Why Do People Buy Prescription Medicines Online? A Qualitative Interview Study

ABSTRACT

Introduction: Many people in the United Kingdom (UK) are turning to the internet to obtain prescription medicines. This introduces a significant public health risk and patient safety concerns, for example because the internet is a source of fake medicines. According to an estimate by the UK government, 1 in 10 people in the UK bought a fake medical product online in 2021 (1). To help address this problem, it is important to understand why people buy prescription medicines online in the first place. Aim(s) This qualitative study aimed to identify why people in the UK purchase medicines online, including their perceptions of risks posed by the availability of fake medicines online. The focus was on prescription-only medicines (POMs). Method(s) Semi-structured interviews were conducted with adults based in the UK who had previously purchased medicines online. Purposive sampling was adopted to achieve diversity regarding participants' experiences and demography. The interviews were conducted online using Microsoft Teams. The recruitment process started in April- 2021 and ended in May-2022. The recruitment was continued until no new codes were identified (data saturation was reached). Interview transcripts were analysed using thematic analysis with the Theory of Planned Behaviour (TPB) acting as a framework to develop the coding of themes (2). Result(s) Twenty participants (12 female, 8 male) were interviewed. Participant age groups were 18-29 (n = 4), 30-39 (n = 4), 40-49 (n = 5), 50-59 (n=4), and >=70 (n = 3). Participants had bought various types of POMs (e.g., antibiotics, and high-risk controlled medicines). Participants demonstrated awareness of the presence of fake medicines online, and they understood risks associated with them. The factors that influenced participants to buy medicines online were grouped into themes including advantages (Avoiding long waiting times;Bypassing gatekeepers;Medicines availability;Lower costs;Convenient process;Privacy) and disadvantages (Medicines safety concerns;Medicines quality concerns;Higher costs;Online payment risks;Lack of accountability;Engage in an illegal behaviour) of purchasing medicines online, the social influencing factors (Interactions with healthcare providers;Other consumers' reviews and experiences;Words of mouth by friends;Influencers' endorsement), the barriers (General barriers;Website specific barriers) and facilitators (Facilitators offered by the illegal sellers of medicines;Facilitators offered by various internet platforms;COVID-19 outbreak as facilitating condition;Consumer personability) of the purchase as well as factors that lead consumers to trust (Website features;Product appearance;Positive previous purchase experience) the online sellers of medicines. Conclusion(s) The in-depth insight into what could drive people in the UK to buy medicines online could enable the development of effective and evidence-based public awareness campaigns that warn consumers about the risks of buying fake medicines from online sources. The findings could also help researchers to design other interventions to prevent people from buying POMs online. A limitation of this study is that although the interviews were in-depth and data saturation was reached, the findings may not be generalisable as this was a qualitative study. However, the TPB which informed the analysis has well-established guidelines to develop a questionnaire, for a future quantitative study.