Self-Medication of Antibiotic Use: Investigating Knowledge and

Attitude Among Rural Population in Umbul Natar Village, South of

Lampung

Dwi Aulia Ramdini

, Muhammad Fitra Wardhana Sayoeti

, Suharmanto

Ramadhan Triyandi

, Muhammad Iqbal

and Rano K Sinuraya

3,4

Departement of Pharmacy, Faculty Medicine, University of Lampung, Bandar Lampung, Indonesia

Departement of Public Health, Faculty of Medicine, Lampung University, Bandar Lampung, Indonesia

Departement of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Indonesia

Unit of Global Health, Department of Health Sciences, University of Groningen/University Medical Center Groningen,

Groningen, The Netherlands

dwi.aulia@fk.unila.ac.id

Keywords: Knowledge, Attitude, Rural Population, Self-Medication with Antibiotic.

Abstract: Self-medication with antibiotics is a common phenomenon among the general population, including in rural

areas. This practice has been the subject of particular attention because the consequences are very dangerous

in terms of the development of antibiotic resistance. There are several factors underlying this practice in rural

communities. Therefore, it is necessary to study the knowledge, attitudes and practices of rural communities.

This study is an observational study with a cross-sectional approach. Data were collected using a validated

questionnaire. A total of 257 respondents dominated by low education level (53,53%) and low-income status

(98,44%). A numerous 59.92% had poor knowledge and 59.53% had a negative attitude. Factors such as

educational level (p=0.035), income status (p=0.010), knowledge (p=0.004) and attitude (p=0.000) were

significantly associated with the practice of self-medication with antibiotics. In general, socio-demographic

factors influence people's decision to self-medicate with antibiotics. The health care providers such as doctors

and physicians should be concerned to improve knowledge and awareness towards antibiotic use in properly.

1 INTRODUCTION

Self-medication of antibiotic is frequently

encountered in the general population. This act

closest to inappropriate antibiotic use and leads to

antibiotic resistance. Ninety percent of antibiotics are

purchased without a prescription (Puspitasari et al.,

2011). The Indonesian Minister of Health has issued

a regulation on general guidelines for the use of

antibiotics in Minister of Health Regulation No. 28 in

2021. Under these rules, antibiotics can only be given

or purchased with a medical prescription (Regulation

of The Minister of Health of The Republic of

Indonesia Number 28 of 2021, 2021).

https://orcid.org/0000-0003-0199-8717

https://orcid.org/0009-0009-2203-5312

https://orcid.org/0000-0002-2075-8308

https://orcid.org/0009-0009-9909-1232

https://orcid.org/0009-0009-7380-189X

https://orcid.org/0000-0001-6109-0482

The practice of self-medication involves the

unsupervised administration of medication, including

antibiotics, by an individual without seeking expert

medical advice for diagnosis or prescription (Nepal &

Bhatta, 2018). It is considered as unhealthy behaviour

and inappropriate as a treatment method.

Previous studies have shown that even when

people have access to knowledge about dosage,

appropriate duration of use and risk of drug

interactions, many still misuse antibiotics (Nepal &

Bhatta, 2018). This leads to antibiotic resistance,

where the infection is difficult to treat with standard

antibiotic therapy (Sachdev et al., 2022; Ventola,

2015).

Antibiotic resistance is a global health problem

and continues to be a major target framework. As

Ramdini, D. A., Sayoeti, M. F. W., Suharmanto, , Triyandi, R., Iqbal, M. and Sinuraya, R. K.

Self-Medication of Antibiotic Use: Investigating Knowledge and Attitude Among Rural Population in Umbul Natar Village, South of Lampung.

DOI: 10.5220/0013672400003873

Paper published under CC license (CC BY-NC-ND 4.0)

In Proceedings of the 1st International Conference on Medical Science and Health (ICOMESH 2023), pages 359-370

ISBN: 978-989-758-740-5

359

many as 700,000 people will die from antimicrobial

resistance in 2013, and by 2025, about 10 million

people will die each year from antimicrobial

resistance (WHO, 2014). Case fatality rates of

resistance in hospital-acquired infections in newborn

babies have been reported to range from 44.3% to

31%. Antimicrobial resistance is a condition where

the infection becomes resistant to standard antibiotic

therapy. This condition can affect the effectiveness of

therapy and the cost of treatment. Several factors are

the cause of antibiotic resistance, including overuse

and misuse (Aris et al., 2012; Voidăzan et al., 2019;

WHO, 2014).

