medicines are substances that are meant to cure illness or injury or to maintain the health of humans .
modern medicines are also called western medicines , conventional medicines , mainstream medicines , orthodox medicines , and allopathic medicines .
medicines are the main treatment modality globally and they have played a key role in alleviating human suffering . however , an important question remains unanswered , how do we define medicines ? for healthcare professionals , they are  tools  to apply their skills as well as to advance their profession . for drug companies , they are commodities being manufactured , distributed , sold and marketed to consumers , and are a profitable business .
but what are they for consumers and patients ? finding an answer to this question is important because consumers perception can influence their drug - taking behavior and in turn can affect  treatment outcomes  .
possible hazards  associated with the  modern medicines  and instead had a  positive image  with the view that medicines should be used in the event of any sickness . on the other hand
an  increasingly negative image  about medicines can also affect peoples adherence , such that minimizing misunderstandings is also 
therefore , it is also pertinent to learn the public 's sources of drug information as well as their perception regarding the color , safety , and efficacy of medicines .
color of medicines has also been found to be associated with beliefs and practices ; white drugs were associated with pain relief , red for building blood , blue to aid sleep , and yellow for malaria treatment in a study in nigeria .
medical treatment in malaysia depends heavily on pharmaceuticals and in the recent past due to higher per capita income , drug use has increased steadily .
the malaysian government 's drug expenditure rose from rm 200 million ( 1 us $ = 3.35 rm - ringgit malaysia approx ) in 1994 to rm 1.12 billion in 2005 . in 2005 , it was estimated that rm 1.13 billion has been spent on purchasing pharmaceuticals in the private sector .
the rise in drug expenses could be an indicator of the high drug utilization , drawing renewed attention and interest towards the issues of  medicine use  in the community . though the use of medicines has increased manifold data describing how people perceive modern medicines is scarce .
studies on the issue could be very helpful to improve compliance , concordance and therapeutic outcome as well as build appropriate medicine use policies in the country .
the findings of the study can also help healthcare professionals to understand their communities better as well as build effective public health interventions .
a qualitative technique was used to conduct this exploratory study and to get an in - depth understanding of the issue .
the inclusion criteria were consumers who were more than 19 years of age living in the four diverse geographical areas in the state of penang , who had visited a community pharmacy at least once in the last 30 days , and were able to speak english .
health professionals , medical students and people working in the medical field / drug industry were excluded from the study .
a  purposive sampling technique  was used to include a diverse group in terms of age groups , race , and areas of residence .
all participants were clearly explained the purpose of the interview and upon consent , appointments were made to interview them at a convenient time .
one of the advantages of the semi - structured interview was conversational flow as well as room for pursing and probing for further relevant information .
the semi - structured interview guide had the following domains : ( a ) public understanding and perception of modern medicines/(b ) sources of information pertaining to modern medicine and ( c ) treatment - seeking / medicine - seeking behavior .
the interview questions were pretested on six consumers to check the validity , reliability and accuracy as well as appropriateness of the questions .
semi - structured interview guide the interviews were conducted in english and continued until the point of saturation when it was felt that no more new themes emerged . during the interviews ,
demographic information comprised gender , age , race , and level of education , and occupation and marital status was also recorded .
interviews were transcribed into a written transcript and each written transcript was sent to the participants for verification . after the participants had verified the transcripts or
key statements from interviews key themes from interviews 
 characteristics of modern medicine / general views regarding medicines 
 ( a)what are modern medicines?consumers viewed medicines as synthetically made and having undergone the process of research , testing and formulation . some consumers also viewed modern medicine as unnatural.modern medicine is something synthetic , not natural and  expensive .  ( respondent 11/age 22)i go to pharmacy .
( respondent 4/age 45)modern medicine as i know is most of them come from herbs .
they extract it and then put into tablet / capsule something like that , it 's not the pure herb , and some chemicals are added as well .  ( respondent 3/age 20)(b)combination of good / bad effectssome people feel that modern medicine can cure illness while others have negative perceptions regarding medicines.i am comfortable with the effects of modern medicine  good effects 
i took  zyloric pills  and it helped because it reduced my uric acid level .
the modern medicine can not heal him ; the modern medicine needs to improve . 
( respondent 7/age 55)the more serious cases , like cancer , after taking for a few months , the amounts of tablet need to add up , because the amounts already no use for them to control .
( respondent 18/age 25)(c)comparing traditional medicine with modern medicinesome of the interviewees compared modern medicine with traditional medicineit can stop the diseases faster , compared with herbs that take time to cure the problem . 
( respondent 2/age 40)chinese medicine can cure , but western ( medicines ) do nt . 
