The role of advertising in changing patient’s attitude towards OTC pharmaceutical products in the Egyptian market

The role of advertising in changing patient’s attitude
towards OTC pharmaceutical products in the Egyptian
market
BY
Hany Wahied Seleem Hamed
(Student number: 10006073)
Supervisor: DR. Raafat Youssef
A Thesis Presented in Partial Fulfillment of the Requirements for
The Degree Master of business administration
(MBA)
Cardiff School of Management
June 2012

2
Acknowledgment
To my son
To my wife
To my parents
To my supervisor
To everyone helped and supported me to achieve my dissertation
Many thanks for your great efforts

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ABSTRACT
Purpose –The aim of the study is to evaluate the role of advertising in changing patient
attitude towards Over the Counter (OTC) pharmaceutical products in the Egyptian market
focusing on the impact of the Egyptian culture on non prescribing direct to consumer
pharmaceutical advertising and its impact on the Egyptians’ decision making, patient
attitudes towards (OTC) products.
Design/methodology – This study is a causal study operated in contrived setting in a
normal environment to describe the role of advertising as (independent variable) on
patient attitude (dependent variable) in an actual experiment performed with very
minimal interference from the researcher. Questionnaires on likert model to test patient
attitude and IDI after exposed to the ad are the main source to collect primary data
reference books, recent journals, trusted internet web sites and IMS data are the main
dependent in collecting secondary data.
The researcher depends on the individual as a unit of analysis. This study is cross sectional
study as data is collected once a time.
The researcher takes a sample (50 patients) to answer questionnaires and a sample (20
patients) to in-depth interview. The whole population is patients that have mild to
moderate symptoms and intend to buy OTC product from different pharmacies without
physician’s recommendations. The researcher depends on stratified sampling process to
answer questionnaires and divides the whole population into strata according to the
regional classification and takes random sample from each stratum and depends on quota
sampling to make the in-depth interviews
Findings – A lot of the candidates refused to use the brand depending on the presence of
celebrity or his fame and disagreed that the celebrity fame indicates the quality and
effectiveness of the brand as they are skeptic about everything related to their health.
On the other side most of the candidates agreed that this ad gives good information about
the symptoms and the brand. Most of the candidates agreed with high enthusiasm that
information of the medication ads is more important factor affects the customer than the

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celebrity. There is a difference between people in taking decision a lot of candidates agreed
to take the decision to purchase.
Conclusion- Purchasing decision of medication mainly depends on information about the
brand and symptoms that included in ads. Celebrities are appreciated in the medication ads
idea is the strong bridge between information and celebrity. Predisposition of patient and
his current case to interact with the ad can change patient attitude and can draw his
believe which is translated into feeling and appear in intention.
Originality/value – This study can help pharmaceutical company to increase their
experience and knowledge about how ads can change consumer attitude which can reflect
on its sales.
Key words – over the counter products (OTC) /patient attitude / direct to consumer
advertising (DTC).

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TABLE OF CONTENTS
Acknowledgments ………………………………………………….2
Abstract ...……………………………………………………………3
Table of contents...………………………………………………….5
List of figures ……………………………………………………….8
List of tables …………………………………………………………9
Chapter –1 – (Introduction) ……………………………...10
1.1. -Purpose of the study…………………………………..…………………………………………………..…11
1.2. -Research problem ………………………………………………………………………………………..…. 12
1.3. -Research objectives………………………………….…………………………………………………..…..12
1.4. -Importance of the study………………………………………………………………………………..……13
1.5. -Structure of the study…………………………………..……………………………………………..…….13
Chapter – 2 – (Literature review)………………………..16
2.1. - Attitude………………………………………………………………………………....................17
2.1.1. -The ABC model of attitudes ……………………………………………………………………………...17
2.1.2. -Sources of Attitudes …………….…………………………………………………………………………….19
2.1.3. - Factors affecting Egyptians attitude………………………………………….............................19
2.1.3.1. - Cultural factors that affect Egyptian people attitude towards OTC products………………….20
2.1.3.1.1. - (Egypt) Geographical profile ………………………………………………………………...........20
2.1.3.1.2. – Religion …………………………………………………………………………………………………20
2.1.3.1.3. - Egyptian culture on Hofstede model scale ………………………………………………………...21
2.1.3.2. - Social factors that affect Egyptian people attitude towards OTC products……………….………..25
2.1.3.2.1. - Reference Groups ……………………………………………………………………………….….….25
2.1.3.2.2. - Social Class ………………………………………………………………………………………….….29
2.1.3.3. - Personal factors that affect Egyptian people attitude towards OTC products …………….….….32
2.1.3.3.1. - (Egypt) Demographical profile………………………………………………………………..……..32
2.1.3.3.2. - Literacy standard ……………………………………………………………………………….………34
2.1.3.4. - Psychological factors that affect Egyptian people attitude towards OTC products ………….…34

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2.1.3.4.1. - Motivation ………………………………………………………………………………………………34
2.1.3.4.2. - Personality………………………………………………………………………………………….……34
2.2. - Overview on Egyptian pharmaceutical market Over The Counter
(OTC) pharmaceutical products……………………………………………………………………35
2.2.1. - Over The Counter (OTC) pharmaceutical products………………………………………………………………...37
2.3. - Direct to consumer advertising (DTC)………………………………………………….44
2.3.1. - Types of direct to consumer advertising (DTC)……………………………………………………………………...44
2.3.2. - Direct to consumer advertising pros and cons………………………………………………………………….……45
2.3.3. - Target customer of direct to consumer advertising of OTC products……………………………………..46
Chapter – 3 – (Research Methodology)……………..…50
3.1. - Research Design……………………………………………………………………………………51
3.1.1-Purpose of the study………………………………………………………………………………………………………………..51
3.1.2-Type of investigation…………………………………………………………………………………………………………….…51
3.1.3-Extent of researcher interference…………………………………………………………………………………………….51
3.1.4-Study setting…………………………………………………………………………………………………………………………...52
3.1.5-Unit of analysis…………………………………………………………………………………………………………………….….52
3.1.6-Time horizon …………………………………………………………………………………………………………………..………52
3.2 Data collection methods……………………………………………………………………..……52
3.2.1. - Secondary data…………………………………………………………………………………………………………………..…52
3.2.2. - Primary data………………………………………………………………………………………………………………………...53
3.3. - Sampling process……………………………………………………………………………….…54
3.3.1. - Questionnaire sampling process……………………………………………………………………………………………54
3.3.2. - In –depth interview (IDI) sampling process…………………………………………………………………….……..55
Chapter-4- (Research findings and data analysis)…..56
4.1. Analysis of consumer questionnaire ……………………………………………………………57
4.1.1. Analysis of personal profile…………………………………………………………………………………………………….57
4.1.1.1. Age…………………………………………………………………………………………………………………………………………. 57
4.1.1.2. Gender………………………………………………………………………………………………………………………………………57
4.1.1.3. Marital status…………………………………………………………………………………………………………………………….58
4.1.1.4. Occupation………………………………………………………………………………………………………………………….……58
4.1.1.5. Income…………………………………………………………………………………………………………………………………..…59
4.1.1.6. Educational level…………………………………………………………………………………………….……..59
4.1.2. Reliability coefficient …………………………………………………………………………………………....................60

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4.1.3. Correlation coefficient…………………………………………………………………………………………………….………61
4.1.4. Analysis of the questionnaire results……………………………………………………………………………….……..62
4.1.4.1- Analysis results of the impact of advertising on changing attitude in general…………………..…..62
4.1.4.2- Analysis results of the impact of advertising on changing attitude in believe phase………..……63
4.1.4.3- Analysis results of the impact of advertising on changing attitude in feeling phase…………..….66
4.1.4.4- Analysis results of the impact of advertising on changing attitude in intention phase…………..68
4.1.4.5- Analysis results of the impact of advertising on changing attitude in WOM …………………..…70
4.1.5. Analysis of the In-depth interview results…………………………………………………………………………..…..71
Chapter-5- Conclusion and Recommendations…...…74
5.1. - Overall Conclusion and Recommendations………………………………………..…74
5.1.1. The attitude toward the advertisement…………………………………………………………………………………..74
5.1.2. Recommendations……………………………………………………………………………………………………..…………..76
5.2. – limitation of the study…………………………………………………………………………...77
BIBLIOGRAPHY…………………………………………………………………………………….….…78
Appendix-I-Consumer Questionnaire……………………………………………………………80
Appendix-I I -Consumer IDI ………………………………………………………………….……..89
Appendix-I I I –Advertising Material …………………………………………………….……..93

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LIST OF FIGURES
Figure 2.1. - Attitude component& manifestation …………………………………………………..18
Figure 2.2. - Egypt Score on Hofstede Model…………………………………………………………….24
Figure 2.3. - Age percentage of the total population………………………………………………...33
Figure 2.4. - Age structure of the Egyptian population…………………………………………….33
Figure 2.5. - Egyptian pharmaceutical OTC market 2011…………………………………………37
Figure 2.6. - Top OTC product sales in the Egyptian pharmaceutical market………….41
Figure 2.7. - Sales presentation of Anti rheumatic non steroidal segment
to the total market……………………………………………………………………………….42
Figure 2.8. - Analgesics in Egyptian market……………………………………………………………..43
Figure 2.9. - NOVARTIS PHARMA market share in the analgesics market……………….43
Figure 2.10. - Direct to consumer OTC advertising…………………………………………………..47
Figure 2.11. - Indirect to consumer OTC advertising (WOM)…………………………………...47
Figure 4.1. - % of participants’ age in the questionnaire………………………………………….57
Figure 4.2. - % of participants’ gender in the questionnaire…………………………………...57
Figure 4.3. - % of participants’ marital status in the questionnaire………………………..58
Figure 4.4. - % of participants’ occupation in the questionnaire…………………………….58
Figure 4.5. - % of participants’ income in the questionnaire……………………………………59
Figure 4.6. - % of participants’ educational level in the questionnaire…………………..59

