beyond the web-based 'dtp' e-communication dashboard:unleashing the true value of pharmaceutical and...

8/3/2019 Beyond the Web-Based 'DTP' e-Communication Dashboard:Unleashing the True Value of Pharmaceutical and Clinical Information

1/108

1

ROBERT KENNEDY COLLEGE

AT

UNIVERSITY OF WALES

Dissertation Submitted in Partial fulfillment of the requirement for the

Degree of Master of Science in Advanced Information Technology

And Business Management (MSCITBM)

Title:

Beyond the Web-Based DTP e- Communication Dashboard: Unleashing the True

Value of Pharmaceutical and Clinical Information

Prepared by: Adel A.M. Seedahmed

Supervisor: Professor. Carol Marrow

July 21, 2011


2/108

2

Declaration of originality

"In presenting this dissertation for assessment, I declare that it is a final copy including any

last revisions. I also declare that it is entirely the result of my own work other than where

sources are explicitly acknowledged and referenced within the body of the text. [Or: in

footnotes, end notes, as appropriate]. This dissertation has not been previously submitted for

any degree at this or any other institution


3/108

3

TABLE OF CONTENT

Abstract..7

Acknowledgement......9

Title..10

1.0 CHAPTER ONE: INTRODUCTION

1.1 Problem overview......11

1.2 Research rational....13

1.2.1 Pharmaceuticals marketing expenditure .13

1.2.2 Research and development R&D.........14

1.2.3 Leveraging evidence-based medicine EBM..16

1.3 Research objective..17

1.4 Research questions.....19

1.5 Research topics...20

2.0 CHAPTER TWO: LITERATURE REVIEW

2.1: The evolution of information technology IT and electronic commerce

e-commerce in business development

2.1.1 The role of information technology IT in business development.....21

2.1.2 The role of electronic commerce e-commerce in business development.................22


4/108

4

2.1.3 e-detailing diverse platforms.......23

2.1.4 Web-based media partners..........24

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

2.2.1 Company perspectives.................26

2.2.2 Customer relationship management CRM technologies..27

2.2.3 Product life cycle management p-LCM....28

2.2.4 Branding..30

2.2.5 Online disease awareness....31

2.2.6 Pharmacovigilance alerts.....32

2.2.7 Social networking site.33

2.2.8 Physicians and healthcare perspectives...33

2.2.9 Main challenges of IT and e-detailing..35

3.0 CHAPTER THREE: RESEARCH DESIGN

3.1Mixed methods research..36

3.1.1 Development of grounded theory....37

3.2. The Qualitative method..39

3.2.1 Methodology...39

3.2.2 Pilot interviews test.39

3.2.3 Sample selection..40

3.2.4 Preparation of interview..40


5/108

5

3.2.5 Ethical issues, privacy and confidentiality of research participants....41

3.2.6 Data collection.41

3.2.7 Reliability and validity42

3.2.8 Data analysis and presentation....42

3.3The Quantitative method..43

3.3.1 Methodology...43

3.3.2 Questionnaire testing...44

3.3.3 Sample selection..44

3.3.4 Ethical issues of research participants.45

3.3.5 Privacy, confidentiality, and anonymity of research participants...46

3.4 Data Collection, Data Capturing, Descriptive Statistics, Validity and Reliability.46

3.4.1 Data collection........46

3.4.2 Data capturing.47

3.4.3 Descriptive statistics....48

3.4.4 Validity and reliability....51

4.0 CHAPTER FOUR: DATA RESULT, DESCRIPTIVE STATISTICS, AND

STUDY FINDINGS

4.1 The qualitative data result......53

4.2 The quantitative data result........56

4.2.1Technology Acceptance Model TAM variables............................56


6/108

6

4.2.2 Technology Acceptance Model TAM variables responses.....58

4.2.3 Descriptive statistics62

4.2.4 Study findings.64

5.0 CHAPTER FIVE: CONCLUSIONS RECOMMENDATIONS, AND

STUDY LIMITATIONS

5.1 Conclusions.......66

5.2 Recommendations..68

5.3 Study limitations....69

REFERENCES AND BIBLIOGRAPHY.71

LIST OF APPENDICES

Figure.1 Technology Acceptance Model TAM.......100

Figure: 2 Marketing expenditure of top five companies....100

Figure: 3 Useful Evidence-Based Medicine EBM URLs....100

Figure: 4 Questionnaire categories.....101

Figure: 5 Sample questionnaires101

Figure: 6 Questionnaire multi items statements.103

Figure 7: Technology Acceptance Model TAM variables responses....104

Figure 8: Perceived usefulness items responses.........105

Figure 9: Perceived ease of use items responses....106

Figure 10: Attitude items responses.....107

Figure 11: Behavioural intention items responses.....108


7/108

7

Abstract

The evolution of information technology IT and electronic commerce e-commerce, may

provide a leading pharmaceutical company with a complementary electronic communication

channels for legitimating ethics, strengthening communication, building trust, and

maintaining a convenient relationship among the physicians, the healthcare professionals, and

the broader medical communities. The objective of this research is to understanding the

perceptions of the physicians and healthcare professional towards traditional detailing, and

explores the potential values of online communication and electronic detailing e-detailing.

Using the technology acceptance model TAM which was developed by Davis (1989),

perceived usefulness and perceived ease of use as influential research model are hypothesized

and empirically supported as fundamental determinants of user acceptance of a given

information system IS and information technology IT (Chau, 1996). Alongside the

technology acceptance model TAM, the research set out to determine the physicians and

healthcare professionals attitude and intention to use the internet and related medical web-

based technologies as a source of pharmaceutical and clinical information (see figure: 1). The

literature review provided an overview of the evolution of information technology IT and

electronic commerce e-commerce in business development. The study is based on the

acceptance and the use of the internet technology to explain the physicians and healthcare

professional computer-usage behavior, and its implication in their clinical practices. For a

theoretical development, the research uses a comparative scheme of qualitative and

quantitative paradigms (Jones et al, 2005) for assessing the physicians and healthcare

professionals acceptance status of information technology IT in order to validate the


8/108

8

internet and related web-based technologies as a source of pharmaceutical and clinical

information. The researcher uses combined research methods, the qualitative research

methods via in-depth face-to-face interviews with eight key opinion leaders KOL in the

healthcare services HCS, and quantitative research method via a descriptive questionnaire.

Through the process of convenient sampling, the data are captured and collected from a

sample of 364 physicians and healthcare professionals in the Saudi Arabia. Using standard

methods for analysis the data, the outcome results and the subsequent technology

acceptance model TAM variables responses of the physicians acceptance behavior and

attitude revealed itself, and produces a useful measures into the interpersonal factors

influencing the internet and related web-based technologies as a source of pharmaceutical

and clinical information. Consistent with Bertrand (2008), the combined results of the

technology acceptance model TAM independent and dependent variables reflect the power

of the internet and medical web-based technology as the most reliable, easily access, and a

convenient source of pharmaceutical and clinical information. The interpretations of the

studys findings have concluded that the physicians and healthcare professionals were in a

positive trend towards the internet technology as a modern source of pharmaceutical and

clinical information. This result is consistent with the study conducted by Joanne (2008) who

further concluded that These results will provide a valuable data, with which

pharmaceutical companies may develop, internet-based marketing strategies (page.4). The

study outcomes and recommendations might help a leading pharmaceutical company to

develop online marketing and educational tools to outreach the physicians, the healthcare

professionals, and the broader medical communities.


