Wilkins (1999, p. 30) summarizes the E-health consumer when he states that:
In this new era of consumerism in health care, consumers are going to take ownership of in-formation about themselves and demand value in exchange for it, such as better clinical out-comes and better service. The concept of the information-empowered consumer is growing rapidly, and the days in which only certain “qualified” medical professionals create and dis-seminate medical information are receding.
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Consumers seeking information about health-related information have more options today than they had in the past .Available technology provides consumers with more outlets to seek information with a sense of empowerment. . The internet is a source of easy and quick access to information including health information.
The internet has reinvented the way consumers search for information and has influenced decision making process especially in the health care industry. In general, health care-related information seekers can be motivated in several ways. (Williams et al. (2003) highlights that people might be searching for information as a healthcare professional, as a consumer trying to diagnosis his illness or as a patient to complement information from a doctor or for general interest browsing.
Several studies indicate that the search for health information online is increasing (Ahmann, 2000; Wilkins, 1999; Natesan, 2005). Consumers are accessing health-related web sites in growing numbers and finding information that were once protected. Larson et al. (2004) however claims that co online information search is perceived as being more risky than other channels of information by consumers (Larson et al., 2004).
Moreover Tan-Torres ( 2000) points out that the inconsistency in the quality of e-health information is a matter of concern as there is an increasing number of websites which offer a large variety of information.
Therefore the consumer should be sceptical about all web sites, they should look for code of conduct labels or other quality labels that may communicate whether a site is reputable and should remember to communicate with doctors or medical professionals openly about web site usage as a means of obtaining health care information.
2.08 “Will you adopt online procurement of Medication?” – Role of cognitive factors
Consumers’ self-awareness underlies their rational planning of future purchase behaviours relative to perceived consequences. The application of socio-cognitive factors to consumers’ proclivity toward (or aversion to) Internet exchange processes is evidenced across a host of effects applications in the social sciences literature. In addition to cognitive and personality variables that have been explored as predictors of online behaviour such as neuroticism, locus of control, shyness, extroversion, and risk-aversion(Amichai-Hamburger & Ben-Artzi, 2000;AmichaiHamburger,Wainapel, & Fox, 2002; Chak & Leung, 2004; Gupta, Su, & Walter, 2004) , there are other important cognitive factors, such as self-efficacy and objectivism, that influence consumers’ pharmaceutical procurement decisions via the Internet.
2.8.1 Impact of Self –Regulation on the procurement of medication online.
Self-regulation is considered as an internal control mechanism that regulates individuals’ behaviours (Bandura, 1986). Social cognitive theory posits that these internal control mechanisms influence both attitudes and behaviours. Higgins (1998) suggested that individuals with a promotion focus are more motivated by the benefits that will accrue to them by taking actions, whereas people who are prevention focused will place more importance on safety.
Promotion focused individuals use “eager strategies,” whereas those with prevention focus prefer “vigilant strategies” (Crowe & Higgins, 1997). Online shopping has been associated with the prevention focus in individuals because of the security concerns and inherent risks (Miyazaki & Fernandez, 2001; Fennis, Kerkhof, & van Noort, 2006; van Noort, Kerkhof, & Fennis, 2007). Moreover, Higgins (1998) stated that while self-regulation is not an inherent individual difference factor, it may still manifest differences across individuals.
Online shopping has been associated with the prevention focus in individuals because of the security concerns and inherent risks (Miyazaki & Fernandez, 2001; Fennis, Kerkhof, & van Noort, 2006; van Noort, Kerkhof, & Fennis, 2007). However in the case of shopping pharmaceuticals online it might not be similar. In the case of purchasing medications online from illegitimate Web pharmacies, consumers are voluntarily engaging in several potentially risk-laden decisions such as fear associated with online acquisition, uncertainty related to suppliers’ integrity and product quality and the qualms linked to self–initiated rather than physician mediated health care decisions. Online shopping is often associated with convenience, but this may not be the principal consideration in the case of self-initiated purchase of medication from online pharmacies.