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LIST OF TABLES
Table 2.1. - Egyptian OTC market segments…………………………………………………….……....39
Table 2.2. - Objective of OTC advertising with respect of target customer…………..…..46
Table 4.1. - Alpha (coefficient of reliability) for questionnaire……………………………….60
Table 4.2. - Correlation results between five parts of consumer questionnaire……..61
Table 4.3. - Analysis results of the impact of advertising on changing attitude
in general……………………………………………………………………………………………..62
Table 4.4. - Analysis results of the impact of advertising on changing attitude in
believe phase……………………………………………………………………………………….63
feeling phase……………………………………………………………………………………..…66
intention phase……………………………………………………………………………………68
WOM……………………………………………………………………………………………….……70

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CHAPTER –1–
Introduction

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CHAPTER ONE –1– Introduction
1.1. Purpose of the study
Most of the researches that found and discuss the changing attitude are prepared in U.S.A.,
western European countries to describe this issue in these countries.
Researches held in U.S.A. and western European countries described the impact of direct to
consumer advertising of prescribed drugs but very few studies discuss this impact on non
prescribed drugs (OTC).
In Egypt, focusing on customers and studying their impact on the pharmaceutical market
may be neglected because advertising depends mainly on how advertisement will be a
habit in the customer’s life regarding to high exposure frequency.
Advertising in Egypt depends on a rule that trust is not built on the truth. When any
company makes media advertisements on any product, it means that this product is a high
quality product regardless of its reality whether it is fact or not.
On the other hand, consumers’ studies are a basic part of the marketing sector in the
multinational companies that invest trillions of dollars in the Egyptian pharmaceutical
market
Although Egypt is one of the most competitive and fast growing market in the Arabian
pharmaceutical market, the researches about the customer attitude that describe this
change are not established well and there is a poor focus on the Egyptian pharmaceutical
market in studying the customers’ attitude in the pharmaceutical sector.
The growing in the over the counter (OTC) defines the importance to study what impacts
this segment.
In this study, the researcher tries to focus on the some fundamentals of attitude and
advertising and facts about Egyptian pharmaceutical market. The researcher tries to draw
the relationship that can collect these facts and fundamentals in one scheme to enrich
studies of customer’s attitudes in Egypt.

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The main reason that motivate the researcher to perform this study is the absence of
the studies that discuss the impact of advertising on the patient attitude in the Egyptian
pharmaceutical market especially in the OTC market
1.2. Research problem
Based on the pervious, it is clear that Egyptian pharmaceutical market requires a lot of
researches to describe all the aspects of this market and focusing on the OTC market which
grew rapidly in the last decade and the best ways of direct to consumer advertising that
can affect the attitude of the consumers and change the market share of the companies in
the pharmaceutical market.
So the researcher define the research problem as
Describe the role of advertising in changing patient attitude towards OTC pharmaceutical
products in the Egyptian pharmaceutical market.
1.3. Research objectives
In order to achieve the purpose of this study, the following questions should be answered.
 How can advertising affect patients’ attitude in Egyptian pharmaceutical market?
 How do advertising affect the OTC pharmaceutical market?
 To what extent can advertising lead to change in attitude towards OTC products?
 To what extent does advertising play a role in Egyptian pharmaceutical market?
 To what extent can (DTC) make patients a source of promotion?
 To what extent dose patient respond to direct to consumer advertising?
 To what does Egyptian culture can affect patient attitude?
 How can ads styles affect patient attitude?
 To what extent ads information can affect patient attitude?
 To what extent can celebrities impact patient attitude?
 To what extent can ads ideas affect patient attitude?

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1.4. Importance of the study
Companies tend to promote their products in many different ways to increase their profit
and market share.
So evaluation of the non prescribing direct to consumer pharmaceutical advertising in
comparison with other promotional ways used in this important industry in the Egyptian
market will give an indication on how the pharmaceutical company can allocate its
promotional resources in the best way to increase their market share to give the
pharmaceutical companies in Egypt the best way to promote their OTC products.
1.5. Structure of the study
This study consists of five chapters, different in contents but serve the main objective of the
study. Each chapter depends on the previous one in a continuous chain to answer the main
question research asks.
Introduction
This chapter contains discussion that focus on the research problem and research
questions and importance and structure of the study.
Literature review
The researcher builds this study on 3 main topics
attitude, OTC market and direct to consumer advertising.
The researcher discusses the attitude topic in general then discusses what factors can
affect attitude and how these factors affect attitudes of the Egyptian people.
The researcher discusses OTC pharmaceutical market in Egypt according to IMS DATA and
analyses this data to give an accurate overview on the Egyptian pharmaceutical market
especially OTC market.
In the last part, the researcher concentrates on the DTC advertising and focuses on the
advertising of non prescribing drugs.

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Research methods
In this chapter, the researcher discusses methodology used in this research focusing on
data collection methods.
 Purpose of the study
Describe the role of advertising in changing patient attitude towards OTC
pharmaceutical products in the Egyptian pharmaceutical market.
 Type of investigation
This study is a casual study to describe the impact of advertising on changing
patient attitude
 Extent of researcher interference
This study is done with minimum interference from the researcher
 Study setting
This study is done in a non contrived setting
 Unit of analysis
This study depends on the individual as the unit of analysis
 Time horizon
This study is a cross-sectional study
 Sampling process
To collect primary data, the researcher depends on the stratified sampling process
to answer questionnaires in which the population represents Egyptian people who
have mildness to moderate symptoms and intend to buy OTC product from different
pharmacies without physician’s recommendations and divides the whole population
into strata based on regional classification to answer questionnaires. IDI sampling
process depends on quota sampling process based on regional classification then
selects judgmentally who will be the candidates to the IDI.

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Research finding and data analysis
This chapter includes the primary data analysis which is collected by customers’
questionnaires and IDI. The researcher depends on SPSS software program (version 19) to
analyze the collected data.
Conclusion and recommendations
This chapter contains all finding after analyzing primary and secondary data and includes
the overall answers about the research questions.

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CHAPTER –2–
Literature review

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CHAPTER -2- Literature review
Changing patient attitude positively to affect the consumer buying decision is the main
target of all companies playing in the pharmaceutical field. As changing the patient attitude
leads to changing the consumer decision towards a specific product.
When consumer buys this product it leads to increase the company sales revenues and
profits and stringing the company image as a good image so the study focus on advertising
and attitude and how advertising make the change in the attitude.
In this study, the researcher focus on the attitudes, factors affecting attitude in the Egyptian
market, give an overview on the Egyptian pharmaceutical market, focus on the OTC
Egyptian market and direct to consumer advertising of OTC products and draw a link
between them to achieve the study objectives.
2.1. Attitude
Although there are over 100 different definitions, Solomon, M. Bamossy, G. Askegaard & S.
Hogg, M. (2006)define attitude as a lasting, general evaluation of people (including oneself),
objects, advertisements or issues. Anything towards which one has an attitude is called an
attitude object.
But other researchers set a definition to attitude as the mixture of the thoughts, feelings,
and tendencies which predisposes the individual to respond in a certain way to objects to
which they relate.
But the definition which is widely accepted is that of Statt, David A. (2006) who defines
attitude as ( A stable long lasting, learned predisposition to respond to certain things in a
certain way. )
2.1.1. The ABC model of attitudes
Solomon, M. Bamossy, G. Askegaard & S. Hogg, M. (2006) agree that an attitude has three
components: Affect (conation), Behavior and Cognition.
Affect (conation) refers to the way a consumer feels about an attitude object.

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Behavior involves the person’s intentions to do something with regard to an attitude
object (but, as will be discussed later, an intention does not always result in an actual
behavior).
Cognition refers to the beliefs a consumer has about an attitude object.
These three components of an attitude can be remembered as the ABC model of attitudes.
This model emphasizes the interrelationships between knowing, feeling and doing.
Solomon, M. Bamossy, G. Askegaard & S. Hogg, M. (2006) argue that consumers’ attitudes
towards a product cannot be determined simply by identifying their beliefs about it. While
all three components of an attitude are important, their relative importance will vary
depending upon a consumer’s level of motivation with regard to the attitude object.
Hawkins, Del. & Mothersbaugh, David L.(2010) summarized three different components of
attitude as in Figure 2.1.
Figure 2.1. Attitude component& manifestation
Initiator
Stimuli:
Products,
situations,
retail
outlets,Ads
and attitude
objects
Component
Affective
(emotions)
Cognative
(thinking)
Conation (action)
Component
Manifestation
feelings about
specific attributes
or overall object
Beliefs about
specific attributes
or overall objects
behavioral intentions
with respect to specific
attributes or overall
object
Attitude
Overall
orientation
toward object

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2.1.2. Sources of Attitudes
Statt, David A. (2006) argued different sources of attitude and listed them as
(a) Family
Family influences have an enormous impact on the formation of attitudes about everything,
including consumer attitudes and even attitudes towards particular brands and products.
(b) Word Of Mouth (WOM)
The growing impact of friends and the peer group in general, on the consumer preferences
of young people and their fast changing fads and fashions in many products areas.
Opinion leaders will have an important influence, even on adult consumers, particularly on
the adoption of new products and innovations.
(c) Direct experience
However, despite the important influences that other people may have on our attitudes
towards certain products, the influence of direct personal experience is usually considered
to be even greater.
There is no substitute for actually trying something yourself and evaluating the experience,
offer free trials, discount coupons and other inducements to consumers.
Consumer attitudes formed through direct experience of a product are apparently held
with greater conviction than those based on other sources, especially advertising.
2.1.3. Factors affecting Egyptians’ attitude
They are many factors affecting Egyptians’ attitude and make it change when any
modification occurs.
 Cultural factors
 Social factors
 Personal factors
 psychological factors

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2.1.3.1. Cultural factors that affect Egyptian people attitude
towards OTC products
2.1.3.1.1. (Egypt) Geographical profile
Egypt is the strategic bridge between Africa and Asia as it exists in the middle of the trade
roads between east and west. It is the birthplace of the powerful civilization that can be
represented as the mother of the civilization.
The area of the Egyptian land is 1,001,450 sq km (386,000 sq miles) and according to the
central agency for public mobilization and statistics CAPMAS (March 2012) Egyptian
population on is (81,770,608). Most of them occupy the Nile banks that represent 4% of the
total area while 96% of area of Egypt is desert.
The condensation of people in 4% of the total area indicate that effect of communication
will be strong and the short distance between Egyptian people will make a consistent
society with his culture and beliefs and values.
2.1.3.1.2. Religion
Muslims in Egypt represent 90% of the religion of total population and Coptic 9%, other
Christians 1%. Islam is the national religion.
It prescribes a way of life, governs political, legal, and social behavior, and organizes an
orderly system for both society and the individual. The rules of Islam can be found in
Islam’s holy book, the Koran, which is believed to have been revealed by Allah to his
Prophet Mohammed.
The Koran is considered to be the direct word of God and is therefore believed to be
infallible. This indicate that the variation in beliefs and values in the hole society will be
low regarding to religions because the effect of religion is under the Egyptian culture
umbrella. Egypt Cultural Overview. [ONLINE](Accessed 09 February 2012)

