Real World Evidence on Perceived Effectiveness, Quality of Life Impact, and Public Attitudes Toward a Common Cold and Flu Medication: A Cross-Sectional Study

1. Introduction

Upper respiratory tract infections (URTIs) are a leading cause of acute illness worldwide and represent a significant public health concern [1,2]. The common cold is the most frequent manifestation of URTIs, characterized by inflammation that often results in malaise, nasal congestion, rhinorrhea, sneezing, pharyngitis, cough, and occasionally fever and headache [3].

Although the common cold is typically self-limiting and resolves without medical intervention, it imposes a substantial short-term burden on quality-of-life (QoL). Symptoms such as nasal congestion, sore throat, cough and headache can impair physical comfort, cognitive performance, mood, productivity and sleep, leading to absenteeism from work or school and reduced daily functioning [4,5,6]. These infections also contribute to considerable economic losses due to reduced productivity. In South Africa, seasonal colds and influenza place a notable burden on the primary healthcare system. The estimated annual cost of influenza-associated illness is $270.5 million, with medically attended mild cases contributing more than double the cost of severe cases [7,8].

Self-management is recommended as first-line care for uncomplicated colds and influenza-like illness, including rest, adequate hydration, and appropriate symptomatic treatment. Previous studies have shown that many individuals seek relief from colds and flu symptoms through self-management [9,10]. Furthermore, guidance from the National Institute for Health and Care Excellence (NICE) [11] and the South African National Department of Health Standard Treatment Guidelines [12] emphasizes supportive care and recognizes the self-limiting nature of cold and flu Over-the-counter (OTC) medicines are widely used within this framework to relieve symptoms, and responsible self-management may help reduce unnecessary healthcare utilization [13].

Despite the widespread use of OTC medications for cold and flu self-management, there remains a limited understanding of how individuals make decisions regarding these products. In particular, little is known about the specific health benefits consumers seek when using cold and flu medications or the product characteristics they value most—such as rapid onset of action, sustained relief, or convenience—as well as their perceptions of effectiveness and impact on quality of life (QoL). Evidence regarding whether individuals feel these products meaningfully improve daily functioning, sleep quality, productivity, and overall well-being remains scarce. Gaining insight into these preferences and perceived outcomes is essential for informing strategies that promote safe, effective, and rational OTC use [14,15].

In this context, MED-LEMON- a hot medication with vitamin C, is an OTC cold and flu medication widely marketed in South Africa for its ability to provide symptomatic relief and alleviate discomfort during episodes of cold and flu [16]. The product contains aspirin, caffeine, vitamin C, and menthol as active pharmaceutical ingredients, and is available in 3 flavours: Original, Lemon menthol, and Cherry menthol. Despite MED LEMON’s presence in the South African OTC cold and flu market, there remains limited peer reviewed evidence evaluating real world user experiences, including perceived effectiveness, QoL outcomes, and attitudes toward the product.

Therefore, this study aims to understand the product characteristics individuals value most when selecting OTC medications for the management of cold and flu symptoms. It further seeks to assess the perceived effectiveness of MED-LEMON and its impact on the QoL of adults in South Africa, as well as to evaluate public attitudes related to trust, satisfaction, and perceived value for money. Results from this study aim to contribute to a broader understanding of public behavior toward OTC medication within the South African context. Importantly, this is the first real-world evidence study of MED-LEMON in South Africa, providing novel insights into patient behavior and preferences in the context of OTC cold and flu medications. The findings are expected to inform healthcare providers, policymakers, and manufacturers by identifying factors that drive OTC medication choice, satisfaction, and perceived value in improving QoL, thereby contributing to improved patient-centered care and evidence-based strategies for OTC medication use.

2. Materials and Methods

2.1. Study Design

A non-interventional retrospective observational cross-sectional study was conducted in South Africa using a self-administered structured online questionnaire via GeoPoll survey platform. The online questionnaire was designed by the study team members to capture comprehensive information relevant to the study objectives. To reduce recall bias, this study only recruited participants who had consumed MED-LEMON within the past three months.

2.2. Ethical Considerations

All respondents provided informed consent to participate in the survey. No personally identifiable data were collected. Ethical approval for the study was reviewed and granted by Pharma-Ethics Research Ethics Committee in South Africa (Ethics Reference No: 250327101).

2.3. Sample

Participants from South Africa were recruited via a professional research organization’s established consumer panel. The established consumer panel is a pre-recruited database of individuals who have previously agreed to participate in survey research and who provide demographic and profiling information upon registration. Panel members are typically recruited through multiple channels (e.g., online advertising and social media) and are verified by the panel provider to ensure data quality and prevent duplicate registrations. Study invitations were distributed to panel members via email and the panel website portal. Individuals who were interested could follow a link to access the informed consent form.