9/108

9

Acknowledgement

To my parents,

To whom passed away, in memory of my brother Yasser Youre not just a memory, you

tried your best to teach us before you went away, we now have a better understanding of

what you tried to say, please always know we love you and no one can take your place. May

Allah bestow your departed soul eternal peace in Jannah, and grant courage to my family to

bear this irreparable loss

To my family, my wife, and my children Moataz, Alaa, Tasneem, and Weaam

For support and tolerance

To Professor Carol Marrow my supervisor

For assistance and advice


10/108

10

Title

Beyond the Web-Based DTP e- Communication Dashboard: Unleashing the True Value of

Pharmaceutical and Clinical Information

DTP: Direct-To-Physician is an advanced online electronic communication and detailing,

directly from the pharmaceutical companies to the physicians and healthcare professionals for

strengthening communication, building trust, and maintaining a convenient relationship.


11/108

11

1.0:CHAPTER ONE: INTRODUCTION

In todays highly competitive healthcare market, pharmaceutical companies face an

intimidating set of communication challenges among the physicians and the medical

communities. Moreover, many ethical concerns have originated and controversy within both

the medical professionals and the societies (Gibbon, 1998). With the growing competition

and spreading of the financial crises and economy recession around the world, a leading

pharmaceutical company have to come up with a new communication channels to stay

competitive in the global market (Pharma, 2008). An integrated online communication and

electronic detailing e-detailing into an electronic customer relationship management e-

CRM technology (Wang et al, 2002) is an efficient way to establish the physicians trust,

retaining physicians loyalty, and building long-stay a credible virtual partnership among the

medical communities and the societies.

1.1 Problem overview

Indeed, a potential costly research and development R&D, product complexity, short

product life-cycle, regulatory requirements, and threats of generic entrance are the major

communication challenges that face pharmaceutical companies in the global market.

Although branding is one of the communication tools to establish the product in the market

(Lim, 2010), the evolution of new innovative pharmaceutical products and establishing the

evidence-based medicine EBM in clinical practices remains the main challenges that faces

the pharmaceutical companies. At present, the international financial crises and economy


12/108

12

recession has a significant impact on the sales growth and the profitability of pharmaceutical

companies (Buysse et al, 2010). As a consequence, most pharmaceutical companies

announced restructuring plans, re-prioritization of the strategic internal programs, and

downsizing of the workforce which might range from 3% to 93% (Zhang, 2009).

Accordingly, cost control and improve sales growths are the determinants factor for the

pharmaceutical companies to stay competitive in the global market (Bernwitz, 2001).

Therefore, the internet and related medical web-based technologies will provides a

tremendous way to lower marketing cost, improve sales growth, and maintain interactive

two-way communication between physicians and healthcare professional. More importantly,

managing the relationship between the drug companies and the physicians is becoming the

critical part for building the physicians trust and maintaining long stay a credible partnership

among the healthcare professionals (Lim et al, 2010). At present, the in-person traditional

communications face many confrontations and many serious concerns have originated.

Consequently, the regulatory code of conduct of marketing pharmaceutical products has been

extremely violated (EMEA, 2005). Further to that, the marketing moral and social

responsibilities which rely heavily on the continuous delivering of accurate and unbiased

drug information to the physicians and healthcare professionals could be significantly

affected. This complex relationship may evolve a hidden conflict of interest, and might

complicate the traditional ability of the physicians to serve as impartial fiduciary agents to

their patients (Reshma, 2007).


13/108

13

1.2 Research rationale

The world economy recession and the international financial crises significantly enforced a

leading pharmaceutical company in putting heightened scrutiny on the economics of their

marketing and sales strategies (Bernewitz, 2001). Nowadays, the significant changes in the

government regulations, regulatory requirements, and the highly dynamic global market will

forced the pharmaceutical companies to look at a potential alternative of new business model

(Sunil, 2010). In a parallel piece, the globalization and fast speed communication has a

significant impact on the pharmaceuticals marketing expenditure, the research and

development R&D, and leveraging evidence-based medicine EBM in the societies.

1.2.1 Pharmaceuticals marketing expenditure

Despite the evolution of the promotional ads and fast speed customer outreach,

pharmaceutical companies increasingly rely on the traditional detailing and face-to-face

promotion to contact the physicians and healthcare professionals. A promotional campaign is

an integral part of the marketing expenditure (Buckley, 2004), representing an essential part

in establishing the brand products and for gathering market feedback necessarily for future

strategies. To extend the brand values, a leading pharmaceutical company spent heavily on

the key opinion leaders KOL (Lim, 2010), which can take a variety of forms such as

offering a free medical samples, sponsoring of medical symposium and conferences, and

contributing in the continuous medical education CME programs. Buckley (2004) has

comments that Physician- targeted promotional budget is significantly greater on all


14/108

14

fronts; both financially and in terms of the eventual outcome make up quarter to third of their

annual budget (page 6). In a parallel piece, Sorrell (2010) released a report showed the

marketing expenditure of the top five companies with the highest expenditures in the US

through the period FY07- FY09 (see figure: 2), and has concluded that The majority of

marketing expenditures outgoing to physicians representing 68%, whereas the prescribed

and the healthcare providers occupied 11% and 10% respectively (page 2). As a

consequence, the traditional face-to-face promotional budget significantly hardens the total

pharmaceutical market expenditure. Currently, the spreading of the financial crisis and

economy recession around the world enforced a leading pharmaceutical company to

restructure the marketing and sales strategies to save profits and maintain its reputation and

competitiveness around the world. Zhang (2009) has stated that Many major pharma and

Biotech companies have been vigorously strengthening their capabilities and paying more

attention to efficiency, cost-effectiveness, and productivity (page 1).

1.2.2 Research and development R&D

Research and development R&D remains the core competence of the companies

competitive advantages tools. A leading pharmaceutical company aims to publicize the

clinical trials CT results of all adequately designed and well-controlled clinical studies,

regardless of the clinical outcome to assess the medical importance of the result from all

other clinical studies of marketed medicines (J&JPRD, 2010). A part of their obligation to the

physicians and the medical communities, a leading pharmaceutical company efficiently uses


15/108

15

the internet and related medical web-based technologies to make well-informed assessments

about their products, caregivers must have access to comprehensive and accurate information

that is also balanced and timely (J&JPRD, 2010). Further to that, meeting the physicians and

clinicians expectations in their daily clinical practices would enhance in establishing the

quality of healthcare services delivered to the patients and the societies. Accordingly the

patients and health care providers can benefit from knowing about clinical studies that are

open for enrollment and the results of studies from the marketed products. Johnson &

Johnson research and development (J&JPRD, 2010), recognizes that the transparency and

information accuracy about their products and investigation drugs is easily accessible, and

they publicly register clinical studies who are open for enrollment and report the results of

clinical trials on marketed medicines to the National Library of Medicines website, this site

offers up-to-date information on federally and privately supported clinical trials for a wide

range of diseases and conditions (J&JPRD, 2010). As part of the US regulatory approval

process, Pfizer Company listed a post marketing commitment PMC

www.pfizer.com/research/pmc, on the Food and Drug Administration FDA website, to

support the clinical use of the drugs and the continuous monitoring of safety. Accordingly in

the coming years, the internet and related web-based technologies will offer a potential

communication tool to conduct online market research, retrieve the necessarily medical and

clinical information, and minimize a potential costly research and development R&D

programs.


