Across the globe, the burden of chronic diseases is increasing. The World Health Organization (WHO) has estimated that 75% of the global population has at least one long-term condition (LTC) (1, 2). Almost one in four of the Saudi population has an LTC (3–6). Effective management of long-term conditions heavily depends on appropriate medication use; however, studies indicate that approximately 50% of patients with chronic diseases do not adhere to their prescribed medications (7–11). A study conducted in Saudi Arabia to examine the factors contributing to medicine-related problems (MRPs) among diabetes mellitus (DM) and cardiovascular diseases (CVDs) patients found that participants were not familiar with their medicines or how to use them effectively (7). Some patients could not name their medications or describe their shape. Similarly, they could not state the specific effect of each type of medicine, and their knowledge was restricted to their general indication (for instance, DM or CVDs) (7). Few patients were able to identify the side effects of their medicines. Some patients had a misunderstanding regarding the side effects of medicines, such as believing that the use of insulin can destroy the body. Others believed that exercise and diet could cure DM without using medicines to manage it (7). Consequently, treatment ineffectiveness was detected because patients did not take their medicines as prescribed. For example, patients reported blood sugar and blood pressure fluctuations, which they adjusted by changing medication doses or food intake without consulting a healthcare provider (7).

Failure to take medicines as intended is likely to result in disease progression and complications, therapeutic failure, and the need for more aggressive treatments, which might increase the risk of MRPs (8–12). Unnecessary suffering, loss in productivity, and even premature death can also result from poor adherence to medications (7–12). Avoidable medical expenses may also follow due to the waste of expensive medicines that are unused or misused and hospitalizations (8–12). One of the ways to address medication adherence challenges and promote rational medication use is the integration of medication-focused messages within public health campaigns. Public health campaigns can be defined as “organized communication activities designed to raise awareness, induce behavior change, and improve quality outcomes for individuals and populations” (13). These campaigns in Saudi Arabia have traditionally focused on preventing diseases and modifying behavioral risk factors, such as tobacco use, physical inactivity, and unhealthy diet (14, 15). While these initiatives have been widely implemented, limited attention has been given to medication use awareness as part of public health efforts. Given the essential role of medicines in managing chronic conditions, integrating medication education into public health campaigns could improve adherence and reduce co-morbidities, multiple drug therapies, medication-related problems (MRPs) (16). A systematic review by Ranjbar et al. (16) analyzed public health campaigns focusing on medication use awareness and found that such initiatives could positively impact medication adherence, reduce medication-related issues, and enhance public knowledge about safe medicine use. The review highlighted various educational strategies, including pharmacist-led interventions, video-based education, and community awareness programs, which were implemented across different countries (e.g., the US, UK, Taiwan, Canada, Jordan, Australia, and Malaysia), and healthcare settings (e.g., community pharmacies, hospitals, and public health initiatives). Some studies focused on general medication use, and others addressed specific use, such as antibiotic use and benzodiazepine use. These findings support the need for structured medication education within public health campaigns to optimize health outcomes and improve medication literacy.

Despite the recognized importance of medication literacy, there is a gap in research examining public perspectives on medication use within public health campaigns in Saudi Arabia. A previous study has explored the public’s knowledge of medication use in specific populations, such as patients with diabetes and cardiovascular disease (7), but a broader assessment of medication awareness in the general population remains unexplored. Furthermore, while campaigns promoting general health awareness are common (14, 15, 17), there is little evidence of structured medication-related campaigns in Saudi Arabia.

This study aims to fill this gap by assessing the public’s attitudes and experiences regarding medication use and public health awareness campaigns in Saudi Arabia. By understanding how the public engages with health campaigns and their perceptions of including medication-related messages, this research provides insights that could inform the development of targeted interventions to promote rational medication use and enhance public health outcomes.

The results of this study provide evidence about the public’s attitudes and experiences related to medication use and public health campaigns. Although many participants encountered campaigns passively (e.g., seeing them in passing), they did not actively engage with the campaigns.