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In Egypt, religious beliefs have a significant effect on the medication ways and to some
extent cleric (Muslim or Christian) play a significant role in this medication ways as
Cupping way
In which a Muslim man puts a vacuum cup free from air on a wounded skin. This way uses
to remove some diseases like arthritis pain on several parts of the body.
Koran medication
Defined as a Muslim way of medication to reduce the effect of some psychological diseases
like nervousness and nervous breakdown as it depend on the role (Dogma is a great
internal power)
Magic
It is a famous way of fraud on who has psychological diseases like epilepsy as magician
who may be cleric (Muslim or Christian) or a fraudulent
Use of some natural resources mentioned in Koran
Muslims believe that all of the natural resources mentioned in Koran can improve the
human life as some plants (Arak tree and palms), fruits (dates, grapes, banana, olive, fig,
Pomegranate), honey, ginger and some vegetables as onion and garlic.
The discovery of good effect of this resources increases the Muslims believes to use the
natural resources as a medical treatment.
These beliefs encourage some pharmaceutical companies to manufacture new products
depending on these resources in tablets, syrup, ointments and creams.
2.1.3.1.3. Egyptian culture on Hofstede model scale
Greet Hofstede discussed that if exploring the Egyptian culture through the lens of the 5-D
Model, the researcher can get a good overview of the deep drivers of its culture relative to
other world cultures.

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2.1.3.1.3.1. Power distance
The extent to which the less powerful members of institutions and organizations within a
country expects and accepts that power is unequally distributed.
Egypt scores high on this dimension (score of 70) which means that people accept a
hierarchical order in which everybody has a place and which needs no further justification.
Hierarchy is seen as reflecting inherent inequalities, centralization is popular, subordinates
expect to be told what to do and the ideal reference is a benevolent autocrat.
This indicate the impact and influence of reference groups and Key Opinion Leaders (KOL)
in the decision making process. Egypt - Greet Hofstede. 2012. [ONLINE] (Accessed 20
February 2012).
2.1.3.1.3.2. Individualism
The fundamental issue addressed by this dimension is the degree of interdependence of a
society which is maintained among its members. It has to do with, whether people´s self-
image is defined in terms of “I” or “We”.
In Individualist society people are supposed to look after themselves and their direct
family only. In Collectivist society people belong to ‘in groups’ that take care of them in
exchange for loyalty.
Egypt, with a score of 25 is considered a collectivistic society. This is manifest in a close
long-term commitment to the member 'group', be that a family, extended family, or
extended relationships.
Loyalty in a collectivist culture is paramount, and over-rides most other societal rules and
regulations. The society fosters strong relationships where everyone takes responsibility
for fellow members of their group.
In collectivist societies offence leads to shame and loss of face, employer/employee
relationships are perceived in moral terms (like a family link); hiring and promotion
decisions take account of the employee’s in-group.
This gives evidence that information exchange in Egyptian society is highly appreciated
and the impact on decision making affected by the gained information from the
information exchange. Egypt - Greet Hofstede. 2012. [ONLINE] (Accessed 20 February 2012).

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2.1.3.1.3.3. Masculinity / Femininity
A high score (masculine) on this dimension indicates that the society will be driven by
competition, achievement and success, with success being defined by the winner / best in
field – a value system that starts in school and continues throughout organizational
behavior.
A low score (feminine) on the dimension means that the dominant values in society are
caring for others and quality of life. A feminine society is one where quality of life is the
sign of success and standing out from the crowd is not admirable.
The fundamental issue here is what motivates people, wanting to be the best (masculine)
or liking what you do (feminine).
Egypt scores 45 on this dimension and is thus considered a relatively feminine society. In
feminine countries the focus is on “working in order to live”, Egyptians strive for
consensus, people value equality, solidarity and quality in their working lives.
Conflicts are resolved by compromise and negotiation. Incentives such as free time and
flexibility are favored.
Focus is on well-being, status is not shown. An Egyptian person is a supportive one, and
decision making is achieved through involvement. Egypt - Greet Hofstede. 2012.
[ONLINE](Accessed 20 February 2012).
2.1.3.1.3.4. Uncertainty avoidance
The dimension Uncertainty Avoidance has to do with the way that a society deals with the
fact that the future can never be known: should we try to control the future or just let it
happen?
This ambiguity brings with it anxiety and different cultures have learnt to deal with this
anxiety in different ways.
The extent to which the members of a culture feel threatened by ambiguous or unknown
situations and have created beliefs and institutions that try to avoid these is reflected in the
UAI score.
Egypt scores 80 on this dimension and thus has a high preference for avoiding uncertainty.
Countries exhibiting high uncertainty avoidance maintain rigid codes of belief and behavior
and are intolerant of unorthodox behavior and ideas.

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In these cultures there is an emotional need for rules (even if the rules never seem to
work) time is money, people have an inner urge to be busy and work hard, precision and
punctuality are the norm, innovation may be resisted, security is an important element in
individual motivation. Egypt - Greet Hofstede. 2012. [ONLINE] (Accessed 20 February 2012).
2.1.3.1.3.5. Long term orientation
The long term orientation dimension is closely related to the teachings of Confucius and
can be interpreted as dealing with society’s search for virtue, the extent to which a society
shows a pragmatic future-oriented perspective rather than a conventional historical short-
term point of view
No scores for Egypt on this dimension. Egypt - Greet Hofstede. 2012. [ONLINE] (Accessed 20
February 2012).
According to Greet Hofstede Egypt can be represented on his model as in (figure 2.2.)
Figure 2.2. Egypt Score on Hofstede Model
0
20
40
60
80
100
Power
distance
Individualism Masculinity Uncertainty
avoidance
Long term
orientation
70
25
45
80
0
%
http://greet-hofstede.com/egypt.html
Egypt score on Hofstede Model

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2.1.3.2. Social factors that affect Egyptian people attitude
2.1.3.2.1. Reference Groups
It is a person or a group that act actually or imaginary as guide to others in believes,
attitude, customs and values.
This guide influences other people (followers) and act as the source of behavior to who
mimic the behavior of the guide.
These followers and the groups interact directly or indirectly to produce huge no of people
have the same values as the main person or group.
Kotler,P. & Keller,K. (2006) identified different types of reference groups
Reference groups are different types
1. Direct influencer reference group are called membership groups.
Kotler,P. & Keller,K. (2006) identified this type as some membership groups are primary
groups, such as family, friends, neighbors, and co-workers, those with whom the person
interacts fairly continuously and informally.
This can be applied in Egypt as these persons can affect the consumer decision by sharing
experience with the customer who has the same symptoms.
Families exert the most effect on any individual in Egyptian society so it represents
the most important item in primary reference group. Egyptian society can be divided into
two major areas
Rural areas in which term family house is most famous as several generations
belong to the same class may live in this house so sharing experience between these
generations is very effective.
Urban areas, some generations of the middle or upper class may reside in the same
building so sharing experience between neighbors require different ways of
communications and it is very effective but to less extent than in rural areas

26
Children generally live at their parents home until they marry; in some cases a son may
bring his wife to live in his parents’ home.
The influence of parents in Egypt as primary reference group is effective on the children till
marriage and its effect may continue in the new life till the person acquires new ideas and
new vision so the family role may be diminished in the lifestyle, politics, economics, and a
sense of personal ambition but not self-worth and religion.
People also belong to secondary groups, such as religious, professional, and trade-union
groups, which tend to be more formal and require less continuous interaction. In Egyptian
pharmaceutical market the secondary reference group is pharmacist who influences the
decision making process with his information and nurses in case of polyclinics.
2. Indirect influencer reference group are called Aspirational groups
Kotler,P. & Keller,K. (2006) identified this type as they are those a person hopes to join and
mimic their values, behaviors and lifestyles, and influence attitudes and self-concept of the
followers in a positive manner dissociative groups are those groups whose values or
behavior are rejected and their influence on the follower in a negative manner
Kotler,P. & Keller,K. (2006) defined an opinion leader is the person in informal who offers
advice or information about a specific product or product category, such as which of
several brands is best or how a particular product may be used.
Reference group’s influence can be measured by a degree of conformity between a person
and the reference group affecting him.
Solomon, M. Bamossy, G. Askegaard & S. Hogg, M. (2006) put a definition to
Conformity , which refers to a change in beliefs or actions as a reaction to real or
imagined group pressure, In order for a society to function, its members develop norms, or
informal rules that govern behavior. If such a system of agreements and rules did not
evolve, chaos would result.

27
Hawkins, Del. & Mothersbaugh, David L. (2010) argued conformity and discussed
The degree of conformity to a group which is a function of
(1) The visibility of the usage situation,
(2) The level of commitment the individual feels to the group,
(3) The relevance of the behavior to the functioning of the group,
(4) The individual’s confidence in his or her own judgment in the area, and
(5) The level of necessity reflected by the nature of the product.
Reasons for conformity
Solomon, M. Bamossy, G. Askegaard & S. Hogg, M. (2006) argued conformity which is not an
automatic process, and many factors contribute to the likelihood that consumers will
pattern their behavior after others.
Cultural pressures: Different cultures encourage conformity to a greater or lesser degree.
Fear of deviance: The individual may have reason to believe that the group will apply
sanctions to punish behavior that differs from the groups.
Commitment: The more a person is dedicated to a group and values membership in it, the
more a motivated person will be to follow the dictates of the group.
According to the principle of least interest, the person or group that is least committed to
staying in a relationship has the most power, because that party won’t be susceptible to
threatened rejection.
Group unanimity, size, and expertise: As groups gain in power, compliance increases. It is
often harder to resist the demands of a large number of people than just a few, and this
difficulty is compounded when the group members are perceived to know what they are
talking about.
Susceptibility to interpersonal influence: This trait refers to an individual’s need to
identify or enhance his image in the opinion of significant others.