16/108

16

1.2.3 Leveraging evidence-based medicine EBM

Evidence-based medicine EBM is the integration of the physicians clinical expertise and

healthcare professionals knowledge with the best available clinical evidence from systematic

research (Hassig, 1999). Obviously, the lack of enough updated clinical and pharmaceutical

information eventually led the physicians and healthcare professionals to take decisions

concerning the medical management of their patients based on their clinical experiences

(Eddy, 2005). Evidence-based medicine EBM is rapidly evolving, and its practice requires

access to clinical evidence and a change in the way medical decisions are made (Lisa, 2007).

As described by Mayer (2010), evidence-based medicine EBM electronic search

encompasses four broad domains: First, asking answerable questions where the clinicians

should be familiar with the proper answerable questions and make sure the question contains

four areas abbreviated by acronym PICO (Akobeng, 2008). P stands for the description of

patient or population; I stand for the intervention, C stands for the comparison group, and

O stands for the outcome. Second, an electronic-based search is the easiest and fastest way

to obtain the ready-made clinical evidence available 24/7. For instance, an electronic medical

books and magazine such as the Journal of American College of Cardiology (JACC, 2011),

the New England Journal of Medicine (NEJM, 2011), the Lancet (2001), and clinical

evidence websites such as Infopoems www.essentialevidenceplus.com, and Up to Date

www.uptodate.com (see figure: 3). Third, applying the evidence to individual patient care

as the primary aims of this aspect are to minimize the medical and treatment errors and to

assure to a greater degree a better clinical outcome. Forth, evaluating the process through a

periodic review of the content will show how well a clinical question has been answered and


17/108

17

advise either in the same or another setting. The evolution of information technology IT

allows easily flow of the medical and clinical information, necessarily to help the clinicians

in making the right clinical decision about individual care. McClellan (2008) have pointed

out that The technological and scientific innovation continued to expand the universe of

medical interventions, treatments, and approaches to care, ushering in an era rich with

potential for improving the quality of healthcare (page 6). Moreover, patients become more

knowledgeable about their medical condition, and they request for the best medical

interventions and/or treatments. The internet and related medical web-based technologies

offer a novel communication tools, to easily access and updates the clinical and

pharmaceutical knowledge.

1.3 Research objective

The primary objective of this research aims to investigate the current relationship between the

pharmaceutical companies and the physicians and healthcare professionals, and explores the

online communication and electronic detailing e-detailing as a potential alternative of

marketing and communication channels. A fully integrated information technology IT and

electronic commerce e-commerce (Liou et al, 2002), will provide a leading pharmaceutical

company with a tremendous tool for building the physicians trust, and maintaining a

convenient relationship among the healthcare professionals and the broader medical

communities. The primary relevance for computer accepting behavior as stated by Davis

(1989) is the perceived usefulness and perceived ease of use, whereas the attitude and


18/108

18

behavioral intention are the secondary one. Therefore, using the technology acceptance

model TAM the research addresses four variables categorized in two aspects, the

independent variables including the usefulness and ease of use the internet technologies, and

the dependent variables including the attitudes and behavioural intention of the physicians

and healthcare professional toward the internet and related web-based technologies as a

source of pharmaceutical and clinical information.

I) Perceived usefulness

Perceived usefulness is the main determinant user of the internet and related web-based

technologies (Yi, 2006), and is considered as dependent and independent variables, and is

strongly linked to outcome expectations. Slatten (2010) has highlighted that perceived

usefulness is the degree to which a person believes that using a particular system would

enhance his or her job performance (page 5). Perceived usefulness is strongly linked to the

studys outcome.

II) Perceived ease of use

Perceived ease of use is the degree to which a person believes that using a particular system

would be free of physical and mental effort (Slatten, 2010). In respect to present research,

perceived ease of use variable has either a direct effect on the physicians behavioural

intention to use the internet technology, or indirect effect via their perceived usefulness of the

internet technology as a source of pharmaceutical means. In essence, it reflects that using the


19/108

19

internet technology perceived to be easier, faster, and reliable as a source of pharmaceutical

and clinical information than the traditional detailing.

III) Attitude

Attitude is an individuals desirability to use the systems (Gardneret al, 2004), and is a

measure of the individual feeling toward using specific system. This provided a hypothetical

explanation of the physicians attitude and intention to use the internet technology in their

clinical practices. Using a comparative method of analysis, the study aims to determine the

relationship between the physicians attitude and their intention to use the internet technology

as a source of pharmaceutical and clinical information in their clinical practices.

IV) Behavioural intention

Behavioural intention to use the internet technology as a source of pharmaceutical means,

has a positive correlation to the perceived usage of the internet technology (Gardneret al,

2004). Behavioural intention measures the strength of physicians and healthcare professional

to use the internet and related technology as a source of pharmaceutical and clinical

information in their clinical practices.

1.4 Research questions

The questions arise from this research are:


20/108

20

Is the traditional model of detailing still the best approach?

Can electronic communication replace the in-person traditional communication? And how do

we balance the mix of in-person and e-detailing along the products life-cycle?

How will we integrate valuable physician feedback and information gleaned from each

electronic communication channel?

How electronic communications and e-detailing attain long-term credibility and trust?

What are the future expectations of e-detailing as a marketing channel?

1.5 Research topics

Chapter one stated the significance of the problem, the research rationale, and the research

objectives and how it will contribute to the healthcare practices. The contextualization of the

study and provided an introduction to its basic components. Chapter two situated review of

the literature with relevant themes or variables, and outlined the conceptual framework of the

study. Chapter three described in details the research design and the research methodology,

with an introduction to its basic component. Chapter four organized and reported the study

main results and findings. The study uses a comparative method of analysis and descriptive

statistics of the technology acceptance model TAM variables responses, the findings

including both the qualitative and quantitative results from the research problems and

research questions. Chapter five interprets and discusses the results and findings in lights of

the studys questions. As a result the conclusions for policy and practices and

recommendations for specific action plan have been made, while stated the studys

limitations for further improvement.


21/108


22/108

22

Information technology IT fully integrated into the companys overall strategy.

Current electronic commerce e-commerce systems expanded to cover entire supply chain.

Quick time to market-entry to gain first mover advantages, and quick time to market-

withdraw to save the companys reputation and minimizing the late withdrawal cost

Healthcare providers and medical societys expectations well-managed.

Website of high qualities that meet physicians and clinicians expectations

Monitoring market shares.

2.1.2 Evolution of electronic commerce e-Commerce

The evolution of information technology IT and increasing the number of internet users,

makes significant changes to the modes of business communication and commenced the era

of electronic commerce e-commerce (Alt, 2003). Pharmaceutical companies use its core

capabilities by means of e-commerce to improve the efficiency and productivity for clinical

development, channel management, and for marketing and sales strategies (Pathak, 2010). To

pursue these strategies, pharmaceutical companies utilize and expanded all platforms of e-

communication channels. Rama (2004) has stated that The pharmaceutical industry achieves

significant tasks by utilizing e-commerce to circulate information in order to build an

integrated network for both the industry and the users (page 99). Leveraging the customer

relationship management CRM technologies enable an interactive two-way communication


23/108

23

(Richard, 2008) among the stakeholders, the key opinion leaders KOL, and the physicians.

With the growing competition, e-commerce enables pharmaceutical companies to create a

high speed e-communication to interact with the physicians, the suppliers, and other

intermediaries. For instance, this is evidenced by 30% yearly growth increases in the online

retail business (Kotler et al, 2008). More importantly, the number of the healthcare

organizations and medical suppliers who visited the web page looking for fast speed and

informative business transaction is increased. Most pharmaceutical companies realize the

necessity of conducting business-to- business B2B, and business-to-customer B2C models

(Porter, 2001). These online business transaction models are becoming the crucial tools for

gaining competitive advantage in the global market. Therefore, a world leading

pharmaceutical companies such as Pfizer, Sanofi Aventis, Glaxo Smith Kline GSK, Bristol-

Myers, Novartis, and Eli Lilly designed and developed websites for launching the innovative

products, increasing the sales volume, and reducing the marketing cost.

