PhD Study : Decision-making about use, overuse, underuse and misuse of over-the-counter non-prescription analgesia for everyday pain amongst university students: A mixed methods study

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Summary

Over-the-counter analgesics taken for pain are a common self-management approach, taken by young people, with 61% reporting use [6]. There is limited evidence that use of these medicines may be higher amongst young women [10], may be associated with lower socio-economic status [10], may be linked to health literacy [18]. Use may also be higher amongst young people who experience chronic pain [16], menstrual pain [9], regular headache [5], and may be associated with increased pain severity [6]. Misuse also appears to be common – overdosing, underdosing and use for reasons other than pain have been reported in a number of studies [5-7,9,13].

Attempts have been made to develop interventions to improve adherence to instructions for use of over-the-counter analgesics [8], however, the choice of theory underpinning many of these interventions focuses on addressing factors associated with pain (e.g. pain catastrophizing, pain anxiety, emotional distress and pain related coping) [11], rather than attempting to influence decision-making, education and understanding of use of over-the-counter analgesics, despite the clear role of these factors in their use [16].

Decision-making about medical treatment may be influenced by a variety of factors including access to information about the treatment [1-3,8,16], the shared nature of some decisions [12,16], beliefs about the treatment [14,17], family influences [15] perceptions of safety and suitability [13,16], as well as access to the intervention [4]. However, these factors have not been studied systematically amongst a group of otherwise healthy participants engaging in use of over-the-counter medicines for everyday pain (e.g. headache, muscle soreness, sports injury, menstrual pain etc.).

This research aims to explore decision-making about use of over-the-counter analgesics to self-manage everyday pain amongst a group of healthy university students.

Objectives of the research:

To determine through questionnaires, the rate of use, underuse, overuse and purpose of use of over-the-counter non-prescription analgesics amongst a group of university students (n=100).

Using the same survey, to determine the correlates of usage patterns for over-the-counter analgesics amongst common pain variables (e.g. pain coping, catastrophising, pain related anxiety, pain intensity, pain location) as well as issues related to access to alternative pain management interventions and attitudes to over-the-counter analgesics amongst a group of university students.

To examine through in-depth interviews, decision-making in relation to use of over-the-counter analgesics for everyday pain for three subsets of students (identified in the survey component of the project): 1) those who engage in frequent use of analgesics, 2) those who have infrequent use and 3) those who engage in misuse.

Methods to be used:

This MRes project will use survey methodology adapted from a previous questionnaire study [6] and guided interview methodologies adapted from a previous study of older adults’ medication use [17] to explore decision-making about over-the-counter analgesics for everyday pain. Participants for this study will be drawn from Ulster University’s School of Psychology, but we also hope to recruit students who might be have prior education in use of these medicines (i.e. Health Sciences and Medicine).

This project can be undertaken as a stand-alone MRes project or as pilot work for a larger project which can be used towards attainment of a PhD in psychology.

Skills required of applicant:

Excellent skills in communication of research findings both in presentation(s) and written document(s).

Interest in health research.

Good skills in reviewing psychological research articles.

Good skills in word processing and use of SPSS.

Note: Training will be provided in qualitative interviewing and analysis.

Essential criteria

Applicants should hold, or expect to obtain, a First or Upper Second Class Honours Degree in a subject relevant to the proposed area of study.

We may also consider applications from those who hold equivalent qualifications, for example, a Lower Second Class Honours Degree plus a Master’s Degree with Distinction.

In exceptional circumstances, the University may consider a portfolio of evidence from applicants who have appropriate professional experience which is equivalent to the learning outcomes of an Honours degree in lieu of academic qualifications.

Funding and eligibility

Recommended reading

1] Bluebond-Langner M, Hall N, Vincent K, Henderson EM, Russell J, Beecham E, Bryan G, Gains JE, Gaze MN, Slater O, Langner RW, Hargrave D. Parents’ responses to prognostic disclosure at diagnosis of a child with a high-risk brain tumor: Analysis of clinician-parent interactions and implications for clinical practice. Pediatric Blood & Cancer 2021;68:e28802.

