Introduction

Common cold and influenza are among the most common acute viral respiratory illnesses worldwide and continue to impose a substantial burden on individuals and health systems because of their high frequency, ease of transmission, and impact on daily functioning [1–3]. In addition to causing discomfort and temporary functional impairment, these conditions are associated with healthcare visits, missed study or work days, and widespread reliance on self-care strategies and over-the-counter symptom-relief products [4–7]. Because these illnesses are usually self-limiting in otherwise healthy individuals, many people make treatment decisions independently, often without formal medical consultation.

In this context, self-management of common cold and influenza symptoms is shaped not only by symptom severity but also by personal beliefs, cultural norms, prior experiences, treatment accessibility, expected speed of relief, and concerns about adverse effects [8]. Pharmaceutical treatments and over-the-counter products are commonly used for symptom relief because they are accessible and are perceived to provide rapid relief; however, inappropriate medication use, particularly antibiotic use for viral illnesses, remains a public health concern. Commonly used pharmaceutical treatments for cold and influenza symptoms include analgesics and antipyretics such as paracetamol and ibuprofen, antihistamines, decongestants, cough suppressants, and throat lozenges. In contrast, herbal remedies remain widely used because they are familiar, accessible, culturally accepted, and often perceived as safer or more “natural” options [9,10]. Examples of commonly used herbal remedies in the regional context include sage, chamomile, anise, ginger, mint, thyme, lemon, and honey-based preparations. Beyond individual preference, broader evidence also suggests that medicine choice is influenced by social and cultural factors, while contemporary studies continue to document substantial use of over-the-counter products for self-medication in cold- and cough-related symptoms [11,12].

The issue may be particularly relevant among university students, a group in which self-medication is highly prevalent [13]. Students commonly manage minor illnesses independently, and their decisions may be influenced by peer advice, social media, prior experience, academic background, and ease of access to pharmacies or home remedies. Prior studies among university populations have shown that mild symptom perception and previous personal experience are major drivers of self-medication behaviors [14–16]. In Jordan, available evidence also suggests that students frequently self-medicate when experiencing common cold and influenza symptoms rather than relying solely on physician-directed care [13,16]. Together, these findings indicate that treatment choices in this population are likely shaped by a combination of convenience, beliefs, and informal health practices.

The regional context is also important. In Jordan and the wider Middle Eastern context, herbal remedies have deep cultural roots and remain integrated into everyday health practices. The region contains rich medicinal plant diversity, and a substantial number of plant species continue to be used in Arab traditional medicine [17]. This cultural familiarity may contribute to continued reliance on herbal remedies, either alone or alongside pharmaceutical treatments, especially for common, self-limiting illnesses such as cold and influenza. At the same time, strong reliance on self-directed care raises concerns about inappropriate medication practices, including the misuse of antibiotics for viral illnesses, which represents an important public health issue in Jordan and contributes to broader antimicrobial-resistance concerns [18,19].

Despite the clinical and public health relevance of these behaviors, evidence from Jordan remains limited regarding how university students choose between herbal remedies, pharmaceutical treatments, and combined therapy when managing common cold and influenza symptoms. Previous studies among university students have examined the prevalence, patterns, attitudes, symptoms, reasons, and sources of advice related to self-medication [13,14,16]. The present study extends this literature by evaluating four specific treatment-decision domains: first-line treatment choice, timing of treatment initiation, responses to perceived herbal treatment failure, and consultation patterns before pharmaceutical treatment use. Understanding these patterns is important because they may reflect not only individual treatment beliefs but also broader issues related to health literacy, rational medicine use, and appropriate help-seeking behavior.

Therefore, this study aimed to examine treatment preferences among Jordanian university students for managing common cold and influenza symptoms, including preferences for herbal remedies, pharmaceutical treatments, and combined therapy. The study also assessed demographic, clinical, and belief-related factors associated with first-line treatment choice, timing of treatment initiation, responses to perceived herbal treatment failure, and medication-obtaining behavior. This study focused on treatment preferences, beliefs, and self-reported behaviors; it did not aim to objectively assess students’ knowledge of common cold, influenza, herbal remedies, pharmaceutical treatments, or antibiotic use.

