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 »  Abstract
 » Introduction
 »  Materials and Me...
 » Results
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 Table of Contents    
SHORT COMMUNICATION
Year : 2022  |  Volume : 54  |  Issue : 2  |  Page : 131-137
 

A preliminary study to evaluate the behavior of Indian population toward E-pharmacy


1 Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh; MM College of Pharmacy, Maharishi Markandeshwar University, Mullana, Ambala, Haryana, India
2 Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, India

Date of Submission28-Oct-2021
Date of Decision21-Mar-2022
Date of Acceptance24-Mar-2022
Date of Web Publication10-May-2022

Correspondence Address:
Prof. Bikash Medhi
Department of Pharmacology, Room No: 4044, 4th Floor, Research Block B, Postgraduate Institute of Medical Education and Research, Chandigarh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijp.ijp_836_21

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 » Abstract 


The use of the Internet has increased exponentially for buying as well as selling of goods. Even the purchase of medications online is no exception. Owing to its benefits, there are certain risk factors in purchase of online medicines. Currently, the data on the use of Internet pharmacies are limited. Thus, the main objective of our study is to assess the knowledge, attitude, and practices (KAP) of Indian population toward E-pharmacy in India carried out in the Department of Pharmacology, PGIMER, Chandigarh. A KAP questionnaire was prepared which was distributed to the participants through Google Forms and a URL sent to them. This questionnaire was divided into four sections including demographics, occupation, income, and use of the Internet to measure the alertness toward the online purchase of medicines. A total of 322 responses were collected, out of which only 268 (83.2%) participants were aware of online pharmacy. The awareness was more in males and that too in urban population. Among the respondents, majority of the users prefer to buy medicines offline (81%, n = 217) which can be due to poor quality of medicines and lack of trustworthy websites. The utmost reason for buying the medicine online was deficiency of availability in the market and differences in the prices. The most preferred drugs respondents were willing to buy online were prescription drugs followed by cosmetics and dietary supplements. In conclusion, of our results, most of the people use the Internet to search for the medications online who prefer to consult the physicians before buying. Therefore, the future of online pharmacy can be improved if there will be some set guidelines, awareness, and knowledge among the users.


Keywords: Attitude, E- pharmacy, knowledge, perception


How to cite this article:
Bansal S, Kaur H, Mahendiratta S, Sarma P, Kumar S, Sharma AR, Joshi R, Bhattacharyya A, Prajapat M, Prakash A, Medhi B. A preliminary study to evaluate the behavior of Indian population toward E-pharmacy. Indian J Pharmacol 2022;54:131-7

How to cite this URL:
Bansal S, Kaur H, Mahendiratta S, Sarma P, Kumar S, Sharma AR, Joshi R, Bhattacharyya A, Prajapat M, Prakash A, Medhi B. A preliminary study to evaluate the behavior of Indian population toward E-pharmacy. Indian J Pharmacol [serial online] 2022 [cited 2022 May 18];54:131-7. Available from: https://www.ijp-online.com/text.asp?2022/54/2/131/344965





 » Introduction Top


E-commerce is defined as the online selling and buying of goods or products, and this concept was developed during the early 1970s. It is done through an online shop, e-shop, e-store, Internet shop, or online store. The description of all the online products is described through text, with photos and with multimedia files.[1]

Application of E-commerce in medicine led to the beginning of online pharmacies which was first initiated in the United States during the year 1999. This included the selling of both nonprescription and prescription-only medicines. However, the official approval for online drug transaction services started on December 1, 2005, after China's Food and Drug Administration issued the provisional rules of the Internet for examination.[2]

The benefit by making use of online shopping is the use of technology for better marketing performance, where retailers generally use different strategies to meet the demand of online purchasers. They also try to understand the consumer in the field of online shopping and specifically study those factors which influence the consumers to shop online. The other advantages of buying online are lower transaction and search cost in comparison to other types of shopping. It also makes faster shopping, providing more alternatives and with reasonable prices.[3]

Although purchasing from E-pharmacies holds many advantages, data from the World Health Organization (WHO) have marked a question upon its safety. The complexity and seriousness of this problem increased when the WHO estimated that about 50% of the medications marketed on the Internet are from counterfeited websites. Internet pharmacies without any regulation sell counterfeit drugs, hence posing a great threat to public health with tragic consequences to consumers.[3] A Western European study conducted on 14,000 people has reported that out of five, one people is acquiring medication from the Internet without prescription. This demonstrated that purchasing Western Europe spent around 10.5 million Euros per year on nonprescription medicines from illegal resources.[4] A survey was also done in Romania to assess the attitude of patients and customers on online purchasing of drugs. It was reported that maximum of the people were not aware about the differences between medications purchased from Internet and conventional pharmacies. Such studies indicate that attention should be paid toward online purchasing of drugs during routine patient care.[5]