Basic Health Research data from the Indonesian

Ministry of Health in 2013 reported that 10% of the

population kept antibiotics at home. Of these, 86.10%

received antibiotics without a prescription (The

Indonesian Ministry of Health, 2013). Antibiotic self-

medication is common in developed and developing

countries with a prevalence range of 35%-75% (F.A.

et al., 2009; Skliros et al., 2010). In Indonesia,

antibiotics are often given without prescription, such

as in pharmacies, drug stores, and even roadside

stalls. A survey on the population in the province of

Yogyakarta reported that 64% of purchases of

antibiotics were without prescription. Generally, the

use of antibiotics is in cases of respiratory disorders,

which is 80% (Hadi et al., 2008), including the

common cold, cough, sore throat, dizziness, and other

symptoms of respiratory disorders. Types of

antibiotics that are often used are amoxicillin,

fradiomycin-gramicidin, tetracycline, and

ciprofloxacin.

There are several factors that contribute to self-

medication with antibiotics. These include a lack of

knowledge about the use of antibiotics, a perception

of the high cost of visiting a doctor, and a belief that

antibiotics must always be used to treat a specific

illness. In fact, self-medication is an important factor

driving the overuse of antibiotics, especially in low

and middle-income countries, where antibiotics are

readily accessible without a prescription

(Ayukekbong et al., 2017). Low-income and middle-

income countries (LMICs) play an important role in

the global response to antimicrobial resistance

(AMR) (Chandler et al., 2016). The population in

these countries considers self-medication with

antibiotics to be cheaper and more affordable than

seeing a doctor. They were often associated with lack

knowledge and negative attitudes towards the

appropriate use of antibiotics (Dyar et al., 2020).

Various factors play a role in the behaviour of self-

medication antibiotics, such as purchasing antibiotics

freely without supervision, economic conditions and

urgency of time, the influence of family or friends,

and the level of community knowledge. Antibiotic

self-medication is affected by ease of access to

getting antibiotics without a prescription (Insany et

al., 2015). Good knowledge and positive attitude

considerably affect the practice of antibiotic self-

medication, although in some situations it does not

result in good practice regarding the use of antibiotics

(Pham-Duc et al., 2019). The study of Al Qarni et al.

stated that individuals with good knowledge about

antibiotics also have a good attitude towards the use

of antibiotics (Alqarni & Abdulbari, 2019).

One of the rural areas not far from the capital city

of Lampung is the village of Umbul Natar South

Lampung. The majority of the population in this

village work as farmers and traders, with a medium to

low level of education, which can provide an

overview of the pattern of antibiotic use in self-

medication. One of the strategies to tackle

antimicrobial resistance is to improve knowledge and

attitudes about antibiotic use. One of the efforts to

support the World Health Organization (WHO)

Emergency Programme on Antimicrobial Resistance

(AMR) is community education. Therefore, it is

necessary to investigate the relationship between

knowledge, attitudes and practices regarding

antibiotic self-medication in rural communities in

South Lampung, Indonesia. This study aims to

identify the factors that influence the implementation

of the antibiotic resistance control programme.

2 METHOD

2.1 Research Design

This is an analytical observational study with a cross-

sectional approach. The instrument used is a

questionnaire consisting of questions about

knowledge, attitudes, and practice in antibiotic self-

medication. The target population is community in

Umbul Natar Village South of Lampung, Indonesia.

Technic sampling by purposive sampling. The

inclusion criteria in this study were people from

adolescence to adulthood who were willing to be

respondents. The exclusion criteria were that the

respondents did not fill out the questionnaire. The

data obtained will be presented descriptively in tables

and figures. To determine the correlation between

demographic factors towards knowledge, attitudes,

and practice, we used the chi-square test was carried

out with a 95% confidence level (p <0.05). This

research has received ethical approval from the

Research Ethics Committee of the Faculty of

ICOMESH 2023 - INTERNATIONAL CONFERENCE ON MEDICAL SCIENCE AND HEALTH

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Medicine, the University of Lampung with Number

1378/ UN26.18/ PP.05.02.00/ 2020.