After providing consent, participants completed a screening questionnaire to determine eligibility. Only those who were eligible were redirected to the survey link to complete a one-time survey. Exclusion criteria were verified based on participants’ self-reported responses in the screening questionnaire.

The inclusion criteria were as follows: adults aged 18-65 years old, residing in South Africa, experienced cold and flu symptoms in the 3 past months, consumed MED-LEMON for their cold and flu symptoms in the past 3 months, and provided consent to participate in this study. Additionally, the following exclusion criteria were applied: adults older than 65 years old and who took other cold and flu or analgesic products concomitantly with MED-LEMON in the past 3 months.

2.4. Sample Size Considerations

The sample size for this study was determined using standard statistical principles to ensure adequate precision in estimating perceived effectiveness and attitudes toward MED-LEMON. Assuming a margin of error of 10%, a standard deviation (SD) of 0.5, and a 95% confidence level, a minimum sample size of approximately n = 200 consumers was calculated as sufficient to address the study objectives. Although larger samples could further reduce the margin of error, the chosen sample size was deemed appropriate for generating real-world evidence and exploratory insights into consumer behavior and attitudes toward OTC cold and flu medications.

2.5. Data Collection and Measures

Data was collected between July 2025 and August 2025. All respondents completed a structured online questionnaire. The structured online questionnaire was designed to align with the study objectives and collected the following information:

• Demographics: Participants reported age, gender, acute and chronic illness status, and other relevant sociodemographic characteristics.
• Importance of symptom relief and product characteristics: Participants rated the importance of symptom relief and various characteristics of OTC cold and flu medications in their selection of such products. Ratings were captured using investigator-designed statements with a 5-point Likert-type agreement scale ranging from “completely disagree” to “completely agree.”
• Perceived effectiveness of MED-LEMON and impact on QoL: Participants provided self-reported assessments of MED-LEMON’s effectiveness in relieving cold/ flu symptoms and its impact on QoL, using investigator-designed statements with 5-point Likert-type agreement scale ranging from “completely disagree” to “completely agree.”
• Reasons for product choice: Participants indicated their motivations for selecting MED-LEMON.
• Attitudes toward MED-LEMON: Participants’ perceptions were assessed regarding product trust, satisfaction, value for money, and likelihood of recommending MED-LEMON to others. These attitudes were measured using investigator-designed agreement statements on a 5-point Likert scale (e.g. from “absolutely dissatisfied” to “completely satisfied”).

2.6. Data Analysis

Only completed questionnaires were analyzed. Questionnaires with missing or incomplete responses were considered as indicative of withdrawal of consent and were therefore excluded from the analysis. Respondent characteristics and demographics were summarized using descriptive statistics. Continuous variables were reported as means and standard deviations, while categorical variables were presented as frequencies and proportions. Exploratory subgroup analyses were conducted to examine variations across predefined groups selected for their potential influence on the outcomes of interest (i.e., perceived effectiveness of MED LEMON and the impact on QoL after MED LEMON use). Subgroups included: (i) income level, measured using the Living Standards Measure (LSM)—a composite index of household wealth and access to services that categorizes the South African population into 10 groups, where LSM 10 reflects the highest material living standards and LSM 1 the lowest, based on indicators such as urban versus rural residence, ownership of major appliances, and vehicle possession; (ii) living location (peri urban/rural vs. urban); (iii) age (18–35 vs. 36–65 years); and (iv) frequency of product use (≤1 sachet/day vs. 2–3 sachets/day).

Between group comparisons were conducted using the chi square test for categorical variables and the independent t-test for continuous variables. Pairwise comparisons were further performed to investigate differences among subgroups, with adjustments applied for multiple comparisons where applicable. Differences between groups were considered significant at the 5% level (P<.05). All data analysis was performed using the Statistical Package for Social Sciences (SPSS), version 23.

3. Results

A total of 249 participants were recruited for this study, with a mean age of 29.6 years (SD = 9.0). Males constituted 55.0% of the study population, while females accounted for 45.0%. All sociodemographic, clinical characteristics, and MED-LEMON consumption details are summarized in Table 1. Most participants resided in Gauteng (43.4%), followed by KwaZulu-Natal (15.7%), Western Cape (12.9%), and Limpopo (8.8%), with smaller proportions from other provinces. Overall, 57.0% lived in peri urban, township, or rural areas, whereas 43.0% lived in urban areas. Educational attainment varied, with the largest proportion reporting a high school diploma (24.5%), followed by completion of secondary school (19.3%) and certificate-level qualifications (16.9%). The majority of participants (58.6%) were classified within the middle-income group (LSM 5–7). Most participants (80.7%) reported having none of the listed chronic conditions.

