title: Factors associated with intention to engage in self-protective behavior: The case of over-the-counter acetaminophen products.
abstract: BACKGROUND
  Inappropriate use of acetaminophen products is a concern due to the severe liver damage associated with intentional or accidental overdose of these products. In 2009, the U.S. Food and Drug Administration (FDA) issued more severe organ-specific warnings for the acetaminophen Drug Facts label to improve protective behavior among patients. However, it is not clear how patients react to such interventions by the FDA.
  
  
  OBJECTIVE
  The objective of this study was to evaluate the factors influencing patients' intention to engage in protective behavior while using acetaminophen products after reading the Drug Facts label. The study specifically looked at the relationship between four Protection Motivation Theory-based risk cognition factors and the intention to engage in protective behavior.
  
  
  METHODS
  An experimental, cross-sectional, field study was conducted using self-administered questionnaires at four community pharmacies in Houston, TX. Two hundred surveys were collected from adults visiting the selected pharmacy stores. Participants were exposed to a simulated label (i.e. Drug Facts label) containing organ-specific warnings for over-the-counter (OTC) acetaminophen products. Risk cognition measures (i.e. measures of perceived severity, perceived vulnerability, response efficacy, and self-efficacy) and measures of intention to engage in protective behavior (always reading warnings, using products with more caution, and consulting a pharmacist/physician) were recorded. Pearson correlation and multiple linear regression analyses, controlling for demographic and behavioral characteristics of the participants, were performed.
  
  
  RESULTS
  Bivariate analyses indicated that an increase in perceived severity, perceived vulnerability and response efficacy were associated with a higher intention to engage in protective behavior. Findings from the multiple regression indicated that increase in perceived severity of liver damage, belonging to a non-healthcare occupation, no history of acetaminophen use and no history of alcohol consumption were associated with a higher intention to engage in protective behavior.
  
  
  CONCLUSIONS
  Higher risk cognition of liver damage associated with inappropriate use of OTC acetaminophen products leads to greater intention to engage in protective behavior while using such products. Developing interventions targeted towards improving reading and adhering to the Drug Facts label could improve risk cognition, and thus improve patients' intention to engage in protective behavior. Regular acetaminophen users, heavy alcohol consumers and healthcare professionals might need other interventions apart from the Drug Facts label to improve their likelihood to engage in protective behavior.
authors.affiliation: Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, 1441 Moursund St, Houston, TX - 77030, USA.
authors.forename: R V
authors.initials: RV
authors.lastname: Sawant
authors.affiliation: RTI Health Solutions, RTI International, Durham, NC 27709, USA.
authors.forename: R K
authors.initials: RK
authors.lastname: Goyal
authors.affiliation: Department of Management, Policy and Community Health, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA.
authors.forename: S S
authors.initials: SS
authors.lastname: Rajan
authors.affiliation: Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, 1441 Moursund St, Houston, TX - 77030, USA.
authors.forename: H K
authors.initials: HK
authors.lastname: Patel
authors.affiliation: Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, 1441 Moursund St, Houston, TX - 77030, USA.
authors.forename: E J
authors.initials: EJ
authors.lastname: Essien
authors.affiliation: Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, 1441 Moursund St, Houston, TX - 77030, USA. Electronic address: ssansgiry@uh.edu.
authors.forename: S S
authors.initials: SS
authors.lastname: Sansgiry
mesh_terms: D000082:Acetaminophen / Q000009:adverse effects / Q000627:therapeutic use*; D000328:Adult; D018712:Analgesics, Non-Narcotic / Q000009:adverse effects / Q000627:therapeutic use*; D056486:Chemical and Drug Induced Liver Injury / Q000209:etiology; D003071:Cognition; D004348:Drug Labeling; D005260:Female; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D004366:Nonprescription Drugs / Q000009:adverse effects / Q000627:therapeutic use*; D010465:Perception; D012306:Risk
chemical_list: D018712:Analgesics, Non-Narcotic; D004366:Nonprescription Drugs; D000082:Acetaminophen
keywords: Acetaminophen; Appropriate use of OTC products; Liver damage; Liver injury; Protective behavior; Risk cognition