Untitled - StudentTheses@CBS

Abstract
In the wake of 500 years of monopoly, the Danish, licensed pharmacies are currently facing the consequences of the digital age. With an increasing empowerment of consumers in society, and potential competitors agitating for liberalization of the prescription market, the pharmacies are being forced the re-­‐
evaluate their value proposition to consumers. In 2004, the Danish Pharmacy Association launched a website, which allows consumers to purchase prescription medicine online. While this represents a renewal of the industry, consumers have not followed suit. Though 73% of Danish consumers have experience with purchasing goods on the internet, only 8% of consumers report having purchased medicine online, and even fewer through the legitimate channel of apoteket.dk. This indicates that something about prescription products in particular is withholding consumers from going online. In this thesis we therefore seek to investigate possible influences on consumers’ perceptions of the online and offline channel’s facilitation of prescription medicine purchase. Based on an existing framework by Torben Hansen (2002), we develop a conceptual framework for our investigation. With this as a structure of our pre-­‐understandings, we perform an explorative study employing a qualitative method. Through an analysis and discussions of the data collected through four in-­‐
depth interviews, we find that several factors affect the respondents’ perceptions of an online and offline channel’s facilitation of prescription purchase. These factors include differing perceived benefits and barriers of the channels, the channels’ perceived compatibility with shopping motives, and the perceived substitutability or complementarity between online and offline channels. While the relatively small sample size categorizes this as an indicative pilot study, we find that our conclusions provide valuable insights for both the pharmacy industry and for future research. With our key findings, we suggest that a more integrated approach to multichannel pharmacies should be employed in the future to accommodate consumer perceptions of the online/offline channels. 1 Table of Contents
1.0 INTRODUCTION ...................................................................................................................................7 1.1 PROBLEM DELIMITATION ..............................................................................................................8 1.1.1 PHARMACIES IN THE DIGITAL ERA.............................................................................................9 1.2 RESEARCH QUESTION ...................................................................................................................9 1.3 RESEARCH DELIMITATION ............................................................................................................10 2.0 RESEARCH OUTLINE ...........................................................................................................................11 2.1 CONCEPTUAL CLARIFICATION .......................................................................................................13 3.0 METHODOLOGY.................................................................................................................................13 3.1 ONTOLOGY ..............................................................................................................................13 3.2 EPISTOMOLOGY ........................................................................................................................14 3.3 DEDUCTION AND INDUCTION........................................................................................................15 4.0 CASE DESCRIPTION ............................................................................................................................15 4.1 HISTORY OF THE DANISH PHARMACIES ...........................................................................................16 4.2 PHARMACIES AS A SOCIETAL INSTITUTION .......................................................................................18 4.3 THE DANISH PHARMACIES AS RETAILERS .........................................................................................19 4.3.1 THE PHARMACIES IN AN INDUSTRY CONTEXT .............................................................................20 4.3.2 THE PHARMACY AS A PURCHASE CHANNEL ................................................................................21 5.0 THEORETICAL BACKGROUND .............................................................................................................23 5.1 CONSUMER CHANNEL CHOICE IN MULTICHANNEL RETAIL ENVIRONMENTS ...............................................23 5.2 HANSEN (2002) “FORBRUGERENS VALG MELLEM OFF-­‐LINE OG ON-­‐LINE INDKØBSKANALER” ......................24 5.3 PURCHASE PROCESS AND DECISION-­‐MAKING FOR PRESCRIPTION DRUGS .................................................27 5.3.1 THE PURCHASE PROCESS .......................................................................................................27 5.3.2 THE PHARMACIST’S ROLE ......................................................................................................29 5.3.3 CONSUMER ROLES IN THE PRESCRIPTION PURCHASE PROCESS ......................................................30 5.4 PERCEIVED RELATIVE BENEFITS AND BARRIERS .................................................................................33 5.4.1 PERCEIVED RISK...................................................................................................................33 5.4.1.1 Purchase medium risk versus product risk .............................................................34 5.4.1.2 Risk types ................................................................................................................34 5.4.1.2.1 Financial risk ......................................................................................................35 5.4.1.2.2 Performance risk................................................................................................36 5.4.1.2.3 Person-­‐related risk.............................................................................................37 5.4.1.2.4 Other types of risk in a pharmacy context.........................................................39 5.4.1.2.5 Risk in a pharmacy context ................................................................................41 5.4.1.3 Risk relievers ...........................................................................................................41 2 5.4.1.3.1 Information as a risk reliever .............................................................................42 5.4.1.3.2 Practical facilitation as a risk reliever ................................................................43 5.4.1.3.3 General psychological principles as risk relievers..............................................44 5.4.2 BENEFITS AND BARRIERS IN A PHARMACY CONTEXT ....................................................................44 5.5 PERCEIVED COMPATIBILITY ..........................................................................................................44 5.5.1 SHOPPING MOTIVES .............................................................................................................45 5.5.1.1 Utilitarian motives ..................................................................................................46 5.5.1.2 Hedonic motives .....................................................................................................46 5.5.1.3 Facilitation of hedonic motives in a pharmacy setting ...........................................48 5.5.2 INDIVIDUAL SHOPPING PATTERNS ...........................................................................................49 5.5.3 COMPATIBILITY IN A PHARMACY CONTEXT ................................................................................50 5.6 PERCEIVED COMPLEXITY ..............................................................................................................51 5.6.1 EXPERIENCE ........................................................................................................................51 5.6.2 ACCESSIBILITY .....................................................................................................................52 5.6.3 COMPLEXITY IN A PHARMACY SETTING .....................................................................................53 5.7 PERCEIVED SUBSTITUTABILITY, COMPLEMENTARITY AND LOCK-­‐IN ........................................................53 5.7.1 TECHNOLOGICAL ACCESS .......................................................................................................54 5.7.2 (SUPPLIER) LOCK-­‐IN .............................................................................................................54 5.7.3 SUBSTITUTABILITY AND COMPLEMENTARITY .............................................................................55 5.7.3.1 Substitutability........................................................................................................55 5.7.3.2 Complementarity....................................................................................................57 5.7.3.2.1 Functional complementarity..............................................................................58 5.7.3.2.2 Symbolic complementarity and trust ................................................................59 5.7.3.2.3 Definitions of complementarity.........................................................................60 5.7.4 SUBSTITUTABILITY, COMPLEMENTARITY, AND LOCK-­‐IN IN A PHARMACY CONTEXT ............................60 5.8 PERCEIVED COMMUNICATIVE ASPECTS ............................................................................................61 5.9 CONCEPTUAL FRAMEWORK ..........................................................................................................62 6. RESEARCH DESIGN...............................................................................................................................64 6.1 QUALITATIVE VERSUS QUANTITATIVE RESEARCH ...............................................................................65 6.2 IN-­‐DEPTH INTERVIEWS ................................................................................................................65 6.2.1 RESPONDENTS ....................................................................................................................66 6.2.2 INTERVIEW DESIGN ..............................................................................................................66 6.2.3 PILOT INTERVIEW .................................................................................................................68 6.3 QUALITY OF RESEARCH ................................................................................................................68 6.3.1 CONSTRUCT VALIDITY ...........................................................................................................68 6.3.2 INTERNAL VALIDITY ..............................................................................................................69 6.3.3 EXTERNAL VALIDITY ..............................................................................................................70 6.3.4 RELIABILITY .........................................................................................................................71 7.0 ANALYSIS...........................................................................................................................................72 7.1 RESPONDENT CHARACTERIZATIONS ................................................................................................72 7.1.1 LISE ...................................................................................................................................74 3 7.1.1.1 Online shopping in general .....................................................................................74 7.1.1.2 Perceived health literacy and perceived empowerment........................................74 7.1.2 KAREN ...............................................................................................................................74 7.1.2.1 Online shopping in general .....................................................................................74 7.1.2.2 Perceived health literacy and perceived empowerment........................................74 7.1.3 JULIE .................................................................................................................................75 7.1.3.1 Online shopping in general .....................................................................................75 7.1.3.2 Perceived health literacy and perceived empowerment........................................75 7.1.4 PERNILLE ............................................................................................................................76 7.1.4.1 Online shopping in general .....................................................................................76 7.1.4.2 Perceived health literacy and perceived empowerment........................................76 7.1.5 PERCEIVED EMPOWERMENT AND PERCEIVED HEALTH LITERACY ....................................................77 7.2 PERCEIVED BENEFITS AND BARRIERS OF ONLINE AND OFFLINE PURCHASE ................................................77 7.2.1 PERCEIVED RISK ...................................................................................................................77 7.2.1.1 Perceived performance risk ....................................................................................78 7.2.1.1.1 Perceived risk relievers for performance risk ....................................................79 7.2.1.1.2 Performance risk in online/offline channels......................................................80 7.2.1.2 Perceived financial risk ...........................................................................................81 7.2.1.2.1 Perceived risk relievers for financial risk ...........................................................82 7.2.1.2.2 Financial risk in online/offline channels ............................................................82 7.2.1.3 Perceived social risk................................................................................................83 7.2.1.3.1 Perceived risk relievers for social risk ................................................................83 7.2.1.3.2 Social risk in online/offline channels .................................................................84 7.2.1.4 Perceived resource-­‐related risk ..............................................................................84 7.2.1.4.1 Mental effort .....................................................................................................84 7.2.1.4.2 Time ...................................................................................................................85 7.2.1.4.3 Perceived risk relievers for resource-­‐related risk ..............................................86 7.2.1.4.4 Resource-­‐related risk in online/offline channels ...............................................86 7.2.2 PRELIMINARY CONCLUSION: BENEFITS AND BARRIERS .................................................................87 7.3 PERCEIVED COMPATIBILITY ..........................................................................................................88 7.3.1 UTILITARIAN SHOPPING MOTIVES............................................................................................88 7.3.2 HEDONIC SHOPPING MOTIVES ................................................................................................89 7.3.2.1 Emotional support ..................................................................................................89 7.3.2.2 Smart shopper feeling.............................................................................................90 7.3.2.3 Exploration..............................................................................................................91 7.3.3 PRELIMINARY CONCLUSION: COMPATIBILITY .............................................................................91 7.4 PERCEIVED SUBSTITUTABILITY AND COMPLEMENTARITY OF CHANNELS ...................................................92 7.4.1 CHANNEL SUBSTITUTABILITY ..................................................................................................92 7.4.1.1 Online substitutability.............................................................................................92 7.4.1.2 Offline substitutability ............................................................................................92 7.4.1.2.1 Doctor as offline pre-­‐purchase stage.................................................................93 7.4.1.2.2 Passive habit ......................................................................................................93 7.4.2 PERCEIVED COMPLEMENTARITY ..............................................................................................94 4 7.4.2.1 Functional complementarity...................................................................................94 7.4.2.2 Symbolic complementarity .....................................................................................96 7.4.3 PRELIMINARY CONCLUSION: SUBSTITUTABILITY AND COMPLEMENTARITY .......................................96 8. DISCUSSION.........................................................................................................................................97 8.1 THEORETICAL IMPLICATIONS ........................................................................................................97 8.1.1 THE FACTOR PERCEIVED BENEFITS AND BARRIERS ......................................................................97 8.1.2 THE FACTOR PERCEIVED COMPATIBILITY ..................................................................................99 8.1.3 THE FACTORS SUBSTITUTABILITY AND COMPLEMENTARITY ..........................................................99 8.2 PRACTICAL IMPLICATIONS ..........................................................................................................103 9. LIMITATIONS AND FUTURE RESEARCH...............................................................................................104 10. CONCLUSION ...................................................................................................................................106 11. PERSPECTIVE ...................................................................................................................................109 REFERENCES ..........................................................................................................................................111 5 List of Figures
Fig. 1. Thesis Progression (Source: Own creation) Fig. 2. Wings in the liberalization debate (Source: Adapted from medwatch.dk (Web G)) Fig. 3. The licensed pharmacies depicted in relation to other industry players (Source: Own creation) Fig. 4. Framework after Danish original (Source: Hansen, 2002) Fig. 5. Hansen’s framework broken down into factors (Source: Own creation) Fig. 6. Generic retail purchase process (Source: Own creation) Fig. 7. The prescription drug purchase process (Source: Own creation) Fig. 8. Conceptual framework (Source: Own Creation inspired by Hansen’s (2002) framework) Fig. 9. Conceptual framework and sub-­‐questions (Own creation) Fig.10. Revised Conceptual Framework (Own Creation) List of Tables
Table 1. Characterizations of respondents Table 2. Respondents’ perceived empowerment and health literacy List of Appendices
Appendix 1: Expert profiles Appendix 2: Hansen’s original framework in Danish Appendix 3: Transcription of interview with Lise Appendix 4: Transcription of interview with Karen Appendix 5: Transcription of interview with Julie Appendix 6: Transcription of interview with Pernille Appendix 7: Quotes in Danish Appendix 8: Interview guide 6 1.0 Introduction
