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Adoption of
Consumers’ usage and adoption e-pharmacy
of e-pharmacy in India
Mallika Srivastava
SVKM’s Narsee Monjee Institute of Management Studies, NMIMS University,
Bangalore, India, and
Madhur Raina Received 23 January 2020
Revised 1 July 2020
Symbiosis International (Deemed University), Pune, India Accepted 23 September 2020

Abstract
Purpose – This paper aims to identify and empirically validate the various factors for adoption, usage and
intention to recommend e-pharmacy for purchasing medications by consumers.
Design/methodology/approach – Based on constructs from well-established theoretical models, the
technology acceptance model, extended unified theory of acceptance and use of technology and self-
determination theory, a model was proposed for the study. The model was validated with a sample size of 184
respondents using partial least squares method and factor analysis to establish and validate relationships
among the various identified constructs.
Findings – The results show that performance expectancy, effort expectancy, social influence and hedonic
motivation have a positive co-relation with adoption of e-pharmacy and the intention to recommend. The
results depict that gender and educational background have no correlation toward adoption and intention to
recommend e-pharmacies for purchasing medicines in India.
Research limitations/implications – This research comes along with a geographic limitation of the
sample size. The research was conducted in an urban suburb city of Bengaluru, India.
Practical implications – At an academic level, this research will provide interesting insights for
exploring adoption and usage intention of consumers toward e-pharmacy. At a managerial level, this
empirically supported study will provide insights into the relationship among the various constructs and the
consumers’ motivation toward adoption and usage intention of e-pharmacy.
Originality/value – This research is the first of its form which uses constructs from the technology
acceptance model, extended unified theory of acceptance and use of technology and self-determination theory
in the online healthcare space to understand consumer usage behavior.
Keywords Healthcare, e-pharmacy, Health service quality, Acceptance, Adoption intention,
Intention to recommend, Usage intention
Paper type Research paper

1. Introduction
The internet has revolutionized our lives, communication, and even purchasing behaviors
and practices. With an increase in access to the internet, its application in the areas of
healthcare is also intensifying. It is estimated that roughly 4.5% of all internet searches
worldwide are related to healthcare queries or information (Das and Faxvaag, 2014). Not
confined to this, today’s consumers use internet not merely for reclaiming healthcare
information, but even for self-diagnosis and attaining various other healthcare-related
services and products (Lanseng and Andreassen, 2007).
International Journal of
Pharmaceutical and Healthcare
Marketing
© Emerald Publishing Limited
1750-6123
Source of Funding: This is a self-funded research study. DOI 10.1108/IJPHM-01-2020-0006
IJPHM In brief, e-pharmacy or online pharmacy refers to trading of medications via a website
and distributing them directly to the consumers (Karahoca et al., 2018). The effortless access
to internet, awareness toward digital literacy, the shift from the physical doctor-patient
interaction to self-diagnosing and an integrated e-commerce supply chain has fueled the
growth of e-pharmacies in the recent years[4]. However, studies have shown that risks such
as counterfeit medications are linked to the purchase of medications online. As per Frost and
Sullivan, the e-pharmacy market in India is projected to reach US$3,657m (INR 25,000
crores) by 2022, thus demonstrating a huge potential in improving access and adherence to
medications for the population.
The research paper is structured as follows. Foremost the literature on online healthcare,
technology acceptance model (TAM), extended unified theory of acceptance and use of
technology (UTAUT2), self-determination theory (SDT) and the eHealth Literacy Scale
(eHEALS) is discussed. This is followed by the hypothesis formulation and proposed model
and then followed by the research methodology used in this study. The consequent sections
include data analytical and findings of the study and conclude with the theoretical and
practical implications.

2. Background
In the recent times, e-health has emerged as an evolving industry. The usage of electronic
health information and services through the internet and mobile technology is commonly
referred to as e-health. These online services allow consumers to acquire the various
healthcare support and facilities by using blogs, online communities and integrated
technology platforms including online healthcare consultation. With the use on online
purchasing platform’s consumers are able effectively manage and improve their and their
family’s healthcare needs and requirements (Harbour and Chowdhury, 2007; Song and
Zahedi, 2007; Cho et al., 2013). Such services also help consumers by rise above the
geographic and cost limitations which have been seen to be associated with the conventional
health information channel (Harbour and Chowdhury, 2007; Xiao et al., 2014). This change
from the traditional to the internet-based healthcare services has enabled consumers to
comprehend the various prevailing health conditions and develop a proactive approach
toward their health (Rains, 2007). Nevertheless, there exists a hesitation associated with the
usage of such services which has an impact on consumer acceptance and usage pattern.
Researchers have argued that online related health information does lack credibility and the
expertise of providers of such information has been questionable (Dutta-Bergman, 2003;
Lemire et al., 2008). Consumers have also reported hesitation to use online health
information and services due to fear of misuse of personal confidential details (Bansal and
Gefen, 2010; Beldad et al., 2010).
Online pharmacies or e-pharmacy can be defined as the process of buying and selling
majorly pharmaceutical medicines over the internet and delivering through the e-commerce
supply chain. Medicines can be classified either as prescription medicines, which require a
doctor’s prescription to be dispensed or non-prescription medicines, commonly known as
over – the – counter medicines – which do not require a physician’s prescription.
The usage of e-health related information and its related e-services require special
attention because these are critical to the decision-making process in respect to the consumer
context. Rains (2007) mentioned in his research that the perceived usefulness of information
acquired from the various e-health searches is an interdependent to an individual’s
perceptions and behavior. In the current scenario, a consumer’s involvement with the online
health services is a combination of his health-related behavior and his intention toward the
e-service usage behavior (Mou et al., 2016). The researcher discusses the Health Belief Model
(1950) which discusses about four beliefs, namely, perceived susceptibility, perceived Adoption of
severity, perceived benefits and perceived barriers. As per the model, an individual’s health e-pharmacy
behavior is governed by either of the above or is a combination of them. Similar, e-services
rendered by other industries, the use of online services for health information necessitates a
consumer’s willingness to engage with the provider either through a platform or technology
applications of an e-service. Existing research literature (Egea and Gonzalez, 2011; Bansal
and Zahedi, 2008) related to online health service asserts that usage of e-services influenced
by a consumer’s trust, belief and perceived usefulness of the e-service.
In this research study, we propose an integrated research model using the constructs
from the existing theories of TAM, extended unified theory of acceptance and use of
technology UTAUT2, SDT to empirically validate the consumer data for acceptance,
usability and intention to recommend e-pharmacy for purchasing medicines. This model
covers constructs of performance expectancy, effort expectancy, social influence, hedonic
motivation and impact of intention to recommend. Gender, age and educational background
have been considered as demographic variables which could have an impact on behavioral
intention. Figure 1 provides the representation of the proposed research model.
Researchers, Wong et al. (2014) mention that the UTAUT2 by Dennis et al. (2003) is one
of the most vigorous models currently in use for amplification of consumer technology
acceptance and use. For this research, we have considered UTAUT2 as the foundation
theory with antecedents of behavior use and intention, namely, performance expectancy,
effort expectancy, social influence and facilitating conditions at the core of proposed model.
The UTAUT2 is talked about as one of the theories which has a strong empirical backup (Im
et al., 2011).
The SDT is an empirically validated theory which interprets behavior as a component of
conscious or non-conscious motives (Ryan and Deci, 2017). SDT as explained by
motivational theorists develops on the concept that all individuals can either be extrinsically
or intrinsically motivated to perform certain action (Davis, 1992). Thus, being one of the
most comprehensive structure for explaining motivation, wellness and the relationship
between the two14. Intrinsic motivation is the drive and aspiration of an individual to

