Dissertation submitted in partial fulfillment of the requirement for the degree of Master of Science in Advanced Information Technology and Business Management (MSCAITBM).

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
1

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
2

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
3

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
4

5. 3.2.5 Ethical issues, privacy and confidentiality of research participants……...………….…41
3.2.6 Data collection………………………………………………………………………….41
3.2.7 Reliability and validity…………………………………………………………………42
3.2.8 Data analysis and presentation…….……………..…………………………….………42
3.3The Quantitative method…………………………………………………..…………43
3.3.1 Methodology………………………………………..….………………………………43
3.3.2 Questionnaire testing…………………………………………………………………...44
3.3.3 Sample selection………………………………………………………………………..44
3.3.4 Ethical issues of research participants……………………………………….…………45
3.3.5 Privacy, confidentiality, and anonymity of research participants…………..………….46
3.4 Data Collection, Data Capturing, Descriptive Statistics, Validity and Reliability.46
3.4.1 Data collection……………………………………………………………………........46
3.4.2 Data capturing……………………………………………………………….…………47
3.4.3 Descriptive statistics…………………………………………………….…...…………48
3.4.4 Validity and reliability………………………………………………………………....51
4.0 CHAPTER FOUR: DATA RESULT, DESCRIPTIVE STATISTICS, AND
STUDY FINDINGS
4.1 The qualitative data result……………………………………………………………......53
4.2 The quantitative data result……………………………………………….….………......56
4.2.1Technology Acceptance Model ‘TAM’ variables…………….………...........................56
5

6. 4.2.2 Technology Acceptance Model ‘TAM’ variable’s responses………………....……….58
4.2.3 Descriptive statistics……………………………………………………………………62
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 questionnaires……………………………………………………………101
Figure: 6 Questionnaire multi items statements…………………………………………….103
Figure 7: Technology Acceptance Model ‘TAM’ variables’ responses…………………....104
Figure 8: Perceived usefulness items responses……………………………………….........105
Figure 9: Perceived ease of use items responses………………………………...………….106
Figure 10: Attitude items responses…………………………………………….....………107
Figure 11: Behavioural intention items responses……………………………….....………108
6

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
professional’s acceptance status of information technology ‘IT’ in order to validate the
7

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
study’s findings have concluded that the physicians and healthcare professionals were in a
positive trend towards the internet technology as a modern source of pharmaceutical and
clinical information. This result is consistent with the study conducted by Joanne (2008) who
further concluded that “These results will provide a valuable data, with which
pharmaceutical companies may develop, internet-based marketing strategies” (page.4). The
study outcomes and recommendations might help a leading pharmaceutical company to
develop online marketing and educational tools to outreach the physicians, the healthcare
professionals, and the broader medical communities.
8

9. Acknowledgement
To my parents,
To whom passed away, in memory of my brother Yasser “You’re 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
9

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.
10

11. 1.0:CHAPTER ONE: INTRODUCTION
In today’s 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 physician’s trust,
retaining physician’s loyalty, and building long-stay a credible virtual partnership among the
medical communities and the societies.
1.1 Problem overview
Indeed, a potential costly research and development ‘R&D’, product complexity, short
product life-cycle, regulatory requirements, and threats of generic entrance are the major
communication challenges that face pharmaceutical companies in the global market.
Although branding is one of the communication tools to establish the product in the market
(Lim, 2010), the evolution of new innovative pharmaceutical products and establishing the
evidence-based medicine ‘EBM’ in clinical practices remains the main challenges that faces
the pharmaceutical companies. At present, the international financial crises and economy
11

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 determinant’s 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 physician’s 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).
12

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

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
14

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 physician’s and
clinician’s 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 Medicine’s 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.
15