2.2 Collected Data Knowledge,

Attitude

Knowledge and attitude measurements were

conducted using a questionnaire adapted from similar

research questionnaires with modifications and

tailored to the expected information (10,20–22). The

questionnaire was narrated in Bahasa Indonesia and

consisted of 4 knowledge questions (K1-K4) on a

Guttman Scale, 7 attitude statements (A1-A7) on a

Likert scale and 4 practice questions on a Guttman

Scale. The questionnaire has been validated with the

Cronchbach score of knowledge, attitude and practice

questions being 0.684; 0.799; 0.604 respectively.

2.2.1 Knowledge

There are 4 question items (K1-K4) in the knowledge

section with true and false statements. K1, K2 and K4

are questions with false statements or unfavourable

question and K3 true statements or favourable

question. The determination of the knowledge level

referred to the cut of mean value of the respondent's

answer. The cut of median score is 3 which means

that less than 3 is considered as poor and more than

equal to 3 was as a good level.

2.2.2 Attitude

This section consists of 7 statement items with the

answers strongly agree, agree, disagree, and strongly

disagree. Statements A1, A2, A3, and A4 are

negative statements so that the highest score starts

from the answers strongly disagree = 4, disagree = 3,

agree = 2, and strongly agree = 1. Statements A5, A6,

and A7 are positive statements so that the highest

score starts from the answers strongly agree = 4, agree

= 3, disagree = 2, and strongly disagree = 1. The

criteria for the positive attitude category refer to the

median cut off score of the respondent's answer value,

where positive attitude ≥ 15, and negative attitude if

the value is < 15.

2.2.3 Practice

This section consists of 3 questions that aim to

determine antibiotic use or the experience of using

antibiotics. Description of the questions P1:

Did you

take the antibiotics as recommended by your doctor

or health care professional, P2:

Have you finished the

full course of antibiotics prescribed by your doctor,

P3:

Did you consult a healthcare professional before

antibiotic use? P4: Would you share the antibiotics

you are currently using if your family were ill.

Question P1-P3 are favourable and P4 unfavourable.

The questions using “Yes” or “No” answer, and if

they had a value of ≥2 then it was considered a good

practice. This statement illustrated respondents doing

antibiotic self-medication and practicing doing

antibiotics self-medication.

3 RESULTS

3.1 Demographic Data

A total of 257 respondents completed the

questionnaire. The socio-demographic data of the

respondents are presented in Table 1. Overall, most

of the respondents were male (50.97%) and

dominated by the age group of 36-55 years

(41.78%). Most of them had primary and basic

education (53.31%). In terms of income status, the

majority of the respondents were below the

regional minimum wage (90.44 %). Many

respondents worked as housewives (26.46%) and

farmers (19.07). Information about antibiotics was

received from the family by 75.49% of

respondents.

3.2 Knowledge’s and Attitude Data

Based on the respondents' answers to several

knowledge questions, the majority of respondents had

poor knowledge (59.92%) and as many as 40.08%

had good knowledge. Table 2 shows respondents'

responses to questions about antibiotics. Many

respondents thought that antibiotics did not need to be

finished (60.31%) and thought that antibiotics could

treat cold and cough (97.28%). In addition, most

respondents understood that antibiotics can boost the

immune system (98.44%), but many of them also

knew that antibiotics have side effects.