Participants named different campaigns that they remembered and which had helped them change their lifestyles. These campaigns focused on raising awareness of the disease and modifying behavioral risk factors associated with increased risk of the disease, such as unhealthy diet and weight, physical inactivity, and tobacco use. None of these campaigns focused on medication use awareness.

The most commonly reported campaigns that were concerned about disease awareness included breast cancer and diabetes campaigns, possibly because breast cancer is the most common cancer affecting women in Saudi Arabia, and the number of women facing this disease continues to rise (20). Saudi Arabia also has one of the highest prevalences of diabetes in the world, with increased prevalence in recent years (21).

This study sheds light on the lack of available campaigns that raise people’s awareness of medication use in Saudi Arabia despite the high number of people who were on prescription and non-prescription medications involved in this study. Raising awareness about medications use has the potential to encourage the public to seek medication advice from pharmacists, a step towards empowering them in their medication-taking practices, helping them to take control of their health, improve their quality of life, decrease disease progression and their overall healthcare expenses, and reduce MRPs (13). A study conducted in Italy to examine the attitude and practice of parents towards non-prescription medicines use for their children found that more than half of parents used over-the-counter drugs without physician supervision since self-care might be favored by the opportunity to buy the drugs in the supermarket corner, where customers can choose medicines by themselves which might increase risk of MRPs (22). Previous studies have shown that antibiotic self-medication or purchase without a prescription is even more worrying (23–26). Indeed, antimicrobial resistance is an increasingly serious threat to global public health, and the misuse of antibiotics is accelerating the process. In addition, a high frequency of non-evidence-based prescriptions of antibiotics to treat upper respiratory tract infections at the primary care level has been reported (27, 28). This is particularly important because most upper respiratory tract infections are viral. Training pharmacists in communication skills to provide understandable arguments to explain and to educate the patient on the proper use of antibiotics might also help rationalize antibiotic use for upper respiratory tract infections.

Evidence also shows that if people have prior knowledge of and access to high quality use of medicine information, up to three-quarters of medicine-related hospitalizations could be prevented each year (29, 30). Quality use of medicine means selecting appropriate medicines if a medicine is required, choosing rational management options, and guaranteeing the patient and carers have the skills and knowledge to use medicines effectively and safely (29, 30). One of the ways to alter people’s behaviors and increase public awareness about the appropriate use of medication is by designing and delivering a public health medicine awareness campaign.

In the current study, 91% of participants believed that a public health campaign can increase people’s awareness about their lifestyle, and 73% believed that using medicines should be part of a public health campaign. The logistic regression analysis results highlight the important effect of several factors on the likelihood of thinking that the “use of medicines” should be part of a public health campaign. Those who were younger or those who did not use a prescription medication were less likely to think that medication use should be part of a public health campaign. A possible explanation for this result is that older people tend to take more medications than younger people as they are more likely to have more than one long-term condition (31–33). Since risks of adverse drug outcomes increase with an increasing number of medications (33), older adults may require more targeted counseling during medical visits or educational campaigns to raise awareness about their medication use.

Those unemployed or students were also less likely to think that medication use should be part of a public health campaign. This could be because the majority of those who were unemployed (71/93, 76%) were aged between 18 and 44 years. Younger people and students may have better Internet skills to locate health and medication information than older adults. Younger members of the population use computers in school or at work. At the same time, some older adults do not know how to work with technology or are interested in doing so. Thus, they ask for help to locate information on the Internet from their children, grandchildren, or close relatives. This could be one of the reasons why older adults lag behind the rest of the population in computer and internet use. This claim was also supported by the number of older adults aged ≥65 years (1.8%) who accessed the Internet and filled out the current study’s online survey.