Figure 1.
Proposed research
model
IJPHM achieve a task, which is self-driven and not influenced by any external influences. The
outcome of intrinsic motivation assures an individual pleasure and satisfaction, post
completion of the task. Extrinsically motivated individuals perform a task because of its
alleged rewards, values and benefits distinctive from the activity itself (Mitchell and Biglan,
1971). Over and above, researchers Davis et al. (1992), explained that extrinsic motivation is
highly externally reinforced. Up till now, studies using SDT to understand motivation in
participatory behaviors leading to value creation is not significantly available in existing
literature (Osei-Frimpong, 2017). The two main extrinsic motivators suggested by
researchers (Davis, 1989), include perceived ease of use and perceived usefulness. These two
factors have reported to have direct impact on consumers’ intention for usage of a system
(Osei-Frimpong, 2017). Perceived usefulness is an individual’s belief that using a specific
information system will increase his/her performance, whereas perceived ease of use is the
users’ expectation that the specific information system will be effortless in usage
(Thompson et al., 1991).
The TAM is based on the theory which propounds that an individual’s usage of the
system is predicted by his/her intention to use an information technology system which is
inclined toward his/her internal attitude and belief of using a system. Furthermore, these
internal beliefs are seen as motivational factors for an individual that help drive the
individual to accomplish their goals (Maclnnis et al., 1991).
The concepts of e-health literacy have laid the foundation for the development of
“eHEALS” which is an instrument designed to evaluate consumers’ skills associated with
usage of information technology in healthcare and thereby assisting decision-makers in
planning their healthcare promotional strategies (Norman and Skinner, 2006). This eight-
item tool has been developed to understand consumers’ perception on ease and ability at
finding, comprehending and application of the information gathered electronically on their
health issues. The researchers identify the need to apply the eHEALS to additional
populations’ categories and confirm relationship among e-health literacy and their levels of
technology expertise.
Furthermore, research has suggested that health service quality is a determining factor
for the satisfaction of health services and customers’ behavioral intention (Davis, 1989). This
theory can be extended to delivery of e-services as well. Research findings have suggested
that the perception of quality of health services can be categorized into four categories,
namely, interpersonal, technical, administrative and environment (Dagger et al., 2007). For
developing a scale for e-health service quality, a number of scholars have recommended it to
be a blended approach of combining and synthesizing of existing literature with precise
healthcare concerns. Eysenbach et al. (2002) in their research concluded that the quality of
information related to the consumers available on the internet can be classified into
accuracy, completeness, readability, design, disclosures and references. Further, Bliemel and
Hassanein (2007) in their study mention that content quality and technical competency of
the website are the determinants of consumers’ satisfaction for online healthcare
information. Researchers Mukherjee and McGinnis (2007), in their study, reported that
security and privacy of patient data help-built trust among the consumers with regard to the
e-health services. Thus, the major concerns of consumers for any e-health service include
privacy and confidentiality, as also argued. To conclude, Hadwich et al. (2010) in their
research identified process, potential and outcomes qualities as the seminal parameters to
measure e-health service quality.
The rationale of the current study is to contribute and intensify our understanding
acceptance, usability and intention to recommend e-pharmacies for purchasing medicines in
India. From a theory-building perspective, the study uses the TAM and UTAUT2 to reflect
on consumers’ adoption and usage to information technology and identify the impact of Adoption of
online healthcare information/service. In addition to this, this study includes constructs from e-pharmacy
the SDT to better explain the association between these constructs (intrinsic and extrinsic
motivation) and their impact on consumers’ usage and adoption of e- pharmacy. In this
study, the researchers have also looked at constructs from e-health service quality to
measure and evaluate customer’s perception on the quality of any e-health services.

