Abstract
BACKGROUND: Inappropriate self-medication and limited health literacy are pressing challenges that contribute to poor health outcomes among older adults. In rural, low-resource settings, these issues are worsened by digital exclusion, which restricts access to reliable health information and informed decision-making. OBJECTIVE: To assess the prevalence and determinants of inappropriate medication and health product (M&HP) use among older adults in rural Thailand, reflecting wider disparities in Southeast Asia. METHODS: A cross-sectional survey was conducted among 1,461 older adults aged ≥60 years, selected through stratified multi-stage sampling from Thailand's Health Regions 7-10, which encompass 20 northeastern provinces. Structured interviews explored health-seeking behavior, digital literacy, and M&HP use. Inappropriate use was defined as the use of two or more items without professional consultation, as per national guidelines. Descriptive and multivariable logistic regression analyses were performed. RESULTS: Of participants, 84.5% reported using M&HPs without professional consultation, and only 14.0% were proficient in accessing health information via smartphones. Inappropriate use was significantly associated with rural residence (aOR = 6.33; 95% CI: 2.19-18.31), low education, chronic illness, unemployment, digital illiteracy, and financial hardship (p < 0.05). CONCLUSION: Digital and social exclusion strongly influence unsafe self-medication practices among older adults. Improving digital health literacy and access to credible information is crucial for enhancing medication safety. Thailand's experience may offer valuable guidance for developing inclusive aging strategies in other low- and middle-income countries.