2.1.3 E-detailing diverse platforms

Traditional face-to-face drug promotion is the dominant marketing tool (Bernewitz, 2001),

where the companys marketing strategies rely heavily on it to outreach the physicians and

healthcare professionals. Nowadays, pharmaceutical companies face major limitations to

keep the existent key opinion leaders KOL and maintained a credible partnership among the

others. The internet and related web-based technologies can greatly expand a company's

reach (Heutschi et al, 2003), by providing a newer electronic communication channel through

diversified e-detailing platforms such as videoconferencing, electronic education modules,


24/108

24

and the use of email and related technologies to promote two-way communications (Sweet,

2009). Videoconferencing is the easiest and the most popular technology of knowledge

transfer via complex traditional and e-detailing (Heutschi et al, 2003). For instance,

iPhysicianNet www.localhealthcompass.com a world leader videoconferencing provider,

operates e-detailing sessions among others pharmaceutical companies and grant the

physicians with a portable computer PC plus internet connection free of charge. Lathian

www.lathian.com a virtual training provider, allows training for specific pharmaceutical

products and services, Heutschi (2003) described this form is quietly suitable for conducting

online continuous medical education CME program. In practice, a global leading

pharmaceutical company is increasingly turning to e-detailing for marketing their products

and services (Jung et al, 2002) among the physicians, and for building long stay a credible

partnership among the broader medical communities and the societies.

2.1.4 Web-based media partner

To maintain its reputation as a source of accurate pharmaceutical and clinical information, a

leading pharmaceutical company upgrades their partnership with the online marketing media

into strategic alliance (Kaplan et al, 2010). More importantly, eliciting the physicians

feedback throughout 24/7 is necessarily for evaluating the companys current status, and

essential for future strategies. From the companys perspective, maximizing the values-

profits ratio fall within synergistic offline-online strategic marketing interactions, which

would provide opportunities for gains in productivity and meet the physicians and healthcare


25/108

25

professionals expectations. For instance, a professional website ExL Pharma

www.exlpharma.com a division of ExL Events Inc. is an industry leader in developing

innovative and educational conferences, that serves the pharmaceutical companies and

associated healthcare communities in the US and Europe. Appature Inc.

www.ignitionpartner.com is another Exl Events Inc. group www.exlpharma.com, which

provides simple website marketing solutions designed exclusively for healthcare companies,

to quickly gain new customer insights and create programs to deepen brand awareness and

drive greater sales growth (ignition, 2011). Below is a list of a useful web-based media

partner:

Online media partner Network site

Cadient Group http://www.cadient.com

Lathian Health http://www.lathian.com

The Little Blue Book http://www.t1bb.com

Physicians Interactive http://www.phyisiansinteractive.com

Within 3 http://www.within3.com

Siren Interactive http://www.sireninteractive.com

Imc2 Health & Wellness http://www.imc2healthandwellness.com

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

In synergy ways, e-detailing augment the traditional detailing (Heutschi et al, 2003), which

will help the pharmaceutical companies to staying in credible, legitimating ethics, building

trust, and maintaining a convenient relationship into the physicians, the stakeholders, and the


26/108

26

broader medical communities . The potential benefits of e-detailing in the pharmaceutical

business from the companys and physicians perspectives are summarized in the following:

2.2.1Companys perspectives

To maintain its reputation, a global leading pharmaceutical company capitalizes on the online

communication and the internet technologies to attain the following:

Enriches the profits-values ratio through lower detail cost and greater physicians reach 24/7.

As reported by the Fact Sheet (2005) traditional detailing is the second largest market

segment of $6.78 billion representing 22% of the total market expenditure. Moreover, a

report released by Fact Sheet on (2007) has estimated that the approximate cost of face-to-

face sales interaction is high relative to the time consumed.

The combine offline-online detailing has a positive marketing effect (Manhattan Research,

2008).

The ease of accessibility and the content of medical and clinical knowledge via online

communication and e-detailing, enable for eliciting the physicians feedback for future

marketing and sales strategies.

Development of e-customer relationship management CRM technology (Alt, 2003) would

provide an easy, fast, and a convenient way to improve the efficiency and productivity of the

business around the world.

Online communication and e-detailing allows marketers to better segmenting the market

potential especially prior the market orientation (Curry et al, 2000).


27/108


28/108

28

Highly professional web content with respect to the physicians interests.

Highly integrated -intranet system for information management allows companies to increase

collaboration among corporate employees, business partners, and suppliers (Berkowitz,

2010).

An electronic customer relationship management e-CRM technology aims to maximize the

lifetime customers values, through efficient integration of the traditional sales force and the

internet-based communication (Alt, 2003). Thereby, this will help pharmaceutical companies

in better segmenting the market based on the customer services such as the key opinion

leaders KOL (Lerer, 2002), understanding the epidemic status of the diseases area, and the

recommended duration of treatment. An example of global technology and service company

specialized in the healthcare field is Cegedim Relationship Management www.cegedim.com

a life sciences industrys leading provider. Cegedim supplies services, technological tools,

specialized software, and data flow management services in the healthcare business.

2.2.3 Product life-cycle management p-LCM

In the modern global economy, pharmaceutical companies are facing time-to-time

challenges; time to enter the market early to gain the first-mover advantages, and time for

short-term profit return (Chataway et al, 2008). Product life-cycle management p-LCM is

recognized as one of the keys leading technologies to facilitate the companies to overcome

these challenges (Ming et al, 2005). As the cost of developing new innovative drugs


29/108

29

continues to escalate, a leading pharmaceutical company is working to improve research and

development R&D programs, shorten the production phases, and establishing the brand in

the market. The core values of product life-cycle management p-LCM are information and

time (Oracle, 2008). Therefore, timely management of the information assets can influence

the timely market-entry to capture the first-mover advantages in the class- therapeutics,

shorten time-to profit, and allows a larger post marketing clinical trials for brand extension

and expansion. Accordingly, product life-cycle management p-LCM technology is the one

of the most rapidly growing technologies in the pharmaceutical market industry, and its

implementation can help improve the information challenges associated with the product

management (Datamonitor, 2007). The holistic approach of the product life-cycle

management p-LCM is characterized by the following:

Improving the visibility of the product information and utilization among the healthcare

organizations and medical suppliers.

Product life-cycle management p-LCM offer a long-term brand protection, as well as short-

term recovery following risen claim of unexpected adverse drug reaction UADR related to

the brand, the unethical marketing, and losing of the drug discovery data (Katz, 2010).

Allows time-reduction through electronic submission compilation, and timely- response to

data request mandated by government regulations and other authorized corporate governance

(Katz, 2010).

Provides a wider scope of what information needs to be reviewed and protected within the

specified time-frame


30/108

30

An efficient implementation of the product life-cycle management p-LCM technology will

help a leading pharmaceutical company to develop a new drug faster, more safely, and at

lower cost (Oracle, 2008).

2.2.4 Branding

Branding of pharmaceutical products is complicated by the short product life-cycles and the

regulatory authorities on communication the basic benefits of the drug (Lim et al, 2010).