Hence, the above literature made us to aim our study to evaluate the knowledge, attitude, and practices (KAP) of Indian population toward E-pharmacy. KAP studies are the most frequently used tool in health-seeking behavior research where it represents a precise population collecting evidence on what is known, believed, and done in relation to a particular topic.[6] Thus, the major objective of this study is to evaluate the current situation concerning purchasing of drugs from online sources and how it influences the use of medical products and drug safety. This was achieved by surveying patients/consumers/caregivers and clients of community practices. The advantage of this kind of survey is that it also assesses the customer attitude toward purchase of other medicinal products such as dietary supplements and herbal remedies.


 » Materials and Methods Top


Study design

This was a questionnaire-based study, carried out in the Department of Pharmacology, PGIMER, Chandigarh. A KAP questionnaire was planned to measure the awareness toward online purchase of medicines. It was divided into four sections, in which the first section was focused on demographic information, i.e., age, gender, education level, occupation, income, and use of the Internet. In addition to this, it also focused on their knowledge of E-pharmacy, their attitude, and practices toward purchase of medicines from E-pharmacy. There were 24 questions in all (8 each related about KAP). The primary version of the survey was developed via wide literature review in English language.[7],[8],[9]

Validation of questionnaire

The questionnaire content was screened out for appropriateness. Validity and pretesting of the questionnaire were randomly done on 20 selected participants of the institute and were performed by experts at the Department of Pharmacology, PGIMER, Chandigarh. The questionnaire was finalized after modification of indefinite and incompatible questions on the basis of the result of the Pretest.

Data collection

The pretested questionnaire was distributed among all the participants. Google Forms was used to manage the survey questionnaire as it was user-friendly. A message relating to the survey was sent to friends, with a URL link to the survey. One-day time was allotted to them for the collection of the filled forms. The participants were requested to answer in as multiple-choice formats.

Statistical analysis

Data were analyzed statistically using SPSS Inc. Released 2007. SPSS for Windows, Version 16.0. Chicago, SPSS Inc. To illustrate demographic characteristics of participants, descriptive statistics were used. Continuous variables were expressed as mean ± standard deviation (SD) while categorical variables were measured as percentages.

Data analysis

Data were retrieved in Excel format from online forms, whereas from offline forms, data were entered into Excel manually. The data were further analyzed by using SPSS statistical software. Qualitative variables were represented as percentage. In the case of normally distributed quantitative data (age), mean ± SD was used for further representation.


 » Results Top


Baseline characteristics of the participants

We approached a total of 550 potential participants for participation in the survey (350 online and 200 offline), out of which 322 volunteered to participate in the survey (online: 195 and offline: 127). The response rate was 64.4%. Out of 322 total participants, 268 participants (83.2%) were aware of online pharmacy. In the next phase, data regarding online pharmacy were collected from these 268 participants [Figure 1].
Figure 1: Participant flowchart

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Awareness about online pharmacy

Aware about online pharmacy (n = 268)

The awareness regarding online availability of medicines is comparable across both genders (males: 51.49% and females: 48.50%). The educational status of the aware population ranged from graduate (n = 153, 57.08%) to postgraduate (n = 83, 30.97%). Awareness was more in urban population (n = 200, 74.62%) as compared to rural (n = 60, 22.38%). Among them, 27.61% used the Internet daily (n = 74), 26.49% used 3–4 times a week (n = 71), 24.62% used the Internet less than once a week (n = 66), and interestingly, 11.19% (n = 30) never used the Internet [Table 1]a.


Click here to view


Not aware about online pharmacy (n = 54)

Among the respondents who were unaware about the online pharmacy, most of them were graduates (n = 31, 57.4%) followed by postgraduates (13, 24.07%). SPSS Inc. Released 2007. SPSS for Windows, Version 16.0. Chicago, SPSS Inc. Among participants who were unaware of online pharmacy, 38.88% (n = 21) never used the Internet while interestingly it included 8 participants who used the Internet daily (14.81%) [Table 1]a.

Online versus offline users: Baseline characteristics

Although a total of 268 respondents were aware about online pharmacy, majority of them preferred to purchase medicine offline (n = 185, 69%).

Among the offline and online pharmacy users, the mean age across both the groups was almost similar (online: 28.34 ± 7.369 and offline: 28.82 ± 7.134).

