Purchasing Generic Prescriptions Drugs: an

Analysis Using Two Behavioral Intention

Models
David Brinberg, Baruch College, CUNY
Vicki Cummings, University of Maryland
ABSTRACT - The present study used Fishbein's theory of reasoned action and a subjective
probability model to examine the decision to purchase generic prescription drugs. Two samples
were used to assess the robustness of each model's predictions In addition, those factors that
differentiate intenders from nonintenders were examined. Both models were found to predict
intention in both a student and nonstudent sample. Using the components of the Fishbein model,
several differences were found between: (1) individuals who intend to purchase generic
prescription drugs with those who do not and (2) the student and nonstudent sample The
implications of these findings for both basic and applied researchers were discussed.
[ to cite ]:

David Brinberg and Vicki Cummings (1984) ,"Purchasing Generic Prescriptions Drugs: an
Analysis Using Two Behavioral Intention Models", in NA - Advances in Consumer Research
Volume 11, eds. Thomas C. Kinnear, Provo, UT : Association for Consumer Research, Pages:
229-234.
[ direct url ]:

http://acrwebsite.org/volumes/6247/volumes/v11/NA-11

Advances in Consumer Research Volume 11, 1984      Pages 229-234

PURCHASING GENERIC PRESCRIPTIONS DRUGS: AN ANALYSIS USING TWO

BEHAVIORAL INTENTION MODELS

David Brinberg, Baruch College, CUNY

Vicki Cummings, University of Maryland

[The computer time for this project was supported through the facilities of the Computer Science
Center at the University of Maryland.]

ABSTRACT -

The present study used Fishbein's theory of reasoned action and a subjective probability model to
examine the decision to purchase generic prescription drugs. Two samples were used to assess
the robustness of each model's predictions In addition, those factors that differentiate intenders
from nonintenders were examined. Both models were found to predict intention in both a student
and nonstudent sample. Using the components of the Fishbein model, several differences were
found between: (1) individuals who intend to purchase generic prescription drugs with those who
do not and (2) the student and nonstudent sample The implications of these findings for both
basic and applied researchers were discussed.

INTRODUCTION

Until recently, consumers have had little or no input into the type of prescription drug product
purchased. With the support of consumer groups and federal government agencies, many states
are repealing anti-substitution laws, thereby increasing the consumer's access to generic
prescription drugs A model law was presented by the Federal Trade Commission in 1979, but
most states adopted their own individual versions (Drug Topics 1979) Currently, forty-eight
states have adopted some type of generic substitution law

Many state anti-substitution laws have several common features. The Drug Product Selection
Law enacted in 1977 to replace New York's previous anti-substitution laws is useful to illustrate
these common features: (1) an approved formulary (positive substitution), (2) a two-sided
prescription form where the physician signs that substitution is or is not permitted, (3) mandatory
substitution by the pharmacist if substitution is approved by the physician, and (4) the pharmacist
having the option to pass on to the consumer the difference in the price between the brand and
generic drug.

By 1984, many leading brand name drugs (2.g., valium) will go off patent, dramatically
increasing the number of pharmaceutical companies that will produce generic equivalents. Given
the rapid growth in the consumers' use of generic prescription drugs, the application of different
decision models is likely to increase our understanding of those factors that influence a
consumer's decision to purchase a generic prescription drug. At the same time, the use of
different decision models is likely to increase our understanding of the scope and limits of these
models. Several models have been developed to predict an individual's decision and to identify
those factors that determine this decision (e g , Fishbein and Ajzen 1975; Jaccard and King
1977). The two models used in the current study are Fishbein's theory of reasoned action
(Fishbein 1979) and a subjective probability model (Jaccard and King 1977).

