ROBERT KENNEDY COLLEGE AT UNIVERSITY OF WALES

Dissertation Submitted in Partial fulfillment of the requirement for the Degree of Master of Science in Advanced Information Technology And Business Management (MSCITBM)

Title:
Beyond the Web-Based DTP e- Communication Dashboard: Unleashing the True Value of Pharmaceutical and Clinical Information

Prepared by: Adel A.M. Seedahmed

Supervisor: Professor. Carol Marrow

July 21, 2011

Declaration of originality
"In presenting this dissertation for assessment, I declare that it is a final copy including any last revisions. I also declare that it is entirely the result of my own work other than where sources are explicitly acknowledged and referenced within the body of the text. [Or: in footnotes, end notes, as appropriate]. This dissertation has not been previously submitted for any degree at this or any other institution

TABLE OF CONTENT

Abstract..7 Acknowledgement......9 Title..10

1.0 CHAPTER ONE: INTRODUCTION

1.1 Problem overview......11 1.2 Research rational....13 1.2.1 Pharmaceuticals marketing expenditure .13 1.2.2 Research and development R&D.........14 1.2.3 Leveraging evidence-based medicine EBM..16 1.3 Research objective..17 1.4 Research questions.....19 1.5 Research topics...20

2.0 CHAPTER TWO: LITERATURE REVIEW

2.1: The evolution of information technology IT and electronic commerce e-commerce in business development
2.1.1 The role of information technology IT in business development.....21 2.1.2 The role of electronic commerce e-commerce in business development.................22 3

2.1.3 e-detailing diverse platforms.......23 2.1.4 Web-based media partners..........24

2.2 The potential benefits and main challenges of IT and e-detailing.25

2.2.1 Company perspectives.................26 2.2.2 Customer relationship management CRM technologies..27 2.2.3 Product life cycle management p-LCM....28 2.2.4 Branding..30 2.2.5 Online disease awareness....31 2.2.6 Pharmacovigilance alerts.....32 2.2.7 Social networking site.33 2.2.8 Physicians and healthcare perspectives...33 2.2.9 Main challenges of IT and e-detailing..35

3.0 CHAPTER THREE: RESEARCH DESIGN

3.1Mixed methods research..36
3.1.1 Development of grounded theory....37

3.2. The Qualitative method..39

3.2.1 Methodology...39 3.2.2 Pilot interviews test.39 3.2.3 Sample selection..40 3.2.4 Preparation of interview..40 4

3.2.5 Ethical issues, privacy and confidentiality of research participants....41 3.2.6 Data collection.41 3.2.7 Reliability and validity42 3.2.8 Data analysis and presentation....42

3.3The Quantitative method..43

3.3.1 Methodology...43 3.3.2 Questionnaire testing...44 3.3.3 Sample selection..44 3.3.4 Ethical issues of research participants.45 3.3.5 Privacy, confidentiality, and anonymity of research participants...46

3.4 Data Collection, Data Capturing, Descriptive Statistics, Validity and Reliability.46 3.4.1 Data collection........46
3.4.2 Data capturing.47 3.4.3 Descriptive statistics....48 3.4.4 Validity and reliability....51

4.0 CHAPTER FOUR: DATA RESULT, DESCRIPTIVE STATISTICS, AND STUDY FINDINGS
4.1 The qualitative data result......53 4.2 The quantitative data result........56 4.2.1Technology Acceptance Model TAM variables............................56 5

4.2.2 Technology Acceptance Model TAM variables responses.....58 4.2.3 Descriptive statistics62 4.2.4 Study findings.64

5.0 CHAPTER FIVE: CONCLUSIONS RECOMMENDATIONS, AND STUDY LIMITATIONS

5.1 Conclusions.......66 5.2 Recommendations..68 5.3 Study limitations....69

REFERENCES AND BIBLIOGRAPHY.71 LIST OF APPENDICES

Figure.1 Technology Acceptance Model TAM.......100 Figure: 2 Marketing expenditure of top five companies....100 Figure: 3 Useful Evidence-Based Medicine EBM URLs....100 Figure: 4 Questionnaire categories.....101 Figure: 5 Sample questionnaires101 Figure: 6 Questionnaire multi items statements.103 Figure 7: Technology Acceptance Model TAM variables responses....104 Figure 8: Perceived usefulness items responses.........105 Figure 9: Perceived ease of use items responses....106 Figure 10: Attitude items responses.....107 Figure 11: Behavioural intention items responses.....108 6

Abstract
The evolution of information technology IT and electronic commerce e-commerce, may provide a leading pharmaceutical company with a complementary electronic communication channels for legitimating ethics, strengthening communication, building trust, and maintaining a convenient relationship among the physicians, the healthcare professionals, and the broader medical communities. The objective of this research is to understanding the perceptions of the physicians and healthcare professional towards traditional detailing, and explores the potential values of online communication and electronic detailing e-detailing. Using the technology acceptance model TAM which was developed by Davis (1989), perceived usefulness and perceived ease of use as influential research model are hypothesized and empirically supported as fundamental determinants of user acceptance of a given information system IS and information technology IT (Chau, 1996). Alongside the technology acceptance model TAM, the research set out to determine the physicians and healthcare professionals attitude and intention to use the internet and related medical webbased technologies as a source of pharmaceutical and clinical information (see figure: 1). The literature review provided an overview of the evolution of information technology IT and electronic commerce e-commerce in business development. The study is based on the acceptance and the use of the internet technology to explain the physicians and healthcare professional computer-usage behavior, and its implication in their clinical practices. For a theoretical development, the research uses a comparative scheme of qualitative and quantitative paradigms (Jones et al, 2005) for assessing the physicians and healthcare professionals acceptance status of information technology IT in order to validate the 7

internet and related web-based technologies as a source of pharmaceutical and clinical information. The researcher uses combined research methods, the qualitative research methods via in-depth face-to-face interviews with eight key opinion leaders KOL in the healthcare services HCS, and quantitative research method via a descriptive questionnaire. Through the process of convenient sampling, the data are captured and collected from a sample of 364 physicians and healthcare professionals in the Saudi Arabia. Using standard methods for analysis the data, the outcome results and the subsequent technology

acceptance model TAM variables responses of the physicians acceptance behavior and attitude revealed itself, and produces a useful measures into the interpersonal factors influencing the internet and related web-based technologies as a source of pharmaceutical and clinical information. Consistent with Bertrand (2008), the combined results of the technology acceptance model TAM independent and dependent variables reflect the power of the internet and medical web-based technology as the most reliable, easily access, and a convenient source of pharmaceutical and clinical information. The interpretations of the studys findings have concluded that the physicians and healthcare professionals were in a positive trend towards the internet technology as a modern source of pharmaceutical and clinical information. This result is consistent with the study conducted by Joanne (2008) who further concluded that These results will provide a valuable data, with which pharmaceutical companies may develop, internet-based marketing strategies (page.4). The study outcomes and recommendations might help a leading pharmaceutical company to develop online marketing and educational tools to outreach the physicians, the healthcare professionals, and the broader medical communities. 8

Acknowledgement

To my parents, To whom passed away, in memory of my brother Yasser Youre not just a memory, you tried your best to teach us before you went away, we now have a better understanding of what you tried to say, please always know we love you and no one can take your place. May Allah bestow your departed soul eternal peace in Jannah, and grant courage to my family to bear this irreparable loss To my family, my wife, and my children Moataz, Alaa, Tasneem, and Weaam For support and tolerance To Professor Carol Marrow my supervisor For assistance and advice

Title
Beyond the Web-Based DTP e- Communication Dashboard: Unleashing the True Value of Pharmaceutical and Clinical Information DTP: Direct-To-Physician is an advanced online electronic communication and detailing, directly from the pharmaceutical companies to the physicians and healthcare professionals for strengthening communication, building trust, and maintaining a convenient relationship.

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1.0:CHAPTER ONE: INTRODUCTION

In todays highly competitive healthcare market, pharmaceutical companies face an intimidating set of communication challenges among the physicians and the medical communities. Moreover, many ethical concerns have originated and controversy within both the medical professionals and the societies (Gibbon, 1998). With the growing competition and spreading of the financial crises and economy recession around the world, a leading pharmaceutical company have to come up with a new communication channels to stay competitive in the global market (Pharma, 2008). An integrated online communication and electronic detailing e-detailing into an electronic customer relationship management eCRM technology (Wang et al, 2002) is an efficient way to establish the physicians trust, retaining physicians loyalty, and building long-stay a credible virtual partnership among the medical communities and the societies.

1.1 Problem overview

Indeed, a potential costly research and development R&D, product complexity, short product life-cycle, regulatory requirements, and threats of generic entrance are the major communication challenges that face pharmaceutical companies in the global market. Although branding is one of the communication tools to establish the product in the market (Lim, 2010), the evolution of new innovative pharmaceutical products and establishing the evidence-based medicine EBM in clinical practices remains the main challenges that faces the pharmaceutical companies. At present, the international financial crises and economy 11

recession has a significant impact on the sales growth and the profitability of pharmaceutical companies (Buysse et al, 2010). As a consequence, most pharmaceutical companies announced restructuring plans, re-prioritization of the strategic internal programs, and downsizing of the workforce which might range from 3% to 93% (Zhang, 2009). Accordingly, cost control and improve sales growths are the determinants factor for the pharmaceutical companies to stay competitive in the global market (Bernwitz, 2001). Therefore, the internet and related medical web-based technologies will provides a tremendous way to lower marketing cost, improve sales growth, and maintain interactive two-way communication between physicians and healthcare professional. More importantly, managing the relationship between the drug companies and the physicians is becoming the critical part for building the physicians trust and maintaining long stay a credible partnership among the healthcare professionals (Lim et al, 2010). At present, the in-person traditional communications face many confrontations and many serious concerns have originated. Consequently, the regulatory code of conduct of marketing pharmaceutical products has been extremely violated (EMEA, 2005). Further to that, the marketing moral and social responsibilities which rely heavily on the continuous delivering of accurate and unbiased drug information to the physicians and healthcare professionals could be significantly affected. This complex relationship may evolve a hidden conflict of interest, and might complicate the traditional ability of the physicians to serve as impartial fiduciary agents to their patients (Reshma, 2007).

