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Official websites use. Share sensitive information only on official, secure websites. Correspondence to Dr Lobna Gharaibeh; l. Online purchasing, including drugs, increased dramatically in the last decade especially through the COVID pandemic. The aim of this study was to investigate the frequency and attitudes of consumers concerning online drug purchasing and assess their perceptions regarding the benefits and disadvantages. Primary outcome measures were extent of trust of the public in online drug purchasing using Likert scale. Multivariate linear regression was used to assess predictors of the trust score. Inclusion criteria; residents of the Hashemite Kingdom of Jordan 18 years or older. The questionnaire was distributed through snowball effect via different social media. A total of participants filled the questionnaire, their average age was Almost all participants, Fifty participants Participant who purchased drugs online had an increase in trust score of 0. In the multivariate model, participants with education level of high school or higher than high school, compared with those with education lower than high school had an increase in trust score of 1. The public recognises the risks in buying drugs online. Awareness campaigns and regulations that control and monitor online drug purchasing should be implemented. Degree of trust, perceived disadvantages and benefits of online drug purchasing were investigated. The internet has evolved over the past 20 years into a widely used method of making purchases of goods and services 1 and online drugstore purchases are no exception. These online portals build internet-based pharmacies that make it simple to buy a wide range of medications, such as generic over the counter medicines, complementary medicines and prescription-only medicines. An early definition by Fung et al stated that an online pharmacy is any supplier legal or illegal operating on the internet that sells medication. Online pharmacies are not the only source of purchasing drugs online, especially in countries such as Jordan, where online pharmacies are still in their humble beginnings and are not well established. Antibiotics sold online without a prescription were found to have substandard packaging and contained impurities and contaminants. The global phenomenon of buying prescription drugs online has substantial effects on the economy, society and health. Several studies, commenters and websites discussed the potential advantages, benefits and hazards of using internet pharmacies and different online sources. According to Fincham , 9 online illegal stores pose a hazard to global public health because they provide cheap, fake medications that have precarious effects on morbidity and mortality. In addition, consumers may obtain prescription-only medication without a prescription. Unrestricted online access to medications enables individuals to participate in illicit and irregular drug use, which might validate unhealthy lifestyle choices. Patients need to be informed about the medications they are taking and where to get them safely, legitimate online pharmacies can provide these services despite the prevalence of illicit ones. Currently, in Jordan, there are no online pharmacies due to prevailing restrictions. The only legal activity is for individuals to upload their prescription on the pharmacy website, facilitating the retrieval of medicines from conveniently located branches. So, any online drug purchase from an online pharmacy is not permitted. Multivitamins, supplements and dermocosmetics can be bought online from virtual shops and the public often mistakenly associates these platforms with online pharmacies. Efforts to establish legal framework in Jordan are necessary but should not be confined to the national level. Regulating the purchase of pharmaceuticals online requires cooperation between international, national and state entities, as well as between patients and medical professionals. This is the first study conducted in Jordan that explores issues related to online drug purchasing from the consumers point of view. This cross-sectional study aimed at investigating the frequency and attitudes of consumers who buy drugs online. The perceptions of consumers regarding advantages and disadvantages of purchasing medications online were also assessed. This was a web-based survey that was conducted in Jordan from November to February through the distribution of a self-administered questionnaire. The questionnaire was developed after thorough and comprehensive literature review to capture most aspects of the subject. Participants were invited to take part in the survey voluntarily and anonymously. Inclusion criteria: residents of the Hashemite Kingdom of Jordan 18 years or older. A cover letter before starting the questionnaire described the aims of the study, importance and insured the confidentiality and anonymity of the information and participants. Only participants who consented and agreed to fill in the survey were able to access the questionnaire. The questionnaire was established in English was reviewed by two external examiners for scientific relevance and clarity, translated to Arabic by a language expert, and then back translated to English to insure matched meaning. Participants completed the