Pain management has become an integral part of modern healthcare, with non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, diclofenac and naproxen among the most widely used medications for relieving pain, inflammation and fever. However, the ease of access and the perceived safety of these over-the-counter (OTC) painkillers have led to their rampant self-medication and overuse, often without adequate understanding of their potential adverse effects. While NSAIDs are generally safe when used appropriately, their misuse or prolonged use is associated with serious health risks, including gastrointestinal bleeding, renal impairment, cardiovascular complications and hypersensitivity reactions [1-4].

In India, the widespread availability of NSAIDs without prescription, coupled with limited public health literacy, has fostered a culture of unsupervised painkiller consumption. Many individuals turn to self-medication as a convenient and cost-effective solution, often relying on pharmacists, family advice or personal experience rather than consulting qualified healthcare professionals. Alarmingly, the habitual use of painkillers without proper guidance remains a silent contributor to a growing burden of drug-related morbidity, particularly in rural and semi-urban populations where access to structured healthcare services is limited [5-8].

Mandi district of Himachal Pradesh, with its blend of urban, semi-urban and rural communities, provides a pertinent setting to explore public behaviors related to NSAID use. Practices such as self-dosing, frequent switching between different NSAIDs, neglecting dosage instructions and overlooking warning signs of side effects are of particular concern in such populations. Despite the well-documented risks associated with NSAIDs, there is a noticeable gap in local data evaluating community-level awareness, patterns of self-medication and understanding of NSAID-associated adverse outcomes.

This study aims to assess the awareness of NSAID use, the prevalence of self-medication practices and the level of knowledge regarding potential side effects among residents of Mandi district. By identifying behavioral trends and knowledge gaps, the research seeks to inform targeted public health interventions, promote rational use of painkillers and ultimately reduce the risk of NSAID-related health complications in the community.

This study employed a descriptive, cross-sectional survey design to assess the awareness, self-medication trends and understanding of the risks associated with non-steroidal anti-inflammatory drug (NSAID) use among residents of Mandi district, Himachal Pradesh. The design was chosen to provide a snapshot of current knowledge, attitudes and practices regarding NSAIDs at the community level.

Study Area and Population

The study was conducted across diverse settings within Mandi district, encompassing urban, semi-urban and rural populations to capture a wide range of socio-demographic backgrounds. The target population included adult residents aged 18 years and older, regardless of gender or previous NSAID use experience. Individuals with both medical and non-medical backgrounds were eligible, except for practicing healthcare professionals, to avoid professional bias.

Study Duration

Data collection was carried out over a three-month period from January to March 2025, allowing ample time to reach a representative sample through both face-to-face and digital modes of survey administration.

Sample Size and Sampling Technique

A sample size of 400 participants was determined based on a 95% confidence level, a 5% margin of error and an expected 50% prevalence of NSAID self-medication behavior, given the lack of prior local data. Participants were selected using a purposive and snowball sampling technique. Initial participants were recruited through community centers, pharmacies, educational institutions and social gatherings, with subsequent participants identified via referrals to expand reach into less accessible rural areas.

Inclusion and Exclusion Criteria

Inclusion Criteria

• Adults aged 18 years and above residing in Mandi district.

• Ability to understand and respond to the survey in Hindi or English.

• Willingness to provide informed consent.

Exclusion Criteria

• Practicing healthcare professionals (doctors, pharmacists, nurses) to minimize professional knowledge bias.

• Individuals unable to complete the survey due to cognitive impairments or communication difficulties.

Data Collection Tool

A structured, pre-tested, bilingual questionnaire (available in Hindi and English) was developed after extensive consultation with pharmacologists and public health experts. The questionnaire included four major sections:

• Demographic Information: Age, gender, education, occupation and residential setting.

• NSAID Usage Patterns: Frequency of use, reasons for use, sources of recommendation (self, pharmacist, family, doctor).

• Knowledge Assessment: Awareness of common NSAIDs, understanding of dosage, potential side effects, contraindications and signs of toxicity.

• Self-Medication Behaviors: Practices related to purchasing NSAIDs without prescription, adherence to recommended dosages and action taken in case of side effects.

Data Collection Procedure

Data were collected through two methods:

• Face-to-Face Interviews for participants with limited literacy or living in remote rural areas. Trained field investigators conducted the interviews using printed questionnaires.

• Self-Administered Surveys via Google Forms for literate and urban participants, circulated through community WhatsApp groups, Facebook networks and local online forums.