The Danish pharmacies hold a long and proud history as the primary distributors of medicine products to Danish consumers. Until recently, this position was unchallenged and undisputed, but for the last twenty years or more, debate has put into question the monopoly of the pharmacies. In 2001, this culminated with the liberalization of the over-­‐the-­‐counter (OTC) medicine market. As a consequence of the liberalization, the Danish pharmacies have been challenged by both new industry players and terms. Today, consumers can purchase over-­‐the-­‐counter medicine in any supermarket or gas station, and in the wake of this, the pharmacies have lost 32% of the OTC market (Danmarks Apotekerforening, 2013a). Since the liberalization of the OTC market, the debate has continued to challenge the current state of the industry of B2C medicine distribution, and several stakeholders suggest that a liberalization of the prescription market should be carried out as well. While this has not (yet) been the outcome, the debate continues to be kept alive by both potential future competitors and political stakeholders. In this setting, the pharmacies are faced with the challenge of proving their worth to consumers, politicians and other stakeholders, while staying true to their identity as both business owners and part of the public health care system. In this quest for relevance, the pharmacies have been forced to re-­‐evaluate their value proposition to the consumers, who are increasingly changing roles and behavior in a digital world of opportunities and knowledge. With this increasing role of the internet in the everyday lives of consumers, it is natural to consider, whether an online presence might provide the relevance needed to keep up with modern times and modern consumers. In 2004, the Danish Pharmacy Association1 (hereafter the DPA) went online with a web-­‐shop providing consumers with more flexible access to the pharmacy. With this, the pharmacies felt ready for the future. But the consumers did not follow suit, and today, only a small percentage of consumers use the online pharmacy (Forbrugerrådet, 2011a). While it is not in itself problematic that consumers prefer traditional pharmacies, it does appear peculiar in the context of a society where the internet seems to be the new scene for other everyday activities, such as bank transactions, doing taxes, or shopping for Christmas presents. Therefore, we find that an understanding of why consumers have not (yet) recognized the value of an online channel might prove both interesting and relevant for designing the pharmacy of the future – no matter if this future lies in the current or a liberalized pharmacy industry. Obtaining such understanding is therefore the objective of this thesis. 1
Danmarks Apotekerforening 7 1.1 Problem Delimitation
In the late 1980’s the internet represented a new world of opportunity – not least for retailing. With the wording of Mahajan & Winds (1988), Hansen (2002) describes the potential of the internet as a market disruption that can “dramatically affect the performance of a firm or an industry” (p. 1). And in hindsight, the birth of the internet has indeed represented a disruption with significant consequences for the way we consume today. As such, consumers and organizations both are increasingly going online. Today, 90% of Danes have access to the internet (Web A), and a large number of these also buy goods online. In 2012, 73% of Danes had tried some form of e-­‐shopping (Danmarks Statistik, 2012), and in February 2013 alone, 52% of the Danish internet population bought goods online (ibid.). This resulted in a total online revenue in 2012 of 18 billion DKR -­‐ an increase of 14% compared to 2011 (Web B). Thus, it appears that Danes have generally accepted this new mode of shopping. This development has contributed to new business models and modes of operation in many industries, and many companies in traditionally analogue industries have not been able to keep up with the rapidly evolving technology and hence changing needs of the consumers. The recording industry and the film industry are examples of such industries where traditional suppliers have not been able to break free of their conventional business models. Here, online services such as Spotify and Netflix, respectively, have gained ground, leading to decreasing market shares for the traditional suppliers (IFPI, 2011, p. 6; and Web C). With such evidence of the online channel gaining momentum in other industries, pharmacies cannot (and do not) disregard the internet’s potential as a new platform for consumption in this market as well. The potential of an online pharmacy seems evident, because it allows consumers to purchase medicine at any time and any place, and do so in the privacy of their own home. As such, an online channel potentially increases the accessibility of prescription medicine, in a manner similar to what was obtained with the liberalization of the OTC market. With a potentially pending liberalization of the prescription market as well, an array of competitors are lurking in the hallways of the industry, and it is seems, that the window of opportunity to tie in consumers to the licensed pharmacies comes with an expiration date. But even if liberalization of the prescription market is not carried out this time around, understanding consumer behavior in the multichannel environment of this millennium surely provides valuable input to increasing customer satisfaction, in order to build a case against liberalization in the future. 8 1.1.1 Pharmacies in The Digital Era
Since the infancy of the internet, medicine and other pharmacy goods have been widely available for purchase online. And since 2004 the Danish pharmacies have provided the opportunity to purchase these goods through licensed online channels (Web D). This could be considered a groundbreaking development in an industry that has only undergone incremental innovation in the preceding half millennium. But as indicated in the introduction, consumers have not followed the pharmacies online. The DPA themselves find that the online channel has not realized its full potential (Danmarks Apotekerforening, 2012), and in a survey from 2011, the Danish Consumer Council (Forbrugerrådet, 2011a) found that merely 5% of consumers have purchased medicine online -­‐ of which only 3% succeeded in finalizing the purchase. According to the Danish Consumer Council (Forbrugerrådet, 2011b), the lack of online pharmacy usage is partly due to a lack of awareness among consumers about the opportunity to buy medicine on the internet. In 2012, the pharmacies launched a campaign to raise awareness of the online pharmacy, increasing the number of new customers by 50% (Danmarks Apotekerforening, 2012). But even with that, at the end of 2012, only 8% of consumers reported having used an online channel when shopping for medicine (Web E). Therefore, even though a lack of awareness may be a contributing factor to the lacking tendency towards online shopping for medicine, other factors may be in play as well. To provide an understanding of these factors is the objective of this thesis. In a strategic paper on the future of pharmacies, the DPA suggests that increased safety and ease of use are central to the future role of an online pharmacy platform. As such, they regard the attributes of the channel itself as the main barriers and benefits of online purchase. But in order to fully understand consumer behavior, the online channel cannot be viewed in isolation from the option that was always there – purchasing medicine through traditional pharmacies. Whether consumers choose an online or offline channel, or a form of bricks-­‐and-­‐clicks option (Gulati & Garino, 2000; Sharma & Krishnan, 2002; Kacen et al., 2013; Verhagen & Dolen, 2009) by combining the two, this choice is based on an individual perception of relative (or synergetic) value. Therefore, in order to fully grasp the potential of online and offline channels, it is necessary to look beyond the statistics of usage and individual channel attributes and explore consumer perceptions of pharmacy purchase in different channels in depth. 1.2 Research Question
Based on the case delimitation provided above, we find that the current developments in the pharmacy industry, as well as the increasingly digital society in which it operates, make it both interesting and relevant to pursue an understanding of consumer attitudes towards online and offline channels as settings for prescription medicine purchase. 9 In order to pursue this understanding, we propose the following research question: RQ: What affects how consumers perceive the online and the offline
channel’s facilitation of prescription medicine purchase from the Danish
licensed pharmacies?
Three sub-­‐questions will guide the research. These have emerged from the conceptual framework developed in the thesis. SQ1: What relative benefits and barriers does the consumer perceive the online and offline
channels as having?
SQ2: How is the online versus the offline channel compatible with the shopping motives of the
consumer?
SQ3: Does the consumer perceive the online and offline channel as complementing or
substituting each other?
With these research questions we have already provided some boundaries for our research, which are elaborated in the following research delimitation. 1.3 Research Delimitation
Firstly, though the pharmacies both distribute OTC and prescription medicine, we choose the market of prescription medicine as our research object, because we find that this represents a unique window of opportunity for the pharmacies at the moment. Furthermore, we find that for prescription products, some of the usual mechanisms for channel choice may be different, because the purchase process involves activities such as a doctor’s consultation and prescription processing by professional staff at the pharmacy. This makes the investigation of channel choice for prescription products interesting also from a theoretical point of view. 10
We also limit our research to include only the perspective of the licensed, Danish pharmacies. Though both illegitimate and foreign operators distribute prescription medicine to Danish consumers, we find that the licensed pharmacies are faced with a window of opportunity to be pro-­‐active in shaping a multichannel business model to meet consumer needs and thus tie in consumers also in the future. While the inclusion of an entire group of distributors would typically be infeasible in a limited empirical case study such as ours, the licensed, Danish pharmacies in many respects operate more as a collective group than as individual players in the market. For example, the common web-­‐shop, www.apoteket.dk, run by the Danish Pharmacy Association, functions as a common online platform. Therefore, this industry consists of a highly homogenous group of players, which can be analyzed as a collective unit. As a consequence, the online and offline channels used in our study are apoteket.dk and the traditional, licensed pharmacies in general, respectively. Finally, the research question refers to consumers in general, and as such, does not provide segmentation of groups of interest. This is because we find that most consumers use the pharmacies from time to time, and that a wide perspective on their perception of online and offline channels is valuable. However, inherent in the choice to focus on the Danish, licensed pharmacies also lies that we focus our attention on consumers, who use these as their channel of purchase for prescription medicine, as these represent the most obvious target group for the pharmacies. With these delimitations clarified, we proceed with a research outline. 2.0 Research Outline