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1.2 Research rationale

The world economy recession and the international financial crises significantly enforced a leading pharmaceutical company in putting heightened scrutiny on the economics of their marketing and sales strategies (Bernewitz, 2001). Nowadays, the significant changes in the government regulations, regulatory requirements, and the highly dynamic global market will forced the pharmaceutical companies to look at a potential alternative of new business model (Sunil, 2010). In a parallel piece, the globalization and fast speed communication has a significant impact on the pharmaceuticals marketing expenditure, the research and development R&D, and leveraging evidence-based medicine EBM in the societies.

1.2.1 Pharmaceuticals marketing expenditure

Despite the evolution of the promotional ads and fast speed customer outreach, pharmaceutical companies increasingly rely on the traditional detailing and face-to-face promotion to contact the physicians and healthcare professionals. A promotional campaign is an integral part of the marketing expenditure (Buckley, 2004), representing an essential part in establishing the brand products and for gathering market feedback necessarily for future strategies. To extend the brand values, a leading pharmaceutical company spent heavily on the key opinion leaders KOL (Lim, 2010), which can take a variety of forms such as offering a free medical samples, sponsoring of medical symposium and conferences, and contributing in the continuous medical education CME programs. Buckley (2004) has comments that Physician- targeted promotional budget is significantly greater on all 13

fronts; both financially and in terms of the eventual outcome make up quarter to third of their annual budget (page 6). In a parallel piece, Sorrell (2010) released a report showed the marketing expenditure of the top five companies with the highest expenditures in the US through the period FY07- FY09 (see figure: 2), and has concluded that The majority of marketing expenditures outgoing to physicians representing 68%, whereas the prescribed and the healthcare providers occupied 11% and 10% respectively (page 2). As a consequence, the traditional face-to-face promotional budget significantly hardens the total pharmaceutical market expenditure. Currently, the spreading of the financial crisis and economy recession around the world enforced a leading pharmaceutical company to restructure the marketing and sales strategies to save profits and maintain its reputation and competitiveness around the world. Zhang (2009) has stated that Many major pharma and Biotech companies have been vigorously strengthening their capabilities and paying more attention to efficiency, cost-effectiveness, and productivity (page 1).

1.2.2 Research and development R&D

Research and development R&D remains the core competence of the companies competitive advantages tools. A leading pharmaceutical company aims to publicize the clinical trials CT results of all adequately designed and well-controlled clinical studies, regardless of the clinical outcome to assess the medical importance of the result from all other clinical studies of marketed medicines (J&JPRD, 2010). A part of their obligation to the physicians and the medical communities, a leading pharmaceutical company efficiently uses 14

the internet and related medical web-based technologies to make well-informed assessments about their products, caregivers must have access to comprehensive and accurate information that is also balanced and timely (J&JPRD, 2010). Further to that, meeting the physicians and clinicians expectations in their daily clinical practices would enhance in establishing the quality of healthcare services delivered to the patients and the societies. Accordingly the patients and health care providers can benefit from knowing about clinical studies that are open for enrollment and the results of studies from the marketed products. Johnson & Johnson research and development (J&JPRD, 2010), recognizes that the transparency and information accuracy about their products and investigation drugs is easily accessible, and they publicly register clinical studies who are open for enrollment and report the results of clinical trials on marketed medicines to the National Library of Medicines website, this site offers up-to-date information on federally and privately supported clinical trials for a wide range of diseases and conditions (J&JPRD, 2010). As part of the US regulatory approval process, Pfizer Company listed a post marketing commitment PMC

www.pfizer.com/research/pmc, on the Food and Drug Administration FDA website, to support the clinical use of the drugs and the continuous monitoring of safety. Accordingly in the coming years, the internet and related web-based technologies will offer a potential communication tool to conduct online market research, retrieve the necessarily medical and clinical information, and minimize a potential costly research and development R&D programs.

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1.2.3 Leveraging evidence-based medicine EBM

Evidence-based medicine EBM is the integration of the physicians clinical expertise and healthcare professionals knowledge with the best available clinical evidence from systematic research (Hassig, 1999). Obviously, the lack of enough updated clinical and pharmaceutical information eventually led the physicians and healthcare professionals to take decisions concerning the medical management of their patients based on their clinical experiences (Eddy, 2005). Evidence-based medicine EBM is rapidly evolving, and its practice requires access to clinical evidence and a change in the way medical decisions are made (Lisa, 2007). As described by Mayer (2010), evidence-based medicine EBM electronic search encompasses four broad domains: First, asking answerable questions where the clinicians should be familiar with the proper answerable questions and make sure the question contains four areas abbreviated by acronym PICO (Akobeng, 2008). P stands for the description of patient or population; I stand for the intervention, C stands for the comparison group, and O stands for the outcome. Second, an electronic-based search is the easiest and fastest way to obtain the ready-made clinical evidence available 24/7. For instance, an electronic medical books and magazine such as the Journal of American College of Cardiology (JACC, 2011), the New England Journal of Medicine (NEJM, 2011), the Lancet (2001), and clinical evidence websites such as Infopoems www.essentialevidenceplus.com, and Up to Date www.uptodate.com (see figure: 3). Third, applying the evidence to individual patient care as the primary aims of this aspect are to minimize the medical and treatment errors and to assure to a greater degree a better clinical outcome. Forth, evaluating the process through a periodic review of the content will show how well a clinical question has been answered and 16

advise either in the same or another setting. The evolution of information technology IT allows easily flow of the medical and clinical information, necessarily to help the clinicians in making the right clinical decision about individual care. McClellan (2008) have pointed out that The technological and scientific innovation continued to expand the universe of medical interventions, treatments, and approaches to care, ushering in an era rich with potential for improving the quality of healthcare (page 6). Moreover, patients become more knowledgeable about their medical condition, and they request for the best medical interventions and/or treatments. The internet and related medical web-based technologies offer a novel communication tools, to easily access and updates the clinical and pharmaceutical knowledge.

1.3 Research objective

The primary objective of this research aims to investigate the current relationship between the pharmaceutical companies and the physicians and healthcare professionals, and explores the online communication and electronic detailing e-detailing as a potential alternative of marketing and communication channels. A fully integrated information technology IT and electronic commerce e-commerce (Liou et al, 2002), will provide a leading pharmaceutical company with a tremendous tool for building the physicians trust, and maintaining a convenient relationship among the healthcare professionals and the broader medical communities. The primary relevance for computer accepting behavior as stated by Davis (1989) is the perceived usefulness and perceived ease of use, whereas the attitude and 17

behavioral intention are the secondary one. Therefore, using the technology acceptance model TAM the research addresses four variables categorized in two aspects, the independent variables including the usefulness and ease of use the internet technologies, and the dependent variables including the attitudes and behavioural intention of the physicians and healthcare professional toward the internet and related web-based technologies as a source of pharmaceutical and clinical information.

I) Perceived usefulness Perceived usefulness is the main determinant user of the internet and related web-based technologies (Yi, 2006), and is considered as dependent and independent variables, and is strongly linked to outcome expectations. Slatten (2010) has highlighted that perceived usefulness is the degree to which a person believes that using a particular system would enhance his or her job performance (page 5). Perceived usefulness is strongly linked to the studys outcome.

II) Perceived ease of use Perceived ease of use is the degree to which a person believes that using a particular system would be free of physical and mental effort (Slatten, 2010). In respect to present research, perceived ease of use variable has either a direct effect on the physicians behavioural intention to use the internet technology, or indirect effect via their perceived usefulness of the internet technology as a source of pharmaceutical means. In essence, it reflects that using the 18

internet technology perceived to be easier, faster, and reliable as a source of pharmaceutical and clinical information than the traditional detailing.

III) Attitude Attitude is an individuals desirability to use the systems (Gardner et al, 2004), and is a measure of the individual feeling toward using specific system. This provided a hypothetical explanation of the physicians attitude and intention to use the internet technology in their clinical practices. Using a comparative method of analysis, the study aims to determine the relationship between the physicians attitude and their intention to use the internet technology as a source of pharmaceutical and clinical information in their clinical practices.

IV) Behavioural intention Behavioural intention to use the internet technology as a source of pharmaceutical means, has a positive correlation to the perceived usage of the internet technology (Gardner et al, 2004). Behavioural intention measures the strength of physicians and healthcare professional to use the internet and related technology as a source of pharmaceutical and clinical information in their clinical practices.

1.4 Research questions

The questions arise from this research are: 19

Is the traditional model of detailing still the best approach? Can electronic communication replace the in-person traditional communication? And how do we balance the mix of in-person and e-detailing along the products life-cycle? How will we integrate valuable physician feedback and information gleaned from each electronic communication channel? How electronic communications and e-detailing attain long-term credibility and trust? What are the future expectations of e-detailing as a marketing channel?

1.5 Research topics

Chapter one stated the significance of the problem, the research rationale, and the research objectives and how it will contribute to the healthcare practices. The contextualization of the study and provided an introduction to its basic components. Chapter two situated review of the literature with relevant themes or variables, and outlined the conceptual framework of the study. Chapter three described in details the research design and the research methodology, with an introduction to its basic component. Chapter four organized and reported the study main results and findings. The study uses a comparative method of analysis and descriptive statistics of the technology acceptance model TAM variables responses, the findings including both the qualitative and quantitative results from the research problems and research questions. Chapter five interprets and discusses the results and findings in lights of the studys questions. As a result the conclusions for policy and practices and recommendations for specific action plan have been made, while stated the studys limitations for further improvement. 20

2.0: CHAPTER TWO: LITERATURE REVIEW 2.1 The evolution of information technology IT and electronic commerce ecommerce in business development
The adoption of the internet technologies has revolutionized many aspects of societies (Sweet, 2009), and created rich online businesses media. As a result it brought a new marketing opportunity. Conceivably, the internet and medical web-based technologies will enable a direct communication between the pharmaceutical company and the physicians and healthcare professionals. More importantly, it allows direct-to-physicians DTP interactive campaigns.

