The behaviour of the people of NE Thailand towards medicines for self-treatment.
Musculoskeletal pain is one of the most common illnesses among the people of north-eastern Thailand and is commonly treated by self-medication. Ya-chud (several medicines together in a small plastic bag) for the treatment of musculoskeletal pain is an illegal treatment, but has been used by lay people for more than twenty years. This thesis sought a better understanding of how people perceive Ya-chud and of their behaviour in taking it for treatment of musculoskeletal pain, with a view to designing an effective implementation programme for the purpose of reducing the usage of Ya-chud. The research used a study group that consisted of people aged 15 or older, and living in two rural (N = 619) and two urban (N = 494) areas of north-eastern Thailand. The study used individual interviews in order to investigate self-treatment of musculoskeletal pain - both with and without Ya-chud - in urban and rural areas. Attitudes of Ya-chud users in the urban areas (N = 136) and the rural areas (N = 128) were measured using a six-point Likert Scale, with a Conbach's alpha coefficient of 0.7509. The research included comparative analyses of variables between these two areas, and between the users and non-users. In-depth interviews and laboratory analysis of Ya-chud samples were carried out to obtain more detailed information. The study found that Ya-chud for musculoskeletal pain was often used as an alternative treatment after previous treatment had been unsatisfactory, particularly when pain was experienced in many locations of the body simultaneously. The discriminant stepwise analysis showed that 85.9 percent of Ya-chud users in both rural and urban areas were at least 25 years old, and had an education level of primary or secondary school. The overall prevalence of Ya-chud users in the rural areas was higher than in the urban areas, but the prevalence of those who had taken Ya-chud within the past year was greater in the urban areas. Ya-chud use also varied with the season, peaking during periods of heavy work such as harvesting. The main source of Ya-chud was groceries (82.3 percent in the urban and 79.6 percent in the rural). People had the perception that Ya-chud was a cheap, potent drug that had beneficial effects. They also perceived that the specific name of Ya-chud was easy to remember and described their symptoms. Attitudes towards Ya-chud were positive in the rural areas but negative in the urban areas (p < 0.01). Most of the respondents did not know the harmful effects of Ya-chud. The study showed that the locations of pain for non-users were the same as for the users, and also that users predominantly experienced 'no change' in their symptoms after taking Ya-chud (46.2 percent rural and 44.6 percent urban, p < 0.01). The results from the in-depth interviews with Ya-chud users indicated that there was more use of massage, rest and health services for the treatment of musculoskeletal pain in the urban areas, but that medicines from drug stores were more often used in the rural areas (p < 0.01). Only 10.9 percent of the respondents were cured by the above treatments in urban areas, and only 4.4 percent were cured by the above treatments in rural areas (p > 0.05). After taking Ya-chud, the result of treatment was a 'cure' for 45.5 percent of users in urban areas and for 35.3 percent of users in rural areas (p > 0.05). Identification of the medicines contained in a packet showed that steroids, NSAIDs and tranquillisers were the most often drugs to be combined. It can be concluded that using Ya-chud for musculoskeletal pain is not only unnecessary, but also represents a dangerous use of these hazardous medicines that mask the symptoms rather than curing the illness. Intensive and continuous education campaigns together with legal enforcement should be beneficial for a short-term programme to reduce Ya-chud use. Long-term programmes should focus on providing licensed dispensers in every drug store, so that the lay people can gain more helpful knowledge about medicines. Licensed dispensers would also help to better implement legal enforcement, since it would then be possible to ensure that the licensed dispensers complied with legislation.
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