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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 11  |  Issue : 2  |  Page : 157-162

Reported patients’ practices, knowledge and attitudes regarding common cold in the community: A cross-sectional study


Department of Pharmacy, Faculty of Pharmacy, Girne American University, Mersin, Turkey; Department of Pharmacy, Osol Aldeen University College, Baghdad, Iraq

Date of Submission02-Dec-2020
Date of Decision03-Feb-2021
Date of Acceptance16-Feb-2021
Date of Web Publication14-May-2021

Correspondence Address:
Anmar Al-Taie
Department of Pharmacy, Faculty of Pharmacy, Girne American University, 99428 Kyrenia, North Cyprus, Mersin 10

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aihb.aihb_142_20

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  Abstract 


Introduction: Lack of knowledge and malpractice with regard to cold, associated symptoms and subsequent management of this illness increase the economic burden and impair patient-related outcomes. The aim of this study was to assess the level of knowledge, practices and attitudes about the common cold and its treatment measures among the general public in different parts of Baghdad province, Iraq. Methodology: A descriptive, cross-sectional study was conducted among 384 participants through an interview using a structured three-part questionnaire, consisting of 28 items assessing the demographic characteristics, practices, level of knowledge and attitude towards common cold. Results: A total of 384 participants were enrolled in this study. About 31.8% of the respondents stated that physicians were the most common source for the provision of education about the common cold and its management. Nearly 54.7% of the participants agreed that common cold is caused by a viral infection and 49.2% disagree about taking medications by the patient own-self without medical advice and the majority 61% agreed about taking medications from the community pharmacy. However, 40.6% of the respondents had negative attitudes regarding the use of antibiotics for common cold. There was a statistically significant difference towards common cold knowledge and attitude concerning education level (P = 0.02) and provision of proper education (P = 0.0001). Conclusion: The study revealed an acceptable level of knowledge and attitude about the common cold among the Iraqi community; however, there are gaps in the general knowledge about the use of antibiotics for the treatment of the cold.

Keywords: Attitudes, common cold, Iraq, knowledge, practice


How to cite this article:
Al-Taie A. Reported patients’ practices, knowledge and attitudes regarding common cold in the community: A cross-sectional study. Adv Hum Biol 2021;11:157-62

How to cite this URL:
Al-Taie A. Reported patients’ practices, knowledge and attitudes regarding common cold in the community: A cross-sectional study. Adv Hum Biol [serial online] 2021 [cited 2021 Oct 25];11:157-62. Available from: https://www.aihbonline.com/text.asp?2021/11/2/157/315951




  Introduction Top


The common cold is the most frequent, acute, self-limiting and short-duration viral infection of the upper respiratory tract that could be self-managed with bed rest, fluid intake and over-the-counter (OTC) treatments. Although self-limiting, the impact of common cold on society and health care is large because it can occur all year round as it is highly prevalent and may be debilitating, which causes declines in physical functions, work productivity and other activities. The virus is spread by direct contact transmission or by aerosol of the secretions and virus.[1] The common cold affects the nose, sinuses, pharynx and larynx with well-recognised symptoms, including sore throat, nasal congestion, nasal obstruction, rhinorrhoea, cough, headache and malaise. These symptoms, which generally relate to the infected mucosa, typically peak at 1–3 days and last 7–10 days, although they occasionally persist for 3 weeks.[2],[3]

General public knowledge and practices about the common cold are the important concerns regardless of being among the most frequent ailments encountered in clinical practice. Consequently, misconception, incorrect level of knowledge, attitudes and practices concerning common cold-associated symptoms and subsequent management have been widely outlined to be the main reason for the use of inappropriate or wrong medicines. Furthermore, this mistreatment could increase the economic burden, impairs patient-related activities and reduces the quality of life. This can be easily seen in the increased self-medication with antibiotics for common cold treatment. This indicates that the major segment of the public believes that common cold is caused by bacteria and antibiotics are effective against both viruses and bacteria which, in turn, could be one of the important contributions to the spread and emergence of bacterial resistance.[1],[4],[5]

The present study aimed to assess the level of knowledge, practices and attitudes about the common cold and its treatment measures among the general public in different parts and districts of Baghdad province, Iraq.