3. Hypothesis development and proposed research model

3.1 Proposed research model
Figure 1 illustrates the detail explanation of proposed research model.

3.2 Hypothesis development

3.2.1 Performance expectancy. Performance expectancy has been defined as the
effectiveness a user gains in accomplishing their tasks while adopting a technology
(Venkatesh et al., 2012). In continuation to this, the online pharmacy can help consumers
purchase medications online thereby reducing their dependency on brick and mortar shops
and providing a 24/7 access to the pharmacy. In case of ailments where the mobility is a
concern, the “home delivery” of the medicines act as a boon to the customers. When the
customers believe that using and adopting the online pharmacy can improve their treatment
patterns, they are most likely to accept and use the platform. Therefore, we hypothesize that:

H1. Performance expectancy has a positive effect on behavioral intention to adopt

online pharmacy to purchase medicines.
3.2.2 Effort expectancy. This is defined as the consumer’s ease of use of technology
(Venkatesh et al., 2012). In the context of online pharmacy, effort expectancy is understood
as consumers’ perceived ease of using online pharmacy for purchasing medications. Prior
studies have claimed that for a new technology the ease of use is no longer a barrier; as users
are technologically sound (Wang et al., 2014). This thereby means that effort expectancy
does influence consumer behavioral intention toward online pharmacy positively, thus the
following hypothesis:

H2. Effort expectancy has a positive effect on behavioral intention to adopt online
pharmacy to purchase medicines.
3.2.3 Social influence. At the initial stages of adoption of a new technology or platform, prior
research has shown that social influence does have a positive impact (Teo and Pok, 2003).
Past empirical research have also validated the fact that intention to use new information
technology platform is positively impacted by social influence (Miltgen et al., 2013; Gao et al.,
2015), thus, the following hypothesis:

H3. Social influence has a positive effect on behavioral intention to adopt online
pharmacy to purchase medicines.
3.2.4 Hedonic motivation. This refers to the pleasure a consumer derives from while
adopting or using a new technology or platform (Venkatesh et al., 2012). Past research
studies have shown that hedonic motivation directly impacts the user’s technology adoption
intention in different contexts. Thus, we propose the following hypothesis:
IJPHM H4. Hedonic motivation has positive effect on behavioral intention to adopt online
pharmacy to purchase medicines.
3.2.5 User’s intention to recommend. Existing research literature support the theory that
users who have an advanced level of intention to adopt a novel information technology
platform or application are expected to become avid adopters (Leong et al., 2013) and are
inclined and motivated to recommend the technology to others (Miltgen et al., 2013). Thus,
we hypothesize that:

H5. Behavioral intention to adopt positively influences behavioral intention to

recommend online pharmacy to purchase medicines.
3.2.6 Impact of age, gender and education. For the demographic parameters the researchers
tried to develop a hypothesis related to age, gender and education in coalition to understand
and validate if these constructs did have an impact on the behavioral intention to adopt
online pharmacy to purchase medicines. Thus, we hypothesize that:

H6. Age positively influences behavioral intention to adopt online pharmacy to

purchase medicines.
H7. Gender positively influences behavioral intention to adopt online pharmacy to
purchase medicines.
H8. Education positively influences behavioral intention to adopt online pharmacy to
purchase medicines.

4. Research methodology
4.1 Item development
To validate the proposed model; the researchers conducted an online structured survey
which integrated constructs from the established theories under study. All the items were
selected from existing theories with inconsequential modifications in wordings to fit the
online pharmacy framework.

4.2 Questionnaire design and data collection

For validation of the proposed model, an online structured survey research method was
used. The measurement items were identified from the existing literature and were modified
marginally to fit in the healthcare context, if required. For the analysis of collected data
partial least squares method and factor analysis was used to establish and validate
relationships among the various identified constructs.
The questionnaire was structured into two main parts. The first part consisting of
demographic questions related to age, gender, education and one filter question: usage of
e-pharmacy for any transactions anytime in the past 60–90 days. The respondents’ age were
categorized into four sub-groups as: 21–30, 31–40, 41–50, 51 and above, with majority of them
falling in the 41–50 years of age group. To further understand the usage pattern of the
consumers’ basis their educational background, the respondents were divided into two major
groups, graduate (bachelor degree) and post-graduate (master degree). The demographic
analysis showed that most of the respondents who qualified for the survey were post-graduate.
As per the Karnataka Integrated Public health Policy 2017, and the release of the National
Digital Health Blueprint (NDHB) by the Ministry of Health and Family Welfare, under the
e-health section, Karnataka Government is working aggressively toward implementation of the
virtual and e-healthcare services and technologies across Karnataka with priority to the major Adoption of
urban cities including Bengaluru. The healthcare providers and policymakers predict that e-pharmacy
usage of information technology in the healthcare space would lay the foundation for accessible
online healthcare which would allow consumers to access online healthcare services and
information anywhere ay anytime. The state government’s run initiative, Primary Health
Center Management Information System, is a positive step toward this mission. This system
has the potential to provide real-time information on patient treatment, diagnosis and drug
availability to the Primary Healthcare Center.
The second part consisted of questions for validation on the constructs. The questionnaire
was staged online and sample size was confined to consumers staying in north suburb of
Bangalore. A five-point Likert scale questionnaire was crafted for all the items in the second
section of the questionnaire. The Table 1, highlights the demographic profile of the respondents.
The constructs have been adapted from various existing literature as illustrated in
Table 2. The items for performance expectancy, effort expectancy, social influence, behavior
intention was adapted from Gao et al. (2015) and Venkatesh et al. (2012). The items for
hedonic motivation were referred from Venkatesh et al. (2012) and Oliveira et al. (2016). The
constructs related to the intentions to recommend were adapted from Oliveira et al. (2016)
and Miltgen et al. (2013).
For this research study, random purposive sampling technique was used for data
collection. In this method, the researcher selects respondents via random sampling but from
a purposefully targeted population. Here, the researcher tries to target respondents who
meet a certain selection criterion. In this research study the respondents, who would have
used e-pharmacy for any transactions anytime in the past 60–90 days, qualified for the
survey. An online survey tool, was used to stage the survey for the respondents who fit into
the selection criterion and were ranging between ages of 30–70 years. The main benefit of
using an online survey includes improved reach to the masses and the survey link’s
accessibility in real time. At the end of the survey, 220 responses were received, however,
184 responses were considered valid for the study.