2.1.1 The role of information technology IT in business development

Nowadays, the internet and information technology IT becomes an integral part of business development (Porter, 2001), and play a major role in enhancing the internal communication and the work productivity within the organizational departments through storing, manipulating, and processing of order information (Davenport et al, 1990). On the other hand, organizations are using information technology IT to overcome the geographical boundaries and lessen time and effort to outreach the clients and customers 24/7 (Carpano et al, 1998). In todays highly competitive market, computer-based information technologies IT may be the primary strategic resource for maintaining competitive advantage (Sabherwal et al, 1991). As summarized by Intel Corp. (2000), the major success factors of information technology IT in pharmaceutical business are: 21

Information technology IT fully integrated into the companys overall strategy. Current electronic commerce e-commerce systems expanded to cover entire supply chain. Quick time to market-entry to gain first mover advantages, and quick time to marketwithdraw to save the companys reputation and minimizing the late withdrawal cost

Healthcare providers and medical societys expectations well-managed. Website of high qualities that meet physicians and clinicians expectations Monitoring market shares.

2.1.2 Evolution of electronic commerce e-Commerce

The evolution of information technology IT and increasing the number of internet users, makes significant changes to the modes of business communication and commenced the era of electronic commerce e-commerce (Alt, 2003). Pharmaceutical companies use its core capabilities by means of e-commerce to improve the efficiency and productivity for clinical development, channel management, and for marketing and sales strategies (Pathak, 2010). To pursue these strategies, pharmaceutical companies utilize and expanded all platforms of ecommunication channels. Rama (2004) has stated that The pharmaceutical industry achieves significant tasks by utilizing e-commerce to circulate information in order to build an integrated network for both the industry and the users (page 99). Leveraging the customer relationship management CRM technologies enable an interactive two-way communication 22

(Richard, 2008) among the stakeholders, the key opinion leaders KOL, and the physicians. With the growing competition, e-commerce enables pharmaceutical companies to create a high speed e-communication to interact with the physicians, the suppliers, and other intermediaries. For instance, this is evidenced by 30% yearly growth increases in the online retail business (Kotler et al, 2008). More importantly, the number of the healthcare organizations and medical suppliers who visited the web page looking for fast speed and informative business transaction is increased. Most pharmaceutical companies realize the necessity of conducting business-to- business B2B, and business-to-customer B2C models (Porter, 2001). These online business transaction models are becoming the crucial tools for gaining competitive advantage in the global market. Therefore, a world leading pharmaceutical companies such as Pfizer, Sanofi Aventis, Glaxo Smith Kline GSK, BristolMyers, Novartis, and Eli Lilly designed and developed websites for launching the innovative products, increasing the sales volume, and reducing the marketing cost.

2.1.3 E-detailing diverse platforms

Traditional face-to-face drug promotion is the dominant marketing tool (Bernewitz, 2001), where the companys marketing strategies rely heavily on it to outreach the physicians and healthcare professionals. Nowadays, pharmaceutical companies face major limitations to keep the existent key opinion leaders KOL and maintained a credible partnership among the others. The internet and related web-based technologies can greatly expand a company's reach (Heutschi et al, 2003), by providing a newer electronic communication channel through diversified e-detailing platforms such as videoconferencing, electronic education modules, 23

and the use of email and related technologies to promote two-way communications (Sweet, 2009). Videoconferencing is the easiest and the most popular technology of knowledge transfer via complex traditional and e-detailing (Heutschi et al, 2003). For instance, iPhysicianNet www.localhealthcompass.com a world leader videoconferencing provider, operates e-detailing sessions among others pharmaceutical companies and grant the physicians with a portable computer PC plus internet connection free of charge. Lathian www.lathian.com a virtual training provider, allows training for specific pharmaceutical products and services, Heutschi (2003) described this form is quietly suitable for conducting online continuous medical education CME program. In practice, a global leading

pharmaceutical company is increasingly turning to e-detailing for marketing their products and services (Jung et al, 2002) among the physicians, and for building long stay a credible partnership among the broader medical communities and the societies.

2.1.4 Web-based media partner

To maintain its reputation as a source of accurate pharmaceutical and clinical information, a leading pharmaceutical company upgrades their partnership with the online marketing media into strategic alliance (Kaplan et al, 2010). More importantly, eliciting the physicians feedback throughout 24/7 is necessarily for evaluating the companys current status, and essential for future strategies. From the companys perspective, maximizing the valuesprofits ratio fall within synergistic offline-online strategic marketing interactions, which would provide opportunities for gains in productivity and meet the physicians and healthcare 24

professionals

expectations.

For

instance,

professional

website

ExL

Pharma

www.exlpharma.com a division of ExL Events Inc. is an industry leader in developing innovative and educational conferences, that serves the pharmaceutical companies and associated healthcare communities in the US and Europe. Appature Inc.

www.ignitionpartner.com is another Exl Events Inc. group www.exlpharma.com, which provides simple website marketing solutions designed exclusively for healthcare companies, to quickly gain new customer insights and create programs to deepen brand awareness and drive greater sales growth (ignition, 2011). Below is a list of a useful web-based media partner: Online media partner Cadient Group Lathian Health The Little Blue Book Physicians Interactive Within 3 Siren Interactive Imc2 Health & Wellness Network site http://www.cadient.com http://www.lathian.com http://www.t1bb.com http://www.phyisiansinteractive.com http://www.within3.com http://www.sireninteractive.com http://www.imc2healthandwellness.com

2.2 Potential benefits and main challenges of electronic detailing e-detailing

In synergy ways, e-detailing augment the traditional detailing (Heutschi et al, 2003), which will help the pharmaceutical companies to staying in credible, legitimating ethics, building trust, and maintaining a convenient relationship into the physicians, the stakeholders, and the 25

broader medical communities . The potential benefits of e-detailing in the pharmaceutical business from the companys and physicians perspectives are summarized in the following:

2.2.1Companys perspectives
To maintain its reputation, a global leading pharmaceutical company capitalizes on the online communication and the internet technologies to attain the following: Enriches the profits-values ratio through lower detail cost and greater physicians reach 24/7. As reported by the Fact Sheet (2005) traditional detailing is the second largest market segment of $6.78 billion representing 22% of the total market expenditure. Moreover, a report released by Fact Sheet on (2007) has estimated that the approximate cost of face-toface sales interaction is high relative to the time consumed. The combine offline-online detailing has a positive marketing effect (Manhattan Research, 2008). The ease of accessibility and the content of medical and clinical knowledge via online communication and e-detailing, enable for eliciting the physicians feedback for future marketing and sales strategies. Development of e-customer relationship management CRM technology (Alt, 2003) would provide an easy, fast, and a convenient way to improve the efficiency and productivity of the business around the world. Online communication and e-detailing allows marketers to better segmenting the market potential especially prior the market orientation (Curry et al, 2000). 26

A unified view of e-detailing would provide significant benefits through leveraging efficient customer relationship management CRM technology, optimizing product life- cycle management p-LCM, branding, and pharmacovigilance technology alerts.

2.2.2 Customer relationship management CRM technologies

In todays business, consolidating the value-profit ratio among the key opinion leaders KOL, the physicians, and the medical suppliers is essential to maintain competitive in the global market. Although customer retention strategy is essential to keep the valuable

customers (Sasser, 1990), customer acquisition strategy is the critical success factor CSF to capture a newer customers for a long-stay business relationship. Therefore, reducing the marketing cost and increasing the sales revenue derived from serving customer is a meant of customer relationship management CRM technologies strategies and implementation. The customer relationship management CRM technology provides the pharmaceutical companies with a mechanism for segmenting its customer base, and to visualize and analyze customers behavior, loyalty, and value within each of those customer segments (Curry et al, 2000). Moreover, the internet-based electronic customer relationship management CRM is a collaborative technology for efficient communication and sharing information between the pharmaceutical companies and the healthcare professionals (Sweet, 2009). These technologies tools efficiently facilitate the following: Real-time communications access throughout 24/7.

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Highly professional web content with respect to the physicians interests. Highly integrated -intranet system for information management allows companies to increase collaboration among corporate employees, business partners, and suppliers (Berkowitz, 2010). An electronic customer relationship management e-CRM technology aims to maximize the lifetime customers values, through efficient integration of the traditional sales force and the internet-based communication (Alt, 2003). Thereby, this will help pharmaceutical companies in better segmenting the market based on the customer services such as the key opinion leaders KOL (Lerer, 2002), understanding the epidemic status of the diseases area, and the recommended duration of treatment. An example of global technology and service company specialized in the healthcare field is Cegedim Relationship Management www.cegedim.com a life sciences industrys leading provider. Cegedim supplies services, technological tools, specialized software, and data flow management services in the healthcare business.