The thesis consists of four main parts and perspectives (see figure 1). The first part, Initiation, (chapter 1 and 2), introduced the theme of the thesis and provided a problem delimitation and research question. The latter will launch the second part of the thesis, Foundation, consisting of the methodology (chapter 3), as well as the case description (chapter 4) and the theoretical background (chapter 5). The funneling of the two latter will result in a case specific conceptual framework for our case study. The third part, the Empirical Study, is based on the conceptual framework, and includes a presentation of the research design (chapter 6), and the analysis of the empirical findings (chapter 7). The last part, Results and Discussion, discusses the empirical results in terms of theoretical and practical implications (chapter 8), and limitations and future research (chapter 9), and provides the conclusion to our study (chapter 9). Finally, additional perspectives on the thesis are provided (chapter 10). 11
Fig. 1. Thesis Progression (Source: Own creation) 12
2.1 Conceptual Clarification
To ensure conceptual disambiguity, we find that a brief conceptual clarification is needed for the basic concepts of the thesis. In this thesis, our focus is the licensed, Danish pharmacies. Therefore, any references to a pharmacy web-­‐
shop, online channel or online pharmacy will imply only their website, apoteket.dk, just as any mentions of the offline pharmacy, traditional pharmacies or physical stores will refer to the licensed pharmacies. Similarly, we have limited our study to prescription products. As such, any reference to shopping or purchase will refer to only this product category unless otherwise noted. Finally, as we will discuss in more detail in section 5.3, consumers purchasing prescription medicine are at the same time patients seeking remedies for a medical problem, and therefore, these titles could, to some extent, be used interchangeably. But since our perspective is their behavior as consumers purchasing a product, this will also be the term used for the remainder of the thesis. 3.0 Methodology
The methodology of the thesis explains how we intend to answer the research question in terms of the basic assumptions underlying the research design, as well as the overall research approach. 3.1 Ontology
Ontology is the assumptions about the nature of things and the world. Therefore, it says something about how the research subject is perceived (Justesen & Mik-­‐Meyer, 2010). Two main scientific directions exist: positivism and hermeneutics (Thurén, 1992). Positivism is part of the realism, in which an objective, essentialistic reality is believed to exist, and social reality, as well as the material world, is believed to exist independently of the perceptions of individuals (Daymon & Holloway, 2011). In the hermeneutical tradition, on the contrary, a multitude of realities exist, because the social world as well as the material world, unlike in the positivistic tradition, does not exist independently from the individual’s perception, because it is socially constructed (ibid.). As such, instead of perceiving phenomena and the world as essentialistic, the hermeneutical approach perceives them as being context-­‐dependent. In this thesis, a hermeneutical approach will be applied. This means that we do not believe that only one truth about the perception of online/offline channels exists. Contrarily, consumers’ differing life worlds may pose a multitude of realities and truths, which are embedded in a context. This ontological belief also has 13
implications on how we perceive our possibility of gaining knowledge about the world, which we will explain in the following. 3.2 Epistomology
The epistemology concerns the perception of what knowledge is and how it is acquired, and is also referred to as ‘theory of knowledge’ (Daymon & Holloway, 2011). Our ontological standpoint has implications for the epistemological approach. Kvale & Brinkman (2010) suggest that the difference between a positivistic and hermeneutical epistemological approach is similar to the distinction between a miner and a traveler. Whereas the positivistic researcher works as a miner trying to dig out the truth, the postmodern, hermeneutic researcher works as a traveler. This means that the hermeneutic researcher is more explorative and descriptive in his approach (ibid.), and does not seek to uncover causal laws (Sørensen, 2010). Therefore, knowledge in the hermeneutic tradition is perceived as being socially constructed, compared to being perceived as the “buried metal” in the positivistic sense. The hermeneutic approach to epistemology claims that experience and understanding are preconditions for each other continuously (Thurén, 1992). This is what is referred to as the ‘hermeneutic circle’ or the ‘hermeneutic spiral’ (ibid.). This means that no understanding can be reached without a pre-­‐understanding, and that knowledge is created on the basis of this pre-­‐understanding. In a continuous process, pre-­‐
understandings evolve when new knowledge is gained (Kvale & Brinkman, 2008). Birkler (2005) defines pre-­‐understanding as “the understanding, which always comes before the actual understanding” (p.96). This means that we, as hermeneutic researchers and interviewers, are part of the knowledge creation, because influence of our pre-­‐understandings on the research is inevitable. As a consequence, objectivity is not a possibility, but not the aim either. A hermeneutic epistemological approach instead seeks a legitimate multiplicity of interpretations (Kvale & Brinkman, 2008). In the hermeneutical tradition, it is thus key to the quality of the research that the pre-­‐understanding is made explicit (ibid.). We have ensured this in several ways. Before conducting the empirical study, we develop a conceptual framework from previous theory, as well as our own pre-­‐understandings. This serves as a structuring and explication of our pre-­‐understandings. We will reflect and elaborate further on our own roles as hermeneutical researchers and knowledge creators in section 6.3 on research quality. 14
3.3 Deduction and induction
In the following, we will clarify the approach to reasoning applied in the thesis. This thesis is centered around a specific case: the licensed, Danish pharmacies and their customers, and as such constitutes a case study. A case study is an empirical inquiry (Yin, 2003), which studies how theory works in practice in a particular setting (Daymon & Holloway, 2011). In order to study this, we have used a combination of a deductive and an inductive approach. Deduction builds on logic and infers from theory to practice, but can be overthrown by experience (Thurén, 1992). We therefore also install an inductive approach, which theoretically implies building on the empirical data from which a general theory is constructed (ibid.) The first part of the thesis constitutes the creation of an appropriate framework for the pharmacy context. As we therefore apply (parts of) an existing framework to practice, we make use of deductive reasoning in this part. This means that we draw conclusions about the case on the basis of existing literature. For the deductive reasoning, several sources have been used. These include secondary data in the form of existing literature including theory and empirical findings, as well as statistics and reports about the topic. Furthermore, we have conducted two expert interviews. These include an interview with two pharmacists in the Department of Pharmacy at the University of Copenhagen, Rasmus Borup and Thomas K.Nielsen, and an interview with chief digital consultant in Bysted, Mikkel Noe Westh (please see appendix 12(both interviews are attached to the thesis as sound files on USB)). These interviews provided us with insights from the two worlds combined in this thesis: The pharmacy world and the digital world. Therefore, they contributed to the strength of the deductive reasoning. The empirical findings are used to revise the framework that was created through a deductive approach prior to the empirical study. Thus, we also make use of inductive reasoning (Thurén, 1992). The conclusions of the inductive research therefore result in theoretical implications. 4.0 Case description
In order to provide the reader with a comprehensive and useful overview of the case, we proceed with a case description exposing relevant matters of the pharmacy industry. With this case description we attempt to illustrate the role licensed pharmacies play in relation to various stakeholders of the prescription medicine market, and the way this affects the industry. To ensure an in-­‐depth understanding, we initiate 2
We also tried to establish a contact to the Danish Pharmacy Association, but this was unsuccessful. 15
the case description with a brief introduction to the historical development of the licensed pharmacies3. The objective is to provide a frame of knowledge to contextualize our findings, as well as an understanding of the role assumed by the pharmacy in relation to purchase of prescription medicine. In the case description, we provide first a macro and then a micro perspective on pharmacies. While the first provides a description of the role pharmacies play in society today, and the regulations that shape the industry for this purpose, the second part looks closer at industry and consumer relations. 4.1 History of the Danish pharmacies