Self-Medication of Antibiotic Use: Investigating Knowledge and Attitude Among Rural Population in Umbul Natar Village, South of

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361

Table 1: Characteristic of Respondents

Characteristics n %

Sex

Male 131 50,97

Female 126 49,03

Age (cut off in years)

<35 135 52,53

≥ 35 122 47,47

Education level

Elementary and basic school 137 53,31

Middle education level 113 43,97

At University level 3 1,17

Income (Regional Minimum Rate)

Under Regional Minimum Rate 253 98,44

Regional Minimum Rate or more 22 8,56

Occupation

Businessman 19 7,39

Employee 17 6,61

Farmer 49 19,07

Freelancer 25 9,73

Housewife 68 26,46

Labor 35 13,62

Student 41 15,95

Unemployement 3 1,17

Source of information Antibiotic Use

Health Providers 29 11,28

Family 194 75,49

Friend/Colleague 32 12,45

Internet 2 0,78

Table 2: Knowledge Respondents on Antibiotic Use

Code Knowledge on antibiotic use Correct response % Incorrect response %

K1 Antibiotics don't require the full

course to be completed

155 60,31 102 39,69

K2 Antibiotic work for the flu and cough 250 97,28 7 2,72

K3 Antibiotic have side effect 251 97,67 6 2,33

K4 Antibiotics boosted your immune

system

253 98,44 4 1,56

Table 3 demonstrates the attitudes of the participants.

Statements A1-A4 are negative statements, whereas

disagree or strongly disagree indicates a positive

attitude. Regarding the results of participants'

responses to several attitude questions, the majority

had negative (59.53%) and some positive (40.47%)

attitudes. A total of 64.59% of respondents agreed

with the statement "Buying antibiotics without a

prescription". A total of 93.39% of respondents

agreed that they give antibiotics to their family as

long as they have the same illness, and 90.66% of

respondents agreed with the statement that they keep

a stock of antibiotics at home for use when they are

ill. In statement A4, 94.55% of respondents agreed

that they use antibiotics for farm animals (chickens).

Overall, negative attitudinal statements (A1-A4)

generally indicate that respondents self-medicate

with antibiotics. Statements A5-A7 are positive, i.e.

respondents agree or strongly agree, indicating a

positive attitude. A total of 89.11% of respondents

disagreed with the statement that a course of

antibiotics must be completed, more than 89.49% of

respondents agreed that not taking antibiotics

properly can be harmful to health (A6) and 94.55%

agreed with the statement that consultation with

health provider before taking antibiotics (A7). Most

respondents also have negative attitudes based on

favorable questions.

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Table 3: Attitude Respondents on Antibiotic Use

Code Statements

Strongly

Disagree

% Disagree % Agree %

Strongly

agree

Buy antibiotics without

rescri

tion

0 0,00 88 34,24 166 64,59 0 0,00

Give antibiotics to the

family as long as

havin

the same illness

3 1,16 9 3,50 240 93,39 5 1,95

Keep stock of

antibiotics at home for

usage when sic

2 0,77 8 3,11 233 90,66 14 5,45

Antibiotics are given to

farm animals

(chickens)

0 0,00 5 1,95 243 94,55 9 3,50

Full course of

antibiotics must be

finishe

0 0,00 229 89,11 13 5,06 15 5,84

Not taking antibiotics

properly can be

harmful to health

2 0,77 230 89,49 21 8,17 4 1,56

A health provider

should be consulted

before taking

antibiotics

0 0,00 5 1,95 243 94,55 9 3,50

Figure 4: Respondent’s Practice of Antibiotic used

Figure 3. Reasons for The Use of Antibiotic Self-Medication

100

7.0

97.67

92.22

93.00

2.33

7.78

P1 (Using Antibiotic recommended by Doctor)

P2 (finished the full course of antibiotics use )

P3 (Consult a healthcare professional before taking

antibiotics)

P4 (Shared antibiotic to Family)

Percentage of Respondent's Answer

No Yes

Low cost

15%

Easy accessible

58%

Low cost and easy

accessible

26%

Medication from

doctor doesn’t work

Self-Medication of Antibiotic Use: Investigating Knowledge and Attitude Among Rural Population in Umbul Natar Village, South of

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363

Figure 3. Reasons to Use Antibiotics without Prescription Among Respondents.

We collected data reason for the use of antibiotic self-

medication from the respondents. Overall,

respondents were considered self-medication with

antibiotic is easy-accessible and low cost. Respondent

also consumed it for some medical problem such as

flu (33%), fever (32%), cough (21%) and others.