Over the past three months, the majority of participants reported using the original flavor of MED-LEMON (81.1%), followed by Lemon menthol (13.7%), and Cherry menthol (5.2%). Most participants consumed MED LEMON for 1–3 days during their cold or flu episode (77.9%), while smaller proportions used it for 4–6 days (18.1%) or 7–10 days (4.0%). Half of the participants reported taking one sachet per day (50.2%). A statistically significant difference in consumption patterns was observed across income groups: fewer participants in the higher income LSM 8–10 group reported using one sachet per day compared with those in the middle income LSM 5–7 group (35.7% vs. 58.0%, p < 0.05) (Table A1).

3.1. Participant-Rated Importance of Symptom Relief from Cold and Flu Medication

Participants rated the importance of various health benefits sought from cold and flu medication. Overall, fever, sore throat, headache, and sinus congestion emerged as the most critical symptoms to address with cold and flu medication (Figure 1). Relief from sore throat was considered the most critical, with 96.4% of respondents rating it as important, very or extremely important. This was followed by fever (96.0%), headache (90.0%), throat irritation (90.0%), and body pain (88.8%). Relief from sinus pain and congestion (84.3%), muscle pain (83.5%), and chills (77.1%) were also considered important by most participants.

3.2. Participant-Rated Importance of Cold and Flu Medication Characteristics

Participants also rated the importance of various characteristics of cold and flu medication. Responses marked as ‘Important’, ‘Very Important’, and ‘Extremely Important’ were grouped together to identify the most valued product attributes. Using this classification, the highest-rated attribute was quick action (fast-acting medication), with 97.2% of participants rating it as important or higher. This was followed by duration of relief (long lasting effects), rated as important or higher by 93.2% of participants, and ease of use (e.g., liquid or tablet form), rated by 91.5%. Although a non-drowsy formulation was considered somewhat less critical than other attributes, it remained important to most participants, with 75.5% rating it as important or higher. Detailed ratings are presented in Figure 2.

3.3. Perceived Effectiveness of MED-LEMON and Impact on QoL

3.3.1. Symptom Relief

Participants reported strong agreement regarding MED-LEMON’s effectiveness in alleviating cold and flu symptoms (Table 2). A large majority felt more in control of their symptoms (88.0%) and reported overall improvement after taking MED-LEMON (93.6%). Relief from specific symptoms was also highly endorsed: 91.2% agreed that MED-LEMON’s triple action provided relief from headache, pain, and fever; 76.7% experienced relief from throat irritation; and 77.5% reported less muscle soreness. Although slightly less participants reported relief from earache (63.9%). Detailed breakdown of results is presented in Table A2.

Notably, a higher proportion of participants who reported taking two to three sachets of MED-LEMON per day reported symptomatic relief compared with those who took one sachet per day during their cold or flu episode. Specifically, individuals in the higher-dose group more frequently reported better overall control of their symptoms (93.4% vs 83.9%, P<.05), as well as reduced muscle soreness (85.8% vs 71.3%, P<.05) and less earache (75.5% vs 55.2%, P<.05) [Table 2].

3.3.2. Impact on QoL

Participants reported notable agreement with statements related to improvements in sleep and emotional well-being. MED-LEMON’s soothing relief helped 93.2% of participants sleep better, and 89.6% reported waking less frequently during the night due to cold and flu symptoms. Feeling well-rested and refreshed was endorsed by 94.4%, while 92.4% reported feeling less frustrated with their symptoms as a result of using MED-LEMON. [Table 2]. Participants also perceived MED LEMON to support daily functioning and social engagement during cold and flu episodes (Table 2). Most participants agreed that MED LEMON made it easier to return to daily routines (88.4%) and maintain normal activities (89.2%). In addition, 96.8% indicated that MED LEMON provided sufficient relief to continue caring for loved ones, and 87.1% reported that their social life was not disrupted by cold or flu symptoms. Furthermore, 88.8% stated that they did not have to miss important events or gatherings due to their cold or flu symptoms.

Notably, a higher proportion of participants who consumed two to three sachets of MED LEMON per day reported improvements in their QoL compared with those who consumed one sachet per day. This included feeling more physically comfortable (91.5% vs. 81.8%, P< .05) and feeling more confident in returning to their normal routine (91.5% vs. 81.1%, P < .05) (Table 2). A detailed breakdown of results is presented in Appendix Table 2.