Methods

Study design and participants – This study employed an observational cross-sectional design to assess treatment preferences among university students in Jordan for common cold and influenza symptoms. The study was designed and reported following the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines [20] for cross-sectional studies to ensure methodological rigor, transparency, and completeness in reporting.

Eligibility criteria – Eligible participants were Jordanian university students aged ≥18 years who were formally enrolled in an undergraduate program at the time of participation. Students expected to graduate, defined in the recruitment materials as students who remained formally enrolled and had six or fewer credit hours remaining, were considered eligible. Responses were excluded if the participant was < 18 years, had already graduated and was no longer enrolled, or was otherwise not currently enrolled as a university student.

Sample size calculation – An a priori power analysis was conducted before data collection using G*Power 3.1.9.7 (Heinrich Heine University, Düsseldorf, Germany). The calculation was based on a linear multiple regression model (fixed model, R² deviation from zero). Assuming an alpha level of 0.05, a statistical power of 0.99, a small effect size (f² = 0.02), and 10 predictors, the minimum required sample size was 1,628 participants. The analysis yielded an actual power of 0.99. The final analytical sample included 1,797 participants, exceeding the minimum required sample size.

The Questionnaire – The research team developed a closed-ended questionnaire in Arabic. It was designed to take approximately five minutes to be completed by participants. The questionnaire underwent expert review by a family medicine specialist to assess face and content validity. The questionnaire was pilot-tested on 10 eligible students to assess clarity, comprehensibility, and completion time. Minor wording refinements were made before full-scale distribution. Data obtained during the pilot phase were not included in the final analysis. The questionnaire consisted of five main sections; each section required completion before participants could proceed to the next section.

1. 1. Demographic and personal information: this section collected data on sex, age, place of residence, marital status, university, field of study (medical or non-medical), academic year, academic performance, chronic disease status, and income. The academic-year item included an “expected to graduate” category, defined in the recruitment materials as students who remained formally enrolled and had six or fewer credit hours remaining. In the English-translated questionnaire, this category was imprecisely labeled as “Graduated”; however, it did not refer to individuals who had already completed their undergraduate degree. The income item was presented using categories in Jordanian dinars but did not specify whether it referred to personal income, family financial support, income from part-time employment, or household income. Because this item could not be interpreted reliably, it was excluded from all statistical analyses.
2. 2. Individuals’ attitudes and choices in managing common cold and influenza symptoms: this section included four questions assessing the symptoms that usually prompt participants to seek treatment, their usual timing of treatment initiation after symptom onset, their usual first-line treatment choice, and the reasons underlying that choice. These questions were intended to assess participants’ general self-reported practices when experiencing common cold or influenza symptoms, rather than behaviors related to a specific recent or medically confirmed episode.
3. 3. The use of herbal remedies: this section included five questions about students’ preferences for using herbal remedies in case of illness, what type of herbal remedies the students prefer to use in case of common cold and influenza, and why they use them. Participants who did not prefer herbal remedies selected the option “I do not prefer using herbal remedies.”
4. 4. The use of pharmaceutical treatments: This section included five questions for participants who preferred pharmaceutical treatments, addressing consultation behavior, commonly used treatment types, reasons for use, and concerns about pharmaceutical treatment use. Medication-obtaining behavior was assessed using predefined questionnaire response options that captured the main patterns relevant to pharmaceutical treatment use in this study, including doctor consultation and prescription-based use, purchasing pharmaceutical treatments without a prescription based on personal experience, consulting only a pharmacist, and not preferring pharmaceutical treatments. These categories were used to describe selected medication-obtaining patterns and were not intended to capture all possible sources of treatment advice, such as family members, friends, or online sources.
5. 5. Beliefs and attitudes toward pharmaceutical treatments and herbal remedies: This section used a five-point Likert scale (strongly agree, agree, neutral, disagree, and strongly disagree). It included ten statements: the first four assessed prior experiences and social influences related to treatment choice, the next three assessed beliefs about the effectiveness of pharmaceutical treatments and herbal remedies, and the final three assessed beliefs regarding treatment safety. In addition, this section included one question about the sources from which students obtained information on the effectiveness of herbal remedies and pharmaceutical treatments for managing the common cold and influenza. The questionnaire used predefined closed-ended response options. A free-text “Other (please specify)” option was not provided for some multiple-response items, including the types of herbal remedies and pharmaceutical treatments used, motivations for herbal remedy use, factors influencing pharmaceutical treatment choice, concerns about pharmaceutical treatments, and sources of treatment information.

