Understanding the perceptions, beliefs, attitudes and engagement in selective anti-microbial self-medication practices in a community in Greater Monrovia, Liberia: A constructivist grounded theory

Abstract

Background: In Greater Monrovia (GM), Liberia, self-medication is a prevalent practice, with individuals often using medications to manage conditions like diarrhoea and respiratory tract infections (RTIs) without professional consultation. Cultural beliefs, perceived cost savings, and a desire for autonomy in health management drive this practice. Commonly used medications include antibiotics like Flagyl, doxycycline, and tetracycline for diarrhoea, and ceftriaxone, erythromycin, and ciprofloxacin for RTIs and typhoid fever. Alongside nonpharmaceutical medicines, herbal remedies such as guava leaves and ginger-lime mixtures are also widely used. However, the unregulated use of these substances contributes to significant public health risks, including antimicrobial resistance (AMR), which is exacerbated by poor access to healthcare and low levels of health literacy in Liberia. Despite the high prevalence of self-medication, there has been limited research into the perceptions, beliefs, and attitudes of Liberians toward this practice. Aim: This thesis aims to explore the perceptions, beliefs, attitudes, and experiences of Liberians regarding self-medication, specifically in the context of managing diarrhoea and RTIs. The research further analyses how these practices contribute to the development of AMR and seeks to propose policy recommendations to mitigate the negative consequences of self-medication in Liberia. Method and Design: The study adopts a qualitative design, using in-depth, semi-structured interviews to collect data from residents in Greater Monrovia (GM). Data were gathered from 26 participants (physicians, pharmacists, patients, and residents) in GM, who were selected using purposive and theoretical sampling methods. The research is underpinned by constructivist grounded theory alongside symbolic interactionism, with Kathy Charmaz's approach providing the methodological framework. The conceptual framework guiding the study is the Socio-Ecological Model (SEM), which helps understand the behavioural factors influencing individuals' decisions to self-medicate. The research follows a constructivist paradigm, utilising an interpretivist approach to explore the social and healthcare barriers contributing to self-medication practices in the region. Findings: Analysis of the interview data revealed three major themes that influence self-medication in GM, Liberia: (1) barriers to accessing healthcare services, (2) the impact of low literacy and education on unsafe medication practices, and (3) the lack of a structured medication dispensing policy. Participants commonly self-medicate for a wide range of conditions, including hypertension, hepatitis-related symptoms, diarrhoea, RTIs, and general body pains. The findings suggest that the practice of self-medication is heavily influenced by socioeconomic factors, the accessibility of medications, and the lack of healthcare infrastructure. Conclusions: The study concludes that self-medication in GM is driven not only by personal beliefs but also by systemic factors such as poor healthcare infrastructure, socioeconomic barriers, and a lack of education regarding the risks of improper medication use. While some participants are aware of the potential dangers of self-medication, they often disregard these risks due to limited healthcare options and perceived autonomy over their health. The study recommends implementing stricter regulations on the sale of antibiotics and other prescription medications, alongside strategies to improve healthcare accessibility and public health promotion education. Monitoring medication sales and enforcing prescriptions could play a crucial role in reducing self-medication practices and mitigating the rise of antimicrobial resistance in Liberia.