The Danish pharmacy industry has a history that goes back 500 years to when king Christian IV issued the first official licenses to operate. But even before that, people sought remedies for all symptoms imaginable through self-­‐appointed healers and trusted experts. In those days, knowledge was reserved for the few, and therefore, people were forced to rely on the effects of what they were given without questions or reflection. When the pharmacy licenses were introduced as a means of regulation of the industry, doctors and pharmacies were closely intertwined, and handled both diagnosis, production and distribution of medicine. But this relationship was ended in the 17th century: Pharmacies continued to produce medicine and provide guidance on the treatment suggested by doctors, while doctors took on the responsibility of diagnosis and treatment. Until the 1960’s this was, more or less, the setup. But the 1940’s and 50’s had given rise to a discussion of the industrialization of science, which led to a separation of the medicine production from the pharmacies. With this, the pharmacy’s primary role became a distributor of commercially produced products4. However, the role as a distributor was still associated with the aspect of guidance, which is integrated in the purchase situation to this day. Until October 2001, the licensed pharmacies remained the sole (legitimate) distributors of pharmaceuticals to Danish consumers. But at this point, political forces called for a liberalization of the OTC medicine market. This meant that anyone could set up an OTC distribution after application with the authorities, and especially gas stations, convenience stores and supermarkets have done so over the years (Web F). This deregulation has resulted in an increasing similarity between the OTC market and other retail markets. The rationale of the liberalization of the OTC market was expectations of lower prices and greater accessibility for consumers. A 2006 proposal for further liberalization of the OTC market (Proposal 2006/1 LSF 51), concludes that the initial liberalization has been a success, since both price reductions and 3
4
Based on a lecture provided by pharmacist T.K Nielsen (please refer to the attached interview sound files) Some products are, however, still produced at the pharmacies – so-­‐called extemporaneous production 16
increased accessibility have been obtained. With 3500 OTC distributors currently registered with the Danish Health and Medicines Authority (of which 324 were added just in 2011) (Web F), accessibility (in terms of number of vendors) does seem to be increased. But according to the DPA’s reports, prices did not meet the objective. Their analysis shows that while prices of the still regulated prescription medicine dropped over 44% from 2000 to 2012, OTC prices increased by 22% (Danmarks Apotekerforening, 2013b). Furthermore, they argue, patient safety is dangerously compromised, when medicine can be purchased outside the pharmacy (Danmarks Apotekerforening, 2013c). This disagreement about the success of the OTC liberalization continues to affect debates, as consumer organizations, politicians and other stakeholders are increasingly agitating for a liberalization of the prescription market as well. In figure 2, a selection of stakeholders are depicted with reference to their stand on the potential liberalization of the pharmacy industry. Fig. 2. Wings in the liberalization debate (Source: Adapted from medwatch.dk (Web G)) As the model depicts, in the political arena, even stakeholders with the same political orientation disagree on the matter of the pharmacy monopoly. These different discourses and perspectives have so far landed 17
the debate at a standstill. But with strong forces such as Matas and Bilka pushing for liberalization on one side, and The Pharmaceutical Industry5 agitating for the monopoly of the pharmacies on the other, the debate will surely continue in the future. This historical introduction brings us to the present day setting, which provides the scene of our investigation. We continue our case description with a macro perspective on pharmacies to provide an understanding of the role pharmacies assume in our society. 4.2 Pharmacies as a societal institution
Due to the historical development of the industry, pharmacies today are deeply embedded in the Danish health care system. Though they are formally individual businesses, they also perform a vital task in supplying consumers with medicine, and are therefore often considered part of the public system as well (Web H). With this role as a societal institution, the industry is heavily regulated. In general terms, the legislation of the industry has two purposes – to facilitate and to limit consumer access to prescription medicine. While these objectives seem to be opposing, they refer to different aspects of the pharmacy’s role as a societal institution -­‐ firstly, as a distributor of medicine and secondly, as a supervisor of medicine use. Beginning with the role as a distributor, the pharmacies represent the final joint of the health system, where the actual remedy for disease materializes in the shape of e.g. a pill or ointment delivered to consumers. By assuming this role, the pharmacies contribute to the “easy and equal access to the health care system” as prescribed by the Health Law (Consolidate act no. 913, 13/07/2010). Since several factors are considered barriers to accessibility, the Pharmacy Law (Consolidate act no. 506, 20/04/2013) regulates the industry to ensure that all citizens have access to medical treatment. As the primary means to ensure accessibility, the Danish Pharmacy Law defines what products the pharmacy must provide. The law requires pharmacies to provide Danish consumers with access to both prescription medicines and OTC products. Even when products are available, physical distance can act as a barrier for accessibility. In an attempt to eliminate this barrier, a concrete goal has been articulated, stating that no citizen must be required to travel more than 15 kilometers to the nearest pharmacy (Web I). This is facilitated through the licensing system. Only a trained pharmacist (cand. pharm.) can obtain a license -­‐ a rule that is installed to ensure high levels of professionalism within the field. 5
Lægemiddelindustriforeningen – not to be confused with the pharmaceutical industry in general 18
To make sure that the outskirts of Denmark provide equal accessibility to medicine, the pharmacy industry is subject to a compensation program among the individual pharmacies (Web J). This entails that pharmacies in densely populated areas must share their profits with pharmacies in more sparsely populated areas. As such, even though the pharmacies are owned as individual businesses, they are tied together in a financial system, which is to ensure that they solve a societal problem. Apart from distance, finances can limit access to treatment as well, and therefore, several means to control price exist. First, legislation determines profit limits for the pharmacies. Every two years the allowed gross margin for pharmacy products is negotiated with the state, and at the moment, the gross margin for prescription medicine is about 19% (Web K). While the profits earned by pharmacies are controlled by the margins system, the makers of the products are free to ask any price they desire for their products. But to increase transparency of the prescription market and to facilitate further regulation, every two weeks, all suppliers of prescription medicine report their asking price to the authorities, who list them on their website, medicinpriser.dk. When a doctor prescribes a prescription product to a consumer, the pharmacist is required to offer the consumer both the prescribed product and the cheapest alternative with the same active ingredient. This is called generic substitution (Web L). All of the regulations described here are present because the product provided by the pharmacy is considered a central means of common good in society. But since medicine is at the same time potentially hazardous, the pharmacies also assume the role of a supervisor of medicine consumption to limit the access to medicine and increase medicine safety. The prescription system provides a natural boundary for the consumer’s access to medicine. While the doctor formally writes the prescription, the pharmacy controls it and provides the actual product. Both advertising and sales promotions (e.g. discounts, two-­‐for-­‐
one offers, package-­‐deals with complementary equipment such as inhalers for asthma medicine etc.) are prohibited. 4.3 The Danish pharmacies as retailers
Apart from the role in society, pharmacies also play a role in relation to their industry and the consumer purchasing prescription medicine. We begin by positioning the pharmacies in relation to horizontal and vertical stakeholders within the industry of B2C prescription medicine distribution. These include internal pharmacy relations, competing prescription medicine distributors, and other industry players. 19
4.3.1 The pharmacies in an industry context
At the moment, there are 314 licensed pharmacies in Denmark, including branches and extra licenses owned by the same pharmacists (Web M). Though these are individual entities within the market, they do, in many respects, operate as a homogenous group. This is, first of all, facilitated by the common societal role described in the previous section. But the group mentality also seems to be related to the common professional background and language, which can be identified in their communication (e.g. Danmarks Apotekerforening, 2008 and Web M). This professionalism is also formalized through authorization, which makes the pharmacies similar to accountants, doctors and lawyers. This professional identity is perhaps the reason why there is a strong culture for organization among the pharmacies. For the last century, the DPA has functioned as a trade association for the pharmacy industry, acting as a communicative link between the industry and the outside world (in relation to e.g. press and lobbyism). Furthermore, most pharmacies are organized in one of the five purchasing associations of the industry6. These associations allow the pharmacies to enjoy economies of scale when purchasing products from wholesalers. With this level of cohesiveness among the pharmacies, internal competition is somewhat suspended. However, other players do exist in the market. In our research delimitation, we indicated that both illegal and foreign distributors compete with the Danish, licensed pharmacies. Though 16% of consumers have purchased medicine from abroad (online or offline) at some point (Epinion Capacent, 2011), and some consumers obviously also purchase medicine illegally (since these suppliers are still operating) we find that their market shares must, all things considered, be considered minimal as compared to the pharmacies’, and thus will not touch upon them further. With this, the pharmacy industry can be illustrated as depicted in figure 3. 6
A-­‐apoteket, APOTEKEREN a.m.b.a, ditapotek a.m.b.a, Pharma+ and Apotekernes a.m.b.a (Web M) 20