For the purpose of this study, perceived herbal treatment failure was operationally defined as the participant’s self-reported perception that herbal remedies did not achieve the desired symptom relief for common cold or influenza symptoms. This was assessed through the questionnaire item asking participants what they would do if natural herbal remedies did not achieve the desired results. Therefore, treatment failure in this study reflects perceived lack of effectiveness rather than a clinically confirmed treatment failure.

A preliminary exploratory factor analysis (EFA) was conducted for the initial 10 Likert-scale belief items using principal axis factoring with direct oblimin rotation. Two items were excluded based on psychometric performance, resulting in a refined 8-item, two-factor solution that explained 59.9% of the total variance. Sampling adequacy was good (KMO = 0.87), and internal consistency was acceptable to good for the two retained subscales (Cronbach’s alpha = 0.83 and 0.66). Detailed EFA and internal consistency results are provided in Supplementary Tables S2 and S5 in S6 File.

Data collection procedure – Data were collected using a closed-ended Arabic questionnaire developed in Google Forms. The questionnaire was distributed via social media platforms. A QR code linked to the questionnaire was also distributed directly to eligible Jordanian university students by the research team. Participants were recruited using a convenience sampling approach from multiple Jordanian universities; therefore, the sample was not designed to be proportionally representative of all universities in Jordan. Participation was voluntary. Informed consent was obtained electronically from all participants before survey initiation. In the first section of the Google Forms questionnaire, participants were presented with an information and consent statement explaining the study purpose, voluntary nature of participation, confidentiality of responses, and de-identified data collection. Only participants who selected “I agree” were able to proceed to the questionnaire and submit responses. No written signed consent was collected because the survey was conducted online. Responses were collected in a confidential, de-identified format. To prevent duplicate submissions, the Google Forms setting “Limit to 1 response” was enabled, which required sign-in with a Google account; no personally identifying information, including email addresses, was collected or stored by the research team. Data collection took place in Jordan from 16 April 2025 to 16 September 2025.

Analysis – Data were exported from Google Forms into Microsoft Excel and subsequently analyzed using IBM SPSS Statistics (version 30). Descriptive statistics were generated for participant characteristics, treatment-related outcomes, and all independent variables included in the regression models. Categorical variables, including symptom categories, medication-related concerns, consultation behaviors, and individual belief items, were summarized using frequencies and percentages. Age was summarized using the mean and standard deviation. Multinomial logistic regression models were used to identify factors associated with treatment-related choices for common cold and influenza. Four main outcomes were examined:

1. 1. First-line treatment choice for common cold and influenza (herbal remedies, pharmaceutical treatments, or combined therapy).
2. 2. Timing of treatment initiation (same day, after 1–2 days, or after ≥3 days).
3. 3. Response after perceived herbal treatment failure, defined as the participant’s perception that herbal remedies did not achieve the desired symptom relief.
4. 4. Medication-obtaining behavior (self-experience, pharmacist consultation, or not preferring pharmaceutical treatments).

For the multinomial logistic regression models, the reference outcome categories were defined a priori as follows: “Do not use any treatment” for first-line treatment choice, “Do not use any treatment” for timing of treatment initiation, “switching to pharmaceutical treatments” for response after perceived herbal treatment failure, and “doctor consultation and prescription-based use” for medication-obtaining behavior. For categorical predictors, the reference categories were specified in the corresponding regression tables, including male sex, urban residence, non-medical field of study, absence of chronic disease, absence of the reported symptom, strongly agree for Likert-scale belief items, and Yarmouk University for the institutional grouping variable.