Although the major mass of communication channels are through the medical journals,

conferences and symposia, continuous medical education CME programs, and hospital

educational forums, branding in the pharmaceutical industry is seen as an important aspect of

communication (Lim et al, 2010). At present, the role of the key opinion leaders KOL are

quite obvious not only during the launching phase of the products but, also to simplify and

delivers the brands messages and emphasize the brands benefits versus the competitors in

the medical communities. As consequences, pharmaceutical companies rely heavily on the

role of the key opinion leaders KOL to augment the brands communication mix in the

clinical practices, and strengthening the brand values in the medical communities (Lim et al,

2010). Further to that the clinicians respond to the new clinical interventions by seeking

information and opinions from peers and opinion leaders, rather than assessing the scientific

merits by themselves (Peteret al, 2004). Moreover , a relatively inexpensive generic drug is

the major threats that hit brand shortly beyond market-entry, Lofgren (2002) has stated that

Public and private third-party payers increasingly encourage or mandate the use of


31/108

31

generics through measures such as generic prescribing and generic substitution (page1). In

this regard, a leading pharmaceutical company can develop an electronic brand hand-led

devices such as, electronic brand-connect eb-CONNECT loaded with pharmaceutical and

clinical information necessarily to help the physicians and clinician to make the proper

clinical judgment for a better clinical care. Therefore, following a successive product-life

cycle management p-LCM programs, the electronic communication and the diversified e-

detailing platforms will offer a broader communication channels to establish the brand among

the physicians, the medical communities, and the societies 24/7.

2.2.5 Online disease awareness

A part of their continuous medical education CME and social responsibility, a global

leading pharmaceutical company increasingly uses e-detailing for disease awareness

campaigns. Sweet (2009) has pointed out that Pharmaceutical companies are capitalizing on

the advent of the internet and the development of new media forms to promote their products

(page 2). Among the tools being used are interactive websites, email prompts, and viral

marketing campaigns using social networking sites (Bampo et al, 2008) such as; YouTube

www.youtube.com, MySpace www.myspace.com, Twitter www.twitter.com, and Facebook

www.facebook.com. Such campaigns are targeting the physicians, the healthcare

professionals, and the general public. For instance, pfizer reportedly collaborating with

Sermo Inc. www.sermo.com a web venture based in Cambridge the US, where tens of

thousands of doctors discuss diagnostic and treatment issues in anonymous postings, this

collaboration allows pfizer's doctors to ask questions and respond to post (Johnson (2007) .


32/108


33/108

33

2.2.7 Social network sites

Realizing the power of the social networking sites, a global leading pharmaceutical company

capitalizes on the social networking platforms (Stockman, 2010) such as, Twitter

www.twiter.com , Blog www.blog.com , Facebook www.facebook , Linkedin

www.linkedin.com , and other social media account for the news, announcements, and

delivering medical and pharmaceutical information (Sweet, 2009). For instance, Pfizer

addressed its mission on the Facebook page; www.facebook.com/pfizer as Good health is

vital for all of us. We strive to provide access to safe, effective and affordable medicines and

related health care services to the people who need them (page 2). A part of the social

responsibilities and for building trust and long stay credibility among the societies and

patients as well, pharmaceutical companies capitalizes on the social networking media to

disseminate their values and visions to create a virtually-loyal customer.

2.2.8 Physicians and healthcares perspectives

A survey conducted by Google (2009) demonstrated that 65% of the physicians access the

internet more than once per day, where 86% of them have used the internet to gather clinical,

medical, and prescription drug information. In particular, the reasons for use of the internet

and related medical web-based technologies were felt primarily in the Physicians acceptance

behavior. An e-detailing solution gives the physicians and healthcare professional greater

control over the time, the place, and the content as well as the quality of the information

(Accela, 2009), and provides a convenient direct-to-physicians DTP electronic


34/108

34

communication throughout 24/7. Undoubtedly, the quality and the quantity of the information

content delivered by e-detailing reinforce the physicians and healthcare professionals to

frequently update their medical knowledge as a part of the continuing medical education

CME programs. On the other hand, the critical success factors CSF of e-detailing is the

accessibility throughout 24/7 and fast speed on retrieving the needed pharmaceutical and

clinical information. For instance, GlaxoSmithKline GSK a leading healthcare company

developed GSKsource website www.gsksource.com , which permits an easy access to be

comprehensive, to update information, and navigate clinical information and services. Sanofi

Aventis, a world leading pharmaceutical company conducted The Partnership for

Prescription Assistance a web-site in US www.sanofi-aventis.us/live, the program is

designed to join America's pharmaceutical companies, the doctors, the patient advocacy

organizations, and the community groups to help qualify patients who lack prescription

coverage get the medicines they need through the public or private program that's right for

them. Generally through the diversified e- detailing platforms, a leading pharmaceutical

company efficiently establishes an interactive two-way communication for delivering

accurate and updated pharmaceutical and clinical information in a fast and flexible way.

Consequently, this allows the companies to access easily the physicians feedback necessarily

to design an efficient customer relationship management CRM strategy, for building trust

and maintaining a convenient relationship into the stakeholders and the physicians.


35/108

35

2.2.9 Main challenges of information technology IT and e-detailing

Although many e-detailing approaches were in the experimental stages, the observer could

find that e-detailing confronted with a series of challenges. These challenges can be

summarized as follows:

In the near future online activities run alongside the offline communication rather than

substitute it. Therefore, e-detailing approaches may burden the companys marketing

expenditure (Heutschi et al, 2003).

The healthcare market structure and the scope of achieving the economies of e-detailing is

limited in various regions, as the e-detailing providers solution were concentrated primarily

in homogeneous healthcare market (Boehm 2002).

The internal field force resists the e-detailing approaches which might raise a conflict among

the sales representatives and the companys management and eventually hindering the

companys marketing and sales strategies.

Regulatory restrictions, where the companys payment, sponsoring of conferences and

symposia, and incentives to the physicians and healthcare professional must comply with the

regulatory code of conduct of promoting medicinal products (EFPIA, 2007).

Long time needed to establish a technical information technology IT foundation.

High subscription cost of the online medical and pharmaceutical websites.


36/108

36

3.0: CHAPTER THREE: RESEARCH DESIGN

In many areas of the health care research, the combining qualitative and quantitative method

in a single study is widely practiced and accepted (Sale, 2002). Alicia (2007) has concluded

that Mixed methods research in healthcare service research HSR is common in the UK, its

use is driven by pragmatism rather than principles, motivated by a perceived deficit of

quantitative method alone to address the complexity of research in healthcare (page 1)

3.1 Mixed methods research

The complexity of the research problems within the health sciences makes using a mixed

methods research design more appropriate to use (Creswell, 2009). In respect to the present

research, the mixed methods are used to uncover a more profound understanding of the

physicians perception and attitude towards the internet and related web-based technology as

a source of pharmaceutical and clinical information. Combining the qualitative and

quantitative method research gives the researcher the opportunity to support the hypothesis

with the evidence, generating a more productive analysis of data, and enables the possibilities

of new ways of thinking that materialized from the two different types of data (Johnson et al,

2007). Similarly, some researchers have argued that the complexities of the most public

health and social interventions such as health education and health promotion programs

require the use of a broad spectrum of quantitative and qualitative methods (Steckleret al,

1992). The qualitative and quantitative aspect of this research is based on a particular

paradigms; the quantitative paradigm is based on positivism where theres only one truth and


37/108

37

the researcher is capable of studying the perceptions of the physicians and healthcare

professionals toward using the internet and related web-based technologies in their clinical

practices, without influencing it or being influenced by it. The qualitative paradigm is based

on articulate respondent of the key opinion leaders KOL in qualitative interviews, because

they are a leader and have the ability to see the holistic picture (Reid, 1996). The researcher

and the object of this research are interactively linked so, that findings are mutually created

within the context of the situation which shapes the research hypothesis (Denzin et al, 1994).