Fishbein's Theory of Reasoned Action

Fishbein and Ajzen (1975) have developed a model of reasoned action that is used: (1) to predict
an individual's intention and behavior and (2) to identify those factors that determine intention.
Intention is viewed as the best predictor of behavior and is determined by an individual's attitude
toward the act plus the perceived social pressure to perform the behavior (subjective norm) The
relationship among the components may be expressed as follows:

Behavior = Intention = Attitude(w1) + Subjective norm(w2)

Attitude is determined by the salient beliefs multiplied by the evaluative aspect of the belief, and
the subjective norm is determined by the normative beliefs multiplied by the motivation to
comply. These relationships may be expressed as follows :
Attitude = biei         Equation 2

where bi = perceived likelihood that the behavior in question will result in some outcome and ei =
evaluation of that outcome

Subjective norm = NbMc         Equation 3

where Nb = belief that a particular referent thinks one should or should not perform the behavior
in question and Mc = motivation to comply with that referent.

w1 and w2 are theoretical parameters reflecting the relative importance of each component in
determining intention. These parameters are generally determined through regression analysis.

The Fishbein model has been tested in a wide variety of cultures (cf. Ajzen and Fishbein 1980)
and with a wide variety of behaviors. For instance, fertility-related behaviors (Davidson and
Jaccard 1975), blood donation (Pomazal and Jaccard 1976), voting behavior (Fishbein and
Coombs 1974), the use of credit unions (Ryan and Bonfield 1980) as well as preventive health
care (Olivier and Berger 1979) have all been predicted successfully by using the extended
Fishbein model. Beardon and Mason (1978) used Fishbein's attitude model to predict the
intention to purchase generic prescription drugs and found a disaggregate model to predict
accurately a personal intention

Subjective Probability Model

Wyer and Goldberg (1970) extended McGuire's (1960) work on syllogistic reasoning and
postulated that subjective probabilities combine in a manner consistent with the laws of objective
probability theory. This model may be expressed as follows:

PB = P"PB|A + P"PB|A        Equation 4

Where: P" = the probability that proposition A is true;

PB|A = the probability that proposition B is true given that proposition A is true; P" = the
probability that proposition A is not true and PB|A = the probability that proposition B is true
given that proposition A is not true.

This model was extended by Jaccard and King (1977) to predict behavioral intention. The
definitions of the components of this model and their interrelationships are presented below:

a) A belief is the relation between two objects; with objects being used in its most generic sense

b) The belief strength is the subjective probability linking the two objects. It is determined on a
scale from 1.00 (extremely likely) to 0 0 (extremely unlikely).

c) The Behavioral Intention is the likelihoot of performing some future behavior and is assessed
using a subjective probability estimate varying from .00 to 1.0. Intention does not basically differ
from other types of beliefs, although it does possess certain distinctive characteristics; it always
links oneself and some action, refers to future behavior and usually correlated with overt
behavior.

d) The conditional probability (PI|B) that is, given the belief is true (or false), what is the
likelihood of an intention" (Jaccard, Knox and Brinberg (1979)

This model may be expressed as follows

PI = PBPI|B + PBPI|B        Equation 5

where PI = an individual's intention to perform a certain behavior; PI|B= an individual's perceived

probability that performing a certain behavior will result in a certain outcome; PB = an
individual's perceived probability of performing a certain behavior given that B is true; PB = is
the perceived probability that the belief is not true (determined by 1-PB ) and PI|B = is the
individual's perceived probability of performing the behavior given that it does not result in that
outcome All probabilities are estimated by the individual except for PB (i.e., 1 - PB)

The difference between the two conditional probabilities (i.e., PI|B - PI|B) is described as the
"psychological relevance" of a belief When the difference is small, the belief is said to be
psychologically irrelevant (e.g., a person would purchase generic prescription drugs regardless of
whether the manufacturer is easy to identify) However, when the difference between the two
conditional probabilities is large, the belief is considered to be psychologically relevant (e.g., a
person would purchase a generic prescription drug given it has been adequately tested, but would
not purchase the drug if it had not been adequately tested).