The predominant motivating factors in online pharmaceutical procurement are cost reduction for medications and obtaining medications that are not easily accessible through brick-and-mortar retail pharmacy channels. Thus, it may be speculated that consumers are acting with a promotion focus rather than a prevention focus. According to regulatory focus theory (Higgins, 1998; Crowe & Higgins, 1997; Zhou & Pham, 2004), promotion focus is associated with the willingness to engage in risk-laden behaviours for specific goal attainment.
2.8.2 Health Value & its impact on online Procurement of medication.
Health value has often been investigated as a moderator as well as an antecedent of health-related behavior (Jayanti & Burns, 1998; Ugland, 1989; Tapler, 1996; Lau, Hartman, & Ware, 1986). It is an individual’s assessment of the value of engaging in health-related behavior (Jayanti & Burns, 1998). According to Rotter (1954), people who believe concurrently that they have control over their health and that they value their health are more likely to engage in health related behaviour than their contemporaries who do not.
Higgins (2002) points out that promotion-focused decision maker will consider promotion relevant value dimensions as more important, and vice versa in the case of prevention-focused decision makers. This means that the promotion-relevant aspects such as staying healthy will be considered in the decision to purchase from online pharmacies by promotion-focused consumers. On the other hand, prevention-focused consumers are more likely to focus on the negative aspects of the action (e.g., counterfeit drugs, reactions with other medications, lack of support of a doctor).
2.8.3 Self Efficacy & its impact on online procurement of medication
Self-efficacy has been found to be a consistent predictor of health behaviour by many researchers (Tapler, 1996; Janz & Becker, 1984; Strecher et al., 1986; Block & Keller, 1997; Jayanti & Burns, 1998). However, its application has been limited to specific health conditions or diseases, and it has rarely been applied to a field such as online procurement of medications.
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An individual’s promotion focus has been related to the higher self-efficacy associated with health behaviours by previous researchers (e.g., Keller, 2006).This means that consumers high in self-efficacy are willing to engage even in risky and new alternatives to achieve their objectives (Keller, 2006; Crowe &Higgins, 1997).Thus, with reference to regulatory focus theory, one can argue that self-efficacious individuals will have a higher propensity to procure medications from online pharmacies as compared to the prevention-focused, low-self-efficacy group.
Further, it has been argued that self-efficacy beliefs influence consumers’ choice behaviours (Bandura, 1986; Litt, 1988; Bagozzi, 1993), especially in challenging situations. These situations that call for self-driven coping may compel consumers to find ways and means to cope with the challenge, encouraging them to take actions that may even be perceived to be more risky. Rising costs and difficulties involved in procuring many medications through traditional channels of distribution present today’s health care consumers with such challenging situations. Online procurement of medication is seen by consumers as a self-driven coping strategy aimed at cost containment and waiting-time reduction (for doctors’ prescriptions) (Erdem & Chandra, 2003). However, safety, ethical, and legal concerns associated with the online procurement of medications suggests that a consumer with low self-efficacy may be less willing to purchase medications online compared to those possessing high levels of self-efficacy
2.8.4 Health Locus of Control & its impact on the procurement of online medication.
Health locus of control refers to the perception of controllability in health-related situations. Since perceived control has been found to influence behaviour (Skinner, 1996; Sprott, Brumbaugh, & Miyazaki, 2001), it is important to understand how health locus of control would influence consumer behaviour related to procuring medications online (i.e., channel choice).
Wallston, Wallston, and DeVellis (1978) conceptualized it as a three dimensional construct consisting of internal, powerful others, and chance dimensions. These three dimensions are distinguished from each other based on who the person ascribes the responsibility for his/her health to. If he/she believes that his/her own actions dictate his/her health, the person is considered to have a high internal health locus of control. Similarly, the person who believes his/her health to be dependent on a powerful other, such as a physician, will be high in powerful others health locus of control. The belief that health results by chance is categorized as chance health locus of control. Rotter (1975) stated that the three dimensions of health locus of control can be categorized based on their internal or external orientations.