Characteristics of the sample Item Frequency

Age 21-30 years 32

31-40 years 52
41-50 years 77
Table 1.
51 years and above 23
Education Graduate 46 Demographic profile
Post graduate 138 of the respondents is
Gender Male 94 mentioned in the
Female 90 below table

Constructs Source

Performance expectancy Gao et al. (2015)4, Venkatesh et al. (2012)

Effort expectancy Gao et al. (2015), Venkatesh et al. (2012)
Social influence Gao et al. (2015), Venkatesh et al. (2012)
Hedonic motivation Venkatesh et al. (2012), Oliveira et al. (2016) Table 2.
Behavioral intention Gao et al. (2015), Venkatesh et al. (2012) The measurement
Intention to recommend Oliveira et al. (2016), Miltgen et al. (2013) items
IJPHM While in the process of testing the proposed research hypotheses, the empirical data was
subjected to a two-step analysis, which included the assessment of measurement model and
structural model. Partial least squares method was conducted to understand and validate
dependencies of the various items used in the model. This included running multiple
regression models to identify the independent and dependent variables. The results assist in
evaluating the fitness and robustness of the model. Exploratory factor analysis was carried
out to map the relationship between each variable to the underlying factor.

5. Data analysis and results

In the subsequent sections, the reliability and validity of the model will be discussed
followed by a discussion on the robustness of the model and arguments supporting
acceptance and rejection of the proposed hypotheses. For testing/validating the model and
relationships between the proposed hypotheses partial least square technique was used.

5.1 Measurement model

The proposed research model was assessed by evaluating the internal reliability. The
reliability of the constructs was examined and determined through Cronbach’s a. For a
construct to confirm the internal reliability of the any study, as a rule of thumb, the value of
Cronbach’s a should be greater than 0.70. For this study, the Cronbach’s a values ranged
from 0.62 to 0.870, which is also tabulated in Table 3. The data shows a robust internal
reliability. This further demonstrates that the constructs which have been adopted and
identified as the part of this study, and hence used in the model development are deemed to
be fit and is in alignment with the research hypothesis.

5.2 Hypothesis testing

For testing the proposed model, exploratory factor analysis and regression models was run
to understand the relationship between the various independent and dependent variables.
The identified hypotheses were tested at a significance level of 0.05. This also helped to
identify and validate the various path relationships among the various constructs used in
the proposed model. In factor analysis, the factors which were identified had Eigen value of
1 or more. The total variance explained by these six identified, namely, intention to adopt,
performance expectancy, social influence, hedonic motivation, effort expectancy was 68%.
The results obtained from the factor analysis are tabulated in Table 4.
Further, regression model was run to understand the relationship between dependent
variable and the independent variable. The result of the regression has been shown in
Table 5. Simultaneously to understand the variance explained by the independent variables
the value of R2 was calculated.

Variables No. of items Cronbach’s alpha

Performance expectancy 4 0.870

Effort expectancy 3 0.852
Social influence 5 0.858
Hedonic motivation 3 0.683
Table 3. Behavioral intention to adopt 6 0.835
Results of reliability Intention to recommend 2 0.627
of all variables Overall sample 23 0.894
Name of the variables/factors Factor loading Share of explained total variance (%) Eigen values
Adoption of
e-pharmacy
Intention to adopt (intention) 14.033 7.710
Intention 1 0.548
Intention 2 0.737
Intention 3 0.676
Intention 4 0.612
Intention 5 0.574
Intention 6 0.673
Performance expectancy (PE) 13.787 2.235
PE1 0.675
PE2 0.720
PE3 0.776
PE4 0.809
Effort expectancy (EE) 12.739 1.735
EE1 0.871
EE2 0.765
EE3 0.766
Social influence (SI) 10.715 1.448
SI1 0.152
SI2 0.183
SI3 0.859
Hedonic motivation (motivation) 9.641 1.295
Motivation 1 0.501
Motivation 2 0.674
Motivation 3 0.701
Intention to recommend 6.741 1.141 Table 4.
Recommend 1 0.775 Factor extraction
Recommend 2 0.884 results

Constructs R R2 F-value p-value

PE and behavioral intention (H1) 0.654 0.427 135.680 0.000

EE and behavioral intention (H2) 0.491 0.241 57.847 0.000
SI and behavioral intention (H3) 0.247 0.061 11.853 0.001
HM and behavioral intention (H4) 0.585 0.342 94.515 0.00
BI and recommend (H5) 0.182 0.033 6.267 0.013
Gender and behavioral intention (H6) 0.073 0.005 0.971 0.326
Age and behavioral intention (H7) 0.202 0.041 7.753 0.006 Table 5.
Education and behavioral intention (H8) 0.097 0.009 1.712 0.192 Regression analysis

Performance expectancy, effort expectancy, social influence, hedonic motivation and age
were found to be statistically significant in elucidating the behavior intention toward
adoption of e-pharmacy for purchasing medicines. The model explains a 42.7% of variance
in behavioral intention associated with e-pharmacy adoption with respect to performance
expectancy, 24% with respect to effort expectancy and 34% with respect to hedonic
motivation. However, the impact with respect to social influence was very less which
accounted for only 6% variance. Subsequently, the behavioral intention to adopt also proved
to be positively impacting the intention to recommend as the p-value was 0.013, thus
supporting H1 to H5 and H7. The results mentioned that gender and education do not
IJPHM significantly influence the behavioral intention to adopt as their p-value was much higher
than the significance level of 0.05, thereby not supporting hypotheses H6 and H8.