Arabic version. Data in the questionnaire included sociodemographic information seven questions , practices and attitudes towards purchasing medications online nine questions , potential benefits of online drug purchasing four questions , potential disadvantages of online drug purchasing four questions and one single question on the trust score of participants in purchasing drugs from online resources. A pilot study was conducted with 20 participants to check the appropriateness of the questions, easy flow and clarity. Feedback and comments were taken into consideration and modifications were made. Responses from the pilot study were not included in the analysis. The Google Form was accessible from October to March The participants involved in the pilot study were contacted to provide feedback on the questions and different aspects of the questionnaire. Modifications were made accordingly. Independent samples t-test was used to compare the means of continuous data between two groups. The scores from the Likert scale were summed into a total score trust score and possible predictors of trust score were assessed using the univariate and multivariate linear regression. Participants were generally young with an average age of However, only 79 General and sociodemographic characteristics of the participants are shown in table 1. Half of the participants, Of those who purchased drugs online, 22 Most of the participants who purchased drugs online were satisfied with the services 43 Only four participants 9. Drugs that were bought from the online source were either prescription or non-prescription, and the online sources were versatile figure 1A,B. Types of drugs purchased and online sources. Online sources used were mainly local within Jordan 24 Almost two-thirds of the participants believed that non-prescription drugs should be sold online. Additionally, a large percentage also believed that prescription drugs should be available for purchasing online table 2. Different aspects related to the benefits and disadvantages of online purchasing of drugs were assessed using the Likert scale. Most of the participants did not agree that benefits included purchasing better quality drugs. Furthermore, a large percentage of the participants agreed that purchasing fraud drugs is a major disadvantage of online drug acquisition table 3. Participants who purchased drugs online had higher benefits score of online purchasing compared with those who did not buy drugs online, Participants who purchased drugs online had an increase in trust score of 0. Possible predictors of the trust score were assessed using univariate and multivariate linear regression table 4. Most participants in the study used the internet regularly, but only a small percentage shopped online regularly and fewer purchased medication online This process must start by training pharmacists and preparing them to protect their customers and communities since many are unfamiliar with resources that aid consumers in identifying legal online pharmacies. Comparison of the total scores of benefits and disadvantages of online drug purchasing showed a higher score of the disadvantages. This might explain the low percentages of participants who were involved in online drug purchasing. Easy delivery to remote areas and quick delivery were the most agreed on benefits, this finding was similar to results of a study conducted in Hungary by Fittler et al where benefits also included getting the drug past the opening hours and low prices. The risk of purchasing damaged drugs was a concern for the participants. The effective interaction between the patient and the pharmacist leads to better healthcare outcomes in terms of compliance and appropriate medication use. An important concern was the quality of drugs that can be bought online, most participants did not agree that they can obtain dugs of good quality online. Counterfeit medications are a global public health issue that can be distributed illegally, mainly through online sources. According to Shakour et al , counterfeit drugs include wrong ingredients, fake packaging, active ingredients that are not similar to those stated on the package, expired drugs and high quantities of impurities. Additional concerns include receiving incorrect information about drugs 31 and numerous order rejections. Individuals who had a higher trust score in online drug purchasing were those with higher education and those who bought drugs online. A possible explanation is that educated individuals search more for health information 33 and consequently drugs. Another possible reason is the confidence of educated individuals in dealing with different products, websites and processes during online purchasing, in addition to their ability to investigate and evaluate risks and benefits. Contrary to results from a recent review on online pharmacies, 23 most of the purchased drugs in this study were non-prescription drugs. However, a large percentage of participants believed that prescription drugs should be available online. In Europe, many prescription drugs such as stimulants, opioids and sedatives are sold on online pharmacies without the physician supervision. As mentioned previously, officially, there are no online pharmacies in Jordan. Obtaining these prescription drugs from rogue pharmacies constitutes an illegal