2.2.3 Product life-cycle management p-LCM

In the modern global economy, pharmaceutical companies are facing time-to-time challenges; time to enter the market early to gain the first-mover advantages, and time for short-term profit return (Chataway et al, 2008). Product life-cycle management p-LCM is recognized as one of the keys leading technologies to facilitate the companies to overcome these challenges (Ming et al, 2005). As the cost of developing new innovative drugs 28

continues to escalate, a leading pharmaceutical company is working to improve research and development R&D programs, shorten the production phases, and establishing the brand in the market. The core values of product life-cycle management p-LCM are information and time (Oracle, 2008). Therefore, timely management of the information assets can influence the timely market-entry to capture the first-mover advantages in the class- therapeutics, shorten time-to profit, and allows a larger post marketing clinical trials for brand extension and expansion. Accordingly, product life-cycle management p-LCM technology is the one of the most rapidly growing technologies in the pharmaceutical market industry, and its implementation can help improve the information challenges associated with the product management (Datamonitor, 2007). The holistic approach of the product life-cycle management p-LCM is characterized by the following: Improving the visibility of the product information and utilization among the healthcare organizations and medical suppliers. Product life-cycle management p-LCM offer a long-term brand protection, as well as shortterm recovery following risen claim of unexpected adverse drug reaction UADR related to the brand, the unethical marketing, and losing of the drug discovery data (Katz, 2010). Allows time-reduction through electronic submission compilation, and timely- response to data request mandated by government regulations and other authorized corporate governance (Katz, 2010). Provides a wider scope of what information needs to be reviewed and protected within the specified time-frame 29

An efficient implementation of the product life-cycle management p-LCM technology will help a leading pharmaceutical company to develop a new drug faster, more safely, and at lower cost (Oracle, 2008).

2.2.4 Branding
Branding of pharmaceutical products is complicated by the short product life-cycles and the regulatory authorities on communication the basic benefits of the drug (Lim et al, 2010). Although the major mass of communication channels are through the medical journals, conferences and symposia, continuous medical education CME programs, and hospital educational forums, branding in the pharmaceutical industry is seen as an important aspect of communication (Lim et al, 2010). At present, the role of the key opinion leaders KOL are quite obvious not only during the launching phase of the products but, also to simplify and delivers the brands messages and emphasize the brands benefits versus the competitors in the medical communities. As consequences, pharmaceutical companies rely heavily on the role of the key opinion leaders KOL to augment the brands communication mix in the clinical practices, and strengthening the brand values in the medical communities (Lim et al, 2010). Further to that the clinicians respond to the new clinical interventions by seeking information and opinions from peers and opinion leaders, rather than assessing the scientific merits by themselves (Peter et al, 2004). Moreover , a relatively inexpensive generic drug is the major threats that hit brand shortly beyond market-entry, Lofgren (2002) has stated that Public and private third-party payers increasingly encourage or mandate the use of 30

generics through measures such as generic prescribing and generic substitution (page1). In this regard, a leading pharmaceutical company can develop an electronic brand hand-led devices such as, electronic brand-connect eb-CONNECT loaded with pharmaceutical and clinical information necessarily to help the physicians and clinician to make the proper clinical judgment for a better clinical care. Therefore, following a successive product-life cycle management p-LCM programs, the electronic communication and the diversified edetailing platforms will offer a broader communication channels to establish the brand among the physicians, the medical communities, and the societies 24/7.

2.2.5 Online disease awareness

A part of their continuous medical education CME and social responsibility, a global leading pharmaceutical company increasingly uses e-detailing for disease awareness campaigns. Sweet (2009) has pointed out that Pharmaceutical companies are capitalizing on the advent of the internet and the development of new media forms to promote their products (page 2). Among the tools being used are interactive websites, email prompts, and viral marketing campaigns using social networking sites (Bampo et al, 2008) such as; YouTube www.youtube.com, MySpace www.myspace.com, Twitter www.twitter.com, and Facebook www.facebook.com. Such campaigns are targeting the physicians, the healthcare professionals, and the general public. For instance, pfizer reportedly collaborating with Sermo Inc. www.sermo.com a web venture based in Cambridge the US, where tens of thousands of doctors discuss diagnostic and treatment issues in anonymous postings, this collaboration allows pfizer's doctors to ask questions and respond to post (Johnson (2007) . 31

Members can also rank postings, which will give insights likely to help the company's development of marketing messages. Sweet (2009) has reported that Sermo rewards the physicians whose input is highly ranked by other members. As a part of social responsibilities and building partnership with the patients and medical communities, Bayer Schering Pharma conducted Thrombosis Advisor a web-site information resource www.thrombosisadviser.com for the physicians and patients about thrombosis. GlaxoSmithKline GSK on its corporate blog in the US; http://alliconnect.com allows conversation for the healthy weight loss products, such active conversation enables GSK eliciting the necessarily feedback for future marketing strategies.

2.2.6 Pharmacovigilance alert

Throughout the product life-cycle period, a leading pharmaceutical company faces with a greater regulatory requirements and increased accountability demands for the protection and welfare of patients (ICPM, 2008). Moving beyond the standard regulatory requirements, pharmacovigilance technology can assist pharmaceutical companies to systematically detect and prevent the adverse drug reactions ADR (Lu, 2009), and preventing the costly safetyrelated market withdrawal. Now a day, information technology IT has transformed the traditional healthcare system and clinical medicine into higher quality and with lower cost (Lu, 2009). In this regard, the post marketing surveillance, the safety data collection in real life clinical practices, and clinical risk assessment are critical for evaluating and managing the safety and risk profile (Lu, 2009). 32

2.2.7 Social network sites

Realizing the power of the social networking sites, a global leading pharmaceutical company capitalizes on the social networking platforms (Stockman, 2010) such as, Twitter www.twiter.com , Blog www.blog.com , Facebook www.facebook , Linkedin

www.linkedin.com , and other social media account for the news, announcements, and delivering medical and pharmaceutical information (Sweet, 2009). For instance, Pfizer addressed its mission on the Facebook page; www.facebook.com/pfizer as Good health is vital for all of us. We strive to provide access to safe, effective and affordable medicines and related health care services to the people who need them (page 2). A part of the social responsibilities and for building trust and long stay credibility among the societies and patients as well, pharmaceutical companies capitalizes on the social networking media to disseminate their values and visions to create a virtually-loyal customer.

2.2.8 Physicians and healthcares perspectives

A survey conducted by Google (2009) demonstrated that 65% of the physicians access the internet more than once per day, where 86% of them have used the internet to gather clinical, medical, and prescription drug information. In particular, the reasons for use of the internet and related medical web-based technologies were felt primarily in the Physicians acceptance behavior. An e-detailing solution gives the physicians and healthcare professional greater control over the time, the place, and the content as well as the quality of the information (Accela, 2009), and provides a convenient direct-to-physicians DTP electronic 33

communication throughout 24/7. Undoubtedly, the quality and the quantity of the information content delivered by e-detailing reinforce the physicians and healthcare professionals to frequently update their medical knowledge as a part of the continuing medical education CME programs. On the other hand, the critical success factors CSF of e-detailing is the accessibility throughout 24/7 and fast speed on retrieving the needed pharmaceutical and clinical information. For instance, GlaxoSmithKline GSK a leading healthcare company developed GSK source website www.gsksource.com , which permits an easy access to be comprehensive, to update information, and navigate clinical information and services. Sanofi Aventis, a world leading pharmaceutical company conducted The Partnership for Prescription Assistance a web-site in US www.sanofi-aventis.us/live, the program is designed to join America's pharmaceutical companies, the doctors, the patient advocacy organizations, and the community groups to help qualify patients who lack prescription coverage get the medicines they need through the public or private program that's right for them. Generally through the diversified e- detailing platforms, a leading pharmaceutical company efficiently establishes an interactive two-way communication for delivering accurate and updated pharmaceutical and clinical information in a fast and flexible way. Consequently, this allows the companies to access easily the physicians feedback necessarily to design an efficient customer relationship management CRM strategy, for building trust and maintaining a convenient relationship into the stakeholders and the physicians.

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2.2.9 Main challenges of information technology IT and e-detailing

Although many e-detailing approaches were in the experimental stages, the observer could find that e-detailing confronted with a series of challenges. These challenges can be summarized as follows:

In the near future online activities run alongside the offline communication rather than substitute it. Therefore, e-detailing approaches may burden the companys marketing expenditure (Heutschi et al, 2003).

The healthcare market structure and the scope of achieving the economies of e-detailing is limited in various regions, as the e-detailing providers solution were concentrated primarily in homogeneous healthcare market (Boehm 2002).

The internal field force resists the e-detailing approaches which might raise a conflict among the sales representatives and the companys management and eventually hindering the companys marketing and sales strategies.

Regulatory restrictions, where the companys payment, sponsoring of conferences and symposia, and incentives to the physicians and healthcare professional must comply with the regulatory code of conduct of promoting medicinal products (EFPIA, 2007).

Long time needed to establish a technical information technology IT foundation. High subscription cost of the online medical and pharmaceutical websites.

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3.0: CHAPTER THREE: RESEARCH DESIGN

In many areas of the health care research, the combining qualitative and quantitative method in a single study is widely practiced and accepted (Sale, 2002). Alicia (2007) has concluded that Mixed methods research in healthcare service research HSR is common in the UK, its use is driven by pragmatism rather than principles, motivated by a perceived deficit of quantitative method alone to address the complexity of research in healthcare (page 1)

3.1 Mixed methods research

The complexity of the research problems within the health sciences makes using a mixed methods research design more appropriate to use (Creswell, 2009). In respect to the present research, the mixed methods are used to uncover a more profound understanding of the physicians perception and attitude towards the internet and related web-based technology as a source of pharmaceutical and clinical information. Combining the qualitative and quantitative method research gives the researcher the opportunity to support the hypothesis with the evidence, generating a more productive analysis of data, and enables the possibilities of new ways of thinking that materialized from the two different types of data (Johnson et al, 2007). Similarly, some researchers have argued that the complexities of the most public health and social interventions such as health education and health promotion programs require the use of a broad spectrum of quantitative and qualitative methods (Steckler et al, 1992). The qualitative and quantitative aspect of this research is based on a particular paradigms; the quantitative paradigm is based on positivism where theres only one truth and 36

the researcher is capable of studying the perceptions of the physicians and healthcare professionals toward using the internet and related web-based technologies in their clinical practices, without influencing it or being influenced by it. The qualitative paradigm is based on articulate respondent of the key opinion leaders KOL in qualitative interviews, because they are a leader and have the ability to see the holistic picture (Reid, 1996). The researcher and the object of this research are interactively linked so, that findings are mutually created within the context of the situation which shapes the research hypothesis (Denzin et al, 1994). The survey was conducted in the Saudi Arabia, and has been designed to investigate the status of the traditional communication of the pharmaceutical companies among the physicians, the healthcare professionals, and the broader medical communities and to explore the potential values of e-detailing and online communication. The prospects survey attempts to answer the following coordinates; the physicians and healthcare professionals attitudes toward traditional face-to-face detailing and e-detailing interactions, their beliefs about the products information conveyed by the traditional detailing and e-detailing, and the future expectations of the online e-detailing.