The survey was conducted in the Saudi Arabia, and has been designed to investigate the

status of the traditional communication of the pharmaceutical companies among the

physicians, the healthcare professionals, and the broader medical communities and to explore

the potential values of e-detailing and online communication. The prospects survey attempts

to answer the following coordinates; the physicians and healthcare professionals attitudes

toward traditional face-to-face detailing and e-detailing interactions, their beliefs about the

products information conveyed by the traditional detailing and e-detailing, and the future

expectations of the online e-detailing.

3.1.1 Development of grounded theory

Using the principles of the grounded theory which was first presented by Glazer and Strauss

(1967), the study applied substantive grounded theory to develop a conceptual hypothesis of

the potential role of the internet and medical web-based technology as a source of

pharmaceutical and clinical information in the healthcare settings. The common features of


38/108

38

the substantive grounded theory is that its carefully induced from the diverse data (Cerniglia,

2008), and its closely related the realities of the perception of the physicians and healthcare

professionals toward the internet and medical web-based technology as a source of

pharmaceutical and clinical information in their daily clinical practices. The substantive

grounded theory is not only understandable to the people working in the substantive field but

also, sharpens their sensitivity to the research problems (Cerniglia, 2008). Rather, the

developed substantive grounded theory transcends and gets applied to any other substantive

field regardless of the time, place, and people participated in the study (Glazer, 2002).

Through a comparative method of analysis, the substantive grounded theory is inductively

derived from the studys findings, which have been obtained through systematic research

methods using the following steps:

1. Identify the research problem from the qualitative interviews, and the categories with relevant

themes that emerge from the previous studies and the literature review, develop the research

questions, and the method used in judging and comparing the results.

2. The combined qualitative and quantitative data is collected and coded to provide a conceptual

framework of the study (Glazer, 2002).

3. The data was analysed and categorised to describe the research hypothesis. The technology

acceptance model TAM variables responses are identified, labelled, and categorised to

describing overall features of the research results and findings.


39/108

39

3.2 The qualitative method

3.2.1 Methodology

Using standardized open-ended interview technique will help provide a theoretical

explanation, grounded by the physicians perception towards the offline and online detailing.

Interviewees will be asked identical questions and the questions were worded so, that

responses are open-ended (Turner, 2010). This type of the questioning technique will help to

elicit responses based on the personal experiences and opinions, toward the potential values

of the internet and related web-based technology as a source of pharmaceutical and clinical

information, and allows the researcher to prepare follow-up questions focuses on the research

hypothesis (Turner, 2010).

3.2.2 Pilot interviews test

Prior to the implementation of the planned interviews, a pilot interviews test has been

conducted with three participants that shared the same interests as those of selected

interviewees (Turner, 2010). The purposes of the pilot interviews test is to assess the

proposed time for the interview , examine the type of questioning technique and the questions

flow , and allow for refinement of the research questions (Turner, 2010).


40/108

40

3.2.3 Sample selection

Using a convenient sampling, eight interviewees were selected based on the criterion-based

sampling that they will be willing to openly and honestly share information and provides the

most credible information to the study (Turner, 2010). Interviewees were carefully selected to

understand their perceptions towards using the internet and related web-based technologies as

a source of pharmaceutical and clinical information in a permissive and non-threatening

environment (Ogunbamerm 2003). The choice of the interviewee was based primarily on the

basis of accessibility and willingness to participate, and was conveniently selected from the

accessible physicians and healthcare professionals. Accordingly, eight participants were

selected from the healthcare authorities; the Saudi Food and Drug Authority S-FDA, the

pharmacy directorates, and the physicians and healthcare professionals in the academic and

governmental hospitals. Interviewees were asked identical unstructured questions in terms of

wording, so that the responses are open-ended (Gall et al, 2003). The researcher aims through

this interview design to allow the participants to contribute as much detailed information as

they desire, to fully express their viewpoints and experiences, and it also allows the

researcher to ask probing questions as a means of follow-up (Turner, 2010). The selected

interviewees have the necessarily skills such as, key opinion leader KOL, having visions

and values, and have the ability to see the holistic pictures (Boyce et al, 2006).

3.2.4 Preparation of interview

In order to provide maximum benefits to the research hypothesis, the researcher applies four

principles to the preparation stage of interviewing (Turner, 2010) which includes the


41/108

41

following ingredients: (1) explain the purpose of the interview (2) address terms of

confidentiality (3) explain the format of the interview (4) indicate how long the interview

usually takes. The sample population for these interviews will be managing the drug

regulatory in Saudi Food and Drug Authority S-FDA, key opinion leaders KOL in

healthcare services, and consultants physicians and general practitioner

3.2.5 Ethical issues, privacy and confidentiality of research participants

Although there is no agreed guideline for judging the ethics of qualitative research (Richard

et al, 2002), the researcher realizes the necessity of the ethical issues which arise when

planning and carrying out this qualitative interviews with the physicians and healthcare

professionals. The researcher recognizes the four potential risks to the research participants

the anxiety and distress, the exploitation, the misrepresentation, and the identification of the

participants in the published paper (Richards et al, 2002) details in section 3.3.4 and 3.3.5.

3.2.6 Data Collection

The data has been collected between June and August, 2010. The conducted interviews were

face-to-face at a time and place convenient for the interviewee. Average duration of the

interview was thirty minutes. The interviews were documented by written description and

transcribed by the researcher.


42/108

42

3.2.7 Reliability and Validity

Assessing the internal reliability and validity of the present research is crucial to ensure

accuracy of the data. Pope (2002) has stated that Qualitative methods are often seen as

scoring highly in terms of internal validity (page 150). Therefore, the study design and the

method of analysis used are quietly suitable for the aid of the research objective in a given

time. However, the study is unlikely to be replicated under the same controlled conditions

(Pope, 2002).

3.2.8 Data Analysis and presentation

As in the grounded theory methodology, the qualitative and quantitative data is collected and

referred to as coding (Creswell, 2007). The detailed procedures for the data analysis consist

of three stages first, open coding is an initial stage in the data acquisition through which the

data is selected, and the open coding categories which is extensively discussed by the

research participants is identified and listed as the central phenomenon for the purposes of the

research questions (Creswell, 2007). Further to that the technology acceptance model TAM

variables responses are labeled and categorized to describe the overall features of the

research hypothesis. Second, axial coding through which the selected categories and the

technology acceptance model TAM variables responses are interconnected to each others,

to form the coding paradigm (Creswell, 2007), which provided insight into specific coding

categories that explain the central phenomenon and built the theoretical model of the study

(Creswell, 2007). Third, selective coding where the core categories in the coding paradigm


43/108

43

are selected and interrelated to generates conceptual statement that hypothesizes the

theoretical model of the study (Creswell, 2007).

3.3 The quantitative method

3.3.1 Methodology

The survey was conducted in a questionnaire format comprising twenty items within four

categories (see figure: 4), each of which has series of questions and each question provide six

answers ranging from strongly agree to strongly disagree from which the respondent

could choose (see section 3.4.2). The responses were scored numerically and then quantified,

categorized, and subjected to statistical analysis using computer excel program. The

descriptive questionnaire items are characterized by:

The questionnaire deals with a specific situation, that requires visibility of the observational

techniques used for the data collection

The physicians and the participants for the research were carefully selected and clearly

defined

Particular attention has been given to safeguard the collected data from the influence of bias

(Powell, 2004).