3.3 Correlation Characteristic

Respondents Toward Knowledge

and Attitude

We also analyzed a number of characteristics in

relation to knowledge and attitudes on a bivariate

basis (Table 4). Gender (p=0.308), level of education

(p=0.075), income (p=0.756) was not significantly

related to knowledge, but age was significantly

related to knowledge (p=0.032) with a p-value > 0.05.

Meanwhile, the factors age (p=0.045) and education

(p=0.018) were significantly related to the

respondents’ attitude with a p-value <0.05, but the

factors age (p=0.161) and income (p=0.102) were not

significantly related to this attitude.

Table 4: Characteristic’s Respondents toward Knowledge and Attitude

Characteristics

Knowledge

p-value

Attitude

p-value

Poor

n=154

Good

n=103

Negative

n=153

Positive

n=104

Gender

0,308

0,161 Male 83 32,3 48 18,7 84 32,7 47 18,3

Female 71 27,6 55 21,45 69 26,8 57 22,2

Age

0,032*

0,045* <35 years 72 28,0 63 24,5 72 28,0 63 24,5

≥ 35 years 82 31,9 40 15,6 81 31,5 41 16,0

Level of Education

0,075

0,018*

Elementary and

basic school

88 34,2 49 19,1 90 35,0 47 18,3

Middle education

level

60 23,3 53 20,6 57 22,2 56 21,8

At University level 6 2,3 1 0,4 6 6 1 0,4

Income (Regional

Minimum Rate)

0,756

0,102

Under Regional

Minimum Rate

142 55,3 93 36,2 144 56 91 35,4

Regional Minimum

Rate and more

12 4,7 10 3,9 9 3,5 13 5,1

Chi square with p value <0,05

Pain

Allergy

Sore throat

Cough

21%

Fever

32%

Flu

33%

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Table 5. Correlation Characteristics toward Self-Medication with Antibiotic

Characteristics

Self Medication Antibiotic

n=11

% Yes

n=246

% p value

Gender

Male 5 1,9 126 49,0 0,947

Female 6 2,3 120 46,7

Age

<35 years 9 3,5 126 49,0 0,093

≥ 35 years 2 0,8 120 46,7

Level of Education

Elementary and basic school 2 0,8 135 52,5 0,035*

Middle education level 9 3,5 104 40,5

At University level 0 0,0 7 2,7

Income (Regional Minimum Rate)

Under Regional Minimum Rate 22 7,53 245 83,90 0,010

Regional Minimum Rate and more 6 2,05 19 6,51

Knowledge

Poor 2 0,8 152 59,1 0,004*

Good 9 3,5 94 36,6

Attitude

Positive 10 3,9 94 36,6 0,000*

Negative 1 0,4 152 59,1

Chi square with p value <0,05

3.4 Characteristic’s Respondents

Toward Self-Medication with

Antibiotic Practice

We also assessed the relationship between socio-

demographic factors, level of knowledge and attitude

towards the practice of antibiotic self-medication

(Table 5). This analysis showed the respondents who

performed or had experience of antibiotic self-

medication based on the factors suspected to be

related. Based on the bivariate analysis, the factors of

education (p=0,035), income (p=0,010), knowledge

(p=0,004) and attitude (p=0,000) were significantly

associated with the practice of antibiotic self-

medication at p<0,05. On the other hand, other socio-

demographic factors such as gender (p=0,947) and

age (p=0,093) were not significantly associated with

the practice of self-medication with antibiotics

4 DISCUSSIONS

This is an observational study of antibiotic self-

medication in a village community in Lampung

Province. Of the 257 participants, 95.71% of

respondents were engaged in the practice of antibiotic

self-medication. The high prevalence of antibiotic

self-medication in the rural population is also found

in several countries, including Greece 77.9% (Skliros

et al., 2010), Sindh Pakistan 81.25% (Bilal et al.,

2016), and India 74% (Pentareddy et al., 2017), and

also in regions with different population

characteristics (non-rural), such as Yogyakarta

Indonesia (58%) (Kristina et al., 2020a), Saudi Arabia

(78.1%) (Al Rasheed et al., 2016), Eritrea (Africa)

(45.1%) (Ateshim et al., 2019), Tanzania (58%)

(Horumpende et al., 2018), and Ethiopia (67%)

(Bogale et al., 2019). These data indicate that self-

medication with antibiotics is common in rural

communities, especially among lower-middle-

income people. Some of the findings among the

respondents included the belief that antibiotics can

enhance the immune system and treat colds and

coughs. A study in Yogyakarta revealed that the

majority of respondents (58%) had a low level of

knowledge about antibiotic use and awareness, and

mistakenly thought that colds and coughs can be

treated with antibiotics (75%) (Kristina et al., 2020b).