6. Discussion and conclusion

6.1 Discussion
Existing research in the healthcare space regarding the adoption of online pharmacy has not
been extensive and has not well explained the correlation between the different constructs
while impact the behavioral intention to adopt and intention to recommend online pharmacy
for purchasing of medications. To fill this gap, the researchers proposed an innovative
model using constructs from TAM, UTAUT2 and SDT, to explore the constructs for online
pharmacy adoption and intention to recommend the purchase on medicines online.
Upon the data analysis, the results support the following details. For the constructs
adopted from the UATUT2 and TAM model the findings suggest that performance
expectancy (H1) and effort expectancy (H2) has high positive correlation with behavior
intention to adopt (H5), which very well supports and is in alignment with the existing
research studies (Gao et al., 2015). The results support the fact that online pharmacy
provides immense benefits to the consumers where they can while sitting in the comfort of
their homes get the medicines delivered at their door steps. They can even choose their
preferred brands and the services provided by the vendors during the buying and post
buying phase ensure that the consumers have a pleasant and satisfactory online experience.
Similarly, for the effort expectancy, as the use of information technology availability and
usage is not a limiting factor for the consumers, the results suggest that the ease of use of the
technology platform does not pose a challenge for the consumers. Thereby meaning ease of
use results in a positive adoption attitude. Today’s consumers have a tendency to learn and
use the new available technology by themselves. In the cases where the consumer faces a
challenge to learn in the initial stages, the perceived benefits motivates them to learn, adopt
and recommend the new skill.
The hypothesis developed related to social influence (H3) demonstrated a positive
correlation with the behavior intention to adopt, and, in turn, intention to recommend. This
implies that opinions and thoughts of individuals whom users/consumers consider
influential or important in their peer group or society does motivate and plays a significant
role in the adoption of an online healthcare service, which is in agreement to the past studies
conducted by Gao et al., 2015, where the researchers found that social network does
influence an users opinion related to adoption of a new technology.
In addition, hedonic motivation (H4), was also found to be a significant construct for this
study. This indicates that using on online application for purchasing medicines is an
enjoyable experience for the users. The users feel motivated to use the e-pharmacy for
purchasing their medicine requirements, thus leading to frequent use and intention to
recommend in the future.
Last but not the least the behavioral intention to adopt (H5) positively and significantly
impacts on adoption and an intention to recommend. The results indicate that when a user
or consumer perceives a technology to be compatible, their behavioral intention to adopt or
recommend are higher. These results are similar to other studies (Oliveira et al., 2016;
Miltgen et al., 2013) that have emphasized on the importance of compatibility and
technology adoption. Our proposed research model, by integrating the various constructs
from the existing theories explained 69% variance associated with behavioral intention to
adopt e-pharmacy.
With regard to intention to recommend e-pharmacy, the results confirm intention to
recommend is influence by behavioral intention to adopt. However, gender (H6) and
Education (H8) had a significant value greater than 0.05 and concluded that these two Adoption of
constructs do not play a significant role in the behavioral intention to adopt and intention to e-pharmacy
recommend. So, hypothesis H6 and H8 were rejected as a result.

6.2 Theoretical implications

The internet has revolutionized our lives, communication, and even purchasing behaviors
and practices. At an academic level, this research will provide interesting insights for
understanding adoption, usage and intention to recommend behavior of consumers toward
e-pharmacy. To comprehend the adoption, usage and recommend intention, the researchers
proposed a different research model using constructs from well-established theories that is,
TAM, SDT and UTAUT2. Empirically, the proposed model demonstrated convincing
explanatory power in predicting the adoption, usage and intention to recommend behavior
of consumers toward e-pharmacy.
In addition, to this, by integrating extrinsic and intrinsic motivation to the TAM model
(perceived usefulness, perceived ease of use) the proposed model is an attempt to better
understand the consumers’ attitude and intention to usage, which, in turn, is a determinant
of actual usage. This revised classification would help researchers understand the
relationship between consumer attitudes and behaviors in the online healthcare space to a
deeper potency. However, the model should be validated for newer and mediating
antecedents. The research findings confirmed that perceived ease of use and perceived
usefulness were strong predictors of consumer behavior intention for e-pharmacy usage. In
relation to intention to recommend, the findings suggest that consumers have an intention to
recommend the usage of online pharmacy through social media networks and other means
of communication only if they have a preferred usage experience.