Field investigators were trained to ensure consistency, neutrality and ethical handling of participant data. Participants were provided with explanations regarding the study purpose and confidentiality assurances before data collection.

Scoring and Data Classification

Correct responses in the knowledge assessment section were awarded one point, while incorrect or "unsure" responses were given zero. Based on total scores, participants' knowledge was categorized into:

• Very Good    (≥80% correct responses)

• Good                              (60%–79%)

• Fair                                (41%–59%)

• Poor                               (<40%)

Behavioral patterns were evaluated descriptively and associations with demographic factors were explored.

Data Analysis

Collected data were entered into Microsoft Excel, cleaned and analyzed using SPSS software version 26.0. Descriptive statistics (frequencies, percentages and means) summarized participant characteristics and knowledge levels. Chi-square tests were used to examine associations between demographic variables and levels of NSAID awareness and self-medication behavior, with a significance threshold set at p<0.05.

Ethical Considerations

Informed consent was obtained from all participants prior to enrollment. Confidentiality and anonymity were rigorously maintained throughout the study and participants were informed of their right to withdraw at any point without any consequences.

The study encompassed 400 participants from Mandi district, with the largest proportion (39.8%) belonging to the 26–35 years age group, followed by 24.8% aged 36–45 years and 23.3% aged 18–25 years, highlighting a predominantly young to middle-aged demographic. Females slightly outnumbered males, accounting for 51.8% of the sample. Educational backgrounds varied, with 34.8% having completed secondary school, 29.5% holding an undergraduate degree and 7.8% reporting no formal education. In terms of occupation, homemakers formed the largest group (34.0%), followed by self-employed individuals (22.0%) and students or unemployed individuals (21.3%). Geographically, a significant rural representation was observed, with 65.8% of participants residing in rural areas compared to 34.3% in urban settings, ensuring diverse socio-economic and educational perspectives in the assessment of NSAID awareness and self-medication behaviors.

The assessment of NSAID awareness among participants revealed generally promising knowledge levels, with 78.5% correctly identifying NSAIDs as pain and inflammation relievers and 81.5% recognizing ibuprofen and diclofenac as examples. While 73.3% acknowledged that NSAIDs could cause stomach ulcers and 66.8% were aware of their potential to harm the kidneys, only 62.8% knew about NSAID-induced blood pressure risks and 61.5% recognized their cardiovascular complications. 

Table 1: Socio-Demographic Characteristics of Participants

A strong majority (83.5%) emphasized the need for doctor consultation during prolonged NSAID use and 79.5% disapproved of self-medicating without prescription. Awareness of important precautions, such as avoiding empty-stomach NSAID consumption (69.8%), recognizing allergic reactions (71.5%) and understanding maximum daily dosage limits (77.3%), was relatively high. However, gaps persisted regarding safe use during viral infections (66.0%) and the risks of combining NSAIDs (68.0%). Encouragingly, 84.5% correctly identified doctors as the appropriate guide for chronic pain management, indicating a generally positive attitude toward seeking professional advice.

Based on cumulative knowledge scores, 42.3% of participants demonstrated a "Good" level of understanding (60–79% correct responses), while 31.0% achieved a "Very Good" score (≥80%), indicating a promising baseline awareness regarding NSAID use and associated risks. However, 19.3% fell into the "Fair" knowledge category (41–59%) and 7.5% exhibited "Poor" knowledge (<40%), highlighting that nearly one-fourth of the population remains inadequately informed about critical NSAID safety concerns. These findings   underscore the urgent need for targeted public health education initiatives to reinforce correct practices and close the remaining knowledge gaps to ensure safer self-medication behaviors within the community.

This study provides critical insights into the current state of public awareness, knowledge and self-medication behaviors related to non-steroidal anti-inflammatory drugs (NSAIDs) among the residents of Mandi district, Himachal Pradesh. Encouragingly, the findings reveal that a substantial portion of participants possesses a reasonable understanding of NSAIDs' intended uses, their classification and the need for caution during prolonged use. With 78.5% correctly identifying NSAIDs as pain and inflammation relievers and 81.5% recognizing common examples like ibuprofen and diclofenac, it is evident that basic drug recognition is relatively high within the community. Additionally, the overwhelming consensus (83.5%) on consulting a doctor for prolonged NSAID use and the significant disapproval (79.5%) of unsupervised self-medication point toward a foundational awareness of the necessity for professional oversight in medication use.