Data must be collected, organized, and presented systemically so that valid and accurate

conclusion may be drawn (Allers, 2010).

The researcher used a Likert Scale (Trochim, 2006), where the collected information has

been grouped into six categories with boxes to tick. The Dont know box is there, in order


44/108

44

to forestall a common analysis error, which is to assume that the middle box represents

something in between the two extremes, whereas a respondent who wants to indicate no

opinion ticks it as if it were neutral. The twenty items were arranged in a logical way to find

out the determinants of the technology acceptance model TAM variables scores necessarily

to reach the research objective.

3.3.2 Questionnaire testing

A pilot test has been carried out after completion of the questionnaire format (Turner, 2010),

to examine the questionnaire structure, the flow of the questionnaire items, and the level of

understanding the questions (see figure: 5). The responders were asked verbally about their

understanding, the time needed to fulfill the questionnaire items, and the ease or difficulties

of answering the questions.

3.3.3 Sample selection

A careful sample selection has been carried out to investigate the research hypothesis, and to

draw a general conclusion about the physicians perception toward the online communication

and e-detailing (Limpanitgul, 2009). Accordingly, the present research follows a five step

procedures from defining the target population to collect the data from the sample

(Limpanitgul, 2009). The sample size of the research was drawn from the Ministry of Health

MOH directorate database of 364 physicians and healthcare professionals. The survey was

followed a non-probability sampling procedure (Trochim, 2006), and has been carried out

within the period from 10th of July 2010 to 5th of August 2


45/108

45

3.3.4 Ethical issues of the research participants

To date, the reservations held about strict ethical guidelines for the health service research

HSR plays a major role in adoption of agreed standard of good practice (Richards et al,

2002). Whilst recognizing the main ethical issues rose on carrying out this research, the

researcher aims to minimize the potential risks and the consequences of legislative change in

human rights and data protection of the research participants. As mentioned by Richard and

Schwartz (2002) the four potential risks of the research participants who might be observed

were: Firstly, anxiety and distress the researcher aims to avoid anxiety and distress provoked

from unpredictable sensitive topics and questions, by designing a research deals with a

specific situation that requires visibility of the observational techniques used for collecting

the data and delivered predictable questions. Secondly, exploitation is an important aspect

which significantly harms the research, the researcher avoided exploiting the power of

relationship and the participants from feeling pressurized to participate in research, because

they depend on the goodwill of their corers (Holloway et al, 1993). Thirdly,

misrepresentation recognizing that the participants are more likely to feel that their views

have been misrepresented and taking out of context, the present research designed to answer

specific questions about their perceptions, attitudes, and behavioral intention towards the

internet and related web-based technologies as a source of pharmaceutical information.

Fourthly, the nature of qualitative health service research HSR collect a large amount of

participants information and views. Therefore, identification of the participants in published

paper by themselves or others, potentially may lead to serious harm. Accordingly, the

researcher recommended strategies for reducing the risk of harm include ensuring scientific


46/108

46

soundness, ensuring privacy and confidentiality, and anonymity of the research participants

(Richards et al, 2002).

3.3.5 Privacy, confidentiality, and anonymity of the research participants

The identity of the participant in this study appears to have become central to the design and

practice of ethical research (Grinyer, 2009). Thus, the privacy and anonymity of the

physicians and healthcare professionals have been designed within the context of this

research, and it was achieved once the data has been collected and not subject to re-construct.

Grinyer (2009) further comments that The research participants should understand how far

they will be afforded anonymity and confidentiality and should be able to reject the use of

data gathering devices such as tape-recorders and video cameras (page 50). As a result, the

participants should be able to recognize themselves, while the reader should not be able to

identify them.

3.4 Data collection, data capturing, descriptive statistics, and validity and

reliability

3.4.1 Data collection

To harvest high quality data, the questionnaire items were structured and sequenced in a way

to ensure easily flow of the categorys variable answer and to avoid burdening on the

respondents working memory (Mora, 2011). The questions were designed as closed-ended


47/108

47

questions with answer choices (CSU, 2011), and were formulated with the right wording so it

accurately reflects the perception of the physicians and healthcare professionals towards the

internet and related web-based technologies as sources of pharmaceutical and clinical

information (see figure:6). Data collection involves all activities and processes to obtain data

necessarily to explore a new era of pharmaceutical and clinical information or to confirm the

previous findings, either qualitatively through in-depth face-to-face interviews, or

quantitatively by contacting the physicians and healthcare professionals through a

questionnaire.

3.4.2 Data capturing

To capture high-quality data, the different parts of the questionnaires item work in harmony

and in consistency to avoid responders confusion (Mora, 2011). With the guidance of

qualified statisticians the data captured onto an Excel Application Program EAP, each

question and option were numbered uniquely and occupied a single field in the database. The

perceptions are measured on a continuum from one extreme position to the opposite extreme

position. The Likert scale response mechanism (Trochim, 2006) and William (2006) allow

for five responses, namely, strongly disagree, disagree, neutral, agree and strongly

agree. Numerical values of one to five were allocated to each response in respective order.

Numerical values with a value of less than three represent a negative perception to the

questions while, numerical values greater than three reflect a stronger perception. The value

three offers a neutral response.


48/108

48

3.4.3 Descriptive statistics

The primary goal of the data analysis is to arrange the collected technology acceptance model

TAM variables responses in a way that the answer to the research questions reveals itself

(Wrenn et al, 2007). Given all the technology acceptance model TAM variables responses,

the resultant substantial large volume of data from this research was carefully condensed and

summarized (Walter, 2009). The use of descriptive statistics (Trochim, 2006) may assist in

the following parameters: First, it indicates the central point around which the questionnaire

data distributed. Second, it may show the relationship of one technology acceptance model

TAM variable to another one. The central location statistic represents a middle point of a

set of observations and is useful for comparative analysis (Trochim, 2006). The following

measures for central location will be used:

The Mean

The mean is the location measure most frequently used for interval-ratio data (Somekh et al,

2002). Mathematically, it is the arithmetic average representing the sum of the ascertained

values in the distribution divided by the number of observations.

The Median

The median is the score found at the exact middle of the set of values (Trochim, 2006). To

compute the median is to list all scores in numerical order where half the scored values will

fall below this median value and the other half above it.


49/108

49

The Mode

The mode is the most frequently occurring value in the set of scores (Trochim, 2006), and is

the only means of measuring central tendency around the mean containing nominal

categorical values (McCluskey et al, 2007).

The Standard Deviation

The standard deviation SD is an important aspect for descriptive statistics because it reveals

the amount of variability of individuals within a data set (Trochim, 2006). The standard

deviation SD gives an accurate and detailed estimate of the dispersion and shows the

relation of the technology acceptance model TAM variables scored values has to the mean

of sample size. The standard deviation SD is the square root of the sum of the squared

deviation from the mean divided by the number of scores minus one and is calculated

according to the formula below:

SD = (X-X) 2

(N-1)

Where:

SD is Standard Deviation

: Sum of score


50/108

50

X: each score

X: The mean or average

N: Number of values

Correlation analysis

The correlation analysis is the statistical tool use in order to measures the linear relationship

between questionnaires variables and how closely they relate to each other (biddle, 2005),

where the value of correlations existed known as a correlation coefficient represented by the

(r) symbol. The (r) values ranged from -1.0 to +1.0, the negative values represent a negative

relationship between the questionnaires item and the positive values represent positive

relationship between the questionnaires items. According to Trochim (2006) the correlation

coefficient(r) was calculated as:

Correlation (r) = [NXY - (X) (Y) / Sqrt ([NX2 - (X)2][NY2 - (Y)2])]

where:

N = Number of respondents . X = First Score.