Fig. 3. The licensed pharmacies depicted in relation to other industry players (Source: Own creation) While the above describes the role of the pharmacies in relation to other industry players, our research focuses on the consumer’s perspective on the pharmacy. Therefore, we find it necessary to also provide a description of ways in which consumers and pharmacies interact. This calls for an overview of the purchase process related to prescription medicine. 4.3.2 The pharmacy as a purchase channel
Until 2004, when the DPA web-­‐shop, www.apoteket.dk was launched, consumers had had to buy their medicine in the physical pharmacy. In 2008, the site was re-­‐organized, and in 2012, an online chat was added to the web-­‐shop to convert the offline service and guidance to an online format. The chat allows consumers to engage in text, sound or visual chat – with the possibility of remaining anonymous themselves. Given that it is administered by the industry trade association, apoteket.dk’s web-­‐shop is not an independent retail platform representing just one retailer. Instead it functions as a common online presence for all Danish pharmacies. To facilitate this somewhat unusual setup, consumers have to choose 21
which pharmacy to purchase from at the beginning of the purchase process. While this is different from most retail websites, it also means that consumers have the exact same assortment to choose from online and offline and at the exact same prices. However, the purchase processes of the online and offline pharmacy channels differ. In the traditional pharmacy, the purchase process can be described as involving five overall steps7. As the first step, the consumer must obtain a prescription from the doctor. This typically entails visiting the doctor’s office (unless it is a re-­‐purchase on an existing prescription). The second step requires the consumers to physically show up at the pharmacy. A prescription must be presented or identification provided for the prescription to be drawn from the electronic database. In the third step, the pharmacist offers advice on e.g. how to use the product, if the consumer accepts it. As the fourth step, the pharmacist must offer the consumer substitution to a cheaper alternative, and finally payment is completed. In this process, the first stage requires interaction between a doctor and the consumer, while the rest of the process is carried out in interaction between the pharmacist and the consumer. Turning to the online purchase process, apoteket.dk (Web O) offers a guide describing the process in four steps – login (with NemID), choosing pharmacy (from a list), finding medicine (facilitated by a list of pending prescriptions), and ordering medicine (during which, the consumer is given a choice between all substituting products -­‐ as opposed to offline, where only the prescribed and the cheapest product are offered). But as with the offline process, the purchase also requires a prescription to be registered in advance. After ordering and of course paying, the online process also requires the consumer to wait for delivery. Several tasks performed by the pharmacist offline are automated or performed by the consumer online. The first step of an online purchase is performed in interaction between a doctor and the consumer, just as in the offline channel. But online all steps from login to payment are performed single-­‐handedly by the consumer. Here, only delivery is performed by the pharmacy. With this, it is apparent that the online and offline purchase processes represent different forms of consumer/pharmacy interaction, and in particular, different levels of consumer involvement in the purchase process. Consumers are thus faced with a choice between to different ways of purchasing from the pharmacy. 7
The initial four stages described at a-­‐apoteket.dk (Web N) 22
As we have now provided the reader with insights on both the historical development of the Danish, licensed pharmacies, and described their roles in relation to society, industry and consumers, we conclude the case description and proceed to provide a theoretical background for our investigations. 5.0 Theoretical background
In this section, we lay the theoretical foundation for our empirical research. Since the focus of our research is the perceptions consumers may hold towards online and offline channels respectively, we start by identifying a framework, which applies in a multichannel pharmacy setting. This framework will function as a structure of our pre-­‐understandings for the empirical research. While a multitude of literature exists within the field of consumer behavior in multichannel settings, little is concerned with consumers’ perceptions of multichannel pharmacies in particular. Therefore, we find that we must look to the more general retail literature for a theoretical starting point. In section 5.1-­‐5.2 we identify and present a such framework. However, since we find that purchase of prescription medicines may differ from other products, we must address the case specific applicability of the theory. In section 5.3 we present relevant findings from the pharmacy literature, which allow us to discuss and refine the generic retail framework for our specific case context. 5.1 Consumer channel choice in multichannel retail environments
Extensive literature exists within the field of multichannel retail settings and consumer channel choice. While many studying these phenomena have focused on selected factors (e.g. channel attributes (Huang, 2003; Balasubramanian, 2005), lock-­‐in effects (Gensler et al. 2012; Verhoef et al., 2007), and service (Sharma, 2002), only few have attempted to provide a comprehensive framework for understanding consumer perceptions of online and offline purchase channels. In order to fully grasp the complexity of consumer perceptions of purchase in online and offline pharmacies we find that such a framework is needed. Thus, Torben Hansen’s working paper “Forbrugerens valg mellem on-­‐line og off-­‐line købskanaler: En litteraturgennemgang og forslag til yderligere forskning”8 (2002) is suggested as a starting point. Hansen provides a literature review and discussion of consumer channel choice in multichannel environments, and as a result suggests five factors affecting online/offline channel perceptions. 8
English translation “The consumer’s choice between online and offline purchase channels: A literature review and recommendations for further research” 23
In the following, we present Hansen’s framework in more detail before initiating the discussions about its applicability in a pharmacy setting. 5.2 Hansen (2002) “Forbrugerens valg mellem off-line og on-line
indkøbskanaler”
In 2002, when Hansen composed his framework, the internet had already existed for 15 years. However, it was still in its infancy as a purchase channel for the ordinary consumer, and as such, constituted an innovative new platform. The objective of Hansen’s paper was to understand how and why consumers chose to adopt this innovation. Today, a decade later, the adoption of online channels is still inconsistent across products and industries, and Hansen’s framework still has significant relevance for understanding the attitudes causing this. In his framework, Hansen expresses a perception of online and offline channels as potentially co-­‐existing, because they may have differing relevance. As such, he regards consumer attitudes towards online and offline channels as relative and contextual. With this, the five factors presented in his framework should all be understood from a consumer’s perspective, rather than as related to an objective utility of the channels. The five factors presented by Hansen (2002) include Perceived relative benefits and barriers, Perceived compatibility, Perceived complexity, Perceived substitutability, complementarity and lock-­‐in, and Perceived communicative aspects. In figure 4 (from Hansen, 2002) these factors are depicted as related to consumer attitudes towards online purchase, and consequently, online purchase intention. But, as previously noted, this should be seen as relative to attitudes towards offline purchase, and in terms, offline purchase intention. Therefore, the framework can be used to investigate perceptions of both online and offline channels. 24
Fig. 4. Framework after Danish original (Source: Hansen, 2002). See appendix 2 for original, Danish version. While the depicted framework provides overall directions for an empirical study of consumers’ channel attitudes, the factors seem somewhat broad and unspecified. However, in his working paper, Hansen also discusses sub-­‐elements of each of the five factors. While he does not term these separately, we have broken Hansen’s original five factors further down into a total of eleven factors (see figure 5 below). These are directly derived from Hansen’s own framework, but made explicit by us, in order to systematize and structure the review and discussion of the framework in relation to a pharmacy setting. 25
Fig. 5 Hansen’s framework broken down into factors (Source: Our creation) While Hansen’s (2002) framework was composed on the basis of a literature review, it has also been applied in an empirical study. In Hansen (2003) a quantitative research method is used to establish linkages between each framework factor and channel choice for grocery shopping. For groceries as a case, not all factors are found indicative of channel choice, indicating that channel choice factors may vary across contexts. As such, the framework must be discussed and revised in concordance with the specific case. In the same study, Hansen segments Danish (and Swedish) online and non-­‐online purchasers according to demographics, and further attempts to determine whether some product types are bought more frequently online than others. In this study, medicine is included as a product group. Hansen finds that ”there seems to be some obstacles present, which prevent consumers from ’going all the way’ and actually make an online […] purchase” (p. 11) and that “such considerations also hold true in relation to other products, e.g. [...] medicine” (ibid.), since only 0,9% of the respondent have purchased medicine online (ibid.). It should, however, be noted, that Hansen’s study was conducted two years before the Danish, licensed pharmacies even provided the opportunity to purchase medicine online. Therefore, his results cannot be viewed as indicative for the current situation of the industry. 26
