<b>Knowledge, Attitude, and Practices of Self-Medication Among Undergraduate Nursing Students in Malakand Division, Pakistan</b>

Background: Self-medication is widespread among healthcare students, raising concerns about irrational drug use, antimicrobial resistance, and professional boundary violations. Nursing students are a critical group given their foundational pharmacological knowledge and future patient care responsibilities. Understanding their knowledge, attitudes, and practices (KAP) is essential to inform educational and policy interventions. Objective: To assess the prevalence, determinants, and patterns of self-medication among undergraduate nursing students in Malakand Division, Pakistan, and to evaluate associated knowledge, attitudes, and misconceptions. Methods: A cross-sectional observational study was conducted from February to October 2024 among 267 third- and fourth-year Bachelor of Science in Nursing students across multiple institutions in Malakand Division. Data were collected through a structured, validated, self-administered questionnaire and analyzed in Jamovi using descriptive statistics, chi-square tests, and logistic regression. Odds ratios with 95% confidence intervals were calculated, and p<0.05 was considered significant. Ethical approval and informed consent were obtained. Results: The prevalence of self-medication was 78.3%. Painkillers (41.6%) were most frequently used, followed by antibiotics (14.2%) and combined polypharmacy (22.1%). Convenience (46.1%) and limited healthcare access (18.0%) were leading motivators. Female students (95.7%) and fourth-year students (83.2%) reported higher prevalence. Despite high awareness of drug side effects (97.8%) and antibiotic resistance (88.0%), misconceptions persisted regarding herbal remedies (39.7%) and dietary supplements (66.3%). Conclusion: Self-medication is highly prevalent among nursing students, influenced by academic seniority and gender. Persistent misconceptions and boundary issues highlight the urgent need for curricular reforms, stewardship training, and regulatory interventions.