3.1.1 Development of grounded theory

Using the principles of the grounded theory which was first presented by Glazer and Strauss (1967), the study applied substantive grounded theory to develop a conceptual hypothesis of the potential role of the internet and medical web-based technology as a source of pharmaceutical and clinical information in the healthcare settings. The common features of 37

the substantive grounded theory is that its carefully induced from the diverse data (Cerniglia, 2008), and its closely related the realities of the perception of the physicians and healthcare professionals toward the internet and medical web-based technology as a source of pharmaceutical and clinical information in their daily clinical practices. The substantive grounded theory is not only understandable to the people working in the substantive field but also, sharpens their sensitivity to the research problems (Cerniglia, 2008). Rather, the developed substantive grounded theory transcends and gets applied to any other substantive field regardless of the time, place, and people participated in the study (Glazer, 2002). Through a comparative method of analysis, the substantive grounded theory is inductively derived from the studys findings, which have been obtained through systematic research methods using the following steps: 1. Identify the research problem from the qualitative interviews, and the categories with relevant themes that emerge from the previous studies and the literature review, develop the research questions, and the method used in judging and comparing the results. 2. The combined qualitative and quantitative data is collected and coded to provide a conceptual framework of the study (Glazer, 2002). 3. The data was analysed and categorised to describe the research hypothesis. The technology acceptance model TAM variables responses are identified, labelled, and categorised to describing overall features of the research results and findings.

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3.2 The qualitative method 3.2.1 Methodology

Using standardized open-ended interview technique will help provide a theoretical explanation, grounded by the physicians perception towards the offline and online detailing. Interviewees will be asked identical questions and the questions were worded so, that responses are open-ended (Turner, 2010). This type of the questioning technique will help to elicit responses based on the personal experiences and opinions, toward the potential values of the internet and related web-based technology as a source of pharmaceutical and clinical information, and allows the researcher to prepare follow-up questions focuses on the research hypothesis (Turner, 2010).

3.2.2 Pilot interviews test

Prior to the implementation of the planned interviews, a pilot interviews test has been conducted with three participants that shared the same interests as those of selected interviewees (Turner, 2010). The purposes of the pilot interviews test is to assess the proposed time for the interview , examine the type of questioning technique and the questions flow , and allow for refinement of the research questions (Turner, 2010).

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3.2.3 Sample selection

Using a convenient sampling, eight interviewees were selected based on the criterion-based sampling that they will be willing to openly and honestly share information and provides the most credible information to the study (Turner, 2010). Interviewees were carefully selected to understand their perceptions towards using the internet and related web-based technologies as a source of pharmaceutical and clinical information in a permissive and non-threatening environment (Ogunbamerm 2003). The choice of the interviewee was based primarily on the basis of accessibility and willingness to participate, and was conveniently selected from the accessible physicians and healthcare professionals. Accordingly, eight participants were selected from the healthcare authorities; the Saudi Food and Drug Authority S-FDA, the pharmacy directorates, and the physicians and healthcare professionals in the academic and governmental hospitals. Interviewees were asked identical unstructured questions in terms of wording, so that the responses are open-ended (Gall et al, 2003). The researcher aims through this interview design to allow the participants to contribute as much detailed information as they desire, to fully express their viewpoints and experiences, and it also allows the researcher to ask probing questions as a means of follow-up (Turner, 2010). The selected interviewees have the necessarily skills such as, key opinion leader KOL, having visions and values, and have the ability to see the holistic pictures (Boyce et al, 2006).

3.2.4 Preparation of interview

In order to provide maximum benefits to the research hypothesis, the researcher applies four principles to the preparation stage of interviewing (Turner, 2010) which includes the 40

following ingredients: (1) explain the purpose of the interview (2) address terms of confidentiality (3) explain the format of the interview (4) indicate how long the interview usually takes. The sample population for these interviews will be managing the drug regulatory in Saudi Food and Drug Authority S-FDA, key opinion leaders KOL in healthcare services, and consultants physicians and general practitioner

3.2.5 Ethical issues, privacy and confidentiality of research participants

Although there is no agreed guideline for judging the ethics of qualitative research (Richard et al, 2002), the researcher realizes the necessity of the ethical issues which arise when planning and carrying out this qualitative interviews with the physicians and healthcare professionals. The researcher recognizes the four potential risks to the research participants the anxiety and distress, the exploitation, the misrepresentation, and the identification of the participants in the published paper (Richards et al, 2002) details in section 3.3.4 and 3.3.5.

3.2.6 Data Collection

The data has been collected between June and August, 2010. The conducted interviews were face-to-face at a time and place convenient for the interviewee. Average duration of the interview was thirty minutes. The interviews were documented by written description and transcribed by the researcher.

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3.2.7 Reliability and Validity

Assessing the internal reliability and validity of the present research is crucial to ensure accuracy of the data. Pope (2002) has stated that Qualitative methods are often seen as scoring highly in terms of internal validity (page 150). Therefore, the study design and the method of analysis used are quietly suitable for the aid of the research objective in a given time. However, the study is unlikely to be replicated under the same controlled conditions (Pope, 2002).

3.2.8 Data Analysis and presentation

As in the grounded theory methodology, the qualitative and quantitative data is collected and referred to as coding (Creswell, 2007). The detailed procedures for the data analysis consist of three stages first, open coding is an initial stage in the data acquisition through which the data is selected, and the open coding categories which is extensively discussed by the research participants is identified and listed as the central phenomenon for the purposes of the research questions (Creswell, 2007). Further to that the technology acceptance model TAM variables responses are labeled and categorized to describe the overall features of the research hypothesis. Second, axial coding through which the selected categories and the technology acceptance model TAM variables responses are interconnected to each others, to form the coding paradigm (Creswell, 2007), which provided insight into specific coding categories that explain the central phenomenon and built the theoretical model of the study (Creswell, 2007). Third, selective coding where the core categories in the coding paradigm 42

are selected and interrelated to generates conceptual statement that hypothesizes the theoretical model of the study (Creswell, 2007).

3.3 The quantitative method 3.3.1 Methodology

The survey was conducted in a questionnaire format comprising twenty items within four categories (see figure: 4), each of which has series of questions and each question provide six answers ranging from strongly agree to strongly disagree from which the respondent could choose (see section 3.4.2). The responses were scored numerically and then quantified, categorized, and subjected to statistical analysis using computer excel program. The descriptive questionnaire items are characterized by: The questionnaire deals with a specific situation, that requires visibility of the observational techniques used for the data collection The physicians and the participants for the research were carefully selected and clearly defined Particular attention has been given to safeguard the collected data from the influence of bias (Powell, 2004). Data must be collected, organized, and presented systemically so that valid and accurate conclusion may be drawn (Allers, 2010). The researcher used a Likert Scale (Trochim, 2006), where the collected information has been grouped into six categories with boxes to tick. The Dont know box is there, in order 43

to forestall a common analysis error, which is to assume that the middle box represents something in between the two extremes, whereas a respondent who wants to indicate no opinion ticks it as if it were neutral. The twenty items were arranged in a logical way to find out the determinants of the technology acceptance model TAM variables scores necessarily to reach the research objective.

3.3.2 Questionnaire testing

A pilot test has been carried out after completion of the questionnaire format (Turner, 2010), to examine the questionnaire structure, the flow of the questionnaire items, and the level of understanding the questions (see figure: 5). The responders were asked verbally about their understanding, the time needed to fulfill the questionnaire items, and the ease or difficulties of answering the questions.

3.3.3 Sample selection

A careful sample selection has been carried out to investigate the research hypothesis, and to draw a general conclusion about the physicians perception toward the online communication and e-detailing (Limpanitgul, 2009). Accordingly, the present research follows a five step procedures from defining the target population to collect the data from the sample (Limpanitgul, 2009). The sample size of the research was drawn from the Ministry of Health MOH directorate database of 364 physicians and healthcare professionals. The survey was followed a non-probability sampling procedure (Trochim, 2006), and has been carried out within the period from 10th of July 2010 to 5th of August 2 44

3.3.4 Ethical issues of the research participants

To date, the reservations held about strict ethical guidelines for the health service research HSR plays a major role in adoption of agreed standard of good practice (Richards et al, 2002). Whilst recognizing the main ethical issues rose on carrying out this research, the researcher aims to minimize the potential risks and the consequences of legislative change in human rights and data protection of the research participants. As mentioned by Richard and Schwartz (2002) the four potential risks of the research participants who might be observed were: Firstly, anxiety and distress the researcher aims to avoid anxiety and distress provoked from unpredictable sensitive topics and questions, by designing a research deals with a specific situation that requires visibility of the observational techniques used for collecting the data and delivered predictable questions. Secondly, exploitation is an important aspect which significantly harms the research, the researcher avoided exploiting the power of relationship and the participants from feeling pressurized to participate in research, because they depend on the goodwill of their corers (Holloway et al, 1993). Thirdly, misrepresentation recognizing that the participants are more likely to feel that their views have been misrepresented and taking out of context, the present research designed to answer specific questions about their perceptions, attitudes, and behavioral intention towards the internet and related web-based technologies as a source of pharmaceutical information. Fourthly, the nature of qualitative health service research HSR collect a large amount of participants information and views. Therefore, identification of the participants in published paper by themselves or others, potentially may lead to serious harm. Accordingly, the researcher recommended strategies for reducing the risk of harm include ensuring scientific 45

soundness, ensuring privacy and confidentiality, and anonymity of the research participants (Richards et al, 2002).