Misperceptions about the indications for antibiotics

may influence people's attitudes and practices

regarding antibiotic use. No study has been done to

investigate the perception that antibiotics improve the

immune system, and it demonstrates a lack of

understanding of the immune system and the role of

antibiotics in the rural population. Another study

found that individuals engage in self-medication with

antibiotics for various reasons such as flu, cough,

Self-Medication of Antibiotic Use: Investigating Knowledge and Attitude Among Rural Population in Umbul Natar Village, South of

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365

common cold, sore throat, diarrhea, toothache, pain

relief, and fever (Aslam et al., 2020; Hawking et al.,

2017). Most people do not understand the difference

between antibacterial and antiviral, they consider they

are the same (Hawking et al., 2017). A similar

misunderstanding is also found in several countries

such as in South Africa (66%) (Farley et al., 2019),

Yogyakarta-Indonesia (70%) (Aris et al., 2012), and

Kosovo (42,1%) (Zajmi et al., 2017). Misconceptions

about antibiotics as having antiviral or antibacterial

properties are also found in some countries such as

Malaysia, 75% of respondents have an understanding

that antibiotics can cure colds and coughs (Ka Keat &

Chew Charn, 2012).

We found age and level of education associated to

attitude of self-medication with antibiotic. Bhardwaj

et al, reported that respondents with a high school

education level had less knowledge of antibiotics than

respondents with higher education (Bhardwaj et al.,

2021). Generally, our discovered shows respondents

in basic school to secondary school level (senior high

school, junior high school, and elementary school)

had insufficient knowledge level. Knowledge is an

essential component to determine attitudes and

practice. Good knowledge supports a person to be

more aware of how to use antibiotics properly

(Voidăzan et al., 2019). And it correlated positively

with attitudes towards antibiotic use (p<0.001) (Ka

Keat & Chew Charn, 2012).

Another fact from this study shows that majority

of the respondents agreed that antibiotics should be

given to farm animals. As reported in several studies,

antimicrobial use in farm animals is also quite

widespread (Founou et al., 2016; Van Boeckel et al.,

2015). One of the reasons for this is a lack of

understanding and public awareness of the correct use

of antibiotics. While antimicrobials have been used to

maintain animal health and improve productivity,

their overuse in feed has led to increased

antimicrobial resistance (Ma et al., 2021). The

attitude assessment showed that 90.75% of

respondents had a negative attitude towards the use of

antibiotics. Based on gender characteristics, men and

women have the same proportion of negative attitudes

towards the use of antibiotics. Mostly, respondents

who have a negative attitude are those with high

school education and below. Only the level of

education and knowledge correlate significantly to

the respondent's attitude (p<0.05). Another study

reported that higher levels of education relate to more

favourable attitudes towards antibiotic use (Alqarni &

Abdulbari, 2019; Waaseth et al., 2019). This indicate

that knowledge does not reflect a positive attitude, it

can be seen in the inconsistency of respondents'

answers. All respondents (100%) gave the correct

answer for the statement that antibiotics require a

prescription. However, 60.96% answered that they do

buy antibiotics without a prescription. People who

have negative attitudes toward antibiotic use tend to

keep antibiotics at home as stock when sick. Most of

the respondents agree with this statement (86,99%).

A study in the Philippines reported about 52.4% of

respondents agree with the statement of the need to

keep antibiotics in stock (Barber et al., 2017). Keep

antibiotic in stock leads improper and overuse

antibiotic, beside antibiotic use needs indication and

dosage appropriate. Numerous people use it refer to

the past history prescription from doctor.