Previous research shows that using knowledge transfer methodology through educational campaigns can lead to improvement in people’s knowledge, which may lead them to initiate behavioral changes (16, 34). Developing a public health campaign that supports appropriate medication-taking behaviors requires comprehensive planning by determining whether sufficient evidence suggests an inappropriate medication-taking practice exists within a certain population. After that, a development phase needs to be conducted that helps to identify objectives and the desired behavior changes or attitudes policy makers want to effect among the target population. Evaluating the success of a campaign is also required by determining whether the messaging results in the desired and intended behavior change (16).

A systematic review of the research on the impact of public health campaigns in raising patients’ awareness of medication use (i.e., adherence and/or knowledge of medications) pre- and post-campaign results showed that only four out of 12 studies of these public health campaigns showed a rise in the level of patients’ awareness of medication use in their post-campaign surveys (16). This is despite various tools being used to convey the messages, such as educational games, face-to-face approach, written information, and videos. The findings of the systematic review support the need for a comprehensive public health campaign that concentrates on the use of medicines. Public health campaigns could be effective when some essential issues are resolved, such as the clarity of the campaign’s message. Regardless of the tools used to deliver the campaign, if the message is not clear and difficult to understand, the individuals will not be able to adapt to the necessary behavior changes. Thus, the campaign messages need to be clear, easy to understand, and delivered correctly to the appropriate intended audience using numerous platforms to increase the messages’ outreach and help participants make what are essentially behavioral changes. Before expecting behavioral change from a community, it is important to devote adequate time to the campaign and information transfer to the population (16).

The current study highlighted an important role for healthcare providers, including doctors and pharmacists, in providing advice regarding medication inquiries for participants involved in this study. Participants frequently mentioned that the pharmacy was a major source of medication information. Although physicians could play a pivotal role in providing health promotion messages that are aligned with the patients’ needs when they are in contact with the patients (32), pharmacists may be the ideal healthcare workers to provide public education about the proper use of medicines. This is because pharmacists are specialized in pharmacotherapy, easily accessible healthcare providers, have frequent contact with the public, and are ideally positioned to convey health promotion messages (9, 35, 36).

These findings are consistent with evidence from previous research showing that pharmacists have improved patients’ medication adherence through their expertise and specialized training in medications (9, 35, 36). Additionally, pharmacists have been identified as trusted sources of medication information (9, 35, 36). Prior studies have also shown that educational interventions conducted by pharmacists seemed to increase the public’s knowledge about the safe and proper use of antibiotics and improve the public’s understanding of antibiotic resistance (37–39). The interaction may also help to foster patients’ trust towards pharmacists (37–43).

Discussion with participants in this study revealed that they were curious mainly about commonly encountered side effects and what to do if a side effect is experienced, followed by drug interactions with food and other medicines, how the medication works in the body, and what will happen if a patient does not take the medication or misses a dose of the medication. Thus, when designing a campaign, the campaign should focus on information tailored to each participant’s situation, needs and preferences. Some studies have shown information on the side effects of medication to be a priority for patients (44, 45). This suggests that healthcare providers could provide more information, assess patients’ understanding of potential side effects, and address any misunderstanding. It is well known that providing information to patients about prescribed medicines is vital for them to understand the benefits and risks of medication and to facilitate their appropriate use. However, providing basic information such as how and why to take medicine does not guarantee appropriate medication use; the information should be tailored to meet the individual’s requirements. Different levels of information may be required for people who are even prescribed the same medicines. Thus, the quality of the information is more important than the quantity. The quality of information refers to the extent to which individuals perceive that information has met their needs and that they are satisfied with the information provided (44).

TV, Twitter, posters, billboards, animation/pictures, and leaflets were reported in the current study as the most appropriate tools to help deliver a good public health campaign. Saudi Arabia ranked fourth in Twitter use after the United States of America (USA), Japan, and the United Kingdom (UK). This is consistent with other studies in the literature that have used different techniques and promotional tools to raise public awareness and promote engagement in medicine-related issues, such as videos, brochures, face-to-face education, educational games, and TV advertisements (16).