6.3 Practical implications

The internet pharmacies provide convenience and efficiency to the consumers. They are a
boon to consumers who are home bound and also where the traditional pharmacies are
inaccessible. However, these online pharmacies as of today are not providing any online
medicine adherence support to their consumers. In the near future with the growing
importance of healthcare information technology and consumer preference for purchasing
medicines online, there seems a major need for online pharmacies to develop patients
adherence online programs either through group support, reminders or live virtual chats.
At a managerial level, this empirically supported study will provide insights into the
relationship among the various constructs and the consumers’ motivation toward adoption
and usage intention of e-pharmacy. These dimensions of consumer motivation shall be of
immense benefit to the healthcare marketers as these will assist them in formulating their
marketing and advertising campaigns as per consumer preference. The extrinsic and
intrinsic motivational factors will provide the healthcare organizations an understanding of
the preferences of the consumers in relation to what motivates and urges a consumer to visit
an e-pharmacy portal and make a transaction. These insights can help service providers
understand the consumer profile of those who may use their sites and understand the
individuals’ needs for seeking healthcare information online and using of the online
pharmacy website. The service providers then by providing useful health services to such
potential online pharmacy seeker gradually can increase their market presence in their
operating space. Further to gain trust of the online consumer the service providers and the
pharmaceutical companies should provide authentic evidence for the healthcare information
published on their website, develop user friendly navigation interfaces and empower the
consumer to take informed decisions regarding their medicine purchase.
IJPHM There is a need for service providers to develop better interactive websites, mobile
applications, gamified tools, which can help increase a positive usage intention of the
consumers toward the e-pharmacy portals. The e-service delivery dimensions can be used
by the healthcare providers to evaluate their quality of service and make improvements for
better consumer satisfaction. Thus, the proposed model can be used by e-pharmacy service
providers/consumers/practitioners as a diagnostic tool to evaluate the quality of e-service
delivery. The intention to recommend is a considerable factor that may generate significance
value for service providers. It is crucial for pharmaceutical companies and e-pharmacy
vendors to understand what motivates the behavior of the consumers to purchase medicines
online to improve the adoption and intention to recommend patterns.
However, the marketers should not devised overly aggressive marketing strategies
merely for capturing the market share and achieving the short-term financial objectives.
Instead, their strategies should revolve around the patient safety and long-term effective use
of the online pharmacy.

6.4 Limitations and future research

Similar to any other research, this study holds a significant scope for further research. As
the popularity of usage of e-pharmacy expands, the influence of various moderating
variables such as age, gender and previous experience of using an online platform for
purchasing medicines should be incorporated in the research. Additionally, the online
survey was carried out in an urban metropolitan city of Bengaluru, India, thus creating a
geographic constraint, thus concluding that the research findings cannot be generalized to a
larger population set. The data collection method used was convenience sampling which
might be a weak sampling technique for understanding the adoption and usage intention of
a technological platform. The researchers recommend a mix of qualitative and quantitative
approach for this study to improve the proposed model’s explanatory power. The testing of
the model basis a comparative study using classified consumer profiles could be a
straightforward way to widen the research and re-validate the robustness of the proposed
model.

6.5 Conclusions
This research presents a mixed and divided response where customers did prefer buying
medications from brick and mortar shop; however, we did see a rising trend of using online
pharmacies for purchasing of medicines among the younger populations. Lack of awareness
regarding the benefits of using the online pharmacy emerged as a thought for discussion.
Thus, there is a need to demonstrate the use and benefits of using e-pharmacies along with
enhanced instruction to the customers. The customers largely appreciated the “home
delivery” of the online purchased medicines and would prefer to order online in cases of
acute illness.
The results suggest the e-pharmacy application to be easy to use. Respondents further
mentioned that developing trust toward the e-vendor is a crucial factor, and thus they
believe the quality of information provided and ease of navigating through the e-pharmacy
would help develop trust toward the e-vendor. Availability of obsolete and imprecise
information would generate a fear of mistrust in the minds of the customers.
If we look at the customer buying process with regard to the purchasing medicines
online, the customers were of the opinion that to make the buying process smooth and hassle
free, guidance must be provided by the e-vendor throughout the buying/purchasing process.
Also, the instructions must be easy to realize and quick resolution of any errors. However,
not to underestimate the requirement of providing up to date information about the
available medicine and any promotional offers. Some of the respondents appreciated the Adoption of
flexibility and power they can demonstrate while using these online portals. They feel e-pharmacy
empowered in such a case where they can select their preferred brand of medicine and add to
the shopping cart as when compared to a physical shop where the pharmacist intervenes in
the selection process.
Some of the respondents demonstrated apprehension in using the online pharmacy as
they perceived it to be time-consuming. In such a case, the e-vendor or marketers need to
ensure that if at all during the buying process, the customer gets jammed, there is smooth
access to a pharmacist, physicians or the customer support desk; else there is a high chance
of the buying process being terminated. Thus, the e-vendors or marketers need to promote
e-pharmacy as a “positive” platform for purchasing medicines which is least time-
consuming.
As per the results of the study, some respondent’s despite of being able to access the
online pharmacy, were not able to comprehend the medical information, thus representing
poor e-health literacy skills. Also, there were some respondents who were unable to even
find an online pharmacy due to poor literacy skills. In such a case, the marketers or
e-vendors can improve the visibility of their website through improved strategies of
keyword and search engine optimization.
The concept of online pharmacies continues to spread as increasing number of consumers
are moving toward internet as an alternate medium for gathering healthcare information and
purchasing pharmaceutical products. To increase the benefits and decrease the risk of e-
pharmacies, a two-level approach can be adopted. The first level should focus on stricter
regulations regarding regulating the online sale and distribution of pharmaceutical
medicines. The policymakers should evaluate all the possible legal and regulatory risks
associated with usage on e-pharmacy and suggest effective measures to manufactures and
consumers to minimize any potential risk. From a user perspective, the second approach
should focus on increasing the health literacy rate among the users and making them aware
about the information privacy issues which are related with the use of online pharmacy. Over
the course of the research, we observed the main reason for the consumers to purchase
pharmaceutical medicines is the low price offers promoted the e-pharmacies. The e-
pharmacies also allow consumers to purchase and make orders from the comfort of their
homes. These e-pharmacies also offer engaging healthcare information over their websites
which also attracts the consumers to visit such online pharmacies. For the repeat purchase
consumers of e- pharmacy, the consumers prefer to purchase from an already tried and tested
e-pharmacy, however, they do weigh against the prices and promotional offers offered by
other online pharmacies, before making their purchasing decision. In an overall sense, the
intention to adopt e-pharmacy is a summation of a consumer’s attitude toward the e-
pharmacy service as a whole and perceived benefit and ease of use of e-pharmacy.