3.3.3. Perceived MED-LEMON Product Attributes

Most participants (85.1%) strongly agreed that MED-LEMON’s non-drowsy formulation helped them remain focused and productive during the day (Table 3). Fast acting relief was also highly endorsed: 82.7% reported experiencing symptom relief within 30 minutes, and 86.8% agreed they were able to return to their daily routine on the same day. Rapid relief from fever was reported by 79.5%, while 74.7% experienced quick relief from chills. Additionally, 91.2% agreed that MED-LEMON provided long-lasting relief from cold and flu symptoms, with a significantly higher proportion of participants taking two to three sachets per day reporting this benefit compared with those taking one sachet per day (95.3% vs 87.4%, P<.05). Convenience of use was also highly rated: 90.8% of participants found MED-LEMON convenient or very convenient to use, with significantly higher proportions observed in participants in LSM 5-7 group (91.1%) and 8-10 group (95.2%) compared with those in the LSM 1-4 group (68.4%), P<.05. Furthermore, 94.0% of participants rated MED-LEMON as easy or very easy to consume in its liquid format. A detailed breakdown of results is provided in Table A3.

3.3.4. Participant-Reported Reasons for Choosing MED-LEMON

The most frequently reported reason for choosing MED-LEMON was trust in its ability to provide relief from cold/ flu symptoms, reported by 63.1% of participants (Table 4). Other factors included brand familiarity (57.0%) and recommendations from friends or family (53.4%). Professional recommendations influenced 21.3%, while 20.5% were motivated by positive online reviews. Advertising and in-store visibility played smaller roles, with 17.3% and 13.7% respectively, and only 3.6% cited promotional offers.

3.3.5. Participants-Reported Attitudes Towards MED-LEMON

Overall, participants expressed highly positive attitudes toward MED-LEMON, as shown in Table 5. A subgroup breakdown of responses by income, location, and frequency of use is presented in Table A4. Most respondents reported liking the product’s flavor, with 83.9% somewhat or completely agreeing. Nearly all participants (98.8%) considered MED LEMON to offer good value for money. Trust in the product was also high: 97.2% regarded MED-LEMON as their first choice for treating cold and flu symptoms, 98.0% trusted it to provide effective symptom relief, and 88.3% trusted it to deliver relief within 30 minutes. Satisfaction levels were similarly strong, with 90.4% reporting they were somewhat or completely satisfied with MED-LEMON. Future use and repurchase intention were equally positive. Most participants indicated they would use MED-LEMON again (96.8%) and repurchase it for future cold and flu relief (99.6%). Furthermore, likeliness to recommend the product was high, with 97.2% stating they would recommend MED-LEMON to friends and family, and 96.4% reporting they would recommend it as their first choice for cold and flu relief.

4. Discussion

This cross-sectional study explored consumer preferences towards OTC medications for the management of cold and flu symptoms in South Africa. Specifically, it examined the product characteristics that individuals consider most important when selecting OTC remedies, assessed the perceived effectiveness of MED-LEMON, and evaluated its impact on adults’ QoL. In addition, the study investigated public attitudes toward trust, satisfaction, and perceived value for money towards MED-LEMON.

The study found that participants rated fever, sore throat, and headache as the most important symptoms to relieve, with 96.0%, 96.4%, and 91.0% of participants, respectively, identifying these as important, very important, or extremely important. Importantly, this study found that MED-LEMON was perceived to effectively address key symptom relief needs of individuals seeking cold and flu medications. Perceived symptom-specific relief closely mirrored participant priorities: 91.2% reported relief from headache, pain, and fever; and 76.7% experienced relief from throat irritation. Additionally, MED-LEMON’s attributes— including its fast-acting formulation, long-lasting symptom relief, and ease of use—were highly endorsed by participants and correspond closely to the product characteristics that consumers considered most important when selecting OTC medications for the management of cold and flu symptoms

Findings from this study also indicate that MED-LEMON was perceived not only to provide targeted relief for the cold and flu symptoms most valued by individuals, but also to support daily functioning and QoL during acute episodes. Most participants reported being able to maintain normal routines, remain socially engaged, sleep better, and continue caring for others while using MED-LEMON. Notably, the majority of participants indicated that they were able to resume their usual daily activities on the same day of consuming MED-LEMON, suggesting a rapid return to functioning.

Importantly, the observed improvements in QoL appear closely linked to the symptom relief provided, suggesting that MED-LEMON may help individuals better manage both physical discomfort and functional impairment while supporting improved sleep quality, focus and productivity during cold and flu episodes. This aligns with a prior study showing that effective symptom management can translate into preserved QoL and reduced disruption of daily activities during URTIs [17].