Regarding educational status, most respondents across both the groups were graduates and postgraduates.

Regarding those who purchase medicine online, 78.31% (n = 65) belonged to urban area and 20.48% (n = 17) to rural area as compared to offline users where 72.97% (n = 135) belonged to urban area and 23.24% (n = 43) to rural area [Table 1]b.

Knowledge, attitude, and practice domains (evaluated in participants who are aware about online pharmacy)

Knowledge domain

Among the respondents who were aware about the online purchase of medicines, only 37.7% (n = 101) were aware about the trustworthy websites for purchasing medicines online. 19.4% (n = 52) of respondents knew about the availability of the pharmacist for responding to queries on online pharmacies. 36.9% (n = 99) of participants considered the name of country to be mandatory aspect for purchasing via online pharmacy. Despite knowledge, only 10.8% (n = 29) of people responded to naming the different sites being used by them for making an online purchase [Table 1]c.

Attitude domain

Despite being aware regarding the online availability of medicines, majority of the users (81%, n = 217) prefer to buy medicine offline. The reason for which can be attributed partly to the perceived threats (38.1%, n = 102) by the users. The chief threats perceived by them included possibility of poor quality of medicine (60.86%, n = 56) and lack of trustworthy website/fear of fake website (18.47%, n = 17). However, 19% (n = 51) of users opine that the medicines available online are authentic as compared to 15.3% (n = 41) who believe the medicines to be of substandard quality while 3% (n = 8) believe them to be fake. The most commonly cited reasons for online purchase were the nonavailability of medicines in the market (20.1%, n = 54), difference in price (20.8%, n = 56), and 24-h availability (17.1%, n = 46) among others. Whereas availability of medicine in the market (26.8%, n = 72) and no idea about the quality of medicine (27.2%, n = 73) have been quoted majorly as a reason behind not buying medicine online. Availability of pharmacists (45.52%, n = 56), ease of access for illiterate (31.7%, n = 39), ease in returning medicines if needed (26%, n = 32), buying as per requirement (34.4%, n = 42), and immediate availability (36.58%, n = 45) have been cited as major reasons behind offline purchase of medicines. Lack of privacy (51.21%, n = 63) and less available brands to choose from (23.57%, n = 29) have been found to be the disadvantages when preferring offline purchase. As far as the experience of both pharmacies is concerned only 16.7% (n = 45) found the online pharmacy to be good in comparison to offline pharmacy where 85.4% (n = 229) of users had good experience [Table 2].
Table 2: Attitude domain questions

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Practice domain

46.66% (n = 21) of the users have been purchasing medicines for about 6–12 months as compared to 37.77% (n = 17) who were buying for more than 1 year. Awareness is least helpful for determining the online purchase as 69% (n = 185) of users never purchased any medicine online as compared to occasional purchasers (24.3%, n = 65). Internet use and the quest for gaining knowledge regarding medical information have increased with the advent of technological advancement. The users who indulge in Internet surfing and search for medical information daily were 27.6% (n = 74) in contrast to 25.4% (n = 68) and 23.9% (n = 64) who used the Internet for sometimes a week and less than once a week, respectively. 51.9% (n = 139) of the users who were aware prefer to consult their physician before purchasing medicines online. 52.2% (n = 140) check whether the package insert is in their familial language or not. As far as preference regarding category of drugs for purchasing online is concerned, 27.2% (n = 73) of users were willing to purchase prescription drugs followed by cosmetics (22.3%, n = 60), dietary supplements (17.9%, n = 48), lifestyle medications (3.7%, n = 10), and narcotics (1.8%, n = 2). However, 25% (n = 67) of users preferred to buy as per their requirement irrespective of the category of drugs. Among the respondents, 59.3% (n = 98) preferred both branded and generic while purchasing online as compared to 26.5% (n = 44) who preferred to buy branded drugs and 14.45% (n = 24) who preferred generic drugs [Table 3].
Table 3: Practice domain questions

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 » Discussion Top


Our study represents one of the few attempts in the literature to determine the current situation of acquiring medicines online and its impact on drug safety and medical product use. The survey was conducted on patients/consumers/caregivers and clients of community pharmacies. To our knowledge, this is the first study in India where we have evaluated the KAP not only toward online purchase of medicines but also other supplementary medicinal products.