3.3.5 Privacy, confidentiality, and anonymity of the research participants

The identity of the participant in this study appears to have become central to the design and practice of ethical research (Grinyer, 2009). Thus, the privacy and anonymity of the physicians and healthcare professionals have been designed within the context of this research, and it was achieved once the data has been collected and not subject to re-construct. Grinyer (2009) further comments that The research participants should understand how far they will be afforded anonymity and confidentiality and should be able to reject the use of data gathering devices such as tape-recorders and video cameras (page 50). As a result, the participants should be able to recognize themselves, while the reader should not be able to identify them.

3.4 Data collection, data capturing, descriptive statistics, and validity and reliability 3.4.1 Data collection
To harvest high quality data, the questionnaire items were structured and sequenced in a way to ensure easily flow of the categorys variable answer and to avoid burdening on the respondents working memory (Mora, 2011). The questions were designed as closed-ended 46

questions with answer choices (CSU, 2011), and were formulated with the right wording so it accurately reflects the perception of the physicians and healthcare professionals towards the internet and related web-based technologies as sources of pharmaceutical and clinical information (see figure:6). Data collection involves all activities and processes to obtain data necessarily to explore a new era of pharmaceutical and clinical information or to confirm the previous findings, either qualitatively through in-depth face-to-face interviews, or quantitatively by contacting the physicians and healthcare professionals through a questionnaire.

3.4.2 Data capturing

To capture high-quality data, the different parts of the questionnaires item work in harmony and in consistency to avoid responders confusion (Mora, 2011). With the guidance of qualified statisticians the data captured onto an Excel Application Program EAP, each question and option were numbered uniquely and occupied a single field in the database. The perceptions are measured on a continuum from one extreme position to the opposite extreme position. The Likert scale response mechanism (Trochim, 2006) and William (2006) allow for five responses, namely, strongly disagree, disagree, neutral, agree and strongly agree. Numerical values of one to five were allocated to each response in respective order. Numerical values with a value of less than three represent a negative perception to the questions while, numerical values greater than three reflect a stronger perception. The value three offers a neutral response.

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3.4.3 Descriptive statistics

The primary goal of the data analysis is to arrange the collected technology acceptance model TAM variables responses in a way that the answer to the research questions reveals itself (Wrenn et al, 2007). Given all the technology acceptance model TAM variables responses, the resultant substantial large volume of data from this research was carefully condensed and summarized (Walter, 2009). The use of descriptive statistics (Trochim, 2006) may assist in the following parameters: First, it indicates the central point around which the questionnaire data distributed. Second, it may show the relationship of one technology acceptance model TAM variable to another one. The central location statistic represents a middle point of a set of observations and is useful for comparative analysis (Trochim, 2006). The following measures for central location will be used:

The Mean The mean is the location measure most frequently used for interval-ratio data (Somekh et al, 2002). Mathematically, it is the arithmetic average representing the sum of the ascertained values in the distribution divided by the number of observations.

The Median The median is the score found at the exact middle of the set of values (Trochim, 2006). To compute the median is to list all scores in numerical order where half the scored values will fall below this median value and the other half above it. 48

 The Mode The mode is the most frequently occurring value in the set of scores (Trochim, 2006), and is the only means of measuring central tendency around the mean containing nominal categorical values (McCluskey et al, 2007).

The Standard Deviation The standard deviation SD is an important aspect for descriptive statistics because it reveals the amount of variability of individuals within a data set (Trochim, 2006). The standard deviation SD gives an accurate and detailed estimate of the dispersion and shows the relation of the technology acceptance model TAM variables scored values has to the mean of sample size. The standard deviation SD is the square root of the sum of the squared deviation from the mean divided by the number of scores minus one and is calculated according to the formula below:

SD =

(X-X) 2 (N-1)

Where: SD is Standard Deviation : Sum of score 49

X: each score X: The mean or average N: Number of values

Correlation analysis The correlation analysis is the statistical tool use in order to measures the linear relationship between questionnaires variables and how closely they relate to each other (biddle, 2005), where the value of correlations existed known as a correlation coefficient represented by the (r) symbol. The (r) values ranged from -1.0 to +1.0, the negative values represent a negative relationship between the questionnaires item and the positive values represent positive relationship between the questionnaires items. According to Trochim (2006) the correlation coefficient (r) was calculated as:

Correlation (r) = [NXY - (X) (Y) / Sqrt ([NX2 - (X)2][NY2 - (Y)2])] where: N = Number of respondents . Y = Second Score. X = Sum of First Scores. X2 = Sum of square First Scores. X = First Score.

XY = Sum of the first and Second Scores. Y = Sum of Second Scores.

Y2 = Sum of square Second Scores.

50

The probability (p) threshold to be no more than 0.05 or 5%, the level of correlation coefficient (r) significance is determined at (p) < 0.05 (Trochim, 2006). The (n) represent the total number of respondents; the large (n) will lead to be statistically significant (r), whereas the smaller (n) conversely will lead to statistically non-significant.

3.4.4 Validity and reliability

To ensure consistency and credibility of the present research, it was necessarily to track the validity and reliability standards of quantitative research. As noted by Golafshani (2003) that Reliability and validity are tools of an essentially positivist epistemology. (Page.598), the validity of the present researcher uses naturalistic approach that seeks to understand, and determines whether the research truly measures the perceptions of the physicians and healthcare professionals toward the internet and medical web-based technologies as a source of pharmaceutical and clinical information. The construct validity is the truthful of the studys concept and the drawn conclusions of the study results and findings (Golafshani, 2003). On the other hand reliability represents that the measurement are accurate and the result is consistent overtime and is readily modifiable by comparative analysis with new data regardless the time, place, and population (Glazer, 2002). Using the collected technology acceptance model TAM variables responses, the reliability and validity of the factors contained in the research was evaluated, and the reliability was assessed using a Pearsons correlation coefficient (r). The purpose of Pearsons correlation coefficient (r) is to measure the internal consistency and reliability of the scored values and to assess whether there is a relationship between two or more technology acceptance model TAM variables (Yaffe, 51

1999). As summarized in the table below, the computed Pearson Product Moment Correlation coefficient (r) showed that the investigated technology acceptance model TAM variables exhibited an alpha value (r) greater than 0.5, with an overall result of 0.98, suggesting a high degree of internal consistency.
Pearson Product Moment Correlation Variable X Variable Y
287.5 16008.75 126.6

Statistic

Mean Biased Variance Biased Standard Deviation Covariance Correlation Determination T-Test P-value(2 sided) p-value (1 sided Degree of freedom Number of Observation

585.2 21686.56 147.3

8098 0.412877948 0.1704682 1.9 0.07 0.03 18 20

For the items relating to perceived usefulness, the Pearson correlation coefficient (r) is + 0.2 indicating a moderate degree of internal consistency. For the items relating to perceived ease of use and attitude the Pearson correlation coefficient (r) is +0.9 indicating a high degree of internal consistency. For the items relating to behavioural intention the (r) value showed a negative correlation of -0.2 indicating that the technology acceptance model TAM variables scores increase and the other decrease and vice versa.

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4.0: CHAPTER FOUR: DATA RESULTS, DESCRIPTIVE STATISTICS, AND STUDY FINDINGS
Realizing the complexity of the internet and related web-based technology as a source of pharmaceutical and clinical information in the healthcare practices, the combining qualitative and quantitative research results maintained favorable views of a new model of online communication and e-detailing.

4.1 The qualitative data result

Qualitative interviews would have provided a comparative cross-section of all physicians and healthcare professionals (Brewster, 2008) and will assist to develop an initial understanding of the physicians perception toward traditional detailing and exploring the future role of the internet and related medical web-based technologies as a source of pharmaceutical and clinical information. The interviews were of an exploratory nature and have been conducted in the participants offices, where the physicians and research participants were asked to describe their experience with the internet technology as a source of pharmaceutical and clinical information and its implication in their daily clinical practices. Each interview was transcribed by the researcher and then coded. There were several significant findings from the interviews that help in designing the questionnaires item for the aid of research objective. The two interviewees included; the vice-president for drug affair in the Saudi Food and Drug Authority S-FDA who urged the physicians and healthcare professionals to efficiently utilize the advanced information technology IT infrastructure in Saudi Arabia, to frequently 53

updates their medical knowledge and improve their professionalism in the healthcare setting that helped in establishing the evidence-based medicine EBM principles in the community and he has comments that With the internet and adoption of a new web-based medical technology, theres no excuse for the physicians and healthcare professionals to update their knowledge about pharmaceutical products, and following the international guideline for managing the diseases. Additionally, he criticized the relationship pattern between the pharmaceutical companies and the physicians so, further he has noted that The Saudi Food and Drug Authorities S-FDA warns the unethical concern arisen from the relationship between pharmaceutical companies and the physicians and healthcare professionals. Therefore, in compliance with the international code of conduct, they develop a local code of conduct for marketing of pharmaceutical and medicinal products in Saudi Arabia. Whereas the Public relation affair manager in the Saudi Food and Drug Authorities S-FDA emphasize the role of the internet and medical web-based technology as a source of pharmaceutical and clinical information and so, he has stated that The internet and related web-based technology offer a valuable tool for the physicians and healthcare professional to update their knowledge about the disease area, pharmaceutical product, and management especially in scattered regions like Saudi Arabia, but the only limitation might be the lack of internet access in some areas. Both interviewees shared the common idea whilst, they emphasize the added-values of the internet and medical web-based technologies on establishing the evidence-based medicine EBM in the society, they are in agreement that the adoption of internet technologies in the healthcare system help significantly in minimizing the frequency of the medical and treatment errors. Additionally, they realize the 54