Socioeconomics is one factor that influences self-

medication, such as income factor. Rural

communities tend to have low incomes or earn below

the regional minimum wage. This condition

encourages people to try solutions to overcome their

health problems by using antibiotics freely/without a

prescription (Haenssgen et al., 2019). The

characteristics of population studies affecting

towards antibiotics self-medication behaviour at

varied levels of significance. The rural population is

identical to the low-income and middle-income. We

found the majority of respondents have income below

the Regional Minimum Wage. Income level as factor

affecting to practice antibiotic self-medication

showed correlated significantly. Based on several

observational studies, it has been reported that

antibiotic self-medication antibiotics is more

frequently found in people with lower middle income

(Aslam et al., 2020). Self-medication was considered

to be less time-consuming, cheaper, and overall, more

convenient than accessing them through healthcare

facilities (Do et al., 2021). In this study, respondents

stated that the reason was that they thought the drugs

prescribed by doctors were less effective, as in the

Haque et al (2019) study which reported that one of

the driving factors is a lack of confidence in the drug

prescribed by physicians (Haque et al., 2019). In

contrast to the study in Croatia, where the number of

respondents with a high level of confidence in

doctor's treatment is greater and who tend to more and

they are those who have good knowledge (Farkaš et

al., 2019).

In general, behaviour is affected by knowledge

and attitudes. This study showed a significant

correlation between knowledge and attitudes towards

antibiotics self-medication (p<0.001). Poor

knowledge and negative attitudes correlate with

respondent's practice in using antibiotics without a

prescription. The results of surveys on the use of

antibiotics in various countries are quite diverse.

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However, there have the same misconceptions

regarding knowledge and awareness, self-medication,

left-over antibiotics, and reasons for using antibiotics

(Antwi et al., 2020). Healthcare professionals,

including physicians, pharmacists, nurses, and other

healthcare professionals, have a responsibility for

clinical practice to keep antibiotics effective

(Napolitano et al., 2019; Pearson & Chandler, 2019;

Rábano-Blanco et al., 2019). The extent of

misconception and inappropriate practice in the

community and has been going on for a long time,

which makes this misunderstanding a serious matter

to be corrected. Attempt to increase knowledge and

awareness of the use of antibiotics can be done in

various ways, one of which is by pharmacist playing

an active role in educating the public (Shehadeh et al.,

2016). In addition, providing direct counselling on

antibiotic information has proven to be effective in

increasing knowledge and awareness of antibiotic use

(Mason et al., 2018). A systematic review study states

that the provision of information through leaflets

delivered during an infectious disease consultation is

more effective in increasing understanding and

attitudes towards drug use (De Bont et al., 2015).

Education on the risks of potential side effects of

antibiotics and their benefits is more likely to have a

major impact on antibiotic self-medication decisions

than education about antibiotic resistance (Spicer et

al., 2020). This study was an observational and did

not specific age population which would give the

certain information about self-medication antibiotic

use in rural areas. Our finding provides the general

information antibiotic self-medication in village

where majority had lower education level. Proper and

wise use of antibiotics is an effort to prevent antibiotic

resistance which is currently considered an

emergency global problem. Based on the results of

this study, factors associated with antibiotic self-

medication behaviour can help determine appropriate

strategies to prevent and overcome this problem.

Such as the outreach of information about antibiotic

use to people living in rural areas, taking into account

the characteristics of the population from the level of

education and socio-economic aspects. Furthermore,

the strategy of providing education for health workers

needs to be improved, especially for rural

populations.

5 CONCLUSIONS

Population living in rural area dominated lower level

of education, income status. These may have impact

or correlate to level of knowledge, attitude and

practice self-medication antibiotic. We found that

knowledge, attitude associated to self-medication

with antibiotic practice. The management risk that

would be implemented is improve the understanding

and awareness toward antibiotic use. Furthermore, it

needs contribution of health professional such

physician, pharmacist and nurse to encourage rural

communities to improving knowledge and positive

attitudes toward behaviour of antibiotic self-

medication.

ACKNOWLEDGEMENTS

We thank participants for their willingness to

complete the questionnaire. Authors would like to

thank pharmacies used as study sites as well as the

surveying pharmacy students at Universitas

Lampung, Indonesia.

CONFLICT OF INTEREST

The authors declared no conflict of interest in this

study

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