activity and predisposes the public to serious consequences. These prohibited activities are also common in developed countries, where despite the prevalence of online pharmacies and the installation of regulations that control their businesses, most of them are poorly regulated, vary in quality and lack sufficient monitoring. Additionally, the fact that half of the participants heard of online pharmacies in Jordan reflects the misconception that websites that sell multivitamins, supplements and dermocosmetics online are mistakenly associated with pharmacies by the public. This confusion necessitates the prompt establishment of regulations and legal regulatory framework that governs and supervises these activities. Different social media proved unreliable sources for online drug purchase. In this study drugs were bought mostly from Amazone, Instagram and Facebook. These venues provide illicit sale of drugs to consumers from high-income and middle-income countries around the world. The study has several limitations including the convenient sampling and the fact that electronic surveys need individuals that can fill in these forms on their phones which might generate bias that could increase the percentage of online drug purchasing. The generalisability may not be affected by this bias since online drug purchasers must possess minimum amount of skill in internet use and technology expertise. Moreover, the cross-sectional nature of the study does not allow follow-up and evaluation of the drug purchases performed online by the participants. Public trend supports the disadvantages of online drug purchasing, which explains the low percentage of this practice. Among the numerous advantages perceived by the public is easy delivery to remote areas and convenience. The public also recognises the risks that are involved, which include receiving damaged drugs, lack of patient—pharmacist relationship and consequent absence of important drug information that can jeopardise the safety of the patient. Individuals with higher education have high trust scores which might be due to their ability to manage and investigate online purchasing processes and sources. In conclusion, alertness to this public health threat should be increased through awareness campaigns that inform the public of the hazards of online purchasing from rogue vendors and guide them to safe and legal online pharmacies or websites. Contributors: LG: author acting as a guarantor. LG: acquisition, analysis, interpretation of data, original drafting, reviewing the submitted draft, responsible and accountable for all aspects of the work. MAM: acquisition, interpretation of data, original drafting, reviewing the submitted draft, responsible and accountable for all aspects of the work. AYA-K: acquisition, interpretation of data, original drafting, reviewing the submitted draft, responsible and accountable for all aspects of the work. AAA: acquisition, interpretation of data, original drafting, reviewing the submitted draft, responsible and accountable for all aspects of the work. AA: interpretation of data, original drafting, reviewing the submitted draft, responsible and accountable for all aspects of the work. NK: interpretation of data, original drafting, reviewing the submitted draft, responsible and accountable for all aspects of the work. IDA: interpretation of data, original drafting, reviewing the submitted draft, responsible and accountable for all aspects of the work. Funding: The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors. Refer to the Methods section for further details. Supplemental material: This content has been supplied by the author s. Any opinions or recommendations discussed are solely those of the author s and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. A cover letter that explained the objectives of the study and guaranteed the anonymity of participants was placed at the beginning of the questionnaire. If the participant consents to participation, they will be able to fill the form. This section collects any data citations, data availability statements, or supplementary materials included in this article. As a library, NLM provides access to scientific literature. BMJ Open. Find articles by Lobna Gharaibeh. Find articles by Mariam Ahmad Alameri. Find articles by Aya Y Al-Kabariti. Find articles by Alhareth A Alsa'd. Find articles by Anas Abed. Find articles by Nida Karameh. Find articles by Ibrahim D Aldeeb. No commercial re-use. See rights and permissions. Published by BMJ. Open in a new tab. Provenance and peer review: Not commissioned; externally peer reviewed. Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel. Prescription medicines drugs for asthma, diabetes and blood pressure. Non-prescription medication drugs for constipation, cough, diarrhoea, cold, vitamins and minerals. Lifestyle medicines such as Viagra and birth control pills. Easy delivery especially for those far from any community pharmacy. Purchasing drugs from online sources is easier and quicker. Online purchase is more susceptible to fraud and deceit such as damaged, counterfeit or drugs that were not ordered. Online purchase bypasses the health professional-patient relationship. Additional fees shipping fee, account set-up fee, delivery fees. Due to the delivery time, I'm getting the drug later compared with a pharmacy.