Antibiotic campaigns, for example, that have not used television tend to have no or less impact on public knowledge and attitude towards antibiotic use (46, 47). In contrast, other antibiotic campaigns in England, France, and Belgium (48–50) that have used television and have been repeated constantly for several years have led to improved public and professional attitudes towards antibiotic use. The French campaign was conducted annually from 2002 to 2007 and used television and radio advertising (48). A progressive reduction in antibiotic use was identified after each campaign using a time series analysis. For example, a 27% reduction in antibiotic use was reported in 2007 (48). Another campaign, ‘Moxy Malone’, was conducted in England for 2 years to reduce the amount of inappropriate antibiotic prescriptions by general practitioners (GPs). Local pharmacists and GPs were interviewed by local media, such as television and radio stations, to give some professional education and prescribing support. Local newspaper health columns were also targeted. The Moxy Malone campaign was associated with a 5.8% absolute reduction in antibiotic prescribing in the intervention group compared with the control group (50).

Reviews of research on social marketing campaigns, including online campaigns, suggest that they can influence people to change their behavior and influence policymakers (51, 52). The Internet especially represents an increasingly common source of health-related information (53–55). This result is consistent with our findings, which showed that 53% of participants reported using the Internet as a major source of medication information. Social media and the Internet allow the sharing and spreading of medicine-related information and allow discussion about different health and medicine-related topics. Thus, health organizations should consider social media within their communication strategy to promote the appropriate web use for medicine-related information seeking in the general population (53). The study findings showed that TV and Twitter are the most appropriate tools to help deliver a good public health campaign should be interpreted carefully because the current study participants were recruited online. There might be a digital divide or a gap between those who do and do not have access to digital information and communication technologies (ICT). For example, the Internet, like any technological innovation, primarily benefits younger and/or more educated people (53, 54). This was evident in the current study, as the vast majority of the sample were aged 18–34 and were educated.

Previous studies showed that younger people prefer to receive health information through the Internet or other electronic means (53, 54, 56), while older people prefer newspapers (56). In the future, preferences may be angled towards online options across various age groups (56). For now, a mixed approach is advised based on prior assessment of community preferences. One important consideration is that online campaigns can achieve higher reach at comparatively low cost (51).

Social media can increase engagement with healthcare issues, enable debate and discussion, and create virtual social networks (57, 58). However, there may be unintended consequences and risks. Concerns regarding misinformation, misinterpretation of health information, and potential difficulties with the confidentiality of personal information remain limitations of using the Internet and social media in delivering health- and medicine-related information, which may compromise health, medicine-taking behaviors, and health outcomes (53, 54, 59–61). In addition, there is a gap in the evaluation of digital platforms true effectiveness. A systematic review by Faus et al. (62) highlighted that while social networks such as Twitter offer high reach and low-cost dissemination, limited evidence supports their impact on actual behavioral changes in public health. Most evaluations focus on engagement metrics rather than assessing whether these campaigns improve health literacy, medication adherence, or long-term behavior modification. In the present study, we found that 55% of participants considered Twitter as an appropriate tool for delivering public health campaigns. Yet, a lack of structured evaluation methods to assess its influence on medication awareness and adherence remains. Future campaigns should integrate post-campaign behavioral assessments and longitudinal follow-ups to determine whether social media-based awareness efforts translate into meaningful health outcomes.

The findings of the current study and review of previous literature highlighted several lessons, some of which may be of general value when delivering a medication awareness campaign:

In conclusion, the results of this study provide evidence about the public’s attitudes and experience related to medication use and public health campaigns. Medication use awareness campaigns might be needed to control irrational habits such as self-medication, lending, borrowing or using leftover prescription and non-prescription medications, and other irrational medication-taking behaviors. The findings of this study can be used as a basis for designing and delivering public health campaigns that raise medication awareness among the population in order to encourage responsible behavior in relation to prescribed and non-prescribed medications.