by my family and friends 1.000 .550
I favorably recommend medicines to family and friends which made me better 1.000 .605
I switch to another medicine on my own, if a doctor's prescription doesn't make me feel
better
1.000 .515
I switch to any economical medicine brand if the one prescribed by the doctor is expensive 1.000 .562
If I run-out of medicine prescribed by the doctor, I switch to another alternative medicine
available at home
1.000 .592
I switch to any other alternative medicine if side-effects are experienced from the doctor’s
prescribed medicine
1.000 .606
I discontinue using a medicine without consulting the doctor 1.000 .695
I discontinue using a medicine on my own after the symptoms disappear 1.000 .676
I discontinue using a medicine after it runs out 1.000 .578
Findings: For the construct of behavioral intention, twelve items had been loaded and all were
accepted. The KMO had been determined at 0.782 whereas the approximate chi-square came out
to be 658.054.
43
Uncertainty Avoidance
Initial Extraction
Through self-medication, the risk that I take is high 1.000 .603
There may be side-effects from the medicines I use through self-medication 1.000 .603
I may suffer harmful side-effects if I take an over/under dose of a medicine 1.000 .735
I may suffer from severe allergic reactions from the medicine I use through self-medication 1.000 .598
People practice self-medication because medicines are freely available (without
prescription)
1.000 .378
Findings: Five items were loaded for the construct of uncertainty avoidance and all had been
accepted. The KMO came out to be 0.678 and with a chi-square of 140,803 approximately.
Perceived Risk
Initial Extraction
I always read the medicine pack/label even if the medicine has been prescribed by the
doctor
1.000 .689
I always read the medicine information sheet (inside the pack) even if the medicine has
been prescribed by the doctor
1.000 .653
I always follow the doctor's instructions while taking medicine 1.000 .576
I always discontinue using medicine after consulting the doctor 1.000 .553
Rules and regulations should be strictly implemented so that chemists sell medicines only
through a doctor's prescription
1.000 .700
Findings: The perceived risk construct was loaded for a total number of five items and all of
them had been accepted. KMO was derived at 0.800 and the approximate chi-square was
344.999.
44
Risk Aversive Behavior
Initial Extraction
I ensure that I always take medicines that are prescribed by the doctor 1.000 .500
When I take a medicine, I ensure that no health risks are involved 1.000 .608
I don’t want to be unsure about the medicines I take 1.000 .388
I would be rather safe than sorry 1.000 .466
I only change medicine if my doctor tells me to do so 1.000 .582
I always take the exact dosage of medicine as prescribed by the doctor 1.000 .492
I always check the expiry date on medicine before consuming them 1.000 .395
Findings: The construct of risk aversive behavior had a total of seven items that had been loaded
and all were accepted. Accordingly, the KMO came out to be 0.823 and with an approximate
chi-square of 439.382.
45
4.6 Pearson’s Correlation Matrix
The correlation matrix of Pearson has been used to identify the correlation between no less
than continuous factors. The worth of the correlation may fall between 0.00 (i.e. no
correlation) and 1.00 (i.e. absolute best correlation). The different components corresponding
to team size should resolve whether or not the correlation is important. In most cases,
however, correlations about 0.8 are thought to be high.
Descriptive Statistics
Mean Std. Deviation N
Behavioral Intention 2.8858 .65836 200
Uncertainty Avoidance 3.3890 .79652 200
Perceived Risk 3.4270 .87962 200
Risk Aversive Behavior 3.7136 .73327 200
Correlations
Behavioral
Intention
Uncertainty
Avoidance
Perceived
Risk
Risk
Aversive
Behavior
Behavioral
Intention
Pearson Correlation 1
Sig. (2-tailed)
N 200
Uncertainty
Avoidance
Pearson Correlation -.233** 1
Sig. (2-tailed) .001
N 200 200
Perceived Risk Pearson Correlation -.269** .282
** 1
Sig. (2-tailed) .000 .000
N 200 200 200
Risk Aversive
Behavior
Pearson Correlation -.213** .443
** .418
** 1
Sig. (2-tailed) .002 .000 .000
N 200 200 200 200
**. Correlation is significant at the 0.01 level (2-tailed).
46
4.7 Hypothesis Testing
In light of Pearson’s Correlation Matrix, the hypothesis could now be concluded.
