The study you post is fascinating. Many of us self-medicate, making this study also work as a general interest story. Of interest to our study this week, the researchers (Shankar, Partha, & Shenoy, 2002) listed a number of problems with their methodology, including the likelihood that female respondents were suspicious of the researchers and did not respond in a manner helpful to the study. However, I suspect that there are a couple of other epistemological aspects that conspire to create further limitations on the study.
How did the researchers know that access to a trained medical doctor was ‘difficult’ or not? They made the assumption that access was a function of the walking time it takes to get to a clinic. While we can presume that some elderly person (among others) in pain cannot easily walk for extended periods of time, in a culture where lengthy walks are daily events, can we actually assume that a 15-minute walk is too arduous? I know that by car, it takes me over 20 minutes to get to many of the clinics I regularly visit (dentist, ENT and so on). I just wonder if the time=access difficulty as a variable is as reliable as the paper intends.
Moreover, many of us self-medicate. For this study (Shankar, Partha & Shenoy, 2002) to have more external validity (Cohen, Manion, & Morrison, 2011), a comparison with non-Nepalese would have been useful. Shankar, Partha and Shenoy tried this with a Latin-American comparison. The results were only slightly dissimilar, but as they rightly pointed out, the epistemological and methodological differences made direct comparisons problematic. Connelly (2014) reports that in the UK, the over-the-counter drug sales for 2013 added up to £2.45 billion. Using back-of-the envelope calculations to divide that figure by the population of the UK, a (highly suspect) result showing that on average every UK resident spent £39 on OTC medicine. My point is that the conclusion that Nepalese choice to self-medicate is due to access difficulties is perhaps naïve. There are many other possible factors in that choice.
Cohen, L., Manion, L., & Morrison, K. (2011). Research Methods in Education. Professional Development in Education (7th ed.). Abingdon: Routledge. http://doi.org/10.1080/19415257.2011.643130
Connelly, D. (2014, 11 September). OTC medicines: a breakdown. The Pharmaceutical Journal. Retrieved on November 2 2016 from http://www.pharmaceutical-journal.com/news-and-analysis/infographics/otc-medicines-a-breakdown/20066445.article
Shankar, P. R., Partha, P., & Shenoy, N. (2002). Self-medication and non-doctor prescription practices in Pokhara valley, Western Nepal: a questionnaire-based study. BMC family practice, 3(1), 1.