It was observed that more than half of the participants were aware of the online purchase of medicines. Age, gender, and educational qualification do not have any significant effect on the purchasing behavior of individuals toward online pharmacy as also demonstrated by Fittler.[8] A survey by Abanmy et al. showed less extensive online purchase of medicines, as 268 participants were aware of the E-pharmacy, but only 83 of them actually purchased the medicines online. There are other population surveys as well on the perceptions and attitude of the consumer but could not find any consistent information on the number of consumers and their characteristics.[2] In our study, most online customers were found to be graduates (61.44%) and belonged to the urban areas (78.31%).

The patient's attitude toward online pharmacies for purchasing of medicines and health products is very important to maintain the integrity of the medication supply chain and for the protection of the patients from illegitimate websites.[10] Even in our survey, it was demonstrated that only 37.7% of the participants were aware of the trustworthy sites and 89.2% did not even answer from which websites they order the medicine. This showed that they had no knowledge of the websites for purchasing of health-care products.

The findings in our survey had some main features which would attract the use of online pharmacy such as differences in the prices and nonavailability of medications in market. These results were consistent with other studies where the most frequent reasons quoted by the interviewees were convenience-related factors such as easy availability (59%) and reduced trips to the pharmacy (41%).[5],[11]

Study results also indicates that people used the internet to search medical information however, and half of them consulted the physician before purchasing the medicine online. Our study also demonstrated the preference of the participants in which maximum number of individuals bought both branded and generic medications.

Limitations of study

The study is exploratory and sample size is small, thus more deep investigation is required.


 » Conclusion Top


In our study, 268 participants were aware of E-pharmacy, but only 83 of them actually purchased the medicines online. While majority of the participants did not respond (88.8%), only 5.2% of people perceive the future of online pharmacy to be good as compared to 1.9% who perceive it to be doubtful. E-pharmacy is the need of an hour today, so it should be allowed to the consumers of India, however sufficient safeguard and rigid regulatory conditions should be maintained to ensure the safety and quality of medicines purchased from online pharmacy.

Acknowledgment

National Postdoctoral Fellowship granted to Dr. Seema Bansal by SERB-DST is highly acknowledged.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
 » References Top

1.
Pappas N. Marketing strategies, perceived risks, and consumer trust in online buying behaviour. J Retail Consum Serv 2016;29:92-103.  Back to cited text no. 1
    
2.
Orizio G, Merla A, Schulz PJ, Gelatti U. Quality of online pharmacies and websites selling prescription drugs: A systematic review. J Med Internet Res 2011;13:e74.  Back to cited text no. 2
    
3.
Moshrefjavadi MH, Rezaie Dolatabadi H, Nourbakhsh M, Poursaeedi A, Asadollahi A. An analysis of factors affecting on online shopping behavior of consumers. Int J Mark Stud 2012;4:81-98..   Back to cited text no. 3
    
4.
Growing threat from counterfeit medicines. Bull World Health Organ 2010;88:247-8.  Back to cited text no. 4
    
5.
Alfahad NF, Albelali MT, Khurshid FM, Al-Arifi MN, Al-Dhawailie AA, Alsultan MS. Perception and knowledge to online pharmacy services among consumers in Riyadh, Saudi Arabia: A pilot survey. Lat Am J Pharm 2015;34:1113-8.  Back to cited text no. 5
    
6.
Ul Haq N, Hassali MA, Shafie AA, Saleem F, Farooqui M, Aljadhey H. A cross sectional assessment of knowledge, attitude and practice towards Hepatitis B among healthy population of Quetta, Pakistan. BMC Public Health 2012;12:692.  Back to cited text no. 6
    
7.
Abanmy N. The extent of use of online pharmacies in Saudi Arabia. Saudi Pharm J 2017;25:891-9.  Back to cited text no. 7
    
8.
Fittler A, Lankó E, Brachmann B, Botz L. Behaviour analysis of patients who purchase medicines on the internet: Can hospital pharmacists facilitate online medication safety? Eur J Hosp Pharm 2013;20:8-12.  Back to cited text no. 8
    
9.
Pál S, László K, András F, Gabriel H, Hajnal F, Adriana C, et al. Attitude of patients and customers regarding purchasing drugs online. Farmacia 2015;63:93-8.  Back to cited text no. 9
    
10.
Mackey TK, Nayyar G. Digital danger: A review of the global public health, patient safety and cybersecurity threats posed by illicit online pharmacies. Br Med Bull 2016;118:110-26.  Back to cited text no. 10
    
11.
Fung CH, Woo HE, Asch SM. Controversies and legal issues of prescribing and dispensing medications using the Internet. Mayo Clin Proc 2004;79:188-94.  Back to cited text no. 11
    


    Figures

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    Tables

  [Table 1], [Table 2], [Table 3]



 

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