[2] Bluebond-Langner M, Hargrave D, Henderson EM, Langner R. ‘I have to live with the decisions I make’: laying a foundation for decision making for children with life-limiting conditions and life-threatening illnesses. Arch Dis Child 2017;102:468-471.

[3] Day E, Jones L, Langner R, Stirling LC, Hough R, Bluebond-Langner M. “We just follow the patients’ lead”: Healthcare professional perspectives on the involvement of teenagers with cancer in decision making. Pediatric Blood & Cancer 2017;65:e26898.

[4] Dixon-Woods M, Cavers D, Agarwal S, Annandale E, Arthur A, Harvey J, Hsu R, Katbamna S, Olsen R, Smith L, Riley R, Sutton AJ. Conducting a critical interpretive synthesis of the literature on access to healthcare by vulnerable groups. BMC medical research methodology 2006;6:35.

[5] Harmer CJ. Over-the-counter analgesics use is associated with pain and psychological distress among adolescents: a mixed effects approach in cross-sectional survey data from Norway. 2021.

[6] Henderson EM, Keogh E, Rosser BA, Eccleston C. Searching the Internet for help with pain: Adolescent search, coping, and medication behaviour. British Journal of Health Psychology 2013;18:218-232.

[7] Jonassen R, Hilland E, Harmer CJ, Abebe DS, Bergem AK, Skarstein S. Over-the-counter analgesics use is associated with pain and psychological distress among adolescents: a mixed effects approach in cross-sectional survey data from Norway. BMC Public Health 2021;21:1-12.

[8] Jung H, Lee J. The effectiveness of an educational intervention on proper analgesic use for dysmenorrhea. European Journal of Obstetrics & Gynecology and Reproductive Biology 2013;170:480-486.

[9] Kapadi R, Elander J. Pain coping, pain acceptance and analgesic use as predictors of health-related quality of life among women with primary dysmenorrhea. European Journal of Obstetrics & Gynecology and Reproductive Biology 2020;246:40-44.

[10] Kirkeby MJ, Hansen CD, Andersen JH. Socio-economic differences in use of prescribed and over-the-counter medicine for pain and psychological problems among Danish adolescents—a longitudinal study. Eur J Pediatr 2014;173:1147-1155.

[11] Kiza AH, Manworren RC, Cong X, Starkweather A, Kelley PW. Over-the-counter analgesics: a meta-synthesis of pain self-management in adolescents. Pain Management Nursing 2021;22:439-445.

[12] Maskrey N. Shared decision making: why the slow progress? An essay by Neal Maskrey. BMJ 2019;367.

[13] O'Connell K, Davis AR, Westhoff C. Self-treatment patterns among adolescent girls with dysmenorrhea. J Pediatr Adolesc Gynecol 2006;19:285-289.

[14] Riva S, Monti M, Antonietti A. Simple heuristics in over-the-counter drug choices: a new hint for medical education and practice. Advances in medical education and practice 2011;2:59.

[15] Skarstein S, Lagerløv P, Helseth S, Leegaard M. How do parents influence their adolescents’ use of over‐the‐counter analgesics: A review of the current literature. J Clin Nurs 2019;28:1451-1464.

[16] Stinson J, Harris L, Garofalo E, Lalloo C, Isaac L, Brown S, Tyrrell J, Ruskin D, Campbell F. Understanding the use of over-the-counter pain treatments in adolescents with chronic pain. Canadian Journal of Pain 2017;1:84-93.

[17] Stone JA, Phelan CH, Holden RJ, Jacobson N, Chui MA. A pilot study of decision factors influencing over-the-counter medication selection and use by older adults. Research In Social And Administrative Pharmacy 2020;16:1117-1120.

[18] Wang T, Chang F, Lee C, Chi H, Huang L, Tseng C. Adolescents’ misperceptions and low literacy associated with the inappropriate use of over-the-counter cold medicines. J Subst Use 2020;25:101-106.

The Doctoral College at Ulster University

Key dates

Submission deadline
Friday 3 June 2022
12:00AM

Preferred student start date
mid September 2022

Applying

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Contact supervisor

Dr Ellen Henderson

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