  Methodology Top


Study design and population settings

This was a descriptive, cross-sectional study involving patients' enrolment from December 2018 to February 2019. A random sample of participants of different age groups and both genders older than 18 years of age and expressed willingness to take part in this study were included, while those who declined participation were excluded. All study participants who expressed willingness, agreement and the ability to take part were fully informed about the proposed study and provided with written informed consent. By using Cochran's sample size formula, a sample size of a large population whose degree of variability is not known and assuming the maximum variability and taking 95% confidence level with ± 5% precision, the sample size required was 384 participants. The study was approved by the Human Research Ethics Committee of the Pharmacy Department, Osol Aldeen University College, Baghdad province, Iraq (05. 15.11.2018) and followed the ethical standards of the 1964 Helsinki Declaration and its later amendments. Around the time of performing the present study as no up-to-date list of community pharmacies was available and to ensure generalizability and minimise selection bias, a four-step sampling approach was achieved. This involves the following procedure: first, the two main parts (divisions) of Baghdad province were selected (Al-Karkh and Al-Rusafa). Second, each of these two parts was divided into four locations (south, north, east and west). Third, a list of districts within each of these eight locations was collected and two of the most populous districts from each location were selected using random numbers. Finally, community pharmacies were selected by convenience sampling within each of the two selected districts.

Questionnaire design

As aforementioned, all data were collected from the community pharmacies in Baghdad province, Iraq. The information was gathered via a structured self-administered questionnaire that was developed for the present study, distributed and filled by direct interview with the participants. The purpose and procedures of the study were described in an introductory letter included with the questionnaire which took about 10 min to complete. The questionnaire was developed after a thorough and comprehensive literature search in well-known databases and customised to suit the study purpose. The questionnaire was translated from English into Arabic language and subjected to a process of forwarding and backward translation. In addition, questions were reworded, reformatted and reordered in light of the feedback received. The face and content validity of the drafted questionnaire was validated and performed by two academicians from the pharmacy and medical background with extensive experience in survey-based research and two community pharmacists. Furthermore, a preliminary test was applied to a representative sample for around 5% of the target sample (n = 19) to address any ambiguity in the questions and to determine whether the data would provide reliable information. The data collected during this pilot part of the study were excluded from the final data statistical analysis.

The final version of the questionnaire consisted of 28 questions divided into three sections. The first section (eight items) gathered data on demographic characteristics of the participants, including age, gender, educational level, cigarette smoking, presence and types of chronic medical conditions, previous provision of proper education about common cold and its management and source for the previous of education about the common cold and its management. The second section consisted of 15 items which evaluated patients' knowledge and attitudes about the common cold concerning its aetiology, transmission methods, clinical features and proper management. The respondents were given options of 'agree', 'disagree' and 'not sure' to choose from. The third section (five items) gathered data to assess patients' attitudes towards therapy failure beyond 7–10 days of treatment of common cold and the respondents were given options to answer either 'Yes' or 'No'.

Statistical analysis

Data were analysed using the Statistical Package for the Social Science (SPSS) software for Windows (IBM Corp. Armonk, NY, USA) version 23.0 and Microsoft Office Excel 2013. Descriptive analysis was used to describe the study population, and the results were expressed in numbers, percentages, means and standard deviations for each of the characteristics, and in terms of all questions relating to knowledge and attitude. A score of 1 was given to positive knowledge and attitude, while a score of 0 was given to negative knowledge and attitude towards every statement. Knowledge and attitude scores for individual statements were summed up and calculated to give the total attitude score of a participant. A cutoff level of <11 was set for negative knowledge and attitude and more than 11 for a positive one. The Chi-square test was used to assess the differences among proportions. P value was considered significant at <0.05 and highly significant at < 0.01.


  Results Top


Regarding the sociodemographic characteristics of the study participants, the mean age of the respondents was 32.6 ± 12.8 years. The majority of the study participants were male (52%) and possessed a university-level qualification (50%). The largest percentage was in the 18–30 year age group (56.8%). More than half of the study participants (56.3%) were non-smokers and the majority reported not to have chronic medical conditions (63.5%). However, hypertension (18.6%), diabetes mellitus (17.1%), arthritis (12.9%) and ischaemic heart disease (11.4%) were the most common chronic medical conditions observed. About 61.2% of the study participants had proper education about the common cold and its management. Consequently, 31.8% of those participants stated that physicians were the most common source for the provision of education about the common cold and its management, followed by advice provision by the pharmacists (25.5%), as shown in [Table 1].
Table 1: Demographic characteristics of the study participants

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In the present study, regarding the level of knowledge and attitudes about the common cold concerning its aetiology, 54.7% of the study participants agreed that common cold is contiguous and caused by a viral infection and 43.2% also agreed that both common cold and acute cough clinically present together. Regarding the level of knowledge about the method of common cold transmission, 52.3% stated that transmission of the common cold could occur by direct hands' contact (touching the nose, mouth and eyes) and 52.1% also stated that transmission of viruses can remain viable for several hours and coat surfaces such as door handles and telephones. For the possible complications of common cold, nearly half of the participants (50.5%) agreed that common cold can develop into a secondary bacterial infection. For the accompanying clinical features, 59.1% also agreed that severe ear pain during common cold requires referral to the physician, while 63.3% stated that early morning coughing, presence of coloured thick sputum and cough more than 2 weeks require referral to the physician, as shown in [Table 2].
Table 2: Patients’ knowledge and attitudes about common cold