28
This enhancement process is often accompanied by the acquisition of products the person
believes will impress his audience and by the tendency to learn about products by
observing how others use them.
Consumers who are low on this trait have been called role relaxed; they tend to be older,
affluent and to have high self-confidence.
The Nature of Reference Group Influence
Hawkins, Del. & Mothersbaugh, David L. (2010) mention that Reference group influence can
take three forms: informational, normative, and identification
It is important to distinguish among these types since the marketing strategy required
depends on the type of influence involved.
Informational influence
Occur when an individual uses the behaviors and opinions of reference group members as
potentially useful bits of information.
This influence is based on either the similarity of the group’s members to the individual or
the expertise of the influencing group member.
Normative influence
Sometimes referred to as utilitarian influence, occurs when an individual fulfills group
expectations to gain a direct reward or to avoid a sanction.
Normative influence is strongest when individuals have strong ties to the group and the
product involved is socially conspicuous.
Ads that promise social acceptance or approval if a product is used are relying on
normative influence.
Identification influence
Also called value-expressive influence, occurs when individuals have internalized the
group’s values and norms.

29
These then guide the individuals’ behaviors without any thought of reference group
sanctions or rewards.
The individual has accepted the group’s values as his or her own. The individual behaves in
a manner consistent with the group’s values because his or her values and the group’s
values are the same.
2.1.3.2.2. Social Class
British Classification
Statt, David A. (2006) mentioned that the standard British classification used in social and
market research has always been somewhat different from the American, as might be
expected in a country with a different class structure. It uses six categories of social class,
as follows, designated by the letters A–E:
British social classes
Classification
A (upper middle class)
B (middle class)
C1 (lower middle class)
C2 (skilled working class)
D (unskilled working class)
E (lower class)
In Egypt, These social classes can be applied on the Egyptian society and their role in the
OTC pharmaceutical market
A (upper middle class): Where the head of the household is in a senior position in
business or the professions and higher managerial administrative or professional, usually
living in town houses or large detached houses in the suburbs.
This class has the ability to be medically covered so their share in the OTC market is low
and limit to the most famous brand names of global companies in Egypt

30
B (middle class): A less senior version of the ‘A’ household. (Middle managers
administrative or professional)
In Egypt, most of this class are medically covered and depend on OTC products but to less
extent. In this class all who depend on OTC products are indifferent to the brand name but
they interest to relief symptoms.
C1 (lower middle class): Small tradesmen, white collar workers, junior managers
administrative or professional and supervisors.
In Egypt, this class depends on OTC products on the base of mild to moderate symptoms
can be relieved by the pharmacist advice but patient with severe symptoms should be
hospitalized as they have medical insurance but in hospitals with low quality and serve a
lot of patients that can reach 50 patient to one physician.
C2 (skilled working class): Blue collar workers and skilled manual workers.
In Egypt, this class depends mainly on OTC products and on pharmacist advice as in class
C1.
D (unskilled working class): People normally in work but as laborers or in other jobs at
the bottom of the occupational ladder, semiskilled or unskilled workers.
In Egypt this class has no medical insurance. This class depends on the small medical units
which reserve limited medical serves and the pharmacist advice which represent the road
of symptoms relieve.
This class depends on OTC pharmaceutical products as the basic way of treatment.
E (lower class): People whose employment is only casual, part time or temporary, the
unemployed, widows, people living on the state retirement pension or welfare benefits.
In Egypt, this class depends in their symptoms treatment on OTC products and some
ethical products such as antibiotics by taking pharmacist advice.

31
Components of social class
Solomon, M. Bamossy, G. Askegaard & S. Hogg, M. (2006) mention that there are three
component of social class but there are two major components of social class are:
Occupation, income. And the third important factor is educational attainment, which is
strongly related to income and occupation.
Occupational prestige
Solomon, M. Bamossy, G. Askegaard & S. Hogg, M. (2006) defined consumer to a great extent
by what he or she does for a living, occupational prestige is one way to evaluate the ‘worth’
of people.
Hierarchies of occupational prestige tend to be quite stable over time, and they also tend to
be similar in different societies.
Because a person’s occupation tends to be strongly linked to his or her use of leisure time,
allocation of family resources, political orientation and so on, this variable is often
considered to be the single best indicator of social class.
In Egypt, occupational prestige is an implied factor as a component of social class. For
example, level of training updates of many managerial careers (middle and some top
depending on position power) in Egyptian government is low comparing the same level in
the private business which impact on the ‘worth’ of Egyptian people who work in the
government. Their skills appear low which is reflected by negative extent on their
occupational prestige.
Income
Solomon, M. Bamossy, G. Askegaard & S. Hogg, M. (2006) argued that the distribution of
wealth is of great interest to social scientists and to marketers, since it determines which
groups have the greatest buying power and market potential.
Wealth is by no means distributed evenly across the classes. Income per se is often not a
very good indicator of social class, since the way money is spent is more telling. Still, people

32
need money to allow them to obtain the goods and services that they need to express their
tastes, so obviously income is still very important.
The relationship between income and social class
Solomon, M. Bamossy, G. Askegaard & S. Hogg, M. (2006) mentioned that although
consumers tend to equate money with class, the precise relationship between other
aspects of social class and income is not clear and has been the subject of debate among
social scientists.
Many people with a lot of money try to use it to improve their social class.
One problem is that even if a family increases household income by adding wage earners,
each additional job is likely to be of lower status. More money does not then result in
increased status or changes in consumption patterns.
2.1.3.3. Personal factors that affect Egyptian people attitude
2.1.3.3.1. (Egypt) Demographical profile
Egyptian population represents in ethnic groups: Egyptian 99.6%, other 0.4% (2006
census). The Age structure of the population is 0-14 years: 32.7% (male 13,725,282
/female 13,112,157), 15-64 years: 62.8% (male 26,187,921/female 25,353,947), and 65
years and over: 4.5% (male 1,669,313/female 2,031,016).
This huge population is medically served as Physicians’ density: 2.83 physicians/1,000
population (2009). Hospital bed density: 1.7 beds/1,000 population (2009) and Health
expenditures represents 6.4% of GDP (2009). Countries of the World.
(2011)[ONLINE](Accessed 23 April 2012).

33
Figure 2.3. Age percentage of the total population
Figure 2.4. Age structure of the Egyptian population
0
10
20
30
40
50
60
70
0-14 years 15-64 years 65 and over
%oftotalpopulation
Age Range
Age range percentage of the
total population
Countries of the World(2011)[ONLINE]
0
5000000
10000000
15000000
20000000
25000000
30000000
0-14 years 15-64 years 65 and over
NumberofPopulation
Age Range
male
female
Countries of the World (2011)[ONLINE]

34
2.1.3.3.2. Literacy standard
The population represents that 71.4% in total population in age 15 and over can read and
write: male: 83% female: 59.4% (2005 estimation). Countries of the World. (2011)[ONLINE]
(Accessed 23 April 2012).
Egyptian people has a high ability to learn and understand anything and everything but
this ability is faced by economical challenges which cause a presence of about 60 students
in each class in some schools which decreases the learning environment and the ability of
the student to be well educated and decrease the innovation.
2.1.3.4. Psychological factors that affect Egyptian people
attitude towards OTC products
2.1.3.4.1. Motivation
Egyptian people are easily motivated but skepticism is highly appreciated when they feel
untruth with the speaker so demotivation is easily come.
2.1.3.4.2. Personality
Egyptian people is a low risk taker ( risk avoiders) and of low tolerability when changing
culture, meaning that change is difficult to be tolerated and the idea of it, is not received
with enthusiasm.
Egyptian people fears from failure and requires a lot of information and evidence to make a
decision.
Companies play in OTC market requires building a strong company image to build strong
brand equity.

35
2.2. Overview on Egyptian pharmaceutical market
Van Arnum, Patricia. (2011).(ONLINE)(Accessed 10 March 2012) Demonstrates that
the pharmaceutical market all over the world considers one of the greatest source of the
universal economy as the global pharmaceutical market is expected to reach $1 trillion by
2014 and nearly $1.1 trillion by 2015, according to the IMS Institute for Healthcare
Informatics.
The market will increase at a compound annual growth rate (CAGR) of 3–6% during the
next five years, slowing from the 6.2% annual growth rate that occurred during the past
five years. Absolute global-spending growth is expected to be $210–240 billion between
2011 and 2015 compared with $251 billion between 2006 and 2010.
Removing the effect of exchange-rate fluctuations, absolute global-spending growth will be
$230–250 billion on a constant dollar basis compared with $228 billion in the previous five
years. For purposes of this analysis, the pharmaceutical market includes all types of
biopharmaceuticals, including biologics, over-the-counter drugs, and traditional medicines
distributed and administered through regulated delivery systems, such as pharmacies,
hospitals, clinics, physician offices, and mail order.
Pharmaceutical Market Trends (2012). [ONLINE] (Accessed 13 March 2012) mentioned that
the Middle East combined with the African Pharmaceutical market is projected to grow at a
CAGR of around 11% during 2010-2012.
The development of infrastructure and rapidly changing regulations in this region are
being seen as the cause of its growth.
Also there is a high prevalence of diseases and huge population base that increases the
overall pharmaceutical sales in this part of the world.
However, The Middle East pharmaceutical market depends on imported pharmaceutical
drugs and therapeutics.
The governments of countries in this region are taking measures to raise their domestic
production through heavy investments in the pharmaceutical industry.

