Planned Behavior in the United Kingdom and Ireland Online Medicine Purchasing Context: Mixed Methods Survey Study

Abstract

Background: Online medicine purchasing is a growing health care opportunity. However, there is a scarcity of available evidence through a behavioral lens, which addresses why consumers buy medicines online. Governments try to influence online medicine purchasing behavior using health campaigns. However, there are little data regarding specific online medicine purchasing behaviors to support these campaigns.

Objective: The theory of planned behavior explains that perceived behavioral control (PBC), attitudes, and norms contribute to intentions, leading to behaviors. This study challenges these assumptions, by testing them in an online medicine purchasing context. We asked: What is the role of attitudes, norms, and PBC in an online medicine purchasing context.

Methods: An anonymous online snowball convenience sample survey, including open and closed questions concerning online medicine purchasing, was implemented. The data were thematically analyzed until data saturation. The emerging themes were applied to each individual response, as part of a case-by-case narrative analysis.

Results: Of the 190 consumers from the United Kingdom and Ireland who consented to participate in the study, 46 participants had purchased medicines online, 9 of which were illegal sales. Of the 113 participants who demonstrated an intention to purchase, 42 (37.2%) completed a purchase. There were many cases in which participants demonstrated an intention to buy medicines online, but this intention did not translate to a purchasing behavior (71/190, 37.4%). Reasons for consumers progressing from intention to behavior are suggested to be impacted by PBC and attitudes. Qualitative data identified access to medicine as a factor encouraging online medicine purchasing behaviors and a facilitator of behavior transition. Despite understanding the importance of why some medicines required a prescription, which is described as an example of legal and health norms, and despite suspicion and concern categorized as negative attitudes in this paper, some participants were still buying products illegally online. Risk reduction strategies were performed by 17 participants (17/190, 9%). These strategies facilitated a transition from intention to behavior.

Conclusions: The study results indicate that a consumer's intention to buy does not automatically translate to a purchasing behavior online; instead, a transition phase exists. Second, consumers followed different pathways to purchase and used risk reduction practices while transitioning from an intention to a behavior. Finally, owing to the covert nature of online medicine purchasing, norms do not appear to be as influential as PBC and attitudes in an online medicine purchasing setting. Understanding how a consumer transitions from an intention to a behavior could be useful for researchers, health care professionals, and policymakers involved in public health campaigns. We encourage future research to focus on different consumer behavior pathways or ideal types, rather than taking a blanket approach to public health campaigns.

Keywords: attitudes; consumer behavior; medicine; online purchasing; perceived behavioral control; planned behavior.

Figure 1

An adapted theory of planned behavior model with red lines representing this study’s proposed contributions, showing attitudes and perceived behavioral control as mediators of the transition from intention to behavior.