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Regarding the proper management of common cold, 42.5% of the study participants agreed that common cold can be treated for 7 days only, while 45% disagree that rest at home with no drug treatment is useful for common cold treatment. Furthermore, 44.5% of the respondents agreed that taking home remedies could help common cold treatment. Interestingly, 49.2% disagree about taking medications for common cold treatment by the patient own-self without medical advice and the majority 61% agreed about taking medications from the community pharmacy and without the need to go to the clinic or hospital (43.8%). However, 40.6% of the respondents suggested antibiotics use to cure the common cold and acute cough. About 61% agreed to have proper therapy after medical advice in case of having other comorbid conditions, as shown in [Table 2].

[Table 3] shows the patients' attitudes towards therapy failure beyond 7–10 days of treatment of the common cold. Nearly 52.3% of the study participants disagree about keeping on the same treatment until symptoms resolve, 62.2% also disagree to change to another drug by the patient own-self and 57% would not use stock home medicines alongside the current treatment. Moreover, 65.1% of the study participants stated that they would not visit the pharmacist for consultation and more advice and prefer going to a clinic or hospital for further diagnosis and treatment (61%).
Table 3: Patients’ attitudes towards therapy failure beyond 7-10 days of treatment of common cold

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The present study also revealed that there was a statistically significant difference towards common cold knowledge and attitude (positive) concerning university education level (71.9%; P = 0.02) and provision of proper education about the common cold and its management (68.9%; %; P = 0.0001), as shown in [Table 4].
Table 4: Association of demographic characteristics with the knowledge and attitude towards common cold among the

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  Discussion Top


Knowledge about the nature and the predisposing causative agents of the common cold is essential to correctly manage this condition. The results of the present study revealed that the majority of the participants displayed an encouraging level of knowledge with regard to the aetiology of the common cold as a result of viral infection and both common cold and acute cough in the majority of clinical cases are reported together. These findings were in agreement with Blaiss et al.[6] and Al-Haddad et al.[7] which reported that 69.6% and 75% of the respondents, respectively, correctly recognised that viruses were the main cause of the common cold.

A study conducted in the Kingdom of Saudi Arabia (KSA)[7] to assess the knowledge and practices of the general public about the common cold found that 63% of the respondents believed that sneezing can spread the cold, 41% believed that direct contact with the infected patients and 32% reported that sharing belongings with the sick people could spread the common cold. Another study conducted by Larson et al.[8] found that 52% of the respondents believed that avoiding direct contact with infected patients could reduce the spread of the illness. Similar to literature, the findings of the present study revealed that more than half of the respondents showed a good level of knowledge and awareness about the spreading and transmission methods of the common cold among the community in Baghdad province.

The management of this self-limited ailment largely depends on the use of symptomatic therapy and home remedies before visiting physicians and the effectiveness in relieving symptoms is the most important driver of choice to reduce the discomfort and the overall impact of cold.[9] In the present study, the respondents showed a good level of awareness about the appropriate measures required in the treatment of common cold and the need for medical advice for offering the proper recommendations and avoiding as possible taking medications for cold treatment by the patient own-self without prior medical advice. The findings of the present study are also in agreement with a study conducted by Reis[10] which found that 50% of the respondents rely on self-care for managing common cold and by Al-Haddad et al.[7] in which 40.3% of respondents rely on self-treatment from leftover medicines at home and 16.1% from their friends and relatives. Furthermore, the majority of the respondents believed that taking medications from the community pharmacy is affordable without the need to go to the clinic or hospital. These findings are higher than those found in the study of Al-Haddad et al.[7] and Reis,[10] in which <30% and 50% of the respondents suffering from common cold seek medical care, respectively. There might be several contributing factors for not getting a medical consultation and advice, such as an unnecessary to see a doctor for minor ailments, high cost of visiting doctor and inconvenience. These are particularly related to financial constraint and lack of healthcare insurance for the general public.[11],[12]

There could be an opportunity to improve the communication between healthcare providers and their patients to receive education and specific recommendations about common cold and its treatment measures which will improve patient-related outcomes.[6] The present study revealed that 31.8% of the respondents stated that physicians were the most common source for the provision of education about the common cold and its management followed by advice provision by the pharmacists. However, considering that the majority of common cold cases are seen in the community pharmacies, this highlights the responsibility of pharmacists to educate patients about common cold/cough and improve public understanding about its proper measures of treatment. Previous studies revealed that pharmacist educational intervention appeared to improve public knowledge about proper and safe medication use with improved patient-related outcomes.[9],[13],[14],[15] This could be achieved through pharmacist involvement in patient education about preventing unnecessary and irrational use of antibiotics for viral upper respiratory tract infections (RTIs), increasing adherence to prescribed medicines, avoiding the concurrent use of more than one product with the same active ingredient and thereby exceeding the maximum recommended daily dose and increased risk of toxicity. Moreover, patients with certain co-morbid medical conditions, such as hypertension or diabetes mellitus as reported in the present study, should be counselled about the ingredients of the OTC medications and carefully review product labels of each medicine to help minimise the potential of adverse drug effects.