necessity of regulatory requirements of the pharmaceutical products and the growing need for a better patients care and safety. Accordingly, the Saudi Food and Drug Authorities S-FDA designed a technology-based National Drug & Poison Information Center NDPIC for early detection and assessment of adverse drug reactions ADR of the pharmaceutical and

medicinal products. On the other hand, three consultants physicians were interviewed in the King Saud Medical Complex KSMC and governmental hospital realizes the scientific values of the internet technology adoption in the healthcare services as a source of pharmaceuticals and medical knowledge and they have stated that the physicians are faced with a barrage of new products, alternative treatments and varying medications, from this point the internet and medical web-based technologies are the dynamic channels and the easiest way to updates their knowledge about pharmaceutical and clinical information. Although the interviewed physicians recognizes the internet and related medical web-based technology as a potentially alternative for delivering accurate pharmaceutical and clinical information when needed 24/7, their judgment is made regarding the innovations clinical benefit (Jonathan, 2008). Interestingly, two of the interviewed physicians have commented that The online disease awareness program may create a critically obsessive medical population, especially those of low medical background and if the medical website is not under a medical consultation. Two of the general practitioners when interviewed were in positive trend towards using the internet technologies as a source of pharmaceutical means and they have stated that The internet technology offers advanced and real solutions to customize the large number of clinical trials and its clinical outcome relative to its adverse effect. A clinical pharmacist in the Ministry of Health MOH directorates when interviewed 55

was in agreement of the tremendous benefits of the internet technology in his daily practice and has stated that The internet technologies values are not only for updating his pharmaceutical and clinical information but, also allows comparing the outcomes and interpretations of different clinical trials that help for a better clinical judgment. In contrast, the only limitation claimed by the interviewees was the higher subscription cost of the online pharmaceutical and clinical websites and the electronic version of the medical magazines. While the sample for our qualitative interviews was small, the data from the interviews explored the context of the research objectives.

4.2 The quantitative data result

In a complementary manner, the quantitative aspect of this research augments the qualitative views mentioned above. The quantitative data was captured, collected, quantified and then analyzed to provide the overall features of the research hypothesis.

4.2.1 Technology acceptance model TAM variables

Using the technology acceptance model TAM variables, the responses of the physicians and healthcare professional toward the internet and related web-based technology model as a source of pharmaceutical and clinical information, were grouped and quantified together to create overall scores for each of the variables items (see figure 7). The central tendency and correlation (r) around the mean were calculated as follow:

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Mean 243.85

Median 180.5

Mode 186

Range 823

Variance 46270.76

St.D 215.106

Correlation 0.413

The chart below represents the technology acceptance model TAM variables responses score:

Whilst 71.6% of the responders showed a positive response towards the internet and related medical web-based technologies as a source of pharmaceutical and clinical information, 16% of the responders showed a negative response. In between the two extremes 12.4% of them was neither agreeing nor disagreeing that using the internet and medical web-based technologies as a source of pharmaceutical information are beneficial to their practices. This result is consistent with the previous findings conducted by Google (2009) which estimated that 73% of the physician considers the internet to be standard part of their clinical practices, and 69% of the physician trusts online clinical information. Section 4.2.2 describes in details the TAM variables responses. 57

4.2.2 Technology acceptance model TAM variables responses.

The independent technology acceptance model TAM variables responses the perceived usefulness and perceived ease of use, as well as the dependent variables the attitude and behavioural intention were grouped to create overall scores for each of the dimensions. Measures of the central tendency and correlation around the mean were calculated using the overall scores.

Perceived usefulness
To identify the perception of the physicians and healthcare professional toward the usefulness of the internet and web-based technologies as a source of pharmaceutical and clinical information, the variables items were grouped and quantified together to create overall scores for each of the dimensions (see figure 8). The central tendency and correlation (r) around the mean of the variables items were calculated as follow:
Mean 255.3 Median 178.5 Mode 285 Range Variance St.Deviation 823 58844.93 242.58 r 0.276

The below chart represent the responses related to the perceived usefulness variables items.

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Among the results, 21.3% of the respondents were strongly agreed while 54.2% of all respondents were in agreement of the potential benefits of the internet technology in their clinical practices. Whilst, 1.3% and 9.8% of all respondents were strongly disagreeing and disagreeing respectively the usefulness of the internet and web-based technologies as a source of pharmaceutical and clinical information, the neither rests 13.3% of them appeared neutral in their perception.

Perceived ease of use

As independent technology acceptance model TAM variable, the responses for the items relating to perceived ease of using the internet and web-based technologies as a source of pharmaceutical and clinical information were grouped and quantified together to create overall scores for each of the dimensions (see figure 9). The central tendency and correlation (r) around the mean were calculated as follow: 59

Mean 241.72

Median 186

Mode 186

Range 644

Variance 45640.63

St.D 213.64

r. 0.96

The below chart represent the responses related to the perceived ease of use variables items:

Whilst 69.1% of all respondent were in a positive extreme, 17.1% of them were in a negative extreme in perceiving the ease of using the internet and web-based technology as a source of pharmaceutical and clinical information. On the other hand, 13.8% of all respondents appear neutral in their perception.

Attitude
The presentation of the items related to the attitude variables responses, were grouped and quantified for each of the dimension (see figure 10).The central tendency and correlation (r) around the mean were calculated as follow:

Mean 226.467

Median 164

Mode 355

Range 553
60

Variance 29442.98

St.D 171.59

r. 0.79

The below chart represent the responses related to the attitude variables items:

Among the respondents, 23.8% and 42.8% of them were strongly agreeing and agreeing respectively and showed a positive attitude , while 16.5% and 4.2%% of them were strongly disagreed or disagreed respectively and showed a negative attitude toward the internet technology as a source of pharmaceutical and clinical information. The neither rest 12.5% of the respondents appeared neutral in their perception.

Behavioural intention
The presentation of the items relating to the behavioural intention variables were quantified and grouped to form overall scores for each of the dimensions (see figure 11). The central tendency and correlation (r) around the mean were calculated as follow:
Mean 72.8 Median 57 Mode 57 Range 144 Variance 2522.59 St.D 50.23 r. 0.44

61

The below chart represents the responses related the behavioural intention variables items:

Consistent with the above results 28% and 41.7% of all the respondents were strongly agreeing and in agreement respectively and showed a positive attitude and intentionally use the internet technology. In contrast, 2.1 % and 19.3% of all the respondents were strongly disagreed and disagreed respectively and showed a negative attitude and intention to use the internet technology as a source of pharmaceutical means, while the neither rest 8.9% of all respondents appeared neutral in their perception.

4.2.3 Descriptive statistics

The Pearson correlation values showed strong positive linear relationships between the technology acceptance model TAM variables responses (r/Pearson correlation values 62

>0.6). All pairs of correlations are significant at the 95% level (p<0.05). The underline chart illustrates the correlations between the technology acceptance model TAM variables.

As a result, the relationships between the technology acceptance model TAM variables and their significance in determining the physicians and healthcare professionals attitude and behavioural intention demonstrated a strong positive trend to use the internet and medical web-based technologies as a source of pharmaceutical and clinical information. The chart below illustrates the descriptive statistics of the technology acceptance model TAM variables response.

63

4.2.4 Study findings

Within the context of these results, perceived usefulness is the most significant determinant of the physicians and healthcare professionals levels of acceptance the internet technology. Data revealed from the technology acceptance model TAM variables responses showed that theres strong positive correlation +0.98 between perceived usefulness and attitude, and positive correlation +0.81 between perceived usefulness and behavioural intention of the physicians and healthcare professional toward the internet and medical web-based technologies as a source of pharmaceutical and clinical information. On the other hand, perceived ease of use showed a positive correlation +0.62 and +0.369 with the physicians attitude and behavioural intention respectively to use the internet technology as a source of pharmaceutical and clinical information. A moderate positive correlation +0.44 exist between perceived usefulness and perceived ease of use the internet technology. Consistent with a 64

Google survey (2009), the interpretations of the above findings revealed that 75.5% and 69.1% of all the respondents, showed a positive trend toward the usefulness and ease of use the internet and medical web-based technologies as a source of pharmaceutical information in their clinical practices.

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5.0: CHAPTER FIVE: CONCLUSIONS, RECOMMENDATIONS, AND THE STUDY LIMITATIONS

In light of the studys findings and the provided literature reviews, the present research empirically supported the conceptual hypothesis of the internet technology as the most reliable and the easiest source of pharmaceutical and clinical information. The data interpretations and the studys main conclusions and recommendations reveal itself, while restates the studys limitations for further improvement.

