Modeling antibiotic self-medication among health sciences students in Pakistan using path mediation and machine learning

Antimicrobial resistance is a significant global health threat, particularly associated with antibiotic misuse in low- and middle-income countries, such as Pakistan. This study aimed to assess the behavioral and psychosocial predictors of antibiotic self-medication among health sciences university students through mediation analysis and machine learning. The study examined the behavioral and psychosocial predictors of antibiotic self-medication among 398 health science students in Punjab, Pakistan, using mediation analysis and random forest.

We measured knowledge, attitude, perception, and practice using a validated questionnaire. Students demonstrated high knowledge (0.78 ± 0.18), a good attitude (3.65 ± 0.66), and a positive perception (3.55 ± 0.77), yet moderate self-medication practice (0.62 ± 0.28). Attitude was a significant predictor of responsible antibiotic-use behaviors in the multivariable regression model (β = 0.289, p < .001).

Structural equation modeling identified a significant association between knowledge and attitude (β = 1.94, p < .001), and between attitude and perception (β = 0.25, p < .001). Furthermore, the analysis indicated that a statistically significant indirect association between knowledge and self-medication practices through attitudes was observed (B = 0.30, 95% CI [0.17–0.45]). The total indirect association of knowledge with self-medication practices was statistically significant (B = 0.30, 95% CI [0.17–0.45]).

Attitude, knowledge, and gender showed relatively greater variable importance in the random forest model, although overall predictive performance was modest (R2 = 0.107). Although students demonstrated strong knowledge of antibiotics, attitudes emerged as the strongest behavioral correlate associated with appropriate antibiotic-use practices. However, the modest RF model performance suggests that additional contextual and systemic factors also contribute to antibiotic self-medication behavior.

The study did not receive any external funding. Institute of Microbiology, University of Veterinary and Animal Sciences, Lahore, 54000, Pakistan Muhammad Zubair Shabbir, Muhammad Adnan Ashraf, Umar Bin Zahoor & Muhammad Abu Bakr Shabbir Al-Shifa Institute of Health Sciences, Narowal, 51600, Pakistan Department of Allied Health Sciences, Superior University, Lahore, 54000, Pakistan Department of Pharmacology and Toxicology, Faculty of Veterinary and Animal Sciences, Bahawalpur, 63100, Pakistan Department of Pathology, University of Veterinary and Animal Sciences, Lahore, 54000, Pakistan Livestock and Dairy Development, Government of the Punjab, Lahore, 54000, Pakistan Correspondence to Muhammad Abu Bakr Shabbir. The authors declare no competing interests.

Responses of the participant were recorded after the ethical approval from the Institutional Review Committee for Biomedical Research, University of Veterinary and Animal Sciences Lahore (No. 311/IRC/BMR). Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material.