Reasons that lead people to buy prescription medicines on the internet: a systematic review

Muscat buying MDMA pills

Objective: Consumers increasingly buy pharmaceuticals online. Then, we identified gaps in the published literature to form a comprehensive theory-based agenda for future research. The search strategy identified forty-eight eligible studies. Results: We identified twelve types of factors influencing purchase intentions and behaviors from online pharmacies: demographics, convenience, availability, price, evaluations of the purchase environment, information sources, internet usage, prior experience, perceived risk, health insurance, privacy, and product. Our analysis also revealed differences between OTC and prescription medications in drivers of purchase intentions and behaviors. Conclusion: While demographic factors tended to be the most often measured influences on intentions and behavior, their role was generally inconsistent, with many contradictory results. However, other factors e. An extensive agenda for future research is advanced. Many consumers now prefer to purchase online, including Thus, many consumers are turning to online pharmacies to purchase medications. Online pharmacies sell or dispense pharmaceutical drugs or other government-regulated medical treatments through the internet or electronic media e. Consumer purchases from online pharmacies continue to grow rapidly due to the convenience, accessibility, and cost savings that they provide Limbu and Huhmann, b. For example, purchases by Hungarian consumers from online pharmacies increased over tenfold between and Fittler et al. Online pharmacies include major corporations e. Illicit online pharmacies violate regulations by selling counterfeit, adulterated, or unapproved drugs or dispensing prescription drugs without a valid prescription Limbu and Huhmann, a. Research on online pharmacies has been growing. Reviews of online pharmacies show how the literature documents online pharmacy types and characteristics, the therapeutic classes and quality of drugs available, and risks to patients and public health Orizio et al. Only one review touches on consumer purchases Almomani et al. This narrative review of 17 studies identifies the prevalence of and reasons for prescription medicine purchases using any internet platform, including search engines, social media, and encrypted messaging applications; however, half the qualitative studies reviewed sampled pregnant women, which limits generalizability. Further, it solely focused on studies of prescription medication purchases published between and Although Almomani et al. In addition, it included no studies published prior to or after Our study reviews almost three times as many studies on online pharmacy purchases alone. Unlike earlier reviews, we included studies of consumer purchases of both prescription and over-the-counter OTC medications to determine if the need for a prescription alters why consumers want to acquire medication online. Also, we did not constrain our review to studies published within a limited date range. This allowed us to show how research into this topic has changed over time. Moreover, our review makes an important distinction between influences on consumer purchase intentions and influences on actual purchase behavior. Although some assume purchase intentions predict actual purchase behavior, prior research in many disciplines has found that they are not the same. For example, a consumer may intend to purchase from an online pharmacy, but time or social influence may shift that purchase to a brick-and-mortar pharmacy. Alternatively, a consumer may not intend to purchase from an online pharmacy, but an unexpected situation e. The current review addresses three key research questions: 1 to what extent have consumer purchase intentions and behavior been investigated as they relate to online pharmacies? Hence, our investigation aims to fill a research gap by systematically scoping a body of literature on this topic of growing interest to researchers in healthcare and public policy. In addition, we provide guidance for the direction of future research and the areas that remain uninvestigated or unstudied, as well as those that represent emerging topics that warrant greater investigation. We carried out a scoping review, which is useful to map the literature on evolving or emerging fields or topics Munn et al. PubMed, one of the most commonly used search tools, is a leading database that covers biomedical and life sciences literature. Web of Science and Scopus are the two largest and most widely used bibliographic databases for searching multidisciplinary literature, as covered in our review. To locate more records from this interdisciplinary literature, we also used relevant synonyms and variants of search terms. We limited the search criteria to exclude all literature irrelevant to our study, such as conference proceedings, grey literature, reviews, books, dissertations, and non-English articles. We included qualitative and quantitative studies of the determinants of medication purchase intentions and behavior over the Internet. Restrictions on the publication year and study population were not applied. It summarizes the number of records identified, screened, and excluded, the reasons for exclusion, and the number of studies included in this review Liberati et al. We retrieved 1, records from electronic databases, which consisted of records from PubMed, from Web of Science, and from Scopus. After removing duplicates, records were retained. Next, titles and abstracts were screened by two researchers independently. After screening titles and abstracts, records that did not meet the inclusion criteria were eliminated. Finally, we assessed the remaining 85 full-text articles. Of these, 38 articles did not meet the eligibility criteria. Forty-seven studies were included in this scoping review. All abstracts and full texts were screened and reviewed independently by two trained coders, who extracted data including authors, publication year, country, journal, population, sample size, research design, drug type, study objective, determinants of purchase intention and behavior, and key findings. This study included forty-seven studies from twenty-nine countries, including nine studies conducted