16. 1.2.3 Leveraging evidence-based medicine ‘EBM’
Evidence-based medicine ‘EBM’ is the integration of the physician’s clinical expertise and
healthcare professional’s knowledge with the best available clinical evidence from systematic
research (Hassig, 1999). Obviously, the lack of enough updated clinical and pharmaceutical
information eventually led the physicians and healthcare professionals to take decisions
concerning the medical management of their patients based on their clinical experiences
(Eddy, 2005). Evidence-based medicine ‘EBM’ is rapidly evolving, and its practice requires
access to clinical evidence and a change in the way medical decisions are made (Lisa, 2007).
As described by Mayer (2010), evidence-based medicine ‘EBM’ electronic search
encompasses four broad domains: First, asking answerable questions where the clinicians
should be familiar with the proper answerable questions and make sure the question contains
four areas abbreviated by acronym “PICO” (Akobeng, 2008). ‘P’ stands for the description of
patient or population; ‘I’ stand for the intervention, ‘C’ stands for the comparison group, and
‘O’ stands for the outcome. Second, an electronic-based search is the easiest and fastest way
to obtain the ready-made clinical evidence available 24/7. For instance, an electronic medical
books and magazine such as the Journal of American College of Cardiology (JACC, 2011),
the New England Journal of Medicine (NEJM, 2011), the Lancet (2001), and clinical
evidence websites such as Infopoems www.essentialevidenceplus.com, and Up to Date
www.uptodate.com (see figure: 3). Third, applying the evidence to individual patient care
as the primary aims of this aspect are to minimize the medical and treatment errors and to
assure to a greater degree a better clinical outcome. Forth, evaluating the process through a
periodic review of the content will show how well a clinical question has been answered and
16

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
17

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

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 individual’s desirability to use the systems (Gardner et al, 2004), and is a
measure of the individual feeling toward using specific system. This provided a hypothetical
explanation of the physicians’ attitude and intention to use the internet technology in their
clinical practices. Using a comparative method of analysis, the study aims to determine the
relationship between the physician’s attitude and their intention to use the internet technology
as a source of pharmaceutical and clinical information in their clinical practices.
IV) Behavioural intention
Behavioural intention to use the internet technology as a source of pharmaceutical means,
has a positive correlation to the perceived usage of the internet technology (Gardner et al,
2004). Behavioural intention measures the strength of physicians’ and healthcare professional
to use the internet and related technology as a source of pharmaceutical and clinical
information in their clinical practices.
1.4 Research questions
The questions arise from this research are:
19

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 product’s 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 study’s questions. As a result the conclusions for policy and practices and
recommendations for specific action plan have been made, while stated the study’s
limitations for further improvement.
20

21. 2.0: CHAPTER TWO: LITERATURE REVIEW
2.1 The evolution of information technology ‘IT’ and electronic commerce ‘e-
commerce’ in business development
The adoption of the internet technologies has revolutionized many aspects of societies
(Sweet, 2009), and created rich online businesses media. As a result it brought a new
marketing opportunity. Conceivably, the internet and medical web-based technologies will
enable a direct communication between the pharmaceutical company and the physicians and
healthcare professionals. More importantly, it allows direct-to-physicians ‘DTP’ interactive
campaigns.
2.1.1 The role of information technology ‘IT’ in business development
Nowadays, the internet and information technology ‘IT’ becomes an integral part of business
development (Porter, 2001), and play a major role in enhancing the internal communication
and the work productivity within the organizational departments through storing,
manipulating, and processing of order information (Davenport et al, 1990). On the other
hand, organizations are using information technology ‘IT’ to overcome the geographical
boundaries and lessen time and effort to outreach the clients and customers 24/7 (Carpano et
al, 1998). In today’s highly competitive market, computer-based information technologies
‘IT’ may be the primary strategic resource for maintaining competitive advantage (Sabherwal
et al, 1991). As summarized by Intel Corp. (2000), the major success factors of information
technology ‘IT’ in pharmaceutical business are:
21

22.  Information technology ‘IT’ fully integrated into the company’s 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 company’s reputation and minimizing the late withdrawal cost
 Healthcare providers and medical society’s expectations well-managed.
 Website of high qualities that meet physicians’ and clinician’s 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
22

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

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 physician’s
feedback throughout 24/7 is necessarily for evaluating the company’s current status, and
essential for future strategies. From the company’s 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
24

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
25

26. broader medical communities . The potential benefits of e-detailing in the pharmaceutical
business from the company’s and physician’s perspectives are summarized in the following:
2.2.1Company’s 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 physician’s feedback for future
marketing and sales strategies.
 Development of e-customer relationship management ‘CRM’ technology (Alt, 2003) would
provide an easy, fast, and a convenient way to improve the efficiency and productivity of the
business around the world.
 Online communication and e-detailing allows marketers to better segmenting the market
potential especially prior the market orientation (Curry et al, 2000).
26