( respondent 6/age 35)traditional medicine do not have side - effect , therefore i trusted the traditional medicine more modern medicine .  ( respondent 9/age 60)(d)factors affecting perception ( size / color)consumers views indicated that the size , color and dosage form are strong determinants of the characteristics of medicine . 

  characteristics of modern medicine / general views regarding medicines 
 ( a)what are modern medicines?consumers viewed medicines as synthetically made and having undergone the process of research , testing and formulation .
some consumers also viewed modern medicine as unnatural.modern medicine is something synthetic , not natural and  expensive .  ( respondent 11/age 22)i go to pharmacy .
( respondent 4/age 45)modern medicine as i know is most of them come from herbs .
they extract it and then put into tablet / capsule something like that , it 's not the pure herb , and some chemicals are added as well . 
( respondent 3/age 20)(b)combination of good / bad effectssome people feel that modern medicine can cure illness while others have negative perceptions regarding medicines.i am comfortable with the effects of modern medicine  good effects
 my pain and inflammation are usually relieved with modern medicine . for my gout condition 
i took  zyloric pills  and it helped because it reduced my uric acid level .
the modern medicine can not heal him ; the modern medicine needs to improve . 
( respondent 7/age 55)the more serious cases , like cancer , after taking for a few months , the amounts of tablet need to add up , because the amounts already no use for them to control .
( respondent 18/age 25)(c)comparing traditional medicine with modern medicinesome of the interviewees compared modern medicine with traditional medicineit can stop the diseases faster , compared with herbs that take time to cure the problem . 
( respondent 2/age 40)chinese medicine can cure , but western ( medicines ) do nt . 
( respondent 6/age 35)traditional medicine do not have side - effect , therefore i trusted the traditional medicine more modern medicine .  ( respondent 9/age 60)(d)factors affecting perception ( size / color)consumers views indicated that the size , color and dosage form are strong determinants of the characteristics of medicine . 
  what are modern medicines ?
consumers viewed medicines as synthetically made and having undergone the process of research , testing and formulation .
( respondent 4/age 45 )  modern medicine as i know is most of them come from herbs .
they extract it and then put into tablet / capsule something like that , it 's not the pure herb , and some chemicals are added as well . 
( respondent 3/age 20 ) combination of good / bad effects some people feel that modern medicine can cure illness while others have negative perceptions regarding medicines .
 my pain and inflammation are usually relieved with modern medicine . for my gout condition 
i took  zyloric pills  and it helped because it reduced my uric acid level .
 ( respondent 2/age 40 )  like my friend having cancer , now already passed away .
 ( respondent 7/age 55 )  the more serious cases , like cancer , after taking for a few months , the amounts of tablet need to add up , because the amounts already no use for them to control .
 ( respondent 18/age 25 ) comparing traditional medicine with modern medicine some of the interviewees compared modern medicine with traditional medicine  it can stop the diseases faster , compared with herbs that take time to cure the problem . 
( respondent 2/age 40 )  chinese medicine can cure , but western ( medicines ) do nt . 
( respondent 6/age 35 )  traditional medicine do not have side - effect , therefore i trusted the traditional medicine more modern medicine . 
( respondent 9/age 60 ) factors affecting perception ( size / color ) consumers views indicated that the size , color and dosage form are strong determinants of the characteristics of medicine . 
oh absolutely , i might be scared looking at the big - sized tablets you know , it looks scary . 
( respondent 12/age 21 )  older people ( adult ) like me never care about color , unless it looks abnormal . like tablet , usually white color but if i see suddenly change to black color , purple then i wo nt take it   ( respondent 13/age 60 )  when i was a child , when i looked at the medicine , normally the red , yellow color tablets will have the sweet color  the white - colored tablets will give me the image that they are very bitter .
when i grew up , i took the white color gastric tablet , i have the image that it might be bitter , but when i tasted it , it had the taste like menthol . in different age , we have different thinking . 
( respondent 14/age 65 ) 
 2source of drug information and information providers 
 ( a)sources of drug informationmany respondents looked on the internet for information on medicines , while others relied on books and newspapers.of course yes  to make sure the medicines taken have no side - effects .
( respondent 6/age 35)  when doctor gives medication , i used to  check in the internet what are the side - effects .
( respondent 16/age 34)  i mean , when i just want to know information about a drug , i will just try to read up and i will try to compare the different sources of information to see whether they are giving the same information , instead of contradictory information .
if they are the same , then the information has to be true   ( respondent 4/age 45)a few of the interviewees found that information leaflets were helpful.so from the leaflets you can know which dosage is more suitable for you . like panadol there are lots of dosages  panadol menstrual .