Most upper respiratory tract illnesses, including the common cold and acute cough, are of viral origin and should not be treated with antibiotics as these medicines are not effective for treatment. This inappropriate practice of using antibiotics to treat common cold will increase the risk of antibiotic resistance. Furthermore, their overuse does not decrease the rate of return visits, can have significant side effects and contributes to excessive healthcare costs.[4],[9],[16] The misuse of antibiotics revealed the poor understanding of the difference between bacterial and viral infection and the beliefs that antibiotics work against both. A possible reason for this negative perception could be related to the use of the term 'germ' in place of the more specific term 'bacteria' or 'virus' during the provision of medical advice to the public.[17] Moreover, frequent prescriptions of antibiotics for viral RTIs have affected the public view for this misunderstanding, making a risk for contracting infections with resistant pathogens.[12] One-third of adults in the United Kingdom incorrectly agreed that antibiotics work on most cold and cough and 43% incorrectly agreed that antibiotics have the ability to kill viruses.[18] This inappropriate practice was widely outlined in the literature reported by Blaiss et al.[6] who found that one-third of the respondents believed that common cold was a result of a bacterial infection, and approximately one-quarter thought that antibiotics were an appropriate treatment option for the common cold. Similar to literature, the majority of the respondents in the present study suggested antibiotics use to cure the common cold and acute cough. The principle key strategic objective to prevent the irrational practices of antibiotics consumption is to improve the awareness and understanding of antimicrobial resistance through effective communication and education to the public. There is a potential for pharmacists to have a greater impact mitigating antibiotic misuse in the community and hospital settings as they are considered as important members of the healthcare team, medicine experts, have easy and frequent contact with the public, trained to enhance patient education on the proper use of antibiotics, the importance of completing the prescribed treatment and avoid self-medication.[19]

The present study revealed that the practices, level of knowledge and attitude about the causes, spreading methods and proper measures for the management of the common cold might be influenced strongly by their educational level and the previous provision about common cold. Those respondents who had received a higher (university) education and previous provision about common cold showed a higher level of knowledge and a more positive attitude towards common cold practices. These findings were in accordance with the results of a study conducted in KSA.[8]

The present study has some limitations that could be taken into consideration. First, the study was conducted in Baghdad province and did not include other parts of Iraq. Second, the survey was self-reported, and this may have contributed to the inconsistent understanding of questions between some participants. Third, the study did not take in consideration the details for OTC medications for the treatment of common cold as one of the study objectives. These limitations could be taken into consideration in future studies to be useful in generalising the level of knowledge, practices and attitudes about common cold in the general public.


  Conclusion Top


To the best of our knowledge, this is the first cross-sectional study conducted to assess the practices, level of knowledge and attitudes about common cold in the general public and in different parts and districts of Baghdad province, Iraq. The study revealed an acceptable attitude about common cold among the Iraqi community which was reflected in their level of knowledge about the aetiology, mode of transmission, possible dealing with the complications and management of this illness. The study also revealed that the affected persons frequently consult healthcare providers for treatment recommendations. However, the study describes gaps in general knowledge about the use of antibiotics for the treatment of common cold and emphasises on a more extensive knowledge-based health education programs which are deduced particularly to those individuals with low levels of education to improve the basic knowledge of this misconception and decrease this malpractice.

Acknowledgement

The author would like to express a deep gratitude to the pharmacists, Aamen Wesam, Aliaa Ibrahim, Rafal Amir and Muhammed Samer, for their help and valuable collaboration.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Li J, De A, Ketchum K, Fagnan LJ, Haxby DG, Thomas A. Antimicrobial prescribing for upper respiratory infections and its effect on return visits. Fam Med 2009;41:182-7.  Back to cited text no. 16
    
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Lim KK, Teh CC. A cross sectional study of public knowledge and attitude towards antibiotics in Putrajaya, Malaysia. South Med Rev 2012;5:26-33.  Back to cited text no. 17
    
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McNulty CA, Boyle P, Nichols T, Clappison P, Davey P. The public's attitudes to and compliance with antibiotics. J Antimicrob Chemother 2007;60:i63-8.  Back to cited text no. 18
    
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  [Table 1], [Table 2], [Table 3], [Table 4]



 

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