The subjective probability model is a normative model and indicates "what man ought to do"
Jaccard and King (1977) pointed out that deviations from the model indicate that the logical
relations may be interfered with by irrational psychological processes. With this in mint, the
model can provide a baseline from which the deviations can be investigated

Research using the subjective probability model does "support the proposition that the
relationship between beliefs and behavioral intention can be described according to mathematical
probabilities" (Jaccard and King 1977 p. 33). The model has been found to be a significant
predictor of intention, with correlations ranging from .69 to 82 for consequences of smoking
cigarettes (Jaccard and King 1977), from 76 to .88 for voting intention (Jaccard, Knox and
Brinberg 1979), and from .35 to 61 for eating at a fast-food restaurant (Durand 1981). Additional
evidence in support of equation 5 is that the total model predicted intention better than any of the
parts (Jaccard, Knox and Brinberg 1979)

Comparison of the Fishbein and the Subjective Probability Motel

In both models, intention is viewed as the best predictor of behavior and is hypothesized to
mediate the relationship between all external variables and behavior. In addition, beliefs are
included in both motels, although related to intention differently. Within the probability model,
the relationship between a belief and intention is described by the laws of objective probability,
and research using this model has typically related a single belief to intention. However, Jaccard
and King (1977) have noted that more than one belief may be included in equation 5 to predict
intention. Fishbein's model uses an expectancy-value formulation and includes the sum of the
"salient" beliefs (weighted by the evaluation of each belief or the motivation to comply) to
predict a person's attitude, subjective norm, and subsequently their intention.

Fishbein makes a distinction between attitudinal and normative beliefs and treats these two types
of beliefs (weighted by the evaluation of the belief and the motivation to comply, respectively) as
the determinants of intention. In the probability model, no distinction is made between attitudinal
and normative beliefs and both may be used to predict intention (see Miniard and Cohen 1981
and Fishbein and Ajzen 1981 for a more detailed discussion concerning the relationship between
attitude and subjective norm). In addition, a measure of overall evaluation (i.e., attitude) and
overall social pressure (i.e., subjective norm) is included in Fishbein's model whereas the
probability model only includes measures of belief strength.

Finally, researchers testing the Fishbein model have typically used regression weights to
determine the psychological importance of attitude and subjective norm in predicting intention.
Several researchers, however, (e.g., Dawes and Corrigan 1974) have questioned the use of
regression coefficients as an index of importance. In the probability model, the "relevance index"
is used as an estimate of psychological importance.

Many researchers (e.g., Ferber 1977; Brinberg and McGrath 1983) have expressed concern in
using only one type of population to examine a model or set of models. A great deal of
psychological and consumer behavior research has been limited to college students and few
attempts have been made to determine the robustness of some model with respect to the sample
examined. In the present study, the robustness of each behavioral intention model was assessed
across two different samples: a college sample from Maryland and a community sample from
Rochester, New York.

In summary, the purpose of this study was threefold: (a) to determine the accuracy of each theory
in predicting the individual's intention to purchase generic prescription drugs, (b) to determine
the robustness of each model across two samples (i e., college and community respondents) and
(c) to describe those factors that influence intention, by comparing individuals who intend to
purchase generic prescription drugs with those who to not.

METHOD

Sampling Procedure

The community sample was selected from suburban Rochester, New York. City data were used
to divide the suburban area into seventeen towns and communities Six of these communities
were randomly selected to participate in the study and then were divided into sampling blocks,
each consisting of residential areas of approximately fifty homes.

Within each community, a block was randomly selected from which to collect data. All units
within a block were included as elements in the sample. Areas sampled included single family
homes, multi-family units, condominium complexes, and apartment complexes. The resulting
sample consisted of a total of six neighborhoods from six different communities; each composed
of approximately fifty households.

The six communities provided a diverse sample with respect to educational levels, ethnic
background, and income. Interviews were conducted at different times during the day and
evening; up to three trips were made to each neighborhood to increase response rate. The
interviewer asked to speak with the individual in the household most likely to purchase a
prescription drug if one were needed by some member of the family (household). The respondent
then was asked to answer sample questions to get a "feel" for the instrument. Once these were
answered, the individual completed the questionnaire. The interviews ranged in length from
twenty minutes to one hour (X= 30 minutes). Over the course of three visits, a total of 109
useable questionnaires were completed by respondents. [There were 31 refusals and 13
respondents with incomplete questionnaires. A total of 153 households were contacted.]