Candidate predictors for each multinomial logistic regression model were selected based on their conceptual relevance to the corresponding outcome, previous literature, and the structure of the questionnaire. Core sociodemographic variables, including age, sex, residence, field of study, chronic disease status, and university group, were included when applicable. Outcome-specific predictors, such as symptom type, concerns about pharmaceutical treatments, consultation behavior, and belief-related items, were included only when directly relevant to the outcome being examined. For the treatment-initiation model, the item “I believe that herbal remedies can be a complete alternative to pharmaceutical treatments” was included because it most directly represented a general treatment belief that could influence whether participants initiated treatment promptly or delayed treatment. The remaining belief items addressed distinct constructs, including social influence, physician recommendation, comparative effectiveness and safety, medication avoidance, and potential adverse reactions, and were therefore not included in the treatment-initiation model. No automated stepwise variable-selection procedure was used.

Adjusted odds ratios (aORs), 95% confidence intervals (CIs), and p-values were reported. A p-value < 0.05 was considered statistically significant. Cross-tabulation and χ² tests assessed associations between sex and treatment-related behaviors.

A sensitivity analysis was performed by repeating the first-line treatment-choice multinomial logistic regression model after excluding participants from Yarmouk University, given its overrepresentation in the original sample. Additionally, an institutional grouping variable (other universities vs Yarmouk University) was included in the multinomial logistic regression models to assess whether the observed associations were influenced by the overrepresentation of a single institution.

Ethics – Ethical approval was obtained on 15/04/2025 from the Institutional Review Board of Yarmouk University (IRB/2025/164). Participation was voluntary. Informed electronic consent was obtained from all participants before participation through the first section of the online questionnaire. Responses were collected confidentially in a de-identified format and were used solely for research purposes.

Results

Participants’ Characteristics – A total of 1,844 submissions were received. Forty-seven responses were excluded because the respondents were younger than 18 years, had already completed their undergraduate degree and were no longer enrolled, or were otherwise not currently enrolled university students, leaving 1,797 responses for analysis. The mean age of participants was 20.87 ± 3.02 years. Most participants were female (69.9%), lived in urban areas (62.7%), and did not report chronic illness (74.6%). Participants were almost equally distributed between medical (49.4%) and non-medical (50.6%) fields. Participant characteristics and descriptive summaries of treatment-related outcomes are presented in Table 1. Descriptive statistics for all independent variables included in the multinomial logistic regression models are provided in Supplementary S3 Table in S6 File.

Download:

• PNG
  larger image
• TIFF
  original image

Table 1. Participant characteristics and descriptive summary of common cold and influenza treatment-related outcomes.

https://doi.org/10.1371/journal.pone.0358179.t001

First-line treatment choice for Common Cold and Influenza – In multinomial logistic regression (Table 2), sex was independently associated with first-line treatment choice preference for common cold and influenza. Females exhibited higher odds of preferring herbal remedies (aOR = 1.87, 95% CI: 1.23–2.86; p = 0.004), pharmaceutical treatments (aOR = 1.61, 95% CI: 1.01–2.55; p = 0.044), and combined therapy (aOR = 2.55, 95% CI: 1.64–3.96; p < 0.001) relative to males. Rural residence was associated with lower odds of preferring pharmaceutical treatments (aOR = 0.57, 95% CI: 0.36–0.89; p = 0.013) and combined therapy (aOR = 0.61, 95% CI: 0.40–0.93; p = 0.023), with no significant association for herbal preference (aOR = 0.78, 95% CI: 0.52–1.17; p = 0.231). Symptom type showed limited effects; sore throat was associated with higher odds of combined therapy (aOR = 1.83, 95% CI: 1.16–2.87; p = 0.009), while fever demonstrated a borderline inverse association with herbal preference (aOR = 0.69, 95% CI: 0.45–1.04; p = 0.076). Regarding medication-related concerns, reporting “possible side effects” was associated with increased odds of preferring herbal remedies (aOR = 1.60, 95% CI: 1.03–2.49; p = 0.038), whereas reporting “no concerns” was associated with reduced odds (aOR = 0.43, 95% CI: 0.24–0.77; p = 0.005). Age, field of study, and chronic disease status were not significantly associated with treatment preference (all p > 0.05).

