The Knowledge‐Attitude Paradox in Analgesic Self‐Medication Among University Students in Ecuador: A Cross‐Sectional Study and Predictive Modeling Analysis

Objective: To evaluate the prevalence and determinants of analgesic self-medication among university students in Ecuador, with a focus on the interplay between pharmacological knowledge and personal attitudes. Methods: A cross-sectional analytical study was conducted with 422 students at Universidad Tecnologica Indoamerica (April–August 2025), selected via stratified random sampling. A validated, structured questionnaire assessed knowledge, attitudes, and practices. Multivariable logistic regression and random forest algorithms were employed to identify key predictors and their relative importance. Results: The prevalence of analgesic self-medication was exceptionally high at 87.5%. Random forest analysis identified attitude as the primary predictor of this behavior (relative importance = 0.252), followed by academic year and pharmacological knowledge. A significant “knowledge–attitude paradox” was observed, wherein health sciences students, despite possessing superior pharmacological knowledge, exhibited the highest rates of self-medication. The predictive model demonstrated excellent discrimination (AUC = 0.81). Conclusion: The high prevalence of self-medication, a finding consistent with emerging international data, necessitates a fundamental paradigm shift in public health interventions. Educational strategies must evolve beyond simple information dissemination to incorporate behavioral science principles aimed at modifying attitudes and risk perceptions, particularly during the formative early years of university education