5.1 Conclusions
Generally, from the previous studys findings, we concluded that detailing is an important source of pharmaceutical and clinical information and it affects the physicians prescription behavior in a positive and significant manner (Puneet et al, 2005). At present, the rich availability of the pharmaceutical and clinical information sources to the physicians it is possible that the in-person traditional detailing maybe retracted by online communication and e-detailing over time (Puneet et al, 2005). With rapid advances in the internet and medical web-based technologies, a novel way of a reliable and convenient communication between the pharmaceutical companies and the physicians has emerged. To stay competitive, a

leading pharmaceutical company must frequently redesigns the marketing and sales strategies to accommodate the highly dynamic market changes and the growing communication challenges (Dien, 2003). Realizing globalization and fast speed communication, information 66

technology IT and e-commerce play a major role of business-transformation in the global market. However, from the extensive literature review it was clear that gaining competitive advantage requires building on the proven principles of the effectiveness of information technology IT in business strategies, and by integrating the virtual and physical activity (Porter, 2001). Obviously , information technology IT is the critical success factors CSF for driven business-transformational processes in the coming future, Alt (2003) has stated that Information technology IT- driven transformation in the pharmaceutical companies create strategic opportunities and competitive pressures at the same time (page 3). Therefore, a leading pharmaceutical company has to integrate the e-detailing approach into the customer relationship management CRM technology to create the physicians e-loyalty and long-term e-credibility. Pharmaceutical companies will need to develop and implement innovative strategies that capitalize on the power of the internet technology and the changes in both the traditional and electronic markets (Minakakis et al, 1999). In a synergy ways edetailing not only strengthen the in-person communication between pharmaceutical sales representatives and the physicians but also, would make the physicians more likely to see out pharmaceutical and clinical information online. Direct-to-physicians DTP e-communication overcomes the concern arisen from the unethical relationship between pharmaceutical companies and the physicians, and create opportunities to pharmaceutical companies for legitimating ethics, building trust, and maintaining a convenient relationship into the physicians and healthcare professionals, the stakeholders, and the broader medical communities

67

5.2 Recommendations
Realizing the current communication pattern between pharmaceutical companies and the physicians in which the gratuities gifts, incentives, sponsorship of conferences and symposia, and alike is the everyday realities (Komesaroff et al, 2002). As a result, the change towards edetailing will require a substantial shift in the attitude and values as well as the marketing and sales strategies (Paul et al, 2002). Therefore, e-detailing planning and implementation requires support both at the management level and at the level of pharmaceutical sales representatives. At present, the successful approach towards e-detailing strategies requires information technology IT specialist within the corporate level and the management level. The primary element of e-detailing techniques is the encouragement of the physicians attitude toward the potential values of the internet and medical web-based technologies as a source of pharmaceutical and clinical information. Therefore, it is highly recommended that pharmaceutical companies have to think of special reward system and effective incentives (Heutschi, 2003) for the use of the diversified e-detailing platforms, such as a broader spectrum of services that support the physicians clinical practice. An efficient implementation of online communication and e-detailing requires a suitable level of integration between offline-online activities, to act in synergistic ways (Heutschi, 2003). Within the context of the product life-cycle management p-LCM programs, customer relationship management CRM technology is a tool that helps pharmaceutical companies and the physicians progress through the product life-cycle. However, pharmaceutical company has to realize that an efficient a leading

integration of e-detailing and

customer relationship management CRM technology, can provide the company with the 68

ability to dynamically customize messaging based on physicians feedback, which lead to delivery of a personalized content more closely aligned with the physicians' wants and needs (Eric, 2010). In this regard, pharmaceutical companies either develop their own web-sites or partnering with a global e-customers relationship management e-CRM technology solution provider, such as Cegedim Relationship Management and Johnson Controls Global Workplace. In the near future, building efficient e-customers relationship management eCRM technology is the core competence among the others, where pharmaceutical companies must pursue to achieve its reputation and to attain competitive advantages in the global market. With regard to the above challenges, the internet and related medical webbased technologies offer a tremendous marketing tool for strengthening communication, legitimating ethics, building trust, and maintaining a convenient relationship into the physicians, the stakeholders, and the broader medical communities. Establishing the brand and medical services through online communication and interactive e-detailing is essential, for building long-stay a credible partnership and future trust of the companys products among the physicians and healthcare professionals.

5.3 Study limitations

Although the research has been conducted in the Saudi Arabia, which gives strong insight into the emerging healthcare market in the gulf area, confirmatory studies are required to establish the conceptual hypothesis of the internet and related medical web-based as a potential source of pharmaceutical and clinical information in the healthcare settings. The 69

study focuses only on the intrinsic factors related to the technology acceptance model TAM variables, and does not take into account the impact of extrinsic factors such as the political, governmental, economical, sociological, and cultural factors that might restrict the application of information technology IT and e-commerce principles in the business strategies. The research does not take into account the resistant to change toward e-detailing among the company managements level as well as the operational field force level. Additionally, the study does not examine the physicians attitude and intention to use the internet technology across all the age group. Realizing that e-detailing approach has been successfully implemented in a homogeneous and advanced healthcare market such as the US (Heutschi, 2003), the present research did not define a proper e-detailing approach to be implemented in a heterogeneous and the developing healthcare market.

70

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Figure 7: Technology Acceptance Model 'TAM' variables' responses

TAM variables Variables Strongly agree S.values Agree S.values Neutral S.values Disagree 1 57 285 161 644 67 201 57 2 69 345 167 668 42 126 55 3 79 395 181 724 51 153 48 4 71 355 207 828 35 105 39 Perceived usfulness items 5 41 205 143 572 57 171 97 6 23 115 181 724 69 207 77 7 38 190 178 712 62 186 78 8 57 285 165 660 71 213 52 Sum 435 2175 1383 5532 454 1362 503 9 69 345 163 652 62 186 62 10 63 315 152 608 33 99 87 Perceived ease of use items 11 62 310 161 644 62 186 48 12 12 60 48 192 57 171 224 13 82 410 161 644 63 189 41 Sum 288 1440 685 2740 277 831 462 14 72 360 149 596 34 102 57 Attitude items 15 71 355 117 468 46 138 82 16 19 95 98 392 62 186 142 Sum 162 810 364 1456 142 426 281 17 35 175 87 348 57 171 156 Behavioural intention items 18 42 210 156 624 42 126 102 19 62 310 104 416 18 54 142 20 126 630 147 588 22 66 57 Sum 265 1325 494 1976 139 417 457 TAM variables' responses 5750 11704 3036 TAM variables' scores (%) 23.58007 47.99672 12.45028 S.values Strongly disagree S.values 114 22 22 110 31 31 96 5 5 78 12 12 194 26 26 154 14 14 156 8 8 104 19 19 1006 137 137 124 8 8 174 29 29 96 31 31 448 23 23 82 17 17 924 108 108 114 52 52 164 48 48 284 43 43 562 143 143 312 29 29 204 22 22 284 38 38 114 12 12 914 101 101 3406 489 13.967603 2.0053311

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Figure 8: Perceived usefulness

1-I would fine using the internet as a source of information useful in my job 2-I like to use the internet web-sites as the primary source of pharmaceutical information 3- Using the internet as a source of pharmaceutical information could improve my practice and patient care 4- Using the internet as a source of pharmaceutical information would safe my time and effort 5- I frequently use the web-sites pharmaceutical information because of the accuracyof of product information 6- I frequently use the web-site pharmaceutical information because of the quality of content 7- I frequently use the web-site pharmaceutical information because of the quantity of content 8- Using the internet as a source of pharmaceutical information enhance my effectiveness in my practice and patient care
Sum

Strongly agree Agree Neutral Disagree Strongly disagree Value % Value % Value % Value % Value % 285 2.791 644 6.3 201 2 114 1.1 22 0.21543

345

3.378 668 6.5

126

1.2 110 1.1

31

0.30356

395

3.868 724 7.1

153

1.5

96

0.9

0.04896

355

3.476 828 8.1

105

78

0.8

12

0.11751

205

2.007 572 5.6

171

1.7 194 1.9

26

0.2546

115

1.126 724 7.1

207

154 1.5

14

0.13709

190

1.861 712

186

1.8 156 1.5

0.07834

285

2.791 660 6.5

213

2.1 104

19

0.18606

2175

21.3 5532 54 1362 13 1006 9.9

137

1.34156

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Figure 9: Percieved ease of use

Strongly agree Value % 9-I find find pharmaceutical product web-sites easy to navigate and obtain clinical information 10-Using the intenet and web-sites as a source of pharmaceutical information would be easy for me 11- It would be easy for me to become skilful at using the internet and web-sitesas a source of pharmaceutical information 12-Interacting with the internet and web-sites to search for pharmaceutical information is often frustrating 13- Using the internet and web-sites pharmaceutical information is a good idea Sum 1440 23.83 2740 45 831 13.8 924 15 108 1.78719 410 6.785 644 11 189 3.13 82 1.4 17 0.28132 60 0.993 192 3.2 171 2.83 448 7.4 23 0.38061 310 5.13 644 11 186 3.08 96 1.6 31 0.51299 315 5.213 608 10 99 1.64 174 2.9 29 0.47989 Agree Neutral Disagree Strongly disagree % 0.13238 8 Value % Value % Value % Value 345 5.709 652 11 186 3.08 124 2.1

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Figure 10: Attitude

Strongly agree Agree 14- Using the internet as a source of pharmaceutical information would be beneficial to my practice 15- I would enjoy using the internet to search for pharmaceutical information 16- I often didn't see pharmaceutical sales representative in my duties because of time constraints Sum 810 23.84 1456 43 426 12.5 562 17 143 4.2096 95 2.797 392 12 186 5.48 284 8.4 43 1.26582 355 10.45 468 14 138 4.06 164 4.8 48 1.41301 Neutral Disagree Strongly disagree % 52 1.53076 Value % Value % Value % Value % Value 360 10.6 596 18 102 3 114 3.4

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Figure 11: Behavioural intention

Strongly agree Value 17- I frequently use the web-sites pharmaceutical information delivered by the sales representative is subject to bias 18- I intend to use the internet as a source of pharmaceutical information as often as needed 19- I would frequently use the internetand web-sites as a source of pharmaceutical information in my practice 20- I plan to use the internet and web-sites technology as a source pharmaceutical information in the future Sum 1325 27.99 1976 41.7 417 8.81 914 19.3 101 2.13395 630 13.31 588 12.4 66 1.39 114 2.41 12 0.25354 310 6.55 416 8.79 54 1.14 284 6 38 0.80287 210 4.437 624 13.2 126 2.66 204 4.31 22 0.46482 % Agree Value Neutral Disagree Strongly disagree Value 29 % 0.61272 % Value % Value % 175 3.697 348 7.35 171 3.61 312 6.59

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