a. H0: The behavioral intention is significantly correlated to uncertainty avoidance
H1: The behavioral intention is not significantly correlated to uncertainty avoidance
Null hypothesis is accepted and believed that the two variables have some association in
the population. The two variables are correlated significantly and correlate together due
to the negative finding (-0.233). It is believed that the consumer behavior towards self-
medication is triggered with the uncertainty avoidance index. The consumer with a high
uncertainty avoidance index will act in a safe manner and not take the risk to engage into
self-medication and had the uncertainty avoidance been low then the consumer’s
behavior would have been more towards a risk-taking attitude. As a situational need of a
person comes to light it may diminish the high uncertainty avoidance index and the
consumer will likely to be engaged in self-medication.
b. H0: The behavioral intention is significantly correlated to perceived risk
H1: The behavioral intention is not significantly correlated to perceived risk
Null hypothesis is accepted and believed that the two variables have some association in
the population. The two variables are correlated significantly and negative in its empirical
outcome (-0.269). It is believed that the consumer will act depending upon how risk is
perceived. How a consumer perceives risk and whether it leads to a risk-taking or risk-
aversive behavior towards self-medication are linked together. Risk perception of a
consumer could be either experiential or influenced by a group reference thereby
increasing or decreasing the confidence and motivation to engage or refrain from self-
medication.
47
c. H0: The behavioral intention is significantly correlated to risk aversive behavior
H1: The behavioral intention is not significantly correlated to risk aversive behavior
Null hypothesis is accepted and believed that the two variables have some association in
the population. The two variables are correlated significantly but are negative in nature (-
0.213). It is believed that the intent of a consumer to behave towards self-medication is
directly linked with the risk aversive behavior. A consumer will refrain from taking risk
if the perception has been developed to avoid risk unless a specific situation arises which
demands a person to practice self-medication. This situation may also be influenced upon
a person.
d. H0: The uncertainty avoidance is significantly correlated to perceived risk
H1: The uncertainty avoidance is not significantly correlated to perceived risk
Null hypothesis is accepted and believed that the two variables have some association in
the population. The two variables are correlated significantly. It is believed that with high
perception of risk, the uncertainty avoidance index of consumers will also remain high
and vice versa that is if the consumer perceives that there is no risk in the act of self-
medication then a low uncertainty avoidance index will be observed. This correlation acts
inversely due to its positivity (0.282) and therefore the perception of risk will vary on the
risk-aversive and risk-taking continuum.
48
e. H0: The uncertainty avoidance is significantly correlated to risk aversive behavior
H1: Uncertainty avoidance is not significantly correlated to risk aversive behavior
Null hypothesis is accepted and believed that the two variables have some association in
the population. The two variables are correlated significantly but the finding is positive in
nature (0.443) and therefore as uncertainty goes up or down, the risk-aversive behavior
increases or decreases accordingly. It is believed that consumers at the time of being risk
aversive towards self-medication display a high uncertainty avoidance index.
f. H0: The perceived risk is significantly correlated to risk aversive behavior
H1: The perceived risk is not significantly correlated to risk aversive behavior
Null hypothesis is accepted and believed that the two variables have some association in
the population. The two variables are correlated significantly but due to positive (0.418)
in nature they move inversely. Therefore the higher the perception of risk, the higher will
be the risk-aversive behavior and vice-versa. It is believed that consumers in accordance
with their perception of risk behave in a risk aversive manner when it comes to self-
medication. If the consumers perceive that there exists a risk then they will avoid the act
of self-medication.
49
5. CONCLUSION AND RECOMMENDATIONS
5.1 Conclusion
The basic purpose of this research study was to gauge the perception and attitude of
consumers towards self-medication in light of the cultural dimension of uncertainty
avoidance. In addition to this an investigation was made to discover the relationship between
the four survey constructs of behavioral intent, uncertainty avoidance, perceived risk and risk
aversive behavior.
In a nutshell, with regard to self-medication, the assertion put forth by Hofstede that Pakistanis are
risk-averse people due to a high index of uncertainty avoidance index is true. Regardless of the fact
that the act of self-medication is considered as a risk-taking behavior, the people operate their
behavior with a two-prong strategy. On one hand, as evident from the focus group finding
and acceptance of all null hypotheses, the people refrain from self-medicating because they
are aware of the risks attached; at the same time they also engage into the practice of self-
medication due to (1) they lack complete knowledge about adverse drug reactions and (2)
they justify their act by citing reasons which in their specific state of affairs holds true. Cost
of medicines, competency of doctors and long waiting queues all play a role independently
and together in motivating a person to self-medicate. This contradiction brings to light the
elements of locus of control which according to research studies in case of Pakistanis is
external (Shah & Amjad, 2011). The locus of control is also directly linked with the religious
beliefs of a person. (Shah & Amjad, 2011) This aspect however demands a separate study.