36
The Egyptian pharmaceutical market is one of the most important markets in Africa and
Middle East as its sales in 2011 represents (EGP 18,915,883,485) by percent growth 10.8%
compared with 2010 and according to the exchange rate April 2012 (3,152,647,248 US $).
The market for OTC healthcare in Egypt Contains: analgesics, medicated skin product,
topical OTC, traditional, indigestion, cough &cold preparation, wound healing agents,
antacids and antiflatulents,H2 blockers and proton pump inhibitors, expectorant, topical
antibacterial, plasters &Bandages, vitamins and first aid kits. IMS DATA EGYPT (2011)
Egypt Pharmaceuticals and Healthcare Expenditure Projections elevated from EGP15.17bn
(US $ 2.69bn) in 2010 to EGP16.12bn (US $ 2.71bn) in Q3 2011; +6.3% in local currency
terms and +0.6% in US dollar terms.
Forecast down significantly from Q2 2011 due to the Middle East and North Africa (MENA)
political crisis. Despite the relatively more stable security environment - compared with
February 2011, expectation about political risk in Egypt still elevated in the near term.
Pharmaceutical sales growth forecasts have been increased from February but remain
below pre-crisis rates.
This is due to the short-term effects of ongoing strikes and the long-term effects of possible
changes to labor laws, reduced investment inflows and political transition on future
economic prosperity MarketResearch.com. [ONLINE] (Accessed 2 March 2012).
And elevated to EGP 16.47bn (US$2.77bn) in Q4 2011; +8.6% in local currency terms and
+2.8% in US dollar terms. Forecast up slightly from Q3 2011 due to government pledge for
greater public healthcare expenditure. MarketResearch.com. [ONLINE] (Accessed 3 March
2012).
In Egypt, The healthcare expenditure comparing with population are low so Egyptian
people depend on OTC products in mild and some of moderate symptoms to overcome this
problem.

37
2.2.1. Over The Counter(OTC) pharmaceutical products
Can be defined as the pharmaceutical products that do not require being in the physician’s
prescription and having a high safety margin to use directly by patients.
OTC products are used as a self medication without physician recommendation for the mild
to early moderate illness such as toothache, headache, migraine, arthritis, neuralgia,
menstrual discomfort, indigestion, cough, common cold, erectile dysfunction.
According to IMS institute (2011) the OTC market in Egypt represents approximately 23%
of the total Egyptian pharmaceutical market about (EGP 5,539,958,139) According to the
exchange rate April 2012 (923,326,356 US $).
Figure 2.5. Egyptian pharmaceutical OTC market 2011
Delorme, Denise E. Huh,Jisu. Reid, Leonard N. Soontae, An. (2010).argued that the OTC drug
market is expected to continue to expand in the near future for several reasons.
First, self-medication is growing and OTC drugs provide a convenient and inexpensive way
to treat minor and ordinary health problems.
Total Market
77%
OTC Market
23%
Egyptian pharmaceutical OTC market 2011
Total Market
OTC Market
IMS DATA EGYPT (2011)

38
Second, Rx-to-OTC switching is not likely to abate, making more medicines available
without a prescription.
Third, the use of OTC medication is encouraged by medical gatekeepers (e.g. HMOs,
insurance companies) as a cost-saving treatment option to expensive prescription drugs.
Fourth, health literacy is likely to increase, especially as use of the internet as a source of
self-medication information expands.
The list of the OTC market segment Table 2.1. indicates the importance of the OTC market
as a part of the Egyptian pharmaceutical market. Although Physician has a share in
prescribing this medicine, patients and pharmacists play the main role in the sales of these
medicines.

39
Table 2.1. Egyptian OTC market segments
SEGMENT
Units
Y/2011
(Absolute)
Units
Y/2011
%PPG
Previous
Year
(Absolute)
EGP Sales
Y/2011
(Absolute)
EGP Sales
Y/2011%PPG
Previous
Year
(Absolute)
ANTIRHEUMATICS NON STEROIDAL 129,406,968 8.9 1,170,819,395.0 13.5
ERECTILE DYSFUNCTION 27,405,082 1.4 508,602,884.0 7.6
ACID PUMP INHIBITORS 14,285,433 15.8 417,707,485.0 13.4
NON-NARCOTIC ANALGESICS 68,826,388 3.0 375,025,061.0 2.7
COLD PREPARATIONS 56,303,485 1.0 282,172,055.0 3.5
H2 ANTAGONISTS 28,573,100 4.1 264,968,742.0 5.5
EXPECTORANTS 46,124,894 13.2 229,343,458.0 12.0
MUTIVITAMINES+ MINERALS 12,115,849 4.4 185,203,573.0 7.2
GASTROPROKINETICS 17,150,752 6.1 172,644,086.0 12.3
IRON COMBINATION PRODUCTS 11,014,597 5.7 165,781,475.0 8.8
DERMATOLOGICAL PREPARATIONS 9,713,853 -21.8 146,293,067.0 5.8
ANTI-INFECTIVE ANTIDIARRIAL 21,890,724 -3.9 138,374,710.0 4.4
TOPICAL ANTIRHEUMATICS &
ANALGESICS
21,006,176 -2.1 135,186,009.0 4.8
VITAMIN B12 INJECTIONS 18,337,365 1.7 131,985,482.0 6.1
ANTIOBESITY PREPARATIONS 1,297,135 -50.1 120,819,253.0 -35.5
ALL OTHER TONICS 6,099,358 3.6 119,528,577.0 5.3
TOPICAL ANTIBACTERIALS 17,796,037 1.3 107,827,658.0 10.0
DIGESTIVES INC ENZYMES 13,485,868 -2.7 85,137,286.0 2.3
OTHER COUGH SEDATIVES 19,601,884 9.9 74,391,310.0 9.7
NASAL DECONGESTANTS 19,432,435 26.1 55,038,534.0 27.0
ANTISEPTICS+DISINFECTANTS 7,887,633 11.4 49,833,966.0 23.0
OTHER COUGH & COLD PREPS 5,890,589 9.6 45,615,993.0 10.6
OTH WOUND HEALING AGENTS 5,247,122 14.6 45,447,565.0 15.5
SLIMMING PREPARATIONS 1,769,501 29.0 43,752,411.0 31.2
APPETITE STIMULANTS 7,094,059 20.3 42,915,732.0 22.5
PLAIN ANTACIDS 8,266,203 -22.7 42,025,797.0 -11.7
CONTACT LAXATIVES 10,731,720 17.3 37,768,908.0 13.9
ANTISPASM SPASTIC COLON COMBS 5,112,478 7.5 37,077,557.0 13.2
TOPICAL ANTI-ACNE PREPS 4,226,345 2.5 35,282,210.0 2.4
ANTACIDS + ANTIFLATULENTS 5,865,649 -5.0 33,775,983.0 0.9
MOUTH ANTIFUNGALS 4,494,145 12.6 32,962,875.0 12.4
EMOLLIENTS & PROTECTIVES 4,015,849 5.1 32,580,118.0 13.3
ANTITUSSIVES PLAIN 6,544,073 0.1 27,937,957.0 7.4
ANTIRHEUMATIC NON-STEROIDAL
COMBINATION
4,531,118 11.0 23,263,229.0 1.4
OTHER NON-THERAPEUTIC
ANTIOBESITY
2,041,942 9.6 22,364,976.0 9.1
ANTIFLATULENTS + OTHERS 1,672,274 -9.6 19,926,501.0 -7.8
ANTACIDS + OTHER DRUGS 3,147,265 3.0 14,650,511.0 3.7

40
International standards of FDA to describe and identify the OTC products and its
composition is not the main base that followed by the pharmaceutical market in Egypt but
the use of medicines as OTC depends mainly on the advice of pharmacists and the patients
information that acquired from direct advertising.
According to IMS DATA EGYPT (2011). The top OTC product sales in the Egyptian
pharmaceutical market are represented in (Figure 2.3.1.) show that EREC which used in
erectile dysfunction and belong to ADWIA Company (Egyptian local company) by (EGP
183,480,192) estimated (US $ 30,580,032) represent the top OTC product.
VIRECTA product of EVA pharma (Egyptian local company) and used in erectile
dysfunction achieving sales estimated by (EGP 163,751,392) estimated (US $ 27,291,898)
which represent the second sales of the top OTC products. IMS DATA EGYPT (2011).
CATAFLAM is the third top sales in the OTC market by (EGP 148,759,568) estimated (US $
24,793,261). It is a product of NOVARTIS PHARMA (multinational company) and the
product belong to the anti rheumatic non steroidal group as anti-inflammatory and
analgesic. IMS DATA EGYPT (2011).
VOLTAREN also is a product of NOVARTIS PHARMA and considered as the fourth top sales
by (EGP 118,325,896) estimated (US $ 19,720,982) and also belong to the anti rheumatic
non steroidal group as anti-inflammatory and analgesic. IMS DATA EGYPT (2011).
CONGESTAL is a product of SIGMA COMPANY (local Egyptian company) and achieves sales
about (EGP 98,282,784) estimated (US $ 16,380,464) as a cold preparation. ZANTAC is a
product of GSK it is a global and famous product all over the world achieve the sixth
position in the top OTC sales about (EGP 92,068,840) estimated (US $ 15,344,806) and
belong to a group of H2 antagonists in treatment of gastritis and hyperacidity. IMS DATA
EGYPT (2011).
BRUFEN, a product of ABBOTT LABS (multinational company) is a famous product
worldwide and can achieve sales (EGP 90,347,964) estimated (US $ 15,057,994) and
belong to the anti rheumatic non steroidal group as anti-inflammatory and analgesic. IMS
DATA EGYPT (2011).

41
Figure 2.6. Top OTC product sales in the Egyptian pharmaceutical market sales in US $
Analgesics category represent nearly 1 billion and 681 million EGP about (US $
280,171,744) divided into 3 divisions according to the IMS Institute
 Anti rheumatic non steroidal which represent the top market segment in the Egyptian
pharmaceutical market and represent approximately 1 billion and 171 million EGP
estimated (US $ 195136565)
 Non narcotic analgesics which represent about (EGP 375,025,061) estimated (US $
62,504,176.8).
 Topical anti rheumatic and analgesics which represent (EGP 135,186,009) estimated
(US $ 22,531,001). IMS DATA EGYPT (2011)
Anti rheumatic non steroidal segment represents the top segment in the Egyptian
pharmaceutical market as this segment represents (EGP1,170,819,395) according to (IMS
2011) about (US $ 195,136,565) according to average exchange rate April 2012.
0
5,000,000
10,000,000
15,000,000
20,000,000
25,000,000
30,000,000
35,000,000
salesinUS$
product name
Top OTC product sales
Top OTC product sales