27. A unified view of e-detailing would provide significant benefits through leveraging efficient
customer relationship management ‘CRM’ technology, optimizing product life- cycle
management ‘p-LCM’, branding, and pharmacovigilance technology alerts.
2.2.2 Customer relationship management ‘CRM’ technologies
In today’s business, consolidating the value-profit ratio among the key opinion leaders
‘KOL’, the physicians, and the medical suppliers is essential to maintain competitive in the
global market. Although customer retention strategy is essential to keep the valuable
customers (Sasser, 1990), customer acquisition strategy is the critical success factor ‘CSF’ to
capture a newer customers for a long-stay business relationship. Therefore, reducing the
marketing cost and increasing the sales revenue derived from serving customer is a meant of
customer relationship management ‘CRM’ technologies strategies and implementation. The
customer relationship management ‘CRM’ technology provides the pharmaceutical
companies with a mechanism for segmenting its customer base, and to visualize and analyze
customer’s behavior, loyalty, and value within each of those customer segments (Curry et al,
2000). Moreover, the internet-based electronic customer relationship management ‘CRM’ is
a collaborative technology for efficient communication and sharing information between the
pharmaceutical companies and the healthcare professionals (Sweet, 2009). These
technologies tools efficiently facilitate the following:
 Real-time communications access throughout 24/7.
27

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 customer’s 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 industry’s leading provider. Cegedim supplies services, technological tools,
specialized software, and data flow management services in the healthcare business.
2.2.3 Product life-cycle management ‘p-LCM’
In the modern global economy, pharmaceutical companies are facing time-to-time
challenges; time to enter the market early to gain the first-mover advantages, and time for
short-term profit return (Chataway et al, 2008). Product life-cycle management ‘p-LCM’ is
recognized as one of the keys leading technologies to facilitate the companies to overcome
these challenges (Ming et al, 2005). As the cost of developing new innovative drugs
28

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
29

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 brand’s messages and emphasize the brand’s 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 brand’s communication mix in the
clinical practices, and strengthening the brand values in the medical communities (Lim et al,
2010). Further to that the clinicians respond to the new clinical interventions by seeking
information and opinions from peers and opinion leaders, rather than assessing the scientific
merits by themselves (Peter et al, 2004). Moreover , a relatively inexpensive generic drug is
the major threats that hit brand shortly beyond market-entry, Lofgren (2002) has stated that
“Public and private third-party payers increasingly encourage or mandate the use of
30

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) .
31

32. Members can also rank postings, which will give insights likely to help the company's
development of marketing messages. Sweet (2009) has reported that Sermo rewards the
physicians whose input is highly ranked by other members. As a part of social responsibilities
and building partnership with the patients and medical communities, Bayer Schering Pharma
conducted Thrombosis Advisor a web-site information resource www.thrombosisadviser.com
for the physicians and patients about thrombosis. GlaxoSmithKline ‘GSK’ on its corporate
blog in the US; http://alliconnect.com allows conversation for the healthy weight loss
products, such active conversation enables GSK eliciting the necessarily feedback for future
marketing strategies.
2.2.6 Pharmacovigilance alert
Throughout the product life-cycle period, a leading pharmaceutical company faces with a
greater regulatory requirements and increased accountability demands for the protection and
welfare of patients (ICPM, 2008). Moving beyond the standard regulatory requirements,
pharmacovigilance technology can assist pharmaceutical companies to systematically detect
and prevent the adverse drug reactions ‘ADR’ (Lu, 2009), and preventing the costly safety-
related market withdrawal. Now a day, information technology ‘IT’ has transformed the
traditional healthcare system and clinical medicine into higher quality and with lower cost
(Lu, 2009). In this regard, the post marketing surveillance, the safety data collection in real
life clinical practices, and clinical risk assessment are critical for evaluating and managing
the safety and risk profile (Lu, 2009).
32

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 Physician’s and healthcare’s 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 Physician’s acceptance
behavior. An e-detailing solution gives the physicians and healthcare professional greater
control over the time, the place, and the content as well as the quality of the information
(Accela, 2009), and provides a convenient direct-to-physicians ‘DTP’ electronic
33