The demographic findings from the research bring to light the fact that educated people
earning average and above average income though are risk-averse but are inclined towards
self-medication as per situations which they face in their lives and that have been identified
above. This fact establishes the rationale that people with education, who are employed and
earning respectable income engage into this act (Klemenc-Ketis et al., 2010; Henry et al.,
2006). But the study could not acquire a respondent base from a lower socio-economic class
which could further justify that people from this group either do not self-medicate or do it
nominally because of their strong affinity towards rules and regulations (Klemenc-Ketis et
al., 2010; Henry et al., 2006).
50
From the literature that had been reviewed and the empirical findings it also came to light
that the consumers are aware of the risks attached with self-medication but they still pursue
the practice basically because of a positive past experience and the influence of credible
reference groups, both of which encourages them to consider the self-medication issue as too
petty. Additionally, the consumers do not perceive the act of self-medication itself to be one
that involves risk. At the same time, where Pakistan’s uncertainty avoidance index states that
people have an affinity towards rules and regulations then these same people at their own
free accord purchase all types of medicines from a pharmacy. That the government
regulations have not been implemented is one aspect but the consumers themselves have
totally disregarded the rule.
The universal fact remain that consumers develop a perception and then form an attitude
leading either towards the act of self-medication or refraining from it. The risk consumers
take towards self-medication is both willing and unknowingly. It’s a matter of how the risk is
perceived to be. The establishment of risk perception comes into action from operational
variables which surround a consumer e.g. lack of regulations, cost of medicine, unawareness
of the danger involved, competency of physicians, etc. Subsequently, the empirical findings
of the research also concluded and accepted the null hypotheses that had been derived
initially.
The risk-taking attribute of the society may have changed over the years if a general
observatory glance is given over the people but just as in selective ethics which a person may
practice, in a similar way, situation-based and experience-based risk-taking behavior is
displayed. Socio-economic factors play a role and so specific situations upon which a person
may not have any control; therefore attitude formation takes place and selective risk-aversive
behavior (e.g. in case of serious ailments such as diarrhea and sleeping disorder) and risk-
taking behavior (e.g. in case of minor ailments such as sore throat and cough) is witnessed.
51
5.2 Recommendations
The primary understanding is that self-medication is not in benefit of a consumer unless it is
an over-the-counter medicine like paracetamol which can be sold and purchased without the
prescription of a physician.
Things can be done to reduce self-medication in any country and it can also be done in third
world countries like Pakistan. Educate, is the number one thing which pharmaceutical
companies, the ministry of health and other stake holders need to plan and initiate. Another
solution could be the reduction in price of medicines and to revisit the overall health care cost
in Pakistan. Stringent implementation of pharmacy regulations is also long overdue.
Finally, in light of the logical criticism of Hofstede, consumer perception and attitude has to
be checked not only for different product and service categories, which can identify risk-
taking consumer behavior but also on the platform of social sciences and coupling it with all
the cultural dimensions of Hofstede and not only uncertainty avoidance. Only then, after
comparing multiple dimensions which a person is exposed to and experiences in life in
general, will the actual uncertainty avoidance index by identified.
52
AREAS OF FURTHER STUDY
At this time on an academic level, the authors have attempted to define the effects of
perception and attitude on consumer behavior towards self-medication. The unanswered
question of ‘why they do it’ could be comprehended in totality if the dimensions of locus of
control and religion are taken into account, both of which are strongly and deeply rooted in
the Pakistani society and serve as a bench mark towards countless deeds and acts by the
people from all walks of life. Additionally, all cultural dimensions put forth by Hofstede have
to be measured parallel and not only uncertainty avoidance because these dimensions possess
an interplay and based upon which consumers behave towards different objective and
subjective elements.
53
BIBLIOGRAPHY
1. Abahussain E, Matowe LK, Nicholls PJ. Self-reported medication use among adolescents
in Kuwait. Med PrincPract 2005; 14: 161-4.
2. Baig S. Self medication practices. Professional Med J Aug 2012;19(4): 513-521.
3. Cronbach, L. J. 1951. Coefficient alpha and the internal structure of tests. Psychometrika
16:297–334.
4. Deschepper R, Lundborg CS, Monnet DL, Scicluna EA, Birkin J, Haaijer-RuskampFM ,
SAR consortium (2007) Attitudes, beliefs and knowledge concerning antibiotic use and
self-medication: a comparative
5. Deshpande SG, Tiwari R. Self-medication-a growing concern. Indian J Med Sci. 1997;
51: 93-6.
6. Dorfman, P. W. and J. P. Howell (1988). "Dimensions of National Culture and Effective
Leadership Patterns: Hofstede revisited." Advances in International Comparative
Management 3: 127-150.