Community Sample Characteristics

Respondents' ages ranged from 19 to 84 (X = 38). A total of 52 people (48%) reported drug
expenses of less than $50.00 per year, and only 33 (30%) had annual expenses of over $100.00
The sample was well educated with less than 2: of the sample having received less than a high
school education. A total of 37 (34%) of the individuals had earned a college degree and 25
(23%) of the respondents had some postgraduate work. The median income ranged between
$20,000 to $25,000.

College Sample Characteristics

A college sample was obtained from an introductory consumer economics class at a large mid-
Atlantic university. A brief explanation concerning the purpose of the study was provided by the
interviewer. The format and items for the student questionnaire were the same as those used for
the community sample. The questionnaire was administered to small groups of respondents. A
total of 96 respondents were obtained.

Respondents' ages ranged from 18 to 58 (X = 22.8). The median income ranged between 0 to
$5,000. Their prescription drug expenditures were also relatively low, with 50 (52%) spending
less than $50 per year and only 25 (26%) with greater than $100.

Instrument Development

A pretest was conducted to determine the salient beliefs for both the community and college
sample A total of 41 college students were selected from an introductory consumer behavior
class, and a total of 47 respondents were randomly selected in a telephone survey from the
greater Rochester area. The salient beliefs were determined by asking the individuals to list the
advantages, disadvantages and other possible consequences of purchasing a generic prescription
drug as well as what relevant others think they should or should not do. Both samples had similar
modal salient beliefs (i.e., cost, safety, efficacy, quality, testing of the drug, ease in obtaining
drug, ease in identifying the manufacturer, and comprehension about usage of the product). This
set of beliefs was similar to those used in related studies (e.g., Beardon and Mason 1978). The
relevant others were close friends, relatives, doctors and pharmacists

Based on the salient beliefs obtained in the pretest, a questionnaire was constructed that
operationalized the components of both the Fishbein and the subjective probability model. Below
are examples of measures obtained for each component of the two models.

Belief = Purchasing a generic prescription drug means that I will be getting a drug that has been
adequately tested

Likely _ _ _ _ _ _ _ unlikely

Evaluation = Getting a drug that has been adequately tested is:

good _ _ _ _ _ _ _ bad

Normative Belief = My doctor thinks I should purchase generic prescription drugs.

likely _ _ _ _ _ _ _ unlikely

Motivation to comply = Generally speaking, I want to do or I want not to do what my doctor

wants me to do:

want to do _ _ _ _ _ _ _ want not to do

Attitude = My purchasing generic prescription drugs is:

good _ _ _ _ _ _ _ bad

Subjective Norm = Most people who are important to me think I should purchase generic
prescription drugs.

likely _ _ _ _ _ _ _ unlikely

PI|B Suppose that in purchasing generic prescription drugs, you are in fact getting high quality
drugs. How likely is it that you would purchase generic prescription drugs?

likely _ _ _ _ _ _ _ unlikely

PI|B = Suppose that in purchasing a generic prescription drug, you are, in fact not getting high
quality drugs. How likely is it that you would purchase generic prescription drugs?

likely _ _ _ _ _ _ _ unlikely

Intention = I intend to purchase generic prescription drugs:

likely _ _ _ _ _ _ _ unlikely

RESULTS

Predictive Accuracy of the Fishbein Model

For the community sample, the multiple correlation of attitude and subjective norm with
intention was 65 ( p < .01), and the standardized regression coefficients were .56 (p < .01) and .
16 (p < .05) for the attitude and subjective norm respectively. For the college sample, the
multiple correlation of attitude and subjective norm with intention was .63 (p < .01), and the
standardized regression coefficients were .44 (p < 01) and 30 (p < .01) for the attitude and
subjective norm respectively. The percent of explained variance was highly similar for the two
samples (i.e., 42.2: and 39.7% for the community and college sample, respectively). In addition,
the zero-order correlations between attitude and subjective- norm with intention were not
significantly different for the two samples. These findings provide evidence for the robustness
(i.e., generalizability) of this theory across diverse samples.