References
Bansal, G. and Gefen, D. (2010), “The impact of personal dispositions on information sensitivity,
privacy concern and trust in disclosing health information online”, Decision support systems,
Vol. 49 No. 2, pp. 138-150.
Bansal, G. and Zahedi, F. (2008), “Efficacy of privacy assurance mechanisms in the context of
disclosing health information online”, AMCIS 2008 proceedings, p. 178.
Beldad, A., De Jong, M. and Steehouder, M. (2010), “How shall I trust the faceless and the intangible? A
literature review on the antecedents of online trust”, Computers in human behavior, Vol. 26 No. 5,
pp. 857-869.
IJPHM Bliemel, M. and Hassanein, K. (2007), “Consumer satisfaction with online health information retrieval: a
model and empirical study”, E-service Journal, Vol. 5 No. 2, pp. 53-84.
Cho, Y.I., Johnson, T.P. and VanGeest, J.B. (2013), “Enhancing surveys of health care professionals: a
meta-analysis of techniques to improve response”, Evaluation & The Health Professions, Vol. 36
No. 3, pp. 382-407.
Dagger, T.S., Sweeney, J.C. and Johnson, L.W. (2007), “A hierarchical model of health service quality:
scale development and investigation of an integrated model”, Journal of service research, Vol. 10
No. 2, pp. 123-142.
Das, A. and Faxvaag, A. (2014), “What influences patient participation in an online forum for weight
loss surgery? A qualitative case study”, Interactive journal of medical research, Vol. 3 No. 1,
p. e4.
Davis, F.D. (1989), “Perceived usefulness, perceived ease of use, and user acceptance of information
technology”, MIS quarterly, pp. 319-340.
Davis, F.D., Bagozzi, R.P. and Warshaw, P.R. (1992), “Extrinsic and intrinsic motivation to use
computers in the workplace”, Journal of applied social psychology, Vol. 22 No. 14, pp. 1111-1132.
Dennis, A.R., Venkatesh, V. and Ramesh, V. (2003), “Adoption of collaboration technologies: integrating
technology acceptance and collaboration technology research”, Working Papers on Information
Systems, Vol. 3 No. 8, pp. 3-8.
Dutta-Bergman, M. (2003), “Trusted online sources of health information: differences in demographics,
health beliefs, and health-information orientation”, Journal of medical Internet research, Vol. 5
No. 3, p. e21.
Egea, J.M.O. and Gonzalez, M.V.R. (2011), “Explaining physicians’ acceptance of EHCR systems: an
extension of TAM with trust and risk factors”, Computers in Human Behavior, Vol. 27 No. 1,
pp. 319-332.
Eysenbach, G., Powell, J., Kuss, O. and Sa, E.R. (2002), “Empirical studies assessing the quality of health
information for consumers on the world wide web: a systematic review”, Jama, Vol. 287 No. 20,
pp. 2691-2700.
Gao, Y., Li, H. and Luo, Y. (2015), “An empirical study of wearable technology acceptance in
healthcare”, Industrial Management & Data Systems, Vol. 115 No. 9, pp. 1704-1723.
Hadwich, K., Georgi, D., Tuzovic, S., Büttner, J. and Bruhn, M. (2010), “Perceived quality of e-health
services: a conceptual scale development of e-health service quality based on the C-OAR-SE
approach”, International Journal of Pharmaceutical and Healthcare Marketing, Vol. 4 No. 2,
pp. 112-136.
Harbour, J. and Chowdhury, G.G. (2007), “Use and outcome of online health information services: a
study among Scottish population”, Journal of Documentation.
Im, I., Hong, S. and Kang, M.S. (2011), “An international comparison of technology adoption: testing the
UTAUT model”, Information & management, Vol. 48 No. 1, pp. 1-8.
Karahoca, A., Karahoca, D. and Aksöz, M. (2018), “Examining intention to adopt to internet of things in
healthcare technology products”, Kybernetes, Vol. 47 No. 4, pp. 742-770.
Lanseng, E.J. and Andreassen, T.W. (2007), “Electronic healthcare: a study of people’s readiness and
attitude toward performing self-diagnosis”, International Journal of Service Industry
Management, Vol. 18 No. 4, pp. 394-417.
Lemire, M., Paré, G., Sicotte, C. and Harvey, C. (2008), “Determinants of Internet use as a preferred
source of information on personal health”, International journal of medical informatics, Vol. 77
No. 11, pp. 723-734.
Maclnnis, D.J., Moorman, C. and Jaworski, B.J. (1991), “Enhancing and measuring consumers’
motivation, opportunity, and ability to process brand information from ads”, Journal of
Marketing, Vol. 55 No. 4, pp. 32-53.
Miltgen, C.L., Popovic, A. and Oliveira, T. (2013), “Determinants of end-user acceptance of biometrics: Adoption of
integrating the ‘Big 3’ of technology acceptance with privacy context”, Decision Support
Systems, Vol. 56, pp. 103-114.
e-pharmacy
Mitchell, T.R. and Biglan, A. (1971), “Instrumentality theories: current uses in psychology”,
Psychological Bulletin, Vol. 76 No. 6, p. 432.
Mou, J., Shin, D.H. and Cohen, J. (2016), “Health beliefs and the valence framework in health information
seeking behaviors. Information Technology & People.
Mukherjee, A. and McGinnis, J. (2007), “E-healthcare: an analysis of key themes in research”,
International Journal of Pharmaceutical and Healthcare Marketing, Vol. 1 No. 4, pp. 349-363.
Norman, C.D. and Skinner, H.A. (2006), “eHEALS: the eHealth literacy scale”, Journal of medical
Internet research, Vol. 8 No. 4, p. e27.
Oliveira, T., Thomas, M., Baptista, G. and Campos, F. (2016), “Mobile payment: understanding the
determinants of customer adoption and intention to recommend the technology”, Computers in
Human Behavior, Vol. 61, pp. 404-414.
Osei-Frimpong, K. (2017), “Patient participatory behaviours in healthcare service delivery: self-
determination theory (SDT) perspective”, Journal of Service Theory and Practice, Vol. 27 No. 2,
pp. 453-474.
Rains, S.A. (2007), “Perceptions of traditional information sources and use of the world wide web to
seek health information: findings from the health information national trends survey”, Journal of
health communication, Vol. 12 No. 7, pp. 667-680.
Ryan, R.M. and Deci, E.L. (2017), Self-determination theory: Basic psychological needs in motivation,
development, and wellness. Guilford Publications.
Song, J. and Zahedi, F. (2007), “Mariam. Trust in health infomediaries”, Decision Support Systems,
Vol. 43 No. 2, pp. 390-407.
Teo, T.S. and Pok, S.H. (2003), “Adoption of WAP-enabled mobile phones among Internet users”,
Omega, Vol. 31 No. 6, pp. 483-498.
Thompson, R.L., Higgins, C.A. and Howell, J.M. (1991), “Personal computing: toward a conceptual
model of utilization”, MIS quarterly, pp. 125-143.
Venkatesh, V., Thong, J.Y. and Xu, X. (2012), “Consumer acceptance and use of information technology:
extending the unified theory of acceptance and use of technology”, MIS Quarterly, Vol. 36 No. 1,
pp. 157-178.
Wong, C.H., Wei-Han Tan, G., Loke, S.P. and Ooi, K.B. (2014), “Mobile TV: a new form of
entertainment? Industrial Management & Data Systems, Vol. 114 No. 7, pp. 1050-1067.
Xiao, N., Sharman, R., Rao, H.R. and Upadhyaya, S. (2014), “Factors influencing online health
information search: an empirical analysis of a national cancer-related survey”, Decision Support
Systems, Vol. 57, pp. 417-427.