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 GSK source website www.gsksource.com , which permits an easy access to be
comprehensive, to update information, and navigate clinical information and services. Sanofi
Aventis, a world leading pharmaceutical company conducted The Partnership for
Prescription Assistance a web-site in US www.sanofi-aventis.us/live, the program is
designed to join America's pharmaceutical companies, the doctors, the patient advocacy
organizations, and the community groups to help qualify patients who lack prescription
coverage get the medicines they need through the public or private program that's right for
them. Generally through the diversified e- detailing platforms, a leading pharmaceutical
company efficiently establishes an interactive two-way communication for delivering
accurate and updated pharmaceutical and clinical information in a fast and flexible way.
Consequently, this allows the companies to access easily the physician’s feedback necessarily
to design an efficient customer relationship management ‘CRM’ strategy, for building trust
and maintaining a convenient relationship into the stakeholder’s and the physicians’.
34

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 company’s 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 company’s management and eventually hindering the
company’s marketing and sales strategies.
 Regulatory restrictions, where the company’s 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.
35

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 (Steckler et al,
1992). The qualitative and quantitative aspect of this research is based on a particular
paradigms; the quantitative paradigm is based on positivism where there’s only one truth and
36

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 physician’s and healthcare professional’s attitudes
toward traditional face-to-face detailing and e-detailing interactions, their beliefs about the
product’s information conveyed by the traditional detailing and e-detailing, and the future
expectations of the online e-detailing.
3.1.1 Development of grounded theory
Using the principles of the grounded theory which was first presented by Glazer and Strauss
(1967), the study applied substantive grounded theory to develop a conceptual hypothesis of
the potential role of the internet and medical web-based technology as a source of
pharmaceutical and clinical information in the healthcare settings. The common features of
37

38. the substantive grounded theory is that it’s carefully induced from the diverse data (Cerniglia,
2008), and it’s 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 study’s 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.
38

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 physician’s 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).
39

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
40

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.
41

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 other’s,
to form the coding paradigm (Creswell, 2007), which provided insight into specific coding
categories that explain the central phenomenon and built the theoretical model of the study
(Creswell, 2007). Third, selective coding where the core categories in the coding paradigm
42

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 “Don’t know” box is there, in order
43

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

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
45

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 category’s variable answer and to avoid burdening on the
respondent’s working memory (Mora, 2011). The questions were designed as closed-ended
46

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 questionnaire’s item work in harmony
and in consistency to avoid responder’s 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.
47

48. 3.4.3 Descriptive statistics
The primary goal of the data analysis is to arrange the collected technology acceptance model
‘TAM’ variable’s responses in a way that the answer to the research questions reveals itself
(Wrenn et al, 2007). Given all the technology acceptance model ‘TAM’ variable’s responses,
the resultant substantial large volume of data from this research was carefully condensed and
summarized (Walter, 2009). The use of descriptive statistics (Trochim, 2006) may assist in
the following parameters: First, it indicates the central point around which the questionnaire
data distributed. Second, it may show the relationship of one technology acceptance model
‘TAM’ variable to another one. The central location statistic represents a middle point of a
set of observations and is useful for comparative analysis (Trochim, 2006). The following
measures for central location will be used:
• The Mean
The mean is the location measure most frequently used for interval-ratio data (Somekh et al,
2002). Mathematically, it is the arithmetic average representing the sum of the ascertained
values in the distribution divided by the number of observations.
• The Median
The median is the score found at the exact middle of the set of values (Trochim, 2006). To
compute the median is to list all scores in numerical order where half the scored values will
fall below this median value and the other half above it.
48

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’ variable’s 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 = Σ (X-X) 2
(N-1)
Where:
SD is Standard Deviation
Σ: Sum of score
49

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 questionnaire’s item and the positive values represent positive
relationship between the questionnaire’s items. According to Trochim (2006) the correlation
coefficient (r) was calculated as:
Correlation (r) = [NΣXY - (ΣX) (ΣY) / Sqrt ([NΣX2 - (ΣX)2][NΣY2 - (ΣY)2])]
where:
N = Number of respondents . X = First Score.
Y = Second Score. ΣXY = Sum of the first and Second Scores.
ΣX = Sum of First Scores. ΣY = Sum of Second Scores.
ΣX2 = Sum of square First Scores. ΣY2 = Sum of square Second Scores.
50