Download:

• PNG
  larger image
• TIFF
  original image

Table 2. Multinomial logistic regression for first-line treatment choice for common cold and influenza. Reference category: Do not use any treatment.

https://doi.org/10.1371/journal.pone.0358179.t002

Overall, 764 participants (42.5%) reported initiating treatment on the same day, 533 (29.7%) after 1–2 days, and 136 (7.6%) after ≥3 days. Regarding first-line treatment choice, 800 participants (44.5%) preferred combined therapy, 476 (26.5%) herbal remedies, 375 (20.9%) pharmaceutical treatments alone, and 146 (8.1%) no treatment.

Sensitivity analysis excluding participants from Yarmouk University showed that the overall pattern of associations was largely preserved (Supplementary S1 Table in S6 File). The institutional grouping variable (other universities vs Yarmouk University) was not significantly associated with first-line treatment choice (all p > 0.05).

Sex was also significantly associated with the distribution of first-line treatment choices (p < 0.001). Combined therapy was reported more frequently by females than males (48.1% vs 36.1%), whereas pharmaceutical treatment alone (19.4% vs 24.3%) and no treatment (6.4% vs 12.2%) were less frequent among females than males.

Timing of treatment initiation – Multinomial logistic regression (Table 3) showed no significant associations between initiation timing and sex, residence, or chronic disease status (all p > 0.05). Medical-field participants had lower odds of initiating treatment on the same day (aOR = 0.55, 95% CI: 0.42–0.72; p < 0.001), while symptom type demonstrated selective effects: headache increased the odds of same-day initiation (aOR = 1.49, 95% CI: 1.14–1.95; p = 0.004), muscle pain increased the odds of initiation after 1–2 days (aOR = 1.64, 95% CI: 1.20–2.24; p = 0.002), and sore throat decreased the odds of same-day initiation (aOR = 0.61, 95% CI: 0.47–0.80; p < 0.001), with a borderline association for initiation after ≥3 days (aOR = 0.67, 95% CI: 0.44–1.02; p = 0.060). Attitudes toward herbal remedies as a complete alternative to pharmaceutical treatments were the strongest predictors, with disagreement and neutral responses generally associated with reduced odds of earlier initiation on the same day or after 1–2 days. Significant associations were also observed for initiation after ≥3 days (disagree: aOR = 0.27, 95% CI: 0.12–0.63; p = 0.003; agree: aOR = 0.57, 95% CI: 0.33–0.99; p = 0.045). The institutional grouping variable (other universities vs Yarmouk University) was not significantly associated with treatment-initiation timing (all p > 0.05).

Download:

• PNG
  larger image
• TIFF
  original image

Table 3. Multinomial logistic regression for timing of treatment initiation for common cold or influenza symptoms. Reference category: Do not use any treatment.

https://doi.org/10.1371/journal.pone.0358179.t003

Response to perceived herbal treatment failure – Multinomial logistic regression was performed to examine participants’ self-reported responses when herbal remedies did not achieve the desired results (Table 4), using switching to pharmaceutical treatments as the reference category. Female sex was associated with lower odds of continuing herbal remedies until recovery (aOR = 0.66, 95% CI: 0.49–0.90; p = 0.007), while no significant associations were observed for combining pharmaceutical treatments with herbal remedies or not preferring herbal remedies (p > 0.05). Medical-field participants were also less likely to continue herbal remedies (aOR = 0.72, 95% CI: 0.53–0.98; p = 0.035), with a borderline association for not preferring herbal remedies (aOR = 0.62, 95% CI: 0.37–1.04; p = 0.068). The presence of chronic disease was associated with higher odds of choosing combined therapy rather than switching directly to pharmaceutical treatments (aOR = 1.50, 95% CI: 1.17–1.91; p = 0.001). Reliance on doctor-prescribed pharmaceutical treatments was consistently associated with lower odds of selecting all non-reference responses—continuing herbal remedies (aOR = 0.38, 95% CI: 0.27–0.51; p < 0.001), combining therapy (aOR = 0.56, 95% CI: 0.45–0.70; p < 0.001), and not preferring herbal remedies (aOR = 0.37, 95% CI: 0.23–0.62; p < 0.001)—indicating a greater likelihood of switching directly to pharmaceutical treatments after perceived herbal treatment failure among participants who relied on physician-prescribed treatment.