In the working paper, Hansen (2002) describes the decision to purchase through an online or an offline channel as embedded in the general purchase process. Therefore, characteristics of the purchase process may also affect attitudes towards online and offline channels. In section 5.3, we discuss characteristics of the purchase process for prescription products, which we find differing from other retail contexts. This provides the basis for our discussions of Hansen’s framework factors in relation to our case (sections 5.4-­‐
5.8), leading to the shaping of our customized framework (section 5.9). 5.3 Purchase process and decision-making for prescription drugs
In this section we provide a thorough overview of theoretical concepts, which contribute to the understanding of prescription medicine purchase. This includes a characterization of the purchase process as compared to other retail contexts, as well as of the roles of consumers and health professionals during the purchase. 5.3.1 The purchase process
A consumer purchase process typically begins with a need or desire, and in multichannel retail literature, it is generally accepted that several stages follow. Common to all is the overall distinction between search and purchase stages (Wang et al., 2012; Chiu et al., 2011; Elliott et al., 2012; Lin et al., 2012; Verhoef et al., 2007; Levin et al., 2005; Kollmann et al., 2012), but most authors propose more elaborate process descriptions. Gupta et al. (2004) propose five general stages of any retail purchase (see figure 6). Since this provides a thorough understanding of what a purchase process entails, we will use this as the point of reference in trying to disclose the differences between general retail purchase and purchase of prescription medicine in particular. Fig. 6. Generic retail purchase process (Source: Own creation) In Gupta et al. (2004), the process is mainly viewed as involving the consumer, who “has to spend time browsing the aisles” (p.7), and “examining and comparing product attributes” (p.8) before making a decision. According to the multichannel theory, consumers are increasingly using different channels in this process to search for and purchase products (Verhoef et al., 2007). This is found to be a result of the 27
relative perceived attractiveness and relevance of channels according to the stage in the purchasing process (e.g. Gensler et al., 2012). For the prescription purchase process, this process seems somewhat altered. Orizio & Gelatti (2010) describe the health market as one in which “knowledge is not equally distributed, and the ‘‘customer’’ is often not sufficiently well informed to know what he needs, and his choices have to be mediated by an expert, the health professional“ (p.36). Therefore, characteristics of the purchase process, such as a doctor’s prescription, and the pharmacist administering the products, are installed to safeguard the patients (ibid.). DeLorme et al. (2011) further describe prescription drugs as “high-­‐involvement products that can only be purchased with gatekeeper approval” (p.767). This gatekeeper function that a doctor and pharmacist holds, results in a purchase process where the consumer no longer has the same freedom as in the purchase process for other retail products. While the patient is still the active party in the first stages of the purchase, where a need is realized (a symptom is felt) and the purchase process (treatment plan) is initiated (by seeking the advice of the doctor), the doctor is the one who searches for and evaluates product options and chooses the more appropriate one. Only after a prescription has been signed, is the consumer offered an option to alter this decision slightly, by choosing a substituting product at the actual point of purchase at the pharmacy (as described in the case description, section 4.0). Here, the pharmacist administers the products, provides professional advice, and oversees the transaction. As such, the consumer’s agency in relation to product choice seems rather limited. In terms of channel choice, however, the doctor is not a gatekeeper as such. Here, the consumer has the exact same freedom to choose channel as for other goods. But we find that the agency of professionals (doctors and pharmacists) during the purchase may influence consumer perceptions of the factors presented in Hansen’s framework9. As such, the special circumstances of a prescription purchase process may in terms affect channel perceptions. With this, the purchase process for prescription medicine can be depicted as follows: Fig. 7. The prescription drug purchase process (Source: Own creation) 9
The purchase process for repurchase may not necessarily include a visit to the doctor, but nor a search stage, as it is a renewal of a prescription. 28
As it appears here, the search process of a prescription purchase only facilitates limited independent search activities for consumers both online and offline. This indicates that not only the doctor, but also the pharmacist may have a central role in the prescription product purchase. 5.3.2 The pharmacist’s role
In our interviews and in the pharmacies’ communication (see case description, section 4.0), we found professional counseling to be a recurring theme. This implies that the search for knowledge, as facilitated through interaction with staff, is considered a central aspect of the value proposition by the pharmacies themselves. However, in Renberg et al. (2010) pharmacy customers are found to be split into two groups – those consumers that perceive the pharmacy’s primary value proposition to be distribution of products and those who perceive it to be their guidance and expert knowledge. Findings from Kaae et al. (2012) further show that 38% of pharmacist initiated dialogue is openly refused by customers and that only 13% of consumers ask for advice10 during the purchase. This indicates that service, in the sense of expert advice, is only valued by some consumers, and that for the other consumers a lack of knowledge is either not perceived to be present, or counseling is not considered a remedy for it. Interestingly, in our expert interviews, pharmacist Thomas K. Nielsen states, that he is ”pretty convinced that consumers are not always aware that they need counseling […] And it gets even worse, when you pound them on the head and say ”you are an idiot, you don’t know anything, you DO need counseling, you just don’t know it” (TKN & RB, 00:56:15). This suggests a discrepancy between the pharmacists’ and the consumers’ perceptions of the pharmacy’s value proposition – a discrepancy that is also discussed by Kaae et al. (2012), who conclude that “results imply that pharmacy staff is more focused on passing along the information that they perceive to be necessary than on differentiating their advice due to the characteristics of the attending customer” (p. 5). While this indicates that the perceptions of counseling may differ among consumers, consequently the perceived ability of online and offline channels to facilitate professional counseling may also differ, and in terms affect consumer perceptions of the channel’s ability to facilitate a prescription purchase. In Goshal & Walji (2006), who examine the ability of websites to provide medical information, the face-­‐to-­‐
face interaction of an offline channel is considered more suitable for consumer medication information, because the direct interaction may overcome inaccuracies and misunderstandings. However, this conclusion is based on an environment where online interaction and dialogue was still considered a limited 10
Unfortunately, Kaae et al.’s quantitative study does not provide answers as to why these consumers are not interested in dialogue. Since consumers who would refrain from dialogue due to e.g. shyness might find an online interaction more settling, other consumers might just find it irrelevant to their purchase experience altogether. Therefore, an understanding of reasons to refuse dialogue might contribute to the understanding of channel perceptions. 29
option. Today, Apoteket.dk offers several modes of interaction, including sound-­‐communication (online calls), visual communication (videocalls) and text-­‐only communication, and consumers can choose to see the online counselor, but not be transmitted visually themselves. With this, both online and offline pharmacies provide access to knowledge and understanding, and the online channel even facilitates it while taking into consideration needs for privacy. We must, however, take into account that consumers are not necessarily aware of these facilitators of knowledge. For example, consumers may not be aware of the different options of online counseling before they have already made the decision to use an online channel for their purchase. Therefore, at least for first time purchasers, the perceived service output of an online channel might not include counseling. This indicates that non-­‐online shoppers might perceive offline pharmacies as superior in relation to counseling and therefore choose traditional channels for prescription purchases. Previous online shoppers, on the other hand, might consider counseling as part of both online and offline service outputs. For them, this could mean either that counseling does not represent a relative value of channels, or that the face-­‐to-­‐face interaction of offline channels or the privacy of an online channel’s counseling would lead them to choose either. While the process of prescription medicine purchase described above and the seeming importance of the pharmacists as a professional counselor could indicate that consumers assume a more passive role in a pharmacy context than in other retail contexts, evidence of the opposite can be found, as discussed next. 5.3.3 Consumer roles in the prescription purchase process
Gregory et al. (2011) find that doctors feel they have the responsibility as well as the right to simplify the alternative options available to the patient, but that some patients are “frustrated by their doctor’s apparent unwillingness to assist them in learning more about different treatment options and undertook information searches on their own” (p.368). This indicates that some patients might want to be included in the decision-­‐making and do not blindly trust the doctor. Several statistics on search behavior in relation to health care further indicate that patients search for information in an early stage of a purchase or treatment situation: 55% of health seekers use the internet for information gathering before physically visiting health care providers (Cotton & Gupta, 2004), and 26% of Danes have even experienced not going to the doctor after searching the web (Yougov, 2013). As such, it seems that patients are indeed assuming an active role in acquiring remedies for illness. In a study about how doctor-­‐patient communication affects prescription drug decision-­‐making, Orizio & Gelatti (2010) refer to “the informed patient”. These patients are not informed by the professionals, but by 30