42
Figure 2.7. Sales presentation of Anti rheumatic non steroidal segment to the total market
Anti rheumatic non steroidal segment has a competition between 147 brand names
representing 68 pharmaceutical companies.
NOVARTIS PHARMA is the big player in this market segment by achieving (EGP
412,280,861) estimated (US$ 68,713,477) under 9 brand names with DICLOFENAC
compound but in a different pharmaceutical form to be more convenient to the consumer.
Non narcotic analgesics segment represent the eighth top segment in the Egyptian
pharmaceutical market as these segment sales is (EGP 375,025,061) estimated (US $
62,504,177).
This segment has a competition between 120 brand names representing 51
pharmaceutical companies. The big player in this segment is GSK by achieving (EGP
76,390,196) estimated (US $ 12,731,699) under 5 brand names with PARACETAMOL
compound with different brand names.
Topical anti rheumatic and analgesics segment sales are (EGP 135,186,009) estimated (US $
22,531,001). This segment has a competition between 162 brand names representing 129
pharmaceutical companies. IMS DATA EGYPT (2011)
94%
6%
Sales of anti rheumatic non steroidal segment
Total Egyptian pharmaceutical
market
Anti rheumatic non steroidal
segment

43
The big player in this segment is NOVARTIS PHARMA by achieving (EGP 31,651,408)
estimated (US $ 5,275,235) under 2 brand names with DICLOFENAC compound. IMS DATA
EGYPT (2011).
Figure 2.8. Analgesics in Egyptian market (IMS data 2011)
Novartis pharma is the big player in the OTC market as it represents 21% of the total
analgesics market (US $ 280,171,744). IMS DATA EGYPT (2011).
Figure 2.9. NOVARTIS PHARMA market share in the analgesics market
70%
22%
8%
Analesics market
Anti rheumatic non steroidal
Non narcotic analgesics
Topical anti rheumatic and
analgesics
79%
21%
Market share of NOVARTIS PHARMA in
analgesics segment
Total analgesics market
NOVARTIS PHARMA market
share

44
OTC pharmaceutical products in the Egyptian market are available only in the pharmacies
as a specialized store for human medication and pharmacist and physician are the main
source of recommendation and information about the OTC products.
The pharmaceutical companies make promotion and advertising in Egyptian
pharmaceutical market in three phases
 Advertising and promotion direct to the physicians (via personal selling)
 Advertising and promotion direct to the pharmacists ( via personal selling and
sales promotion)
 Advertising and promotion direct to the consumers (by using different tools of
advertising).
These phases occur with different types of promotions and advertising and at different
levels. This study tries to focus on the direct to the consumers advertising and promotion
of OTC products and how it causes changing in the Egyptian patients’ attitude.
2.3. Direct to consumer advertising (DTC)
Can be defined as the type of advertising that can educate, inform and remind the
consumer with the benefits, risks and usage of a specified and specialized product that can
affect consumer life or affect consumer life style and this product requires specialized
skilled person who gives it to the consumer and changes this indirect to direct decision
2.3.1. Types of direct to consumer advertising (DTC)
Wilkes, M.S., Bell, R.A., & Kravitz, R.L. (2000) mentioned that there are three forms of DTC
allowed by the Food and Drug Administration (FDA)
Help-seeking advertisements educate consumers about a disease or medical condition
but do not mention a specific drug.

45
Pharmaceutical companies use this type to build the company image and position
themselves in the customer mind (trust in our company) and consequently (trust in our
product).
Reminder advertisements provide the name of the drug without mentioning the use of
the drug or any information related to efficacy or safety, this type of advertisement is not
required to provide a brief summary.
In this type pharmaceutical companies try to put the product name as flash spot in the
customer mind
Product-specific advertisements mention the brand name of the drug, describe its
therapeutic use and represent its safety and efficacy profile in simple language. Most of
(DTC) located in this category as most of pharmaceutical companies try to build product
image, loyalty and increase sales volume by using this type of advertising
Direct to consumer advertising pros and cons
Calfee, J.E. (2002) argued that DTC expenditures seem to have a positive point of view by
some observers as they think
 DTC provide consumers essential information that they would ignore about the
disease’s symptoms that can facilitate patients’ acceptance for diagnosis and treatment.
 DTC increase the communication channels between patients and physicians because it
gives patients chance to understand physician’s instructions and ways of treatments
 DTC increase consumers’ awareness and participation in the decision-making process
by acquiring information about medical therapies, talking to their physicians about medical
symptoms and conditions.
While Schueler,Kirk R.( 2008) argued that DTC expenditures seem to have a negative point
of view by some observers as they think
 DTC are predominantly for new drugs that are positioned as innovative but may not
offer substantial benefits over other, less expensive medicines.

46
 DTC used for promoting drugs that have poorly definite safety profiles. This could
expose consumers to unnecessary risks.
 DTC advertisements’ quality is suspected since they are not often pre-reviewed by the
FDA and frequently judged unacceptable by the FDA after airing,
 DTC advertisements provide incomplete and misleading information,
 DTC advertising may influence physicians to prescribe drugs that may be unnecessary
or suboptimal versus alternative approaches including lifestyle changes.
2.3.3. Target customer of direct to consumer advertising of OTC products
Delorme, Denise E. Huh,Jisu. Reid, Leonard N. Soontae, An. (2010) mentioned that
Advertising is used to target two consumer segments
These segments are Users and nonusers of OTC products. The influence of advertising
appears before purchase and after purchase.
Before purchase, OTC drug advertisements target nonusers of certain types of OTC drugs
(e.g. acetaminophen) or users of other branded products (Tylenol versus new brand) to
affect first purchase (i.e. trial).
After purchase, advertising targets OTC drug users to remind and reinforce learned user
behaviors. Except for the introduction of new products and brands, like most consumers
advertising, OTC drug advertising does most of its work after purchase to promote
continued use, prevent product/brand switching, and build product/brand loyalty.
Table 2.2. Objective of OTC advertising with respect of target customer
Before purchase After purchase
Users Shifting from one brand to
another
remind and reinforce
behavior
Non users Shifting from one OTC drugs
to another in the same
indication
Promote continued use,
prevent product/brand
switching, and build
product/brand loyalty.

47
Delorme, Denise E. Huh,Jisu. Reid, Leonard N. Soontae, An. (2010) also mentioned that OTC
drug advertising’s influence can be direct or indirect. The direct influence of OTC drug
advertising is a one-step process – advertising exposure directly influences nonuser/user
behavior as in (Figure2.10.).
Figure 2.10. Direct to consumer OTC advertising
Delorme, Denise E. Huh,Jisu. Reid, Leonard N. Soontae, An. (2010) described The indirect
influence of OTC drug advertising as a two-step process and involved an interpersonal
moderator who enthusiastic to the advertising message and spread it to users and
nonusers which is called Word Of Mouth (WOM) as in (Figure 2.11.).
Figure 2.11. Indirect to consumer OTC advertising (WOM)
Despite what many believe, the direct power of OTC drug advertising is limited;
Advertisements that produce interpersonal interaction between the health professional
and the consumer are especially effective.
As one industry executive has noted, millions spent to advertise a drug that cannot
accomplish what a doctor or pharmacist can in a single day.
Advertising Direct Users and non users
Advertising Direct Moderator Direct Users and non
users

48
In Egypt, marketing and promotional strategies that followed by pharmaceutical
companies are mainly below the line strategy as media with different types television,
radio, magazines and newspapers.
Although these tools can reach a wide range of consumers, customers do not accept these
tools well and pharmaceutical companies try to avoid these tools because these forms of
mass media marketing are very expensive and less credible in the customer mind.
Print and web advertisements have less exposure but offer a greater amount of
information and focus more on the consumer.
Printed advertising in the pharmacies are more credible than mass media advertising by
using
 Posters paid or none paid
 Informative pamphlets that contain simple information about a disease related to the
product and ways to overcome this disease
 Pamphlets contains simple information about the product indications and usage
Printing advertising can affect the customer decision.
Customers depend on their experience after product usage to repurchase or export
satisfaction to others by (WOM) Word Of Mouth.
One customer can affect the decision of others to buy a definite product.

49
CHAPTER –3–
Research
Methodology

50
Chapter -3- Research Methodology
3.1 Research Design
3.1.1-Purpose of the study
This research is a basic research and the main reason motivate the researcher to perform
this study is the absence of studies that discuss the impact of advertising on the patient
attitude in the Egyptian pharmaceutical market especially in the OTC market.
The researcher tries to help the pharmaceutical companies that play in the OTC market to
the best way to allocate their resources in a profitable way as knowing the role of
advertising and its effects can lead to the best way to change patient attitude and increase
the brand market share, sales, and profits and build the brand image.
So the study tries to describe the role of advertising in changing patients’ attitude towards
OTC products in the Egyptian pharmaceutical market.
3.1.2-Type of investigation
This study is a causal study to describe the impact of advertising on the patients’ attitude
when patients are exposed to ads.
In this study, the researcher tries to know the role of advertising as (independent variable)
on patient attitude (dependent variable) in an actual experiment.
3.1.3-Extent of researcher interference
This study will be performed with very minimal interference from the researcher as
questionnaires will be distributed to candidates to answer questions and collected after
answering them but if there is any difficulty to understand any question, the researcher
will clarify it in a simple and a neutral manner without giving any directions to candidates
for selection.
In the IDI, the researcher will ask questions directly to candidates in a simple and a neutral
manner without giving any directions to candidates.

51
The researcher only clarifies the candidates’ point of view without any criticism to his
opinion to know what is in his mind, his feeling and his decision.
3.1.4-Study setting
This study is casual study operated in contrived setting in a normal environment.
Candidates answer the questionnaire after being exposed to the ad in a pharmacy.
IDI will be performed in a normal environment. Candidates will be interviewed in
pharmacies and answer most of the questions after exposed to the ad
3.1.5-Unit of analysis
The researcher depends on the individual as a unit of analysis. This study mainly depends
on describing the change in the patients’ attitude after ad exposure. For this reason the
researcher will collect primary data depending on individual.
3.1.6-Time horizon
The researcher will collect data once a time so this study is cross sectional study.
Candidates who share in questionnaire answer or IDI perform it once a time and data will
be collected after finishing the questionnaire. After finishing IDI the researcher collect
taped data at once.
3.2 Data collection methods
The researcher depends on a combination between primary data and secondary data.
3.2.1. – secondary data
The researcher depends on different sources to obtain data that support this study.
Reference books, recent journals, trusted internet web sites and IMS data are the main
dependent in collecting secondary data to support this study with actual data about the
Egyptian pharmaceutical market especially OTC market and data about the Egyptian
society to identify all sides.