Download:

• PNG
  larger image
• TIFF
  original image

Table 4. Multinomial logistic regression for responses after perceived herbal treatment failure. Reference category: Switching to pharmaceutical treatments.

https://doi.org/10.1371/journal.pone.0358179.t004

Belief items showed selective associations. For the statement that herbal remedies have a healing ability equal to or exceeding that of pharmaceutical treatments, strong disagreement and disagreement were associated with higher odds of continuing herbal remedies (strongly disagree: aOR = 5.12, 95% CI: 2.10–12.48; p < 0.001; disagree: aOR = 2.13, 95% CI: 1.08–4.20; p = 0.030). Strong disagreement with the statement that pharmaceutical treatments weaken the immune system compared with herbal remedies was associated with higher odds of choosing combined therapy (aOR = 1.87, 95% CI: 1.01–3.46; p = 0.048). Finally, for the belief that herbal remedies have no side effects compared with pharmaceutical treatments, strong disagreement and neutral responses were associated with higher odds of continuing herbal remedies (strongly disagree: aOR = 4.49, 95% CI: 2.08–9.71; p < 0.001; neutral: aOR = 1.88, 95% CI: 1.13–3.12; p = 0.015), while strong disagreement was also associated with higher odds of not preferring herbal remedies (aOR = 5.08, 95% CI: 1.22–21.16; p = 0.026).

Institutional grouping showed an outcome-specific association: participants from universities other than Yarmouk University had higher odds of combining pharmaceutical treatments with herbal remedies rather than switching directly to pharmaceutical treatments (aOR = 1.46, 95% CI: 1.17–1.82; p < 0.001), whereas the other comparisons were not statistically significant.

Medication-obtaining behavior – A multinomial logistic regression model was used to examine medication-obtaining behavior (buying pharmaceutical treatments without a prescription based on personal experience, consulting only a pharmacist, or not preferring pharmaceutical treatments), using doctor consultation and prescription-based use as the reference category (Table 5). Field of study was a significant predictor; participants in the medical field had higher odds of buying pharmaceutical treatments without a prescription based on their own experience (aOR = 1.76, 95% CI: 1.39–2.23; p < 0.001) and of not preferring pharmaceutical treatment use (aOR = 1.84, 95% CI: 1.27–2.66; p = 0.001). Residence was also significant for the “consult only a pharmacist” category, with rural participants having lower odds than urban participants (aOR = 0.64, 95% CI: 0.49–0.83; p < 0.001). Regarding symptom type, reporting muscle pain was associated with higher odds of buying pharmaceutical treatments without a prescription (aOR = 1.31, 95% CI: 1.00–1.70; p = 0.049). No significant associations were observed for age, sex, chronic disease status, or the other symptom categories (all remaining p > 0.05).

Download:

• PNG
  larger image
• TIFF
  original image

Table 5. Multinomial logistic regression for medication-obtaining behavior. Reference category: Doctor consultation and prescription-based use.

https://doi.org/10.1371/journal.pone.0358179.t005

Institutional grouping was also associated with selected medication-obtaining behaviors. Compared with Yarmouk University participants, students from other universities had higher odds of purchasing pharmaceutical treatments without a prescription based on personal experience (aOR = 1.50, 95% CI: 1.18–1.91; p < 0.001) and consulting only a pharmacist (aOR = 1.53, 95% CI: 1.19–1.98; p < 0.001), whereas no significant association was observed for not preferring pharmaceutical treatments (p = 0.201).

Additionally, among the 1,797 participants, 867 (48.2%) self-reported antibiotic use for common cold or influenza symptoms. This proportion represents overall self-reported antibiotic use, regardless of how antibiotics were obtained, including through medical prescription, previous personal experience, or pharmacist advice. Because antibiotic type, indication, dose, duration, and clinical appropriateness were not collected, this finding should be interpreted as reported antibiotic use rather than confirmed inappropriate antibiotic use. Among herbal remedies, sage (54.3%), chamomile (43.9%), anise (40.1%), and ginger (37.5%) were the most commonly preferred choices among participants.