( respondent 2/age 40 ) 
 3medicine - taking and treatment - seeking behavior 
 ( a)medicine - taking behaviorsome respondents complied with the medicine use instructions while others did not follow.if
they ask me to take an antibiotic three times per day , i will divide the hours per day by three and take it every eight hours .
i would even wake up at night to take the antibiotic at the exact time .
other medication i will stop taking after the symptoms have resolved , because if the sickness was healed already there are no need for the medication . 
( respondent 16/age 34)(b)treatment - seeking behavioryes , but before i seek the doctor 's attention , i will give a few days for my body to build up antibodies to fight the sickness .
after a few days , if ca nt be cured , then only i will see a doctor . 
but if in my home , if the sickness is like fever or running nose , usually i wo nt see doctor . i ll take  panadol  and try whether i can recover or not .
source of drug information and information providers 
 ( a)sources of drug informationmany respondents looked on the internet for information on medicines , while others relied on books and newspapers.of course yes  to make sure the medicines taken have no side - effects .
( respondent 6/age 35)  when doctor gives medication , i used to  check in the internet what are the side - effects .
( respondent 16/age 34)  i mean , when i just want to know information about a drug , i will just try to read up and i will try to compare the different sources of information to see whether they are giving the same information , instead of contradictory information .
if they are the same , then the information has to be true   ( respondent 4/age 45)a few of the interviewees found that information leaflets were helpful.so from the leaflets you can know which dosage is more suitable for you . like panadol there are lots of dosages  panadol menstrual
( respondent 2/age 40 ) 
  sources of drug information many respondents looked on the internet for information on medicines , while others relied on books and newspapers .
 of course yes  to make sure the medicines taken have no side - effects .
when doctor gives medication , i used to  check in the internet what are the side - effects .
( respondent 3/age 20 ) drug information providers   the doctor because they are more experienced 
 i mean , when i just want to know information about a drug , i will just try to read up and i will try to compare the different sources of information to see whether they are giving the same information , instead of contradictory information .
if they are the same , then the information has to be true   ( respondent 4/age 45 ) a few of the interviewees found that information leaflets were helpful .
  so from the leaflets you can know which dosage is more suitable for you . like panadol there are lots of dosages  panadol menstrual .
( respondent 2/age 40 ) medicine - taking and treatment - seeking behavior 
 ( a)medicine - taking behaviorsome respondents complied with the medicine use instructions while others did not follow.if
they ask me to take an antibiotic three times per day , i will divide the hours per day by three and take it every eight hours .
i would even wake up at night to take the antibiotic at the exact time .
other medication i will stop taking after the symptoms have resolved , because if the sickness was healed already there are no need for the medication .
 ( respondent 16/age 34)(b)treatment - seeking behavioryes , but before i seek the doctor 's attention , i will give a few days for my body to build up antibodies to fight the sickness .
after a few days , if ca nt be cured , then only i will see a doctor . 
but if in my home , if the sickness is like fever or running nose , usually i wo nt see doctor
. i ll take  panadol  and try whether i can recover or not .
medicine - taking behavior some respondents complied with the medicine use instructions while others did not follow .   if they ask me to take an antibiotic three times per day , i will divide the hours per day by three and take it every eight hours .
i would even wake up at night to take the antibiotic at the exact time .
i will stop taking after the symptoms have resolved , because if the sickness was healed already there are no need for the medication .
 ( respondent 16/age 34 ) treatment - seeking behavior  yes , but before i seek the doctor 's attention , i will give a few days for my body to build up antibodies to fight the sickness .
after a few days , if ca nt be cured , then only i will see a doctor . 
but if in my home , if the sickness is like fever or running nose , usually i wo nt see doctor . i ll take  panadol  and try whether i can recover or not .
the themes showed varied opinions , one group perceived modern medicine as  beneficial  while the others have  negative views  towards medicines .
previous studies have also shown mixed trends ; some have a fairly negative view of medicines , perceiving them to be generally harmful substances over - prescribed by doctors,[79 ] while a study in sweden highlighted  positive perception regarding medicine .
the participants stated traditional medicine as  natural  and safer , which is fine up to some extent , however , the worrying part was the assumption that traditional chinese medicines ( tcms ) have no side - effects and tcms can cure while western medicines do nt .
these beliefs are in line with an earlier study which states that the patients who regularly use herbal medicine were more likely to perceive  modern medicines  as harmful substances.[79 ] as tcms are widely used in malaysia , there is a need to inform and educate the public regarding their potential advantages and harmful effects .
another misconception which needed correction and education is that  all drugs including anti - cancers  can cause  dependence  .
a few themes were correctly identified such as that  tablets  are generally used for  non - acute conditions  while injection for  serious conditions  .