52
3.2.2. - Primary data
The researcher depends on two ways to collect the primary data questionnaires and in-
depth interviews (IDI)
3.2.2.1. –Questionnaires
The researcher uses a questionnaire as a tool to test the effect of advertising on changing
attitude after patients’ exposure to DTC ad. These questionnaires help to draw what the
patient think, believe, feel, and decide.
The questionnaire is divided into different parts each part tests a specific item depending
on likert model.
In the beginning, the researcher collects demographic information to segment the sample
into groups which can indicate the effect of demographical background.
The second part, the researcher collects general information about the patient preferences
which reflect on his attitude.
The third part, the researcher tries to penetrate into the patient beliefs to collect
information about in what he thinks.
The fourth part, the researcher tries to translate the inner feeling of patients and collect
information about emotions which reflected on his decision.
The fifth part, the researcher identifies the ad persuasive effect which appears in the
patient intention to buy the brand.
The last part, the researcher tries to test the extent of effectiveness of the ad on patients’
attitude and after usage and how ad indirectly makes the patient source of promotion.
3.2.2.2. - In –depth interview (IDI)
Face to face interview is the best way to test actions and reactions. The researcher depends
on this technique to understand how patients think, feel and respond to the ad (stimulus)
and enable him to observe signs, gestures and facial expressions of the candidates which

53
support the idea of testing patients’ attitude and increase the information flow from the
patients which help full understanding about the patient attitude.
IDI consist of 5 phases
Introduction phase (10 minutes)
In which the interviewer introduces himself and gives a choice to the interviewee and
describes the IDI format to the interviewee to accept or reject this interview.
Discussion phase (1 min -20 minutes)
In which the interviewer asks the interviewee several probes (open probes type) to
motivate the interviewee to express himself in his answers.
Projective techniques (20 minutes)
Usage of this technique is very effective in clarifying the hidden ideas that may be present
inside the interviewee and appear in different forms. The interviewer uses two different
projective techniques sentence completion and brand personality.
Discussion phase (2 min -20 minutes)
The interviewer completes the discussion phase by the interviewee recommendations
Summary and finish (10 minutes)
The interviewer summarizes all ideas collected and thanks the interviewee and give
incentive (4 gigabits Flash memory).
3.3. – Sampling process
The researcher takes a sample (60 patients) to answer questionnaires and a sample (18
patients) to in-depth interview this is because this study describes the role of advertising in
changing the patient’s attitude.
3.3.1. - Questionnaire sampling process
The whole population is patients that have mild to moderate symptoms and intend to buy
OTC product from different pharmacies without physician’s recommendations. They vary
in social class. The researcher will depend on stratified sampling process and divides the

54
whole population into strata according to the regional classification provided that fixing
other variables.
According to the regional classification, the researcher will take random sample from each
stratum to decrease sampling errors and take equal number of patient from each stratum.
The researcher will take patients randomly from each stratum.
Questionnaire will be distributed to the candidate manually and collected after answering
it.
3.3.2. - In –depth interview (IDI) sampling process
The whole population is patients that have mild to moderate symptoms and intend to buy
OTC product from different pharmacies without physician’s recommendations.
The researcher depends on quota sampling process. The whole population will be divided
into strata according to the regional classification provided that fixing other variables.
According to the regional classification, the researcher will take non random sample from
each stratum and take equal number of patients judgmentally depending on priority of
entering pharmacies.

55
Chapter-4-
Research Findings
And data analysis

56
Chapter-4- Research findings and data analysis
4.1. Analysis of consumer questionnaire
4.1.1. Analysis of personal profile
4.1.1.1. Age
Figure 4.1. % of participants’ age in the questionnaire
Sample contains 66% of age 20-30 years this gives an indication that young adult has the
preference to use OTC products.
4.1.1.2. Gender
Figure 4.2. % of participants’ gender in the questionnaire
20-30 years 30-40 years 40-50 years 50-60 years over 60 years
Age 66% 14% 10% 4% 6%
0%
10%
20%
30%
40%
50%
60%
70%
Age
Male Female
Gender 60% 40%
0%
20%
40%
60%
80%
Gender

57
4.1.1.3. Marital status
Figure 4.3. % of participants’ marital status in the questionnaire
4.1.1.4. Occupation
Figure 4.4. % of participants’ occupation in the questionnaire
single married divorced
marital status 42% 56% 2%
0%
10%
20%
30%
40%
50%
60%
Marital status
Top
managment
Middle
managment
First line
managment
Occupation Unemployed
Occupation 14% 22% 22% 34% 8%
0%
5%
10%
15%
20%
25%
30%
35%
40%
Occupation

58
4.1.1.5. Income
Figure 4.5. % of participants’ income in the questionnaire
4.1.1.6. Educational level
Figure 4.6. % of participants’ educational level in the questionnaire
0-1000 1000- 2000 2000-4000 4000-6000
income 44% 34% 14% 8%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
income
post
graduated
higher
education
intermediate
education
literate illitrate
Educational level 12% 82% 2% 2% 2%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Educational level

59
4.1.2. Reliability coefficient
Table 4.1. Alpha (coefficient of reliability) for questionnaire
scale No of
items
Standard
deviation
Mean Variance Alpha Number of
items
eliminated
Number of
items after
elimination
Overall
scale
34 19.713 114.56 388.619 0.910 --------------- ---------------
General 4 3.344 14.28 11.158 0,787 --------------- ---------------
Believe 11 8.149 34.92 66.402 0.865 --------------- ---------------
Feeling 9 6.042 30.50 36.50 0.730 --------------- ---------------
Intention 5 3.720 15.58 13.840 0.507 --------------- ---------------
WOM 5 3.239 19.28 10.491 0.573 --------------- ---------------
From the table above, Alpha of the overall questionnaire parts (general-believe-feeling-
intention and WOM) is 0.91 which indicates that the overall questionnaire internal
consistency is very good and estimates the reliability of the overall questionnaire is very
good as one unit and indicates that the correlation between the different parts and phrases
is strong.
When separating the questionnaire into sections, there is a good internal consistency and
that it estimates the reliability of parts (general, believe and feeling) as alpha value is over
0.7.
But sections (intention and WOM) are not far from 0.7 as separate parts. In fact, these two
sections are one unit as these parts test to what extent the customer is affected and to what
extent this effect motivates the customer to be a source of promotion to others word of
mouth (WOM). When seeing them as one unit, alpha value will be 0.669 which is very close
to 0.7.

60
4.1.3. Correlation coefficient
Table 4.2. Correlation results between five parts of consumer questionnaire
scale General Believe Feeling Intention WOM
General 1
Believe 0.554** 1
Feeling 0.587** 0.588** 1
Intention 0.615** 0.804** 0.804** 1
WOM 0.512** 0.600** 0.488** 0.512** 1
**correlation is significant at the level of 0.01(2.tailed).
From Table 4.2. It is observed that the correlation values between the five different parts
of the questionnaire and the correlation values ranging between nearly 0.5 and 0.8 which
give indication that there is a close positive relationship between all parts of the
questionnaire and it indicates that all questionnaire parts can comply with the literature
review.
So it is clear that testing attitude by using these variables is very effective to identify how
customers’ attitude changes after exposing to any stimulus.

61
4.1.4. Analysis of the questionnaire results
In this part, the researcher analyzes all parts of the questionnaire in details.
4.1.4.1- Analysis results of the impact of advertising on changing attitude in general
Table 4.3. Analysis results of the impact of advertising on changing attitude in general
Strongly
Disagree
Disagree No
Opinion
Agree Strongly
Agree
General
1- You like showing this type of ads
4% 24% 2% 62% 8%
2- This type of ads can build your
trust in the brand 8% 46% 4% 36% 6%
3- This brand is well known 4% 4% 2% 50% 40%
4- This ad remind you with the
high benefits of brand 2% 18% 2% 56% 22%
General Mean Median Variance Standard
deviation
1-You like showing this type of
ads
3.46 4.00 1.151 1.073
2-This type of ads can build your
trust in the brand 2.86 2.00 1.388 1.178
3-This brand is well known 4.18 4.00 0.926 0.962
4-This ad remind you with the
high benefits of brand 3.78 4.00 1.114 1.055
As shown in Table 4.3. Most of the candidates who share in questionnaire like showing
this type of ads and interested to know what is in the ads with 62% agreement with a mean
3.46 but most of them is skeptic about the brand that present to be promoted in the ad by
46% by a mean 2.86.

62
The brand is well known. 50% of all candidates know the brand with mean 4.18 and 40%
of all candidates know the brand very well and were enthusiastic when answering this
question with mean 4.18. When these candidates saw the ad, the ad plays a major role as a
remainder to them by its benefits with 56% of the total candidates with a mean 3.78.
4.1.4.2- Analysis results of the impact of advertising on changing attitude in
believe phase
Table 4.4. Analysis results of the impact of advertising on changing attitude in believe
phase
Believe phase
Strongly
Disagree
Disagree No
Opinion
Agree Strongly
Agree
5- The celebrity in the ad is famous
0% 0% 0% 38% 62%
6- You think that celebrity fame is
an effective factor in medication
ads to purchase it
14% 30% 6% 36% 14%
7- You think that this celebrity in
the medication ads is highly
effective
12% 32% 6% 28% 22%
8- Use of celebrities in this ad is
highly appreciated 8% 28% 14% 36% 14%
9- You can use this product when
you see a famous celebrity in
ads
22% 56% 4% 16% 2%
10- The celebrity gives evidence on
the quality and effectiveness of
the product
14% 56% 6% 14% 10%
11-The celebrity builds your trust
to purchase the product
18% 54% 0% 18% 10%
12-Your purchasing decision
depend on the celebrity
28% 58% 6% 4% 4%

63
13-This ad gives a good information
about symptoms and the
product
6% 18% 4% 56% 16%
14-You believe that ad’s
information is more important
than the celebrity
4% 4% 0% 36% 56%
depend on the ads information 8% 12% 8% 42% 30%
Believe phase Mean Median Variance Standard
deviation
5-The celebrity in the ad is
famous 4.62 5.00 0.240 0.490
6-You think that celebrity fame
is an effective factor in
medication ads to purchase it
3.06 3.50 1.813 1.346
7-You think that this celebrity in
the medication ads is highly
effective
3.16 3.50 1.974 1.405
8-Use of celebrities in this ad is
highly appreciated 3.20 3.50 1.510 1.229
9-You can use this product when
you see a famous celebrity in
ads
2.20 2.00 1.061 1.030
10-The celebrity gives evidence
on the quality and effectiveness
of the product
2.50 2.00 1.439 1.199
11-The celebrity builds your
trust to purchase the product
2.48 2.00 1.602 1.266
depend on the celebrity
1.98 2.00 0.877 0.937
13-This ad gives a good
information about symptoms
and the product
3.58 4.00 1.310 1.144
14-You believe that ad’s
information is more important
than the celebrity
4.40 5.00 0.816 0.904
depend on the ads information 3.74 4.00 1.543 1.242