According to Rotter (1975), the three dimensions of health locus of control can be categorized based on their internal or external orientations. The categorizations of individuals into internals and externals is based on whether they perceive that the results (of their behaviours) are dependent on themselves (internal locus of control) or outside their control (external locus of control) (Rotter,1966; Strickland, 1978; Norman & Bennett, 1996; Armitage, 2003; Wallston, Wallston, & DeVellis, 1978).
According to Rajasree and Lou E.( 2009) online procurement of medications, due to its inherent risk content, may be a health behaviour that is likely to be avoided by consumers with external locus of control (i.e., powerful others health locus of control and chance health locus of control). If a person believes in the ability of a powerful other (e.g., his physician) to deal with the problem (illness), she/he is likely to rely on the physician’s advice rather than procure medications online by her/himself. Similarly, consumers with high chance health locus of control are less likely to try their luck by buying from unknown sources. Health locus of control is just a domain specific form of control. Therefore, it can be speculated that consumers high in internal health locus of control will seek to buy online, as it gives them more control over their purchases. These control factors include cost savings, expansive product choice, and even additional medication accessibility. In accord with regulatory focus theory, consumers with internal locus of control (i.e., promotion-focused individuals) are willing to take risks and try new options to achieve their goals of obtaining medication that will alleviate their problems.
2.8.5 Objectivism & its impact on the procurement of online medication
According to Leary et al. (1986), objectivism is the “tendency to base one’s judgments and beliefs on empirical information and rational considerations” (p. 36). Individuals who are objective in nature will place more emphasis on information obtained from empirical supports during decision making.
Regulatory focus theory suggests that prevention-focused individuals are more concerned with security, safety, and protection in general (Higgins, 1998; Higgins & Spiegel, 2004). Pham and Avnet (2004) assert that promotion-focused individuals rely more on affective information rather than objective information. Thus, it can also be argued that since objectivism is more associated with prevention focus rather than promotion focus, objective consumers may stay away from online procurement of drugs.
2.8.6 Gender, Income, Educational Status and Insurance Status & impact on online medication procurement
Many studies have identified the gender differences that exist in health care consumption behaviors (e.g., Conner & Norman, 1996; Stelmach et al., 2004; Green & Pope, 1999). These studies find women to be more proactive in seeking health care services and to be more involved in health-related behaviors. On the other hand, online shopping literature finds men to have a greater propensity to shop online than women (Otnes & McGrath, 2001; Shim, Eastlick, & Lotz, 2000; Briones, 1998; Rajamma & Neeley, 2005). Garbarino and Strahilevitz (2004) stated that one reason for this difference could be the higher perception of risk associated with buying online among women
Very few studies have examined the influence of income, educational status, or insurance status on the consumer’s propensity to procure medications online. One of the motivating factors for any consumer in procuring medications online is the lower cost. The conclusion from this argument is that lower-income consumers may prefer procuring medications online than their higher-income counterparts. However, it is to be noted here that the lower income consumers may not always have Internet access (Jump for Web Prescription Sales, 2004) and may not have the knowledge or familiarity with the different technologies involved to be successful Internet shoppers.
Rajasree and Lou E. (2009) stated that in spite of the hypothesized differences across consumers with respect to their propensity to procure medications online based on income and level of education, no differences are expected based on consumers’ insurance coverage. Low-income consumers are less likely to have insurance coverage than higher income consumers. Consumers without insurance coverage are likely to abstain from buying medications from brick-and-mortar or Internet-based pharmacies as far as they can help it, since they have to pay for it anyway. On the other hand, consumers with insurance coverage are likely to be indifferent to where they buy the medications, as their insurance covers the cost.
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