respondents associated red and yellow with  sweet  while purple and black were considered as  non - appealing  depicting that these colors could lead to non - compliance .
another study found that red , yellow and orange had a stimulant effect while blue and green are related to tranquilizing effects .
many consumers correctly identified doctors and pharmacist as sources of drug information and relied on the health professionals advice and suggestion while others looked for friends , internet , newspapers and books .
although there is a question mark regarding the reliability of drug information , many people were interested in checking the information on the internet . also , many consumers were just concerned with the side - effects of a medicine  as every drug has some side - effects , this approach could create misunderstanding about the issues .
a few participants mentioned that they are  searching drug information  from websites recommended by / for doctors or pharmacists , however it was unclear whether these websites were designed for healthcare professionals or for consumers .
misconceptions  regarding  medicine information - seeking behavior  demanding further research and community education on the issue .
many consumers exactly followed their doctors instructions on how to take medicines ; however a few consumers reported that they stop taking medicines once the symptoms have been resolved .
patient compliance is strongly related to perceptions of the necessity of medication . in previous studies , it has been observed that consumers were reluctant to take the drug even though they knew that they needed to take the medicine to cure the disease . in the present study
we have observed that in many cases consumers do not mind missing a few doses of a medicine .
the malaysian government is spending more than 1 billion rm ( malaysian ringitt ) to subsidize pharmaceuticals in public hospitals , however , if the medicines are not used properly , then this could lead to poor compliance as well as 
many consumers in the present study were getting information from the media and some of them overly emphasized the  adverse effects  .
moreover , the inadequate information provided by health professionals and adverse effects with the medicine could be the reasons influencing consumers medicine use behavior . as a large number of people rely on the internet to get drug information , and
the internet also supports the view  to try alternative medicine  , hence influencing consumers medicine - taking behavior .
there is evidence that the participants occasional meeting with the pharmacist generated a positive attitude towards medicines , hence there is a need to involve more pharmacists , doctors and organize public health campaigns around the issue .
compliance is a well - documented problem in malaysia and a previous study suggests that there is a need for health education programs so that better compliance could be achieved .
the study was only conducted in penang which may affect its generalization to other parts of malaysia .
only english - speaking consumers were interviewed and as their level of knowledge could be better than non - educated people , it is difficult to say that all issues have been identified .
nevertheless , the study unearthed some crucial information gaps and shed light on vital medicine use issues in malaysia .
the study was only conducted in penang which may affect its generalization to other parts of malaysia . only english - speaking consumers were interviewed and as their level of knowledge
could be better than non - educated people , it is difficult to say that all issues have been identified .
nevertheless , the study unearthed some crucial information gaps and shed light on vital medicine use issues in malaysia .
consumers understanding regarding modern medicine varied , ranging from accurate information to misleading and incorrect information .
traditional medicine was considered harmless and it was found out that dosage form and medicine color could affect consumers medicine - seeking and use behaviors .
corrective actions could be to create  consumers medicine information sources  , build public health campaigns as well as to conduct empirical research on these issues .
 the objective of this study was to evaluate consumers perceptions regarding  modern medicines  in penang , malaysia . to conduct this exploratory study , 
 qualitative techniques were used . 
 consumers more than 19 years of age and could speak english , who had visited a pharmacy in the last 30 days , were included from the four major areas of penang . 
 eighteen interviews were conducted until the point of saturation . 
 the interviews were audio - taped and then transcribed verbatim for thematic content analysis . 
 many consumers correctly identified the major characteristics and properties of modern medicines ; however , others raised doubts regarding the safety , quality and efficacy of  modern medicines  . 
 there were many misconceptions such as  all modern medicines can cause dependence  , traditional medicines are completely  free of side - effects  and  western medicines cure while chinese medicines do nt  . 
 color was also considered a strong determinant of the safety and characteristics of a medicine . 
 regarding consumers  medicine information seeking behavior  , many consumers would seek information from doctors and pharmacists ; however , there were others , who would look for books , or get it from the internet and friends . of concern 
 many consumers emphasized that while  self - searching for drug information  they would only look for side - effects . 
 misconceptions regarding medicine - taking behavior , medicine use and compliance were also identified . 
 though several consumers complied with the medicine - taking instructions , many reported that they would stop taking medicines , once they feel better . 
 though many consumers correctly identified the characteristics of  modern medicines  , 
 misconceptions regarding " medicine information sources and  medicine - taking behavior  were rampant . 
 the situation demands corrective actions including community - oriented educational campaigns to improve  medicine use  in the society . 
INTRODUCTION
MATERIALS AND METHODS
RESULTS
DISCUSSION
Limitations of the study
CONCLUSION