64
About 62% of the total candidates know the celebrity very well and they like showing the
ad after showing the celebrity which takes their attention with a mean 4.62. While 36% of
the candidates with a mean 3.06 agreed that presence of a famous celebrity is a big add to
this medication which grabs their attention effectively. And 36% of candidates appreciate
the usage of celebrities in the medication ads with a mean 3.2.
32% of the candidates disagreed about the usage of this celebrity in the ad with a mean
3.16.
A lot of the candidates 56% refused using the brand depending on the presence of celebrity
or his fame with a mean 2.2. Also 56% of them disagreed that the celebrity fame indicates
the quality and effectiveness of the brand with mean 2.5 as they are skeptic about
everything related to their health.
A lot of the candidates 54% disagreed that the celebrity in medication ads can build the
trust to purchase the brand with a mean 2.48. Also 58% disagreed that the medication
purchasing decision is not dependant on the celebrity with a mean 1.98.
On the other side, 56% of the candidates agreed that this ad gives good information about
the symptoms and the brand 3.58.
Most of the candidates 56% agreed with high enthusiasm that information of the
medication ads is more important factor affects the customer than the celebrity with a
mean 4.4 and 36% of them agreed with the same item which reflects the importance of the
information in the medication ads.
A lot of candidates 42% agreed with a mean 3.74 that information is the most important
factor affecting decision making and can change the patient attitude. Follow the last
percent 30% agreed with high enthusiasm and support that the information is the most
important factor in medication ads.

65
feeling phase
Table 4.5. Analysis results of the impact of advertising on changing attitude in feeling
phase
Feeling phase
Strongly
Disagree
Disagree No
Opinion
Agree Strongly
Agree
16-Ad’s idea is easily understood 6% 6% 10% 54% 24%
17-The ad idea is very attractive 10% 24% 8% 38% 20%
18-The ads colors is very attractive 8% 28% 6% 42% 16%
19-You like hearing or showing an
attractive ad about the brand to
take a buying decision
6% 14% 12% 58% 10%
20- This ad can persuade you to buy
this brand
16% 22% 8% 50% 4%
21-You require more information
to buy this brand
2% 22% 4% 42% 30%
22-Company reputation gives you
good feeling about the brand
effect
6% 6% 0% 48% 40%
23-This ad gives you a motive to
purchase without physician or
pharmacist recommendations
20% 38% 4% 22% 16%
24-When you see this ad, you feel
this brand will relieve your
symptoms
16% 42% 4% 30% 8%
Feeling phase Mean Median Variance Standard
deviation
16-Ad’s idea is easily
understood
3.84 4.00 1.117 1.057
17-The ad idea is very attractive
3.34 4.00 1.739 1.319
18-The ads colors is very
attractive
3.30 4.00 1.602 1.266

66
19-You like hearing or showing
an attractive ad about the brand
to take a buying decision
3.52 4.00 1.112 1.054
20-This ad can persuade you to
buy this brand
3.04 4.00 1.549 1.245
21-You require more
information to buy this brand
3.76 4.00 1.370 1.170
22-Company reputation gives
you good feeling about the
brand effect
4.22 4.00 0.665 0.815
23-This ad gives you a motive to
purchase without physician or
pharmacist recommendations
2.76 2.00 2.023 1.422
24-When you see this ad, you
feel this brand will relieve your
symptoms
2.72 2.00 1.634 1.278
This ad affects candidates and the acceptance to the ad is high as there is 54% of the
candidates understand the main idea of the ad with a mean 3.84 and 38% of the candidates
see that the idea is very attractive with a mean 3.34 which give a good indication about the
ad formulation and its hidden message which lead to change attitude.
Also the color of the ad as a stimulus seems to be attractive to 42% of the candidates with a
mean of 3.3 and not attractive to 28% of them which indicate the variation in acceptance
and the reflection on attitude.
Feeling is a good indication of changing attitude as 58% like hearing about an attractive ad
or showing it with a mean 3.52 before taking a decision and their feeling can be translated
into decisions. The ad persuades 50% of them and makes them satisfied to buy the brand
with a mean 3.04.
Although they agreed with the ad, they feel that they required more information about the
brand to purchase by agreement of 42% with mean 3.76 and enthusiastic agreement 30%
of the candidates.

67
Most of the candidates ,48% agreed and 40% enthusiastically, agreed that the company
reputation is an important factor in purchasing decision as it reflects on the patient feeling
and causes change in patient’s attitude.
Due to the skepticism appears on the Egyptian people towards everything that related to
their health. 38% of them disagreed to purchase the brand without pharmacist or
physician recommendation with a mean 2.76.
Although candidates like showing ads, 42% of them disagreed that this ad can give them
feeling of symptoms relieve with mean 2.72.
intention phase
Table 4.6. Analysis results of the impact of advertising on changing attitude in
intention phase
Intention phase
Strongly
Disagree
Disagree No
Opinion
Agree Strongly
Agree
25-After showing this ad you intend
to purchase this brand
14% 22% 10% 42% 12%
26-You are interested to know
more information about the
brand involved in it
6% 16% 6% 48% 24%
27-You can purchase and use the
brand in another indication
even if you have a bad
experience with this brand
18% 44% 8% 18% 12%
depend on pharmacist or
physician recommendation
regardless of your own
experience
6% 28% 2% 42% 22%
depend on ads regardless of
your friends advise
20% 40% 4% 26% 10%

68
Intention phase Mean Median Variance Standard
deviation
25-After showing this ad you
intend to purchase this brand
3.16 4.00 1.688 1.299
26-You are interested to know
more information about the
brand involved in it
3.68 4.00 1.406 1.186
27-You can purchase and use
the brand in another indication
even if you have a bad
experience with this brand
2.62 2.00 1.710 1.308
depend on pharmacist or
physician recommendation
regardless of your own
experience
3.46 4.00 1.641 1.281
depend on ads regardless of
your friends advise
2.66 2.00 1.780 1.334
Based on the above table there is a difference between people in taking decision as 42% of
candidates agreed to take the decision to purchase with a mean 3.16 which depends on
different factors. These factors cause variety in the degree of agreement and disagreement
which can reflect on changing attitude.
Purchasing decision of medication mainly depends on information about the brand and
symptoms which cleared in agreement of 42% of the candidates with a mean 3.68
Experience of the candidates is better to them than recommendation as 44% of the
candidates with mean 2.62 refused to use the brand if they have a bad experience with it in
another indication.
But 42% of the candidates’ medication purchasing decision with mean 3.46 depends on the
pharmacist or physician recommendation regardless to their own experience.
40% of the candidates with mean 2.66 depend on word of mouth (WOM) more than the ads
which augment that the WOM is more effective than ads.

69
4.1.4.5- Analysis results of the impact of advertising on changing attitude in WOM
Table 4.7. Analysis results of the impact of advertising on changing attitude in WOM
WOM
Strongly
Disagree
Disagree No
Opinion
Agree Strongly
Agree
30-Your friends appreciate your
advice
0% 10% 2% 68% 20%
31-You will advise your friends to
use this brand if it relieve your
pain
0% 8% 0% 54% 38%
32-If you see someone have back
pain you can advise him with
this brand
4% 12% 0% 58% 26%
33-You prefer sound of experience
more than recommendations 10% 22% 0% 48% 20%
34-You like talking about ads that
attract you to your friends 8% 16% 0% 48% 28%
WOM part Mean Median Variance Standard
deviation
30-Your friends appreciate your
advice
3.98 4.00 0.632 0.795
31-You will advise your friends
to use this brand if it relieve
your pain
4.22 4.00 0.665 0.815
32-If you see someone have back
pain you can advise him with
this brand
3.90 400 1.112 1.055
33-You prefer sound of
experience more than
recommendations
3.46 4.00 1.723 1.313
34-You like talking about ads
that attract you to your friends
3.72 4.00 1.593 1.262
Word Of Mouth (WOM) is the second effective way after individual experience and before
advertising so testing it as a result of exposing to the ad would give a powerful indication
about the changing in attitude as it will affect the customer and convert him to be a source
of promotion.

70
Most of candidates 68% think that their friends appreciate their advice with a mean 3.98
which indicate the effect of (WOM).
If there is a good experience with the brand, most of the candidates 54% agreed and 38%
enthusiastically agreed to advise their friends to use it if there is a need with mean 4.22.
This also most of candidates 58% agreed and 26% enthusiastically agreed to advise their
friends to use it if there is back pain which is one of the brand indications with mean 3.90.
Although candidates prefer experience in medication decisions, they are skeptic to use this
brand before recommendation of pharmacist which cleared in 48% of them and mean 3.46
prefer experience than recommendation but the variety of preference augments
skepticism.
By the same percent 48% of the candidates agreed and 28% enthusiastically agreed can
talk to their friends about ads that affect them with mean 3.72.
4.1.5. Analysis of the In-depth interview results
In-depth interview is the best way to test actions and reactions. The researcher depends on
this technique to understand how patients think, feel and respond to the ad.
There are 13 questions involved in this structured interview. Although there are some
differences between the candidates’ answers, there are several points of agreement.
(Q1) The common diseases that are required OTC medication.
All of them agreed that the common diseases and symptoms are toothache, headache,
migraine, arthritis, neuralgia, menstrual discomfort, indigestion, cough, common cold,
erectile dysfunction. These symptoms are common with different extents
(Q2) There is a difference between the candidates in answering this question as some of
them see that any change in the healthy status require recommendations but most of them
see that the recommendation is required only in severe cases not in all cases but in mild to
moderate symptoms, OTC products are the first choice to relieve symptoms.

The role of advertising in changing patient’s attitude towards OTC pharmaceutical products in the Egyptian market

The role of advertising in changing patient’s attitude towards OTC pharmaceutical products in the Egyptian market

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