Table 2: Awareness and Knowledge of NSAIDs and Self-Medication Among Participants

Table 3: Knowledge Score Classification

However, despite these positive trends, notable knowledge gaps and risky behavioral practices persist. Awareness regarding the serious adverse effects of NSAIDs such as gastrointestinal bleeding, renal impairment and cardiovascular risks was moderate to low, with only 66.8% acknowledging the potential for kidney damage and 62.8% understanding the association with elevated blood pressure. Furthermore, misconceptions about the safe combination of different NSAIDs (only 68.0% correct) and the dangers of NSAID use during viral infections (66.0%) were prevalent, indicating an incomplete grasp of safe medication practices. Particularly concerning is the limited awareness about cardiovascular complications (61.5%) associated with long-term NSAID use a significant gap given the rising burden of non-communicable diseases like hypertension and heart disease in India.

The strong rural representation (65.8%) in this study underscores additional challenges faced by semi-urban and rural communities. In these areas, where access to structured healthcare advice is often limited, practices such as self-medication based on pharmacists' advice or family recommendations become widespread. Although the data showed that 84.5% agreed doctors should guide chronic pain management, practical behaviors may differ due to socio-economic and accessibility barriers, potentially leading to dangerous patterns of NSAID overuse or misuse. Rural residents and individuals with lower educational attainment appeared more vulnerable to misconceptions, highlighting the need for geographically and educationally tailored interventions.

Behavioral practices also raised red flags. While 80.3% of participants agreed that NSAID use should be discontinued upon experiencing side effects, the fact that nearly one-fifth either disagreed or were unsure reflects gaps in translating knowledge into action. In addition, the moderate awareness of drug-drug interactions (64.5%) and the relatively low recognition of hospitalization risks due to NSAID overuse (68.5%) suggest that many users may fail to recognize early warning signs or understand when professional intervention is necessary. These gaps could contribute to preventable complications such as acute kidney injury, gastrointestinal perforations and cardiovascular events.

Overall, the knowledge score classification further emphasized the mixed picture: while 31.0% achieved a "Very Good" score and 42.3% a "Good" score, nearly 27% of the participants demonstrated only "Fair" or "Poor" knowledge, leaving a considerable proportion of the community at risk for unsafe NSAID use practices. This finding mirrors similar patterns reported in other Indian studies, where high NSAID consumption often correlates with limited awareness of their side effects.

Given these findings, there is an urgent need for targeted public health interventions in Mandi district to promote the rational use of NSAIDs. Community-based education campaigns should focus not only on the therapeutic benefits of NSAIDs but also on their risks when misused. Pharmacists must be engaged proactively to counsel patients about side effects, dosage limits and contraindications, especially since they often serve as the first point of contact in rural health settings. School and college health education programs could also incorporate safe medicine use modules to instill responsible self-medication habits early on. Moreover, innovative strategies like community radio broadcasts, mobile health messaging and the distribution of simple visual aids in local languages can bridge the literacy gaps and empower individuals to make informed decisions regarding NSAID use [8-10].

Finally, the study’s cross-sectional design provides a valuable snapshot but does come with limitations. The reliance on self-reported data may introduce social desirability bias and the purposive sampling technique, while practical, may not fully capture the behavior of all subgroups, particularly those completely disconnected from healthcare systems. Nonetheless, the study’s strong sample size, its inclusion of rural-urban diversity and the balanced gender distribution lend credibility to its findings.

This study highlights that while a considerable proportion of Mandi district's residents possess a foundational awareness of non-steroidal anti-inflammatory drugs (NSAIDs) and their appropriate use, significant gaps in comprehensive knowledge and safe self-medication practices persist. Although encouraging levels of recognition regarding the therapeutic role of NSAIDs and the necessity for medical consultation were observed, awareness about the serious risks of gastrointestinal, renal and cardiovascular complications remains insufficient among many participants. Particularly concerning is the prevalent trend of unsupervised NSAID use, fueled by limited health literacy, easy over-the-counter availability and socio-economic barriers to formal healthcare access, especially in rural areas. These findings underscore the urgent need for targeted, community-driven educational interventions to bridge the knowledge-practice gap, promote rational painkiller use and empower individuals to recognize early signs of drug-related harm. Strengthening pharmacist counseling, integrating medicine safety education into public health programs and expanding access to professional guidance through culturally sensitive initiatives will be critical steps toward reducing the health burden associated with NSAID misuse and ensuring safer pain management behaviors in the community.

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