in the United States, five studies in Saudi Arabia, and three studies each in Australia, China, India, and the United Kindom see Table 2. Twenty-one studies were carried out in Asia, eighteen studies in Europe, eleven studies in North America, three studies in Australia, and two studies in Africa. Interestingly, no research was carried out in South America. All studies, except a longitudinal study by Hawdon et al. Forty-two studies employed survey methodology, four interviewed adult individuals, one used a focus group, and another conducted an experiment Three studies were published in the Journal of Medical Internet Research , and three appeared in the Saudi Pharmaceutical Journal. The included studies recruited 27, respondents, with an average sample size of Thirty-seven studies focused on the general adult population, three on patients, two on women, two on students, and three on other populations. Eight studies focused on prescription drugs, eight studies on OTC medication, and the remainder either included both or did not specify. Figure 2 shows consistently few studies conducted on the topic until Four studies were published in , then the publications sharply fell in and Beginning in , we see a growing wave of publications peaking in , with twelve studies. Our analysis of prior studies revealed some differences between OTC and prescription medication in factors influencing online purchase intentions and behaviors. Intentions toward online purchases of prescription medications were primarily motivated by price, availability, convenience, and education. Prescription drug online purchase behavior was adversely affected by perceived risk. Purchase behavior was positively related to health insurance coverage, information sources, and convenience. Most studies involving OTC medication studied purchase behavior. The major driving forces of consumer purchases of OTC medication online were information sources, availability, internet usage, and convenience. Evaluation of the purchase environment, information sources, and prior experience primarily influenced purchase intentions toward OTC medication online. As shown in Table 3 , education, gender, and income were the most frequent demographic predictors of purchase intentions toward online pharmacies. However, the scoping review reveals some contradictory findings. Higher education was at times associated with increased purchase intentions Holiday-Goodman et al. In contrast, another study indicated that individuals with lower education levels had greater intentions to purchase from an online pharmacy Ivanitskaya et al. Holiday-Goodman et al. In contrast, Hu et al. Online pharmacy purchase intentions also were greater among young, White, and married consumers Holiday-Goodman et al. The most frequent demographic predictors of purchase behavior included age, education, gender, and income. Again, the evidence is contradictory. Five studies reported that more older consumers purchased from online pharmacies Brown and Li, ; Cokro and Arfenda, ; Desai et al. In many studies, higher education was associated with increased purchase e. Three studies showed that males purchased medications online more frequently than females Rajamma and Pelton, ; Szekely et al. Higher income was positively associated with increased medication purchases online Rajamma and Pelton, ; Brown and Li, ; Desai et al. Brown and Li also reported that online pharmacy users were more likely to be married; however, Jairoun et al. OTC medicine was most often purchased online by young consumers living in urban areas than smaller settlements Roblek et al. Convenience was a frequently demonstrated predictor of purchase intentions Holiday-Goodman et al. Convenience-related factors, such as fast delivery, choices of delivery times and addresses, reduced visits to the pharmacy, and easy telephone access to the pharmacist for drug information were common reasons supporting intentions to purchase medications from online pharmacies Alfahad et al. Convenience was also a dominant motivation for purchasing behavior. Consumers who bought medications online indicated that buying drugs online was more convenient Brijnath et al. Other convenience-related motivations included easy access Alwhaibi et al. Moureaud et al. The studies included in this review reveal that the availability of various drug products and more options Little et al. Unavailability in the local market Abanmy, ; Bowman et al. Several studies indicated that price significantly promoted medication purchases online. Nine studies found that lower prices were positively associated with increased purchase behavior Brijnath et al. Similarly, another study found that higher prices were associated with decreased purchase behavior Almomani et al. In addition, some studies explored the effects of sales promotions, which reduced prices. Sales promotions such as deals, discounts, and special offers were common facilitators of intentions to purchase medicine online Little et al. Few studies explored purchase environment evaluations as determinants of purchase behavior. One study showed that people who spent more time online were more willing to purchase medication online Fittler et al. Purchase behavior was influenced by frequency of internet usage Roblek et al. Some information source-related factors enhancing purchase behavior included word-of-mouth from friends Almomani et al. Three dimensions of perceived risk -- that is financial, physical, and source risks i. Research shows that prior experience of purchasing goods online Fittler et al. Research showed that people without health insurance coverage were more likely to demonstrate purchase intentions toward online pharmacies Cicero and Ellis, Similarly, another study reported an inverse association between Medicaid insurance coverage and purchase behavior Brown and Li, However, two other studies found that health insurance coverage motivated consumers to engage in online medication purchase behavior Brown and Li, ; Desai et al. Cicero and Ellis showed that perceived anonymity could be a primary reason that consumers intended to purchase from online pharmacies that dispensed Tramadol, a prescription medication, without a prescription. In terms of behavior, Alwhaibi et al. For example, many consumers bought sexual enhancers online because