Pharmacist-Led Online Lesson Followed by Higher Self-Reported Medicine Knowledge in Slovak Adolescents

Adolescents are taking more medicines than ever, yet many of them understand surprisingly little about what they are swallowing. A new pre–post evaluation from Bratislava, Slovakia, suggests that a single pharmacist-led online lesson was followed by shifts in how 15- to 18-year-olds rate their own knowledge about medicines and how they view the safety of prescription drugs. The study, conducted among students at four secondary schools between February and March 2021, is one of the few real-world tests of brief pharmacist-delivered education in adolescent populations, a gap that has persisted even as health literacy has moved up the public health policy agenda in Europe and beyond.

The context for the intervention is sobering. Research indicates that young people often hold only a basic and sometimes inconsistent understanding of medicines, may have inaccurate expectations about their effects, and do not always grasp when and why medicines should be used. This matters particularly for self-medication, which is increasingly common and frequently involves over-the-counter (OTC) products. Limited knowledge combined with low awareness of risks can lead to medication-related intoxications and other forms of misuse, and patterns of medicine use established during adolescence often persist into adulthood. Parents are usually the main source of information, but their knowledge is often incomplete, pushing adolescents toward online forums and social media where quality is highly variable. The online environment can even encourage outright dangerous behaviour: viral challenges such as the ‘Benadryl challenge’ and the ‘paracetamol challenge’, first reported in the United States, have also been observed in Slovakia and may promote the misuse of medicines.

Against this backdrop, the research team designed an exploratory single-group pre/post-intervention study. The educational content was prepared by pharmacists in collaboration with teachers and a pilot group of students, covering definitions of medicines and active substances, distinctions between prescription medicines, OTC medicines and dietary supplements, the basics of medicine development, reliable sources of information, frequently used medicine groups such as analgesics, antihistamines, cough medicines, nasal preparations and antibiotics, adverse effects, misuse, antibiotic resistance, drug interactions, overdose, and the risks of combining medicines with alcohol. After a pilot session with four female students to test clarity and timing, the final session lasted approximately 70 minutes and was delivered online by a pharmacist over Zoom, Microsoft Teams or Google Meet, depending on each school’s preference.

Data collection took place during the COVID-19 pandemic, when participating schools were operating through distance education, so adolescents completed the online questionnaires remotely from home as part of their online school activities. The questionnaires were built in Microsoft Forms and distributed through online learning platforms, primarily Microsoft Teams, via hyperlink or QR code. The instrument was based on a previously validated questionnaire developed by other researchers, with specific items selected and response options modified after permission from the original authors; the adapted questionnaire was not independently revalidated, which the authors flag when interpreting findings. Likert-scale items used five response options from ‘strongly agree’ to ‘strongly disagree’, coded 1 to 5 with lower values indicating stronger agreement.

Of 183 adolescents who completed the pre-intervention questionnaire and 163 who completed the post-intervention questionnaire, participant-generated identification codes allowed 129 unambiguous pre–post matches, and after applying eligibility criteria, 122 paired questionnaires entered the final analysis. The mean age of the sample was 16.75 years, and 51.6 percent were girls. Most rated their health as very good or good. Headaches, reported by 59.8 percent, and nervousness, reported by 42.6 percent, were the most frequent acute complaints over the previous six months, while allergies and skin disorders led the chronic conditions. Prescription medicine use was reported by 42.6 percent of participants, with systemic antihistamines the most common group and desloratadine the single most frequently reported medicine. OTC use was nearly universal at 89.3 percent, led by ibuprofen and paracetamol, and 60 percent of OTC users reported taking such medicines on more than two occasions during the monitored period.

The statistical results were clear-cut. Using the Wilcoxon signed-rank test on the paired sample, the researchers found higher self-reported knowledge ratings after the educational session (p < 0.001, r = 0.34) and increased perceptions of prescription medicine safety (p < 0.001, r = 0.38). No statistically significant overall change was found in perceptions of OTC medicine safety (p = 0.229, r = 0.11). Stratified by sex, knowledge ratings rose in both boys (r = 0.42) and girls (r = 0.28), with the moderate effect size among boys being the most consistent finding of the study. Perceived safety of prescription medicines increased in both sexes, with a larger effect among girls (r = 0.49) than boys (r = 0.26), and a small but significant increase in OTC safety perceptions appeared among girls (r = 0.28). Age-stratified analyses showed significant knowledge gains among 17-year-olds (r = 0.34) and significant prescription safety changes among 15-year-olds (r = 0.66) and 18-year-olds (r = 0.55), but no consistent age-related pattern overall.