7. Ellis, J., Mullan, J. (2009), Prescription medication borrowing and sharing: risk factors
and management. Australian Family Physician, 38(10), 2009, 816-819.
8. Filho L, Antonio I, Lima-Costa MF, Uchoa E. Bambui Project: a qualitative approach to
self-medication. Cad SaudePublica 2004;20:1661-9.
9. GEERT-HOSFTEDE. National Cultural Dimensions. Available at: http://www.geert-
hofstede.com/countries.html (Accessed on January 2, 2013)
10. Graves, D. (1986). Corporate Culture - Diagnosis and Change: Auditing and changing the
culture of organizations. London, Frances Printer.
11. Haider S, Thaver IH (1995). Self medication or self care: implication for primary health
care strategies. J. Pak. Med. Assoc., 45 (11): 297-298.
54
12. Hofstede G, Bond MH (1988). The Confucius connection: From cultural roots to
economic growth.
13. Hussain S, Malik. F, Hameed A, Riaz H (2010). Exploring health seeking behaviour,
medicine use and self medication in rural and urban Pakistan. Southern Med. Rev., 3: 32-
34.
14. James, H., et al., Influence of medical training on self medication by students.
International Journal of Clinical Pharmacology and Therapeutics, 2008. 46(1): p. 23-29.
15. Klemenc-Ketis, Z., Kersnik. J, Grmec S. The effect of carbon dioxide on near-death
experiences in out-of-hospital cardiac arrest survivors: a prospective observational
study. Critical Care 2010 14:R56.
16. Kometa, Dr. S., "How to perform and interpret factor analysis using SPSS” Data
Retrieved from: http://www.ncl.ac.uk/iss/statistics/docs/factoranalysis.php Date: January
15, 2013
17. Likert, R. (1931). A technique for the measurement of attitudes. Archives of
Psychology. New York: Columbia University Press.
18. McSweeney B. Hofstede's model of national cultural differences and their consequences:
a triumph of faith – a failure of analysis. Human Relations 2002; 55: 89-118.
19. Montastruc JL, Bagheri H, Geraud T, Lapeyre MM (1997). Pharmacovigilance of self-
medication. Therapie, 52: 105-110
20. Mumtaz Z, Salway S, Waseem M, Umer N (2003). Gender-based barriers to Primary
health care provision in Pakistan: the experience of female providers. Health Policy Plan,
18: 261–269.
21. Nunnally, J. C., & Bernstein, I. H. (1994). Psychometric Theory (3rd
ed.). New York:
McGraw-Hill.
22. Olie, R. (1995). The 'Culture' Factor in Personnel and Organization Policies. International
Human Resource Management: An integrated approach. A. Harzing and V. R. J. London,
Sage Publications: 124-143.
55
23. PEER REVIEWED OPEN ACCESS JOURNAL. File S1: Questionnaire for self-
medication with antibiotics. Available at: http://www.plosone.org (Accessed on January
22, 2013)
24. Prince, M. and Davies, M (2001) "Moderator teams: an extension to focus group
methodology", Qualitative Market Research: An International Journal, Vol. 4 Iss: 4,
pp.207 – 216
25. Runciman WB, Roughead EE, Semple SJ, et al. Adverse drug events and medication
errors in Australia. Int J Qual Health Care 2003; 15 Suppl 1: i49-i59.
26. Schoenberg, N.E. & Drew, E.M. (2002). Articulating Silence: experiential certitude and
biomedical controversies over hypertension symptomatology. Medical Anthropology
Quarterly, 16(4), 458-475.
27. Schwartz, S. H. (1999). "A Theory of Cultural Values and Some Implications for Work "
Applied Psychology 48(1): 23-47.
28. Sekaran, U. (2000). Research methods for business. New York: John Wiley & Sons, Inc.
29. Shah, M., Amjad, Dr. S. Cultural Diversity in Pakistan: National vs Provincial.
Mediterranean Center of social and Educational Research 2011; 2:2:331-344
30. Shankar PR, Partha P, Shenoy N. Self-medication and non-doctor prescription practices
in PokharaVaelley, Western Nepal: a questionary-based study. BMC FamPract
2002;3:17-23.
31. Sturm AW, van der Pol R, Smits AJ et al. Over-the-counter availability of antimicrobial
agents, self-medication and patterns of resistance in Karachi, Pakistan. J
AntimicrobChemother1997; 39:543–547. European study. Pharmacoepidemiol and Drug
Safety. 16:1234-43.