they did not want to discuss their condition with their physician Koenraadt and van de Ven, As shown in Table 3 , two studies reported a positive association between product quality and behavioral intentions Holiday-Goodman et al. In two other studies, product variety motivated purchase behavior from online pharmacies Alwhaibi et al. This scoping review sought to understand the current landscape of empirical research on the drivers of consumer purchase intentions and usage behavior of online pharmacies. Scholarly interest in this topic has been growing exponentially over the last few years. Using rigorous scoping review methods, forty-eight articles published to date met the inclusion criteria, including 12 published in Although we sought qualitative and quantitative studies that applied various methodological approaches, the existing literature was mostly limited to surveys. In terms of sample populations, however, the existing literature exhibits greater diversity in both population types e. However, Latin America has been ignored in the existing literature, including the major markets of Mexico, Brazil, Chile, Colombia, and Argentina. This scoping review identified twelve general factors, which include many individual facilitators and inhibitors of consumer purchase intentions and behavior that have been studied so far Table 3. Of these, the greatest amount of research has investigated the demographics of consumers who purchase or intend to purchase from online pharmacies. Due to the conflicting results, few implications can be gleaned from the prior research related to demographics or the role of health insurance coverage. However, higher-income consumers, White American consumers, and more educated consumers in nine of ten studies had higher online medication purchase intentions and behavior. The implication for researchers and practitioners from the income and education findings seems to be that greater financial and cognitive resources help consumers navigate the online environment to find medications for purchase. Policymakers seeking to dissuade purchases from rogue or illegitimate online pharmacies should target messages and campaigns to these demographic groups. Convenience and availability factors more consistently influenced online medication purchase intentions and behavior. Consumers intended or chose to purchase from online pharmacies due to faster and more convenient delivery, ease of use and gathering information, accessibility, the ability to bypass healthcare providers or regulatory gatekeepers, availability outside of store hours, and access to medications unavailable locally. A practical implication for brick-and-mortar pharmacies is that enhancing their convenience e. Price was also a consistent influence on online medication purchase intentions and behavior. Factors that lowered prices or increased price savings and value received from online medicine purchases tended to attract consumers. To better challenge online pharmacies, brick-and-mortar pharmacies should become more price competitive. A policy implication is that public policymakers and regulators attempting to control the illicit dispensing of medicine online should consider regulation reductions, subsidies, or other ways to lower prices through legitimate pharmacies. Favorable evaluations of the purchase environment also consistently benefitted purchase intentions and behavior across many types of evaluations, such as attitudes, trust, emotional response, aesthetically pleasing and functional design evaluations, enjoyment, and satisfaction. Thus, it appears that many consumers who purchase from or intend to purchase from online pharmacies do so because they hold positive evaluations of those pharmacies. An important implication of this finding is that policymakers, regulators, and brick-and-mortar pharmacies interested in discouraging online medication purchases must engage in attitude change campaigns before expecting consumers who purchase online to alter their intentions or behavior. Attitude change can take time as it requires learning new information and responses through repeated exposure to counterinformation or social influence from family, friends, or trusted others, such as experts or celebrities. This scoping review summarized prior research findings in which social influence and other information sources motivate online medication purchase intentions and behavior. Intentions and behavior were influenced by information and recommendations from expert sources, such as healthcare providers and websites with drug information; personal sources, such as friends and family; independent sources, such as social media influencers and reviews by other consumers; and non-personal sources, such as social media marketing. One implication is that pharmacists, healthcare providers, policymakers, and regulators should be able to indirectly influence consumer behavior toward online medicine purchases if they tap into the social and normative influence of one or more of these information sources. Perceived financial, physical, or source risks inhibit online medicine purchase intentions and behavior, whereas greater health literacy and experience with online pharmacies, online shopping in general, and the internet or social media encourage online medicine purchasing. The benefits of online pharmacies e. An implication is that brick-and-mortar competitors or public policymakers should heighten consumer awareness of these risks if they wish to discourage consumer online medicine purchases. Further, legitimate online sellers can highlight risks to differentiate their verified online pharmacies from illicit or rogue online pharmacies. Finally, this scoping review documented other factors that had been investigated sparingly see Appendix A. For example, some studies have begun to investigate how consumer personality predisposes some consumers toward e. Other studies have begun to investigate situational influences on consumer online medication purchase intentions and behavior e. Individually, these other factors have been studied so rarely that it is difficult to confidently predict the general effect on purchase intentions and behavior without future research. These other influences are listed in the Appendix A. The analyzed literature indicates several gaps