One possible explanation for the asymmetry between prescription and OTC perceptions lies in how the session framed safety. It presented quality, efficacy and safety as fundamental properties of medicines, explained medicine development and clinical testing, and addressed dose-related risks, adverse effects, interactions and misuse. The observed increase in perceived safety may therefore reflect a better understanding that medicines can be used safely when used appropriately, rather than a belief that medicines are without risk. Previous research suggests that adolescents tend to perceive OTC medicines as familiar and relatively safe, which may reduce their sensitivity to educational messages. From a clinical pharmacy perspective, this highlights a need for more targeted communication addressing specific misconceptions about commonly used non-prescription medicines, particularly given that even familiar OTC products such as analgesics can be associated with unsafe use patterns, incorrect dosing and underestimation of adverse effects among adolescents.

The parental dimension of the findings deserves particular attention. Most adolescents, 66.4 percent, reported discussing medicine use with their parents, yet less than half, 42.6 percent, said they had never taken medicines without their parents’ knowledge. Parents supervised prescription medicines more often (46.7 percent) than OTC medicines (34.4 percent), and in 15.6 percent of cases involving OTC use, parents were entirely unaware their child was taking the medicine. Unsupervised OTC use peaked among 18-year-olds at 23.1 percent. Spearman correlations showed weak positive associations between parental communication and supervision among girls (ρ = 0.341 for prescription medicines and ρ = 0.284 for OTC medicines), while among 18-year-olds, communication was moderately associated with supervision of prescription medicines (ρ = 0.489) and with perceived prescription medicine safety before the intervention (ρ = 0.417). The authors conclude that communication may play a role but is not sufficient on its own, supporting the involvement of both adolescents and caregivers in educational interventions.

The findings come with important caveats. Because no control group was included, the design cannot clearly distinguish the intervention effect from testing effects, temporal influences or social desirability bias. Responses were based on self-assessment rather than objective testing, and perceived knowledge does not necessarily correspond to actual understanding, so the observed changes should be interpreted with caution. The analyses were restricted to adolescents who completed both questionnaires, with no formal attrition analysis possible, and the post-intervention questionnaire was completed immediately after the session, meaning the study reflects only short-term changes and says nothing about whether gains persist. Participants were recruited from a single urban area, and the exploratory sex- and age-stratified analyses involved multiple comparisons, so isolated significant subgroup findings warrant caution.

Nevertheless, the study offers an initial view of how adolescents respond to pharmacist-led education on medicines in real-world school settings. The most noticeable differences appeared for prescription medicines, particularly among girls, whereas perceptions of OTC medicines remained relatively stable despite their frequent use, suggesting that established safety perceptions may be less responsive to a single brief session than self-reported knowledge. With ibuprofen and paracetamol dominating adolescent OTC use and headaches the leading complaint behind it, the authors argue that future interventions may benefit from focusing explicitly on commonly used analgesics and from age-adapted approaches. Whether the changes observed shortly after the session are maintained over time remains an open question, and further controlled work is needed to establish the durability of pharmacist-delivered medication literacy education in this age group.

Subject of Research: Pharmacist-led education and adolescents' self-reported medication knowledge and medicine safety perceptions

Article Title: A pre–post evaluation of pharmacist-led education on adolescents’ self-reported medication-related knowledge and perceptions of medicine safety

Article References: Urbankova, J., & Kosirova, S. (2026). A pre–post evaluation of pharmacist-led education on adolescents’ self-reported medication-related knowledge and perceptions of medicine safety. Pharmacia, 73, Article e204525. https://doi.org/10.3897/pharmacia.73.e204525

Image Credits: AI Generated

DOI: 10.3897/pharmacia.73.e204525

Keywords: pharmacist-led education, adolescents, medication knowledge, medicine safety, over-the-counter medicines, self-medication, health literacy, school-based intervention, Slovakia, pre-post study, parental supervision, prescription medicines