Further reading
Ball, M.J. and Lillis, J. (2001), “E-health: transforming the physician/patient relationship”, International
journal of medical informatics, Vol. 61 No. 1, pp. 1-10.
Baptista, G. and Oliveira, T. (2015), “Understanding mobile banking: the unified theory of acceptance
and use of technology combined with cultural moderators”, Computers in Human Behavior,
Vol. 50, pp. 418-430.
Conner, C. (2002), “The influence of personal characteristics, perceived innovation characteristics,
attitude, and subjective norm upon intent to adopt internet pharmacy service: An adoption of
innovations study”, Doctoral dissertation.
Davis, F.D., Bagozzi, R.P. and Warshaw, P.R. (1989), “User acceptance of computer technology: a
comparison of two theoretical models”, Management Science, Vol. 35 No. 8, pp. 982-1003.
IJPHM Engström, J. and Elg, M. (2015), “A self-determination theory perspective on customer participation in
service development”, Journal of Services Marketing, Vol. 29 No. 6/7, pp. 511-521.
Eysenbach, G. (2001), “What is e-health?”, Journal of medical Internet research, Vol. 3 No. 2, p. e20.
Goldzweig, C.L., Towfigh, A., Maglione, M. and Shekelle, P.G. (2009), “Costs and benefits of health
information technology: new trends from the literature”, Health Affairs, Vol. 28 No. 2, pp. w282-w293.
Holden, R.J. and Karsh, B.T. (2010), “The technology acceptance model: its past and its future in health
care”, Journal of biomedical informatics, Vol. 43 No. 1, pp. 159-172.
Lin, S.P. (2011), “Determinants of adoption of mobile healthcare service”, International Journal of Mobile
Communications, Vol. 9 No. 3, pp. 298-315.
Morahan-Martin, J.M. (2004), “How internet users find, evaluate, and use online health information: a
cross-cultural review”, Cyber Psychology & Behavior, Vol. 7 No. 5, pp. 497-510.
Mun, Y.Y., Jackson, J.D., Park, J.S. and Probst, J.C. (2006), “Understanding information technology
acceptance by individual professionals: toward an integrative view”, Information &
Management, Vol. 43 No. 3, pp. 350-363.
Mun, Y.Y., Yoon, J.J., Davis, J.M. and Lee, T. (2013), “Untangling the antecedents of initial trust in Web-
based health information: the roles of argument quality, source expertise, and user perceptions
of information quality and risk. Decision support systems, Vol. 55 No. 1, pp. 284-295.
Parthasarathy, M. and Bhattacherjee, A. (1998), “Understanding post-adoption behavior in the context
of online services”, Information systems research, Vol. 9 No. 4, pp. 362-379.
Raina, M. and Srivastava, M. (2019), “Usage Intention towards Online Healthcare in context to
consumer”, Indian Journal of Public Health Research & Development, Vol. 10 No. 5, pp. 686-691.
Song, J. (2007), “Trust in health infomediaries. Decision support systems, Vol. 43 No. 2, pp. 390-407.
Talukder, M.S., Chiong, R., Bao, Y. and Hayat Malik, B. (2019), “Acceptance and use predictors of
fitness wearable technology and intention to recommend: an empirical study. Industrial
Management & Data Systems, Vol. 119 No. 1, pp. 170-188.

Corresponding author
Mallika Srivastava can be contacted at: [email protected]

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