These findings provide valuable evidence for using MED-LEMON to relieve cold and flu symptoms and enhance the overall well-being of individuals suffering from cold and flu. Notably, individuals who consumed two to three sachets per day-consistent with the recommended regimen of MED-LEMON- reported greater symptom relief and enhanced QoL, including improved focus and productivity, compared with those taking only one sachet per day. These findings suggest that adhering to the full dosage range may optimize treatment outcomes.

The high overall convenience rating for MED-LEMON (90.8 %) masks a notable disparity by socioeconomic segment: participants in the higher-income LSM 5-7 and LSM 8-10 groups rated convenience at 91.1 % and 95.2 %, respectively, whereas only 68.4 % of those in the lower-income[18–21 LSM 1-4 reported the product to be convenient (P< .05). This disparity may reflect practical barriers faced by lower-income households, such as limited access to hot water or adequate kitchen facilities required for the powder-based formulation of MED-LEMON. This interpretation aligns with study findings showing that participants in the LSM 1–4 group used fewer sachets per day than those in higher-income groups, suggesting potential convenience or access constraints. Previous research similarly showed that socioeconomic status influences medication access, usage patterns, and adherence, with lower-income individuals often facing greater environmental and resource-related barriers to optimal therapy use [18,19,20,21]. Collectively, these findings suggest that although MED-LEMON’s format is broadly acceptable, infrastructure-related limitations and resource constraints among lower-income users may reduce ease of use and adherence to the full recommended dosage regimen, potentially affecting perceived effectiveness.

Overall, the positive consumer perceptions of MED LEMON’s effectiveness and value have important implications for public health and OTC medicine policy in South Africa. In a context where access to formal healthcare is often limited by cost and resource constraints, OTC medications play a critical role in enabling self-care and reducing the burden on primary care facilities. MED-LEMON’s ability to provide rapid symptom relief and support a prompt return to daily functioning suggests that effective OTC options can help maintain productivity and QoL during acute cold and flu episodes, while also minimizing unnecessary clinic visits. Policymakers and healthcare providers should consider these findings when developing strategies to promote responsible self-care, ensure equitable access to trusted OTC products, and provide clear guidance on appropriate use to optimize outcomes and safeguard public health.

A key strength of this study lies in its consumer-centered design, as data was collected directly from individuals who use MED-LEMON, ensuring that findings reflect authentic consumer experiences. Additionally, the use of real-world data, self-reported data on perceived effectiveness provides valuable insights into everyday usage patterns, enhancing the ecological validity of the results. However, certain limitations should be acknowledged. First, the reliance on a digital online survey may have introduced selection bias as individuals with limited internet access or lower digital literacy were less likely to participate, potentially skewing the sample toward younger, more tech-savvy consumers. Second, recall bias is an inherent concern in self-reported data; although this was mitigated by recruiting participants who had consumed MED LEMON within the past three months, inaccurate recollection may still have occurred. Third, the absence of clinical verification means that responses reflect subjective perceptions rather than objective measures of effectiveness, which may have been influenced by expectancy effects or prior beliefs about the product. In addition, unmeasured confounders—such as variation in cold and flu severity or differences in health-seeking behaviour—may have affected perceived outcomes, limiting causal interpretation. Finally, because this study was conducted among South African consumers who reported using MED LEMON, the findings may not be generalizable to populations in other countries or to individuals with different healthcare access, cultural practices, or OTC medication preferences.

5. Conclusions

This study provides real-world evidence on consumer decision-making, perceived effectiveness, and attitudes toward OTC cold and flu medications, with a specific focus on MED-LEMON. The findings offered valuable insights into the factors influencing OTC medication selection among individuals managing acute cold/ flu symptoms, highlighting the importance of attributes such as effective symptom relief, ease of use, and overall user satisfaction.

Perceptions of MED-LEMON aligned with key consumer priorities, and its use was associated with reported benefits in QoL during periods of illness. These results contribute to the growing body of evidence supporting patient-centered approaches to OTC medication use and underscore the relevance of incorporating consumer perspectives when evaluating treatment options and designing self-care strategies for health promotion.

Overall, the study informs healthcare providers, policymakers, and manufacturers by identifying determinants of OTC medication choice, perceived value, and user satisfaction. From a public health perspective, these insights support evidence-based decision-making and may contribute to the optimization of population-level strategies for the management of cold/flu symptoms, potentially improving self-care practices and reducing unnecessary healthcare utilization.