32. Tavakol, M. and Dennick, R. (2011) “Making sense of Cronbach’s alpha.” International
Journal of Medical Education; 2:53-55
33. WIKIPEDIA. Self-Medication. Available at: http://www.wikipedia.org/selfmedication
(Accessed on December 19, 2012)
56
34. WORLD HEALTH ORGANIZATION. The role of the pharmacist in self-care and self-
medication. Hangue: World Health Organization, 1998; 17. Available
at:http://www.wsmi.org/pdf/boarddeclarationselfcare.pdf (Accessed on 7th January 2013)
35. Zafar SN, Syeed R, Waqar S, Zubairi AJ, Vaqar T, Shakh M, et al. Self-medication
amongst university students of Karachi: Prevalence, Knowledge and attitudes. J Pak Med
Assoc. 2008; 58(4): 214-17
36. Zikmund, W.G. (2002). Business Research methods (6th ed.). United States of America:
Harcourt College Publishers.
57
APPENDIX
a. Focus Group Guide
Thank you for agreeing to participate. We are very interested to hear your valuable opinions.
The purpose of this study is to learn how consumers develop perceptions and form an attitude
towards the act of self-medication and whether consumers take this risk willingly or
unknowingly. We hope to learn about consumer behavior in Pakistan; their level of awareness
and the factors which trigger the specific act of self-medication.
The information you give us is completely confidential, and we will not associate your name with
anything you say in the focus group. We will ask participants to respect each other’s
confidentiality.
We would like to record the focus group so that we can make sure to capture the thoughts,
opinions, and ideas we hear from the group. No names will be attached to the focus group and
the audio file will be destroyed as soon as they are transcribed. You may refuse to answer any
question or withdraw from the study at anytime.
Please check the boxes below to the best of your knowledge and to show that you agree to
participate in this focus group.
Gender: Male Female Marital Status: Single Married
Age Group: 21-26 27-32 33-38 39-44 45-50 50-55 55+
Education: Intermediate Graduate Masters
Employment Status: Employed Self-Employed Unemployed
Household Income: Rs. 50,000-74,000 Rs. 75,000-99,000 Rs. 100,000-124,000
Rs. 125,000-149,000 Rs. 150,000 +
Family Members: ___ Adults ___ Children (up to 12 y.o) ___ Children (13-17 y.o)
58
The focus group session will last for 60 minutes approximately and during which you should feel
free to sit and walk, take notes or use the white board to express your thoughts.
Beginning the Focus Group Session
Welcome and introduce yourself and the note-taker, and send the Consent Form around to the
group.
Introducing the focus group with a review on:
a) Who we are and what we’re trying to do?
b) What will be done with this information?
c) Why we asked you to participate?
Explanation of the process.
Ask the group if anyone has participated in a focus group before. Explain that focus groups are
being used more and more often in consumer research.
About focus groups
a) We learn from you (positive and negative).
b) Not trying to achieve consensus, we’re gathering information.
c) No virtue in long lists: we’re looking for priorities.
d) The reason for this focus group is that we can get more in-depth information from a
smaller group of people. This allows us to develop the statements for the subsequent
survey questionnaire.
59
Ground Rules
a) Everyone should participate.
b) Information provided in the focus group must be kept confidential.
c) Stay with the group and please don’t have side conversations.
d) Turn off cell phones.
e) Turn on Audio Recording
f) Ask the group if there are any questions before we get started, and address those
questions.
g) Participant Introductions (name, working where and as, born where, hobbies & family)
Discussion begins, make sure to give people time to think before answering the questions and
don’t move too quickly. Use the probes to make sure that all issues are addressed, but move on
when you feel you are starting to hear repetitive information.
Focus Group Questions
a) What are your thoughts about self-medication? (Your feelings and approach) Why and
how?
b) Which ailments do you think individual typically opt for self-medication?
c) Which drugs are usually brought for self-medication purpose?
d) Do you think it’s a risk or is it safe to self-medicate?
e) Why do people prefer self-medication? (if people are in the habit to do so)
f) Who’s opinion matters in using drugs?
g) How do you perceive risks in general, in your life?
h) Why do people take risks? (helmet, swimming, CNG, overhead bridge, smoking)
60
Underlying variables:
a) Situation faced before self-medication
b) Ailment treated
c) Decision to do so – past experience and/or under influence
d) Medicines consumed
e) Cost
f) Time
Probes for Discussion:
a) Personal satisfaction
b) Ego, self-concept and confidence
c) Belief in your self
d) Belief in fate and destiny
e) Experiential perception
f) Family traditions
g) Knowledge based decisions
That concludes our focus group. Thank you for coming and sharing your thoughts and opinions
with us. If you believe that you have missed a certain point or fact which you wanted to share
then please note it down on the sheet provided so that it may assist in compilation of the
research.
61
b. Survey Questionnaire
62
Recommended