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
study’s 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’ variable’s responses, the reliability and validity of the factors
contained in the research was evaluated, and the reliability was assessed using a Pearson’s
correlation coefficient (r). The purpose of Pearson’s correlation coefficient (r) is to measure
the internal consistency and reliability of the scored values and to assess whether there is a
relationship between two or more technology acceptance model ‘TAM’ variables (Yaffe,
51

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.
Pearson Product Moment Correlation
Statistic Variable X Variable Y
Mean 287.5 585.2
Biased Variance 16008.75 21686.56
Biased Standard Deviation 126.6 147.3
Covariance 8098
Correlation 0.412877948
Determination 0.1704682
T-Test 1.9
P-value(2 sided) 0.07
p-value (1 sided 0.03
Degree of freedom 18
Number of Observation 20
For the items relating to perceived usefulness, the Pearson correlation coefficient (r) is + 0.2
indicating a moderate degree of internal consistency. For the items relating to perceived ease
of use and attitude the Pearson correlation coefficient (r) is +0.9 indicating a high degree of
internal consistency. For the items relating to behavioural intention the (r) value showed a
negative correlation of -0.2 indicating that the technology acceptance model ‘TAM’
variable’s scores increase and the other decrease and vice versa.
52

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 participant’s 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 questionnaire’s item for the aid of research objective.
The two interviewees included; the vice-president for drug affair in the Saudi Food and Drug
Authority ‘S-FDA’ who urged the physicians and healthcare professionals to efficiently
utilize the advanced information technology ‘IT’ infrastructure in Saudi Arabia, to frequently
53

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

55. necessity of regulatory requirements of the pharmaceutical products and the growing need for
a better patient’s 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 innovation’s clinical
benefit (Jonathan, 2008). Interestingly, two of the interviewed physicians have commented
that “The online disease awareness program may create a critically obsessive medical
population, especially those of low medical background and if the medical website is not
under a medical consultation”. Two of the general practitioners when interviewed were in
positive trend towards using the internet technologies as a source of pharmaceutical means
and they have stated that “The internet technology offers advanced and real solutions to
customize the large number of clinical trials and its clinical outcome relative to its adverse
effect”. A clinical pharmacist in the Ministry of Health ‘MOH’ directorates when interviewed
55

56. was in agreement of the tremendous benefits of the internet technology in his daily practice
and has stated that “The internet technologies’ values are not only for updating his
pharmaceutical and clinical information but, also allows comparing the outcomes and
interpretations of different clinical trials that help for a better clinical judgment”. In contrast,
the only limitation claimed by the interviewees was the higher subscription cost of the online
pharmaceutical and clinical websites and the electronic version of the medical magazines.
While the sample for our qualitative interviews was small, the data from the interviews
explored the context of the research objectives.
4.2 The quantitative data result
In a complementary manner, the quantitative aspect of this research augments the qualitative
views mentioned above. The quantitative data was captured, collected, quantified and then
analyzed to provide the overall features of the research hypothesis.
4.2.1 Technology acceptance model ‘TAM’ variables
Using the technology acceptance model ‘TAM’ variables, the responses of the physicians
and healthcare professional toward the internet and related web-based technology model as a
source of pharmaceutical and clinical information, were grouped and quantified together to
create overall scores for each of the variables’ items (see figure 7). The central tendency and
correlation (r) around the mean were calculated as follow:
56

57. Mean Median Mode Range Variance St.D Correlation
243.85 180.5 186 823 46270.76 215.106 0.413
The chart below represents the technology acceptance model ‘TAM’ variables’ responses
score:
Whilst 71.6% of the responders showed a positive response towards the internet and related
medical web-based technologies as a source of pharmaceutical and clinical information, 16%
of the responders showed a negative response. In between the two extremes 12.4% of them
was neither agreeing nor disagreeing that using the internet and medical web-based
technologies as a source of pharmaceutical information are beneficial to their practices. This
result is consistent with the previous findings conducted by Google (2009) which estimated
that 73% of the physician considers the internet to be standard part of their clinical practices,
and 69% of the physician trusts online clinical information. Section 4.2.2 describes in details
the TAM variables’ responses.
57

