Using best-worst scaling experiment to understand factors influencing self-medication practices with antimicrobial drugs: A survey of students studying health programs at a tertiary institution in Ghana

Antimicrobial drugs have saved millions of lives, but their widespread use to treat infections has significantly contributed to healthcare challenges, particularly antimicrobial resistance (AMR), which poses a global threat. This study investigated the factors influencing self-medication practices with antimicrobial drugs among health science students at a tertiary institution. A cross-sectional survey was conducted from July to August 2024, using interviewer-administered questionnaires to collect data from 300 students. Participants were selected proportionally based on their disciplines through a random sampling technique. We employed the maximum difference model for data analysis. Our results indicated that 51.67% of participants were male, and 77.93% were between 18 and 25 years old. While 58% of respondents perceived themselves to be in good health, 44.67% reported using antimicrobial drugs without a prescription, with 51.33% having done so in the past year. Ampicillin was the most reported non-prescription antimicrobial; participants typically obtained it from pharmacies (52.33%). The key findings revealed that a good knowledge of antimicrobial drugs was the most significant factor influencing self-medication practices, indicated by a marginal utility estimate (MUE) of 0.6958 and a marginal probability (MP) of 0.1243, with a 95% confidence interval (CI) of 0.6203 to 0.7712. Other important influencing factors included previous knowledge of health conditions (MUE: 0.6205; MP: 0.1153; 95% CI: 0.5448 to 0.6959), previous experiences with the same illness (MUE: 0.4886; MP: 0.1011; 95% CI: 0.4122 to 0.5648), previous use of antimicrobial drugs (MUE: 0.2189; MP: 0.0772; 95% CI: 0.1416 to 0.2959), easy access to over-the-counter antimicrobial drugs (MUE: 0.1711; MP: 0.0736; 95% CI: 0.0938 to 0.2482), and the concept of self-care (MUE: 0.1075; MP: 0.0690; 95% CI: 0.0301 to 0.1848). Conversely, participants tended to trade off frustration with hospital protocols, like long waiting queues/times for medical care (MUE: -0.358; MP: 0.0433; 95% CI: -0.4349 to -0.2815), distance to health facilities (MUE: -0.362; MP: 0.0432; 95% CI: -0.4389 to -0.2855), poor quality of care provided (MUE: -0.374; MP: 0.0427; 95% CI: -0.4506 to -0.2971), and dissatisfaction with healthcare workers’ attitudes (MUE: -0.392; MP: 0.0419; 95% CI: -0.4688 to -0.3155). This study is the first to quantify the factors influencing self-medication practices with antimicrobial drugs among health science students using a best-worst scaling (BWS) statistical design methodology. The findings could inform policy discussions on effective health promotion strategies and regulations for prescribing and dispensing antimicrobials. Such efforts are essential for addressing the issue of AMR in Ghana and other developing countries.