Discussion

Interpretation of Main Findings – The main finding of this study was the predominance of mixed or integrative self-care, with combined use of herbal remedies and pharmaceutical treatments emerging as the most common first-line choice for common cold and influenza symptoms. This finding suggests that many Jordanian university students do not view herbal remedies and pharmaceutical treatments as mutually exclusive options, but rather combine them as part of their self-management practices. This pattern is consistent with the regional cultural context, where herbal remedies remain familiar and socially accepted, while pharmaceutical treatments are also widely accessible and perceived as effective for symptom relief.

Sex was an important predictor of first-line treatment choice. Female participants had higher odds of choosing all active treatment options compared with males, particularly combined use of herbal remedies and pharmaceutical treatments (aOR = 2.55, 95% CI: 1.64–3.96; p < 0.001). This pattern is consistent with previous evidence suggesting that women are generally more proactive in health-seeking behavior and more likely to use medications [21,22]. In the present study, this may reflect greater willingness among female students to use multiple symptom-relief strategies rather than relying on no treatment.

Field of study was most relevant to medication-obtaining behavior. Medical-field participants had higher odds of purchasing pharmaceutical treatments without a prescription, which may reflect greater confidence in self-management and familiarity with treatment options among students with health-related academic exposure [23]. However, this finding should not be interpreted as evidence of appropriate medication use, because the study assessed self-reported behavior rather than clinical appropriateness. The association between muscle pain and non-prescription pharmaceutical treatment purchase is also plausible, as analgesics are commonly used in self-medication among university students [24].

Timing of treatment initiation was associated with selected symptoms and beliefs. Participants reporting headache were more likely to initiate treatment on the same day, whereas those reporting sore throat were less likely to do so. These findings suggest that treatment timing may depend not only on symptom presence but also on how students perceive symptom severity and the need for immediate relief. The association between belief in herbal remedies as a complete alternative and treatment initiation further supports the role of health beliefs in shaping self-care behavior.

Regional and Population-Specific Considerations – The regional context is important when interpreting these findings. Jordan is located in the Middle East, a region with a long tradition of herbal medicine use and rich medicinal plant diversity, with more than 2,600 plant species reported in the region and several still used in Arab traditional medicine [17]. In this context, the continued use of herbal remedies for common cold and influenza symptoms is not unexpected. Rather, it likely reflects cultural familiarity, perceived safety, household availability, and intergenerational advice. At the same time, the frequent use of pharmaceutical treatments and combined therapy suggests that students often integrate traditional and modern treatment approaches rather than relying exclusively on one modality.

Residence was also relevant. Rural participants showed lower odds of pharmaceutical and combined treatment use than urban participants, while residence was not significantly associated with choosing herbal remedies alone. This may reflect differences in access, treatment availability, health-seeking norms, or preferences for specific sources of advice between rural and urban settings. However, because this study did not directly assess healthcare access, pharmacy density, or household treatment practices, these explanations should be interpreted cautiously.

Conclusion

This study suggests that Jordanian university students commonly use integrative self-management approaches for cold and flu symptoms, with combined use of herbal remedies and pharmaceutical treatments as the most frequent pattern. Treatment preferences were associated with demographic factors, particularly sex and place of residence, while concerns about medication side effects were linked to greater preference for herbal remedies among some students. Medical-field students had lower adjusted odds of continuing herbal remedies after perceived herbal treatment failure, relative to switching to pharmaceutical treatments, suggesting that academic background may influence treatment-related decisions. The notable level of self-reported antibiotic use further highlights the need for stronger education on appropriate self-management, rational medication use, and antibiotic stewardship for common viral respiratory illnesses.

Supporting information

Acknowledgments

We acknowledge the Faculty of Medicine at Yarmouk University, particularly the Department of Pediatrics, Family Medicine, Gynecology, and Obstetrics, for their support in supervising medical students’ research projects.