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

X = Sum of First Scores. Y = Sum of Second Scores.

X2 = Sum of square First Scores. Y2 = Sum of square Second Scores.


51/108

51

The probability (p) threshold to be no more than 0.05 or 5%, the level of correlation

coefficient(r) significance is determined at (p) < 0.05 (Trochim, 2006). The (n) represent the

total number of respondents; the large (n) will lead to be statistically significant (r), whereas

the smaller (n) conversely will lead to statistically non-significant.

3.4.4 Validity and reliability

To ensure consistency and credibility of the present research, it was necessarily to track the

validity and reliability standards of quantitative research. As noted by Golafshani (2003) that

Reliability and validity are tools of an essentially positivist epistemology. (Page.598), the

validity of the present researcher uses naturalistic approach that seeks to understand, and

determines whether the research truly measures the perceptions of the physicians and

healthcare professionals toward the internet and medical web-based technologies as a source

of pharmaceutical and clinical information. The construct validity is the truthful of the

studys concept and the drawn conclusions of the study results and findings (Golafshani,

2003). On the other hand reliability represents that the measurement are accurate and the

result is consistent overtime and is readily modifiable by comparative analysis with new data

regardless the time, place, and population (Glazer, 2002). Using the collected technology

acceptance model TAM variables responses, the reliability and validity of the factors

contained in the research was evaluated, and the reliability was assessed using a Pearsons

correlation coefficient(r). The purpose of Pearsons correlation coefficient (r) is to measure

the internal consistency and reliability of the scored values and to assess whether there is a

relationship between two or more technology acceptance model TAM variables (Yaffe,


52/108

52

1999). As summarized in the table below, the computed Pearson Product Moment

Correlation coefficient (r) showed that the investigated technology acceptance model TAM

variables exhibited an alpha value (r) greater than 0.5, with an overall result of 0.98,

suggesting a high degree of internal consistency.

Statistic Variable X Variable Y

Mean 287.5 585.2

Biased Variance 16008.75 21686.56

Biased Standard Deviation 126.6 147.3

Covariance

Correlation

Determination

T-Test

P-value(2 sided)

p-value (1 sided

Degree of freedom

Number of Observation

Pearson Product Moment Correlation

8098

0.412877948

0.1704682

1.9

0.07

0.03

18

20

For the items relating to perceived usefulness, thePearson correlation coefficient(r) is + 0.2

indicating a moderate degree of internal consistency. For the items relating to perceived ease

of use and attitude thePearson correlation coefficient(r) is +0.9 indicating a high degree of

internal consistency. For the items relating to behavioural intention the (r) value showed a

negative correlation of -0.2 indicating that the technology acceptance model TAM

variables scores increase and the other decrease and vice versa.


53/108

53

4.0: CHAPTER FOUR: DATA RESULTS, DESCRIPTIVE STATISTICS,

AND STUDY FINDINGS

Realizing the complexity of the internet and related web-based technology as a source of

pharmaceutical and clinical information in the healthcare practices, the combining qualitative

and quantitative research results maintained favorable views of a new model of online

communication and e-detailing.

4.1 The qualitative data result

Qualitative interviews would have provided a comparative cross-section of all physicians and

healthcare professionals (Brewster, 2008) and will assist to develop an initial understanding

of the physicians perception toward traditional detailing and exploring the future role of the

internet and related medical web-based technologies as a source of pharmaceutical and

clinical information. The interviews were of an exploratory nature and have been conducted

in the participants offices, where the physicians and research participants were asked to

describe their experience with the internet technology as a source of pharmaceutical and

clinical information and its implication in their daily clinical practices. Each interview was

transcribed by the researcher and then coded. There were several significant findings from

the interviews that help in designing the questionnaires item for the aid of research objective.

The two interviewees included; the vice-president for drug affairin the Saudi Food and Drug

Authority S-FDA who urged the physicians and healthcare professionals to efficiently

utilize the advanced information technology IT infrastructure in Saudi Arabia, to frequently


54/108

54

updates their medical knowledge and improve their professionalism in the healthcare setting

that helped in establishing the evidence-based medicine EBM principles in the community

and he has comments that With the internet and adoption of a new web-based medical

technology, theres no excuse for the physicians and healthcare professionals to update their

knowledge about pharmaceutical products, and following the international guideline for

managing the diseases. Additionally, he criticized the relationship pattern between the

pharmaceutical companies and the physicians so, further he has noted that The Saudi Food

and Drug Authorities S-FDA warns the unethical concern arisen from the relationship

between pharmaceutical companies and the physicians and healthcare professionals.

Therefore, in compliance with the international code of conduct, they develop a local code of

conduct for marketing of pharmaceutical and medicinal products in Saudi Arabia. Whereas

the Public relation affair managerin the Saudi Food and Drug Authorities S-FDA

emphasize the role of the internet and medical web-based technology as a source of

pharmaceutical and clinical information and so, he has stated that The internet and related

web-based technology offer a valuable tool for the physicians and healthcare professional to

update their knowledge about the disease area, pharmaceutical product, and management

especially in scattered regions like Saudi Arabia, but the only limitation might be the lack of

internet access in some areas. Both interviewees shared the common idea whilst, they

emphasize the added-values of the internet and medical web-based technologies on

establishing the evidence-based medicine EBM in the society, they are in agreement that

the adoption of internet technologies in the healthcare system help significantly in

minimizing the frequency of the medical and treatment errors. Additionally, they realize the


55/108

55

necessity of regulatory requirements of the pharmaceutical products and the growing need for

a better patients care and safety. Accordingly, the Saudi Food and Drug Authorities S-FDA

designed a technology-based National Drug & Poison Information Center NDPIC for early

detection and assessment of adverse drug reactions ADR of the pharmaceutical and

medicinal products. On the other hand, three consultants physicians were interviewed in the

King Saud Medical Complex KSMC and governmental hospital realizes the scientific

values of the internet technology adoption in the healthcare services as a source of

pharmaceuticals and medical knowledge and they have stated that the physicians are faced

with a barrage of new products, alternative treatments and varying medications, from this

point the internet and medical web-based technologies are the dynamic channels and the

easiest way to updates their knowledge about pharmaceutical and clinical information.

Although the interviewed physicians recognizes the internet and related medical web-based

technology as a potentially alternative for delivering accurate pharmaceutical and clinical

information when needed 24/7, their judgment is made regarding the innovations clinical

benefit (Jonathan, 2008). Interestingly, two of the interviewed physicians have commented

that The online disease awareness program may create a critically obsessive medical

population, especially those of low medical background and if the medical website is not

under a medical consultation. Two of the general practitioners when interviewed were in

positive trend towards using the internet technologies as a source of pharmaceutical means

and they have stated that The internet technology offers advanced and real solutions to

customize the large number of clinical trials and its clinical outcome relative to its adverse

effect. A clinical pharmacist in the Ministry of Health MOH directorates when interviewed


56/108

56

was in agreement of the tremendous benefits of the internet technology in his daily practice

and has stated that The internet t

beyond the web-based 'dtp' e-communication dashboard:unleashing the true value of pharmaceutical and...

Documents