Predictive Accuracy of the Subjective Probability Model

The predictive accuracy of the probability model was determined by correlating the predicted
and obtained intention score. A summary of this analysis may be found in Table 1. The
correlations ranged from 35 to .70 (p < .01) for the community sample, with an average
correlation of .55. For the college sample, the correlations ranged from .26 to 68 (p < .01), with
an average correlation of .48.

The robustness of this model was determined by comparing the correlation of each belief with
intention across the two samples Using a Fisher's r-z to compare these correlations,there were no
significant differences in the predictive accuracy of the model. As with the Fishbein model, one
implication of this finding is that the subjective probability model is robust across both a
nonstudent and student population.

TABLE 1

PREDICTIVE ACCURACY OF THE SUBJECTIVE PROBABILITY MODEL

Diagnostic Use of Fishbein's Model

A strategy presented by Ajzen & Fishbein (1980) to determine those factors most likely to
influence intention is to identify differences between individuals who intent to perform a
behavior with those who to not. Given the four basic components of Fishbein's model (i.e.,
beliefs, evaluations, normative beliefs, and motivation to comply), each needs to be examined to
determine the extent to which intenders are different than nonintenders. To accomplish this
comparison, a Hotelling's T2 analysis was conducted for each component of Fishbein's model
When comparing beliefs, intenders were significantly different than nonintenders for both the
community (12 = 77 0; p < 01) and college sample (T2 = 27.9; p < .01). A summary of these
comparisons may be found in Table 2.

TABLE 2

COMPARISON OF BELIEFS FOR INTENDERS AND NONINTENDERS

TABLE 2

COMPARISON OF BELIEFS FOR INTENDERS AND NONINTENDERS

In both the community and college sample, intenders believed that generic drugs were safer,
more adequately tested and of higher quality than nonintenders. Intenders also were less
confused about the usage of generic drugs than nonintenders. There were significant differences
between the beliefs of the college and community sample (T2 = 17.6; P < .05). The two beliefs
significantly different for the two groups were: the ease of identifying the manufacturer (t(203) =
2.86; p < .01; X = -.46 and .28 for the community and college sample, respectively) and the
safety of the drug (t(203) = 2 14; p < 05; X = 2.03 and 1.68 for tile community and college
sample, respectively).

When comparing the evaluation of the beliefs, intenders were significantly different than
nonintenders for both the community (Ti = 29.9; P < .01) and college sample (T2 = 38.9; p < .
01). A summary of these comparisons may be found in Table 3.

In the community sample, intenders evaluated the cost of the generic drugs as more positive than
the nonintenders. No other evaluations significantly differed between the two groups. For the
college sample, intenders evaluated the cost, quality, safety, and effectiveness of generic drugs
more positively than nonintenders There were no significant differences between the evaluation
of the beliefs when comparing the college and community sample.

For the community sample, the normative beliefs of intenders were significantly different than
nonintenders (T2 = 18.8; p < .01). For the college sample, there was a similar trend between
intenders and nonintenders (T2 = 10.2; p < 10). In both samples, intenders believed that both
close friends and the pharmacist were more likely to think they should purchase generic
prescription drugs than nonintenders. A summary of these comparisons may be found in Table 4
There were no significant differences between the college and community sample with respect to
the normative beliefs.

Finally, for the community sample, the motivation to comply of intenders was significantly
different than nonintenders (T2 = 15.9; p < .01). In the college sample, there was a trend for
intenders and nonintenders to differ significantly (T2 = 8 4; p < .10) Intenders in the community
sample were more likely to comply with their pharmacist (p < 01) For the college sample,
intenders were more likely to comply with their close friends (p < .01). A summary of these
comparisons may be found in Table 5.
 TABLE 3

COMPARISON OF THE EVALUATION OF THE BELIEFS FOR INTENDERS AND

NONINTENDERS

TABLE 4

COMPARISON OF THE NORMATIVE BELIEFS FOR INTENDERS AND

NONINTENDERS

TABLE 5

COMPARISON OF THE MOTIVATION TO COMPLY OF INTENDERS AND

NONINTENDERS

There were significant differences between the community and college sample with respect to
their motivation to comply (T = 14.9; p < .01). The community respondents were less likely to
comply with close friends (c(203) = 1.97; D < .05; X = 13) and more likely to comply with a
doctor (t(203) = 1.74; p < .10; X = 1.14) than college students (X = 54 and .79 for close friends
and doctor, respectively).