58. 4.2.2 Technology acceptance model ‘TAM’ variables’ responses.
The independent technology acceptance model ‘TAM’ variables’ responses the perceived
usefulness and perceived ease of use, as well as the dependent variables the attitude and
behavioural intention were grouped to create overall scores for each of the dimensions.
Measures of the central tendency and correlation around the mean were calculated using the
overall scores.
 Perceived usefulness
To identify the perception of the physicians and healthcare professional toward the usefulness
of the internet and web-based technologies as a source of pharmaceutical and clinical
information, the variables’ items were grouped and quantified together to create overall
scores for each of the dimensions (see figure 8). The central tendency and correlation (r)
around the mean of the variables’ items were calculated as follow:
Mean Median Mode Range Variance St.Deviation r
255.3 178.5 285 823 58844.93 242.58 0.276
The below chart represent the response’s related to the perceived usefulness variables’ items.
58

59. Among the results, 21.3% of the respondents were strongly agreed while 54.2% of all
respondents were in agreement of the potential benefits of the internet technology in their
clinical practices. Whilst, 1.3% and 9.8% of all respondents were strongly disagreeing and
disagreeing respectively the usefulness of the internet and web-based technologies as a
source of pharmaceutical and clinical information, the neither rests 13.3% of them appeared
neutral in their perception.
 Perceived ease of use
As independent technology acceptance model ‘TAM’ variable, the responses for the items
relating to perceived ease of using the internet and web-based technologies as a source of
pharmaceutical and clinical information were grouped and quantified together to create
overall scores for each of the dimensions (see figure 9). The central tendency and correlation
(r) around the mean were calculated as follow:
59

60. Mean Median Mode Range Variance St.D r.
241.72 186 186 644 45640.63 213.64 0.96
The below chart represent the response’s related to the perceived ease of use variables’ items:
Whilst 69.1% of all respondent were in a positive extreme, 17.1% of them were in a negative
extreme in perceiving the ease of using the internet and web-based technology as a source of
pharmaceutical and clinical information. On the other hand, 13.8% of all respondents appear
neutral in their perception.
 Attitude
The presentation of the items related to the attitude variables’ responses, were grouped and
quantified for each of the dimension (see figure 10).The central tendency and correlation (r)
around the mean were calculated as follow:
Mean Median Mode Range Variance St.D r.
226.467 164 355 553 29442.98 171.59 0.79
60

61. The below chart represent the response’s related to the attitude variables’ items:
Among the respondents, 23.8% and 42.8% of them were strongly agreeing and agreeing
respectively and showed a positive attitude , while 16.5% and 4.2%% of them were strongly
disagreed or disagreed respectively and showed a negative attitude toward the internet
technology as a source of pharmaceutical and clinical information. The neither rest 12.5% of
the respondents appeared neutral in their perception.
 Behavioural intention
The presentation of the items relating to the behavioural intention variables were quantified
and grouped to form overall scores for each of the dimensions (see figure 11). The central
tendency and correlation (r) around the mean were calculated as follow:
Mean Median Mode Range Variance St.D r.
72.8 57 57 144 2522.59 50.23 0.44
61

62. The below chart represents the response’s related the behavioural intention variables’ items:
Consistent with the above results 28% and 41.7% of all the respondents were strongly
agreeing and in agreement respectively and showed a positive attitude and intentionally use
the internet technology. In contrast, 2.1 % and 19.3% of all the respondents were strongly
disagreed and disagreed respectively and showed a negative attitude and intention to use the
internet technology as a source of pharmaceutical means, while the neither rest 8.9% of all
respondents appeared neutral in their perception.
4.2.3 Descriptive statistics
The Pearson correlation values showed strong positive linear relationships between the
technology acceptance model ‘TAM’ variables’ responses (r/Pearson correlation values
62

63. >0.6). All pairs of correlations are significant at the 95% level (p<0.05). The underline chart
illustrates the correlations between the technology acceptance model ‘TAM’ variables.
As a result, the relationships between the technology acceptance model ‘TAM’ variables and
their significance in determining the physicians’ and healthcare professionals’ attitude and
behavioural intention demonstrated a strong positive trend to use the internet and medical
web-based technologies as a source of pharmaceutical and clinical information. The chart
below illustrates the descriptive statistics of the technology acceptance model ‘TAM’
variables’ response.
63