in the literature and future research directions that could be addressed. Thus, a systematic review or meta-analysis that incorporates the post studies will likely be able to be conducted within the next decade once sufficient research has been published. This should further our understanding of the factors that facilitate and inhibit online medication purchasing as well as help determine the relative strength of different influences. Most studies The remainder includes a handful of qualitative studies and a single experiment. Future research employing methods other than surveys e. Similarly, future research should advance the understanding of online purchase drivers by using more generalizable and diverse samples, patient rather than general adult samples, and samples that permit cross-cultural comparisons. Third, this scoping review finds that a vast majority of the prior research did not specify whether online purchases of OTC or prescription medication or both were being studied. Future research should specify this because the current review shows differences in the drivers of online OTC and prescription drug purchase intentions and behavior. Fourth, demographics e. As noted in previous reviews Tugwell et al. Thus, rather than relying on demographics, future research should attempt to identify the underlying explanatory determinants to better predict purchase intentions and behavior from online pharmacies. Studies, including moderation or mediation tests, could also help better understand the mechanisms at work. Once the underlying explanatory determinants associated with a demographic variable such as age or gender have been identified, the indirectly related demographic variables can serve to identify likely target audiences for public health campaigns and patient education materials regarding online pharmacies. For example, psychographic variables, such as personality, perceptions, attitudes, beliefs, lifestyle, interests, and values, can offer the potential to identify deeper motivations and could better identify why some consumers buy medications online whereas others do not. To direct future research into other uninvestigated or underinvestigated areas, Table 4 lists some research questions that warrant exploration to better understand the driving influences on consumer purchase intentions and behavior. Finally, the prior literature uncovered by this scoping review tends to be atheoretical and exhibits a general lack of definitions for key constructs posited as factors influencing consumer purchase intentions or behavior. To aid pharmacology researchers and investigators from other fields, the research questions in Table 4 are linked to theories and well-defined constructs in the literature from psychology, consumer research, advertising, health communication, and marketing. For example, Fittler et al. Using the constructs from the marketing literature of search engine optimization and search engine marketing, how can legal sellers take action against these rogue sites and use search engine results to promote medication purchases from legitimate online and brick-and-mortar pharmacies? While demographic factors tended to be the most often measured influences on intentions and behavior, their role was generally inconsistent, with many contradictory results. These findings of our scoping review should aid verified online pharmacies and brick-and-mortar stores in understanding ways to encourage consumer medication purchases. Further, our scoping review revealed a general lack of definitions for constructs studied and a paucity of theoretical justification as to why certain factors or individual influences should affect purchase intentions or behavior. This research agenda should help future studies in this area move beyond descriptive analysis to theory-testing and discovering the underlying explanations of how specific influences affect online medication purchase intentions and behaviors. To accomplish this, these future research directions are based on theories and concepts developed in other areas focused on stimulating intentions or prompting behaviors e. Investigating research questions based on this agenda should help healthcare providers, public policymakers, and regulators design more effective interventions to promote more positive individual patient and public health outcomes as well as benefit researchers interested in this topic of increasing interest and economic importance. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher. Abanmy, N. The extent of use of online pharmacies in Saudi Arabia. Saudi Pharm. Adjie, E. 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Does Changing behavioral intentions engender behavior change? A meta-analysis of the experimental evidence. Wiedmann, K. Online distribution of pharmaceuticals: investigating relations of consumers' value perception, online shopping attitudes and behaviour in an e-pharmacy context. General barriers and website-specific barriers Almomani et al. Note: Italicized text indicates reported findings that are negatively related to purchase intentions or behavior. Keywords: online pharmacy, scoping review, over-the-counter OTC medication, prescription drug, purchase intention, purchase behavior. A scoping review. The use, distribution or reproduction in other forums is permitted, provided the original author s and the copyright owner s are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. Limbu, limbuy montclair. Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher. Top bar navigation. About us About us. Sections Sections. About journal About journal. Article types Author guidelines Editor guidelines Publishing fees Submission checklist Contact editorial office. Drugs Outcomes Research and Policies. Yam B. Huhmann 2. Illicit online pharmacies violate regulations by selling counterfeit, adulterated, or unapproved drugs or dispensing prescription drugs without a valid prescription Limbu and Huhmann, a Research on online pharmacies has been growing. TABLE 1. Search stratetegy. TABLE 2. Characteristics of studies included in this review. Number of studies by year. TABLE 3. Factors influencing purchase intention and behavior from online pharmacies. TABLE 4. Future research agenda and research questions.

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