Diagnostic Use of the Subjective Probability Model

As noted earlier, the difference between the two conditional probabilities is used as an index of
psychological importance Table 5 contains a summary of the relevance scores for each belief for
the college and community sample

TABLE 6

RELEVANCE SCORES FOR THE COMMUNITY AND COLLEGE SAMPLES

For each belief, the relevance score is relatively high, suggesting that all beliefs may be
considered at least somewhat relevant. In addition, there is a high degree of similarity between
the relevance of the beliefs for the community and college sample (r = .99; p < .01).

Both the probability model and the Fishbein model purport to identify beliefs chat, when
modified, are likely to change intention. One strategy for identifying these beliefs is to use the
relevance index (from the probability model) and the correlation between a belief and intention (i
e., the degree to which a belief can differentiate intenders from nonintenders; Ajzen and Fishbein
1980). Convergence between the beliefs identified by using each model can provide support for
the use of either approach in identifying psychologically important beliefs. To determine this
convergence, the correlation between a belief and intention was converted to a z score and
correlated with the mean relevance score for that belief. This correlation was significant (r =.77
and .93; p < .01, for the community and college sample, respectively), indicating high
convergence between the two approaches for identifying "psychologically important" beliefs
This finding suggests that for this behavior both techniques measure the same underlying
construct i.e., psychological importance Thus, either technique may be useful to a researcher
interested in identifying psychologically important beliefs in order to change an individual's
intention to purchase generic prescription drugs.

DISCUSSION

Both the Fishbein theory of reasoned action and the subjective probability model were
significant predictors of an individual ' s intention to purchase generic prescription drugs. In
addition, the predictive accuracy of both models was highly similar across two different samples
of respondents, i.e., college students in Maryland and a nonstudent sample in suburban
Rochester, New York This robustness across two samples increases our confidence in the use of
these two models

The findings from the present study have implications for both basic and applied researchers. For
basic researchers, the robustness of these models across samples should increase a researchers
confidence that these two behavioral intention models are able to accurately predict intention for
a sample other than college students. In addition, when indices of importance were derived from
both models (i e., the relevance index from the probability model and the correlation between
beliefs and intention in Fishbein's motel), these measures were highly correlated, indicating
convergence in the measure of psychologically import and beliefs. Thus, either approach may be
used to measure important beliefs. Future work needs to be conducted to examine in greater
detail the measurement of importance and which (if either) technique is more effective

For applied researcher, these findings also have a number of interesting implications Several
concepts within Fishbein's model were found to differ for those individuals who intend to
purchase generic prescription drugs with those who do not. These detailed comparisons between
intenders and nonintenders provide a profile for each group that educators and marketers may
use to develop educational programs or advertisements. For instance, in the community sample,
nonintenders believed it was less likely that generic drugs were a safe product than intenders
Given this difference a marketer would want to focus their advertisement on the safety of the
drug since this belief differentiates nonintenders from intenders. Differences between intenders
and nonintenders for the other components of Fishbein's model also may provide useful
information in the development of any change program Since the present study only examined
generic prescription drugs, future research would be needed to determine whether similar
marketing strategies would be developed for branded drugs.

In sum, the present study used two behavioral intention models to examine the decision to
purchase generic prescription drugs. Two samples were used to assess the robustness of each
model's predictions. In addition, those factors that differentiate intenders from nonintenders were
examined. Both models were found to predict intention in both a student and nonstudent sample.
Several differences were found between:(l) individuals who intent to purchase generic
prescription drugs with those who do not and (2) the student and nonstudent sample. Finally, the
implications of these findings for both basic and applied researchers were discussed.

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