“the kaleidoscopic universe of health-­‐related websites.” (p.31). This indicates that the internet has a significant role in producing informed patients. Lober & Flowers (2011) refer to “e-­‐patients”, described as individuals who are ‘‘equipped, enabled, empowered, and engaged in their health and health care decisions.’’ (p.178), and note that this patient empowerment parallels broader trends of consumer empowerment in society. An abundance of literature studying patient empowerment exists (e.g. Holmström & Röeing, 2009; Conrad & Barker, 2010; Anderson & Funnel, 2010). Schulz & Nakamoto (2013) identify empowered patients as those who do not passively receive and accept information, but rather extract meaning perceived as personally relevant and choose the behavior found appropriate for their particular health situation. Not only are patients perhaps more empowered today than previously -­‐ according to Dutta & Bergman (2005, in DeLorme et al., 2011), they are also expected to ”accept more responsibility for acquiring and using information to make wise health decisions” (p.766). This tendency towards a more active patient role is also evident in the way patient-­‐doctor relations are articulated in the health care system (Web P; Web Q). Here, the focus on dialogue, patient involvement, and shared decision-­‐making seems to indicate that the patient’s point of view has gained legitimacy in decision-­‐making, and that a new subjective medicine has emerged, in which the perspective of treatment has shifted from “saving lives” to “improving lives”, as suggested by Sullivan (2003). In this setting, what patients feel they need from their health professionals may be knowledge (which they can apply themselves) rather than a professional’s choice between available options. With the tendency towards empowerment, which puts the patient’s opinion at the center of decision-­‐
making, some authors have suggested that a shift from patient to consumer is happening (Lober & Flowers., 2011). Kronenfeld (2001) suggests that this is because health care is increasingly viewed by consumers as similar to other goods in society, and thus that physicians are “no longer viewed as the unapproachable professionals of the past, but as mechanics for the body” (p.311). This is also the focal discussion in Tomes (2006, in Lober & Flowers, 2011), who discusses the difference between patients and consumers and finds that despite some overlapping roles, the main difference is that doctors and patients fight for the same goal, whereas doctors and consumers (i.e. seller and buyer) are on opposing sides of the “transaction”11, and therefore potentially have differing goals. Therefore, a patient would perceive the doctor as a partner, whereas the consumer might have a different agenda than the doctor.12 With this, we find that the level of 11
Although medical treatment is free in Denmark, the term transaction in this case refers to the fact that the patient consults the doctor to ”acquire” a prescription. 12
As described in Conceptual clarification (section 2.1), we will use the term consumer for the remainder of our discussions. 31
empowerment perceived by consumers may affect their perceptions of their own roles and the roles of health professionals during prescription purchase. We find that since the concept of empowerment relates to the way decisions are made in a pharmacy purchase situation, it may also provide a useful level of understanding about the way pharmacy channels are perceived. To ensure consistent use of the terms throughout the thesis, we provide the following definition of perceived empowerment, based on the theoretical input from the pharmacy literature: “the consumer’s sense of not just passively receiving and accepting information, but rather extracting meaning perceived as personally relevant and choosing the behavior found appropriate for one’s particular health situation, either because it is perceived as expected or because one wants to” While we find an increasing focus on consumers as active parts of decision-­‐making, this, however, has also given way to debate about the consumer’s capacity to take on this role. Health literacy is a term describing the consumer’s ability to understand medical information and capacity to use it effectively (Schulz & Nakamoto, 2013; Nutbeam, 2006). While this is used as a parameter for objective measure, we find that the perceived health literacy, (which Schulz & Nakamoto (2013) refer to as psychological patient empowerment13), holds more relevance in relation to consumer attitudes towards the purchase channel. This form of health literacy refers to a subjective experience of capability in a health context. In regards to the consumer’s competencies in decision-­‐making, Kaae et al (2012) note that ”customers’ perceptions of illness and medicine differ from those held by health professionals, such as pharmacists” (p.256). This is supported by Ramström et al.(2006)’s findings that patients have their own beliefs regarding medications and make choices about whether or not to take a drug accordingly. These observations suggest that while consumers with high perceived literacy may feel both entitled, expected and equipped to make health decisions (as suggested by Lober & Flowers, 2011), their lack of professional training, as well as their personal involvement, may lead them to different conclusions than the doctor or pharmacist. But while this, from a professional point of view, perhaps is problematic, the consumer may perceive the quality of the decision as high, if they perceive their own heath literacy as high. On the other hand, consumers with low perceived health literacy may feel that they need the professional’s guidance, and are unable to live up to an active role in the purchase. With this, we define perceived health literacy as “The subjective experience of one’s own capability of decision-­‐making in a health context”. 13
To clearly separate the concepts of consumer roles (empowerment) and perceived ability to fill these roles (psychological patient empowerment), we use the term perceived health literacy, as used by Nutbeam (2006). 32
Based on these discussions, we find that consumers’ perceived empowerment and perceived health literacy might both be important constructs for understanding consumer decision making in a prescription drug purchase process, and consequently for understanding their perceptions of the factors of Hansen’s (2002) framework. With this, we have provided a theoretical basis for discussing Hansen’s (2002) framework factors in relation to our case. 5.4 Perceived Relative Benefits and Barriers
According to Hansen (2002), a basic factor of consumer channel choice in multichannel environments is the perceived benefits and barriers related to the online and the offline channel respectively, and the importance assigned to them according to context. Hansen (2002) specifically distinguishes between factors contributing to the overall perceived risk and factors that relieve those risks – so-­‐called risk relievers, as constituting these barriers and benefits. 5.4.1 Perceived Risk
Several studies suggest that perceived risk influences on retail channel choice (Cox & Rich, 1964; Gunderson, 2000; Ross, 1975; Spence et al., 1970 – all in Gupta et al., 2004; Lin et al., 2012). According to Hansen’s (2002) framework, perceived risk affects consumers’ purchase intention, and Gensler et al. (2012) suggest that loss (i.e. risk) aversion may in fact weigh heavier than potential gains in shaping the consumer’s attitude towards a channel. Though Gupta et al. (2004) suggest that the online channel may be perceived as more risky than the offline, due to the separation in space of consumer and product, they also find that online channels provide better search options to relieve risk. As such, risk is an ambiguous concept, and furthermore, it is not a concept exclusively reserved for either the online or the offline channel. It may therefore affect attitudes towards both in either a positive or a negative direction. In this context, it is important to understand that we do not view risk as an absolute, but as an individually perceived concept. As defined by Gupta et al. (2004), it is about the likelihood of an uncertainty turning into a consequence, and the importance this would have, as perceived by the consumer. According to Hansen (2002), the perceived likelihood of a wrong decision is affected by the consumer’s assessment of own competence for retrieving and assessing information during the purchase. This indicates, that in a pharmacy context, the consumer’s perceived health literacy (as defined in section 5.3) could be affecting risk perceptions during purchase, and as such, perceptions of the channels’ facilitation of the purchase. 33
To establish the effect of risk on channel perceptions it is therefore important to allow for the emergence of individual risk perceptions in our data collection. But first, a more thorough understanding of the concept of risk is provided and discussed in relation to our case to establish the relevance of the construct in relation to our case specific framework. 5.4.1.1 Purchase medium risk versus product risk
Firstly, to understand consumer risk perceptions, the object to which risk perceptions are directed must be established. In Gupta et al. (2004) a distinction between purchasing medium risk and product risk is made. While the first refers to channel specific risk (such as e.g. payment security), the latter refers to risk linked to the product (e.g. shoes not fitting). But the two are also closely intertwined, since the nature of the product can affect perceptions of channel risk. In particular, Hansen (2002) finds that the ability to quantify product attributes, and thus form a pre-­‐purchase expectation of the product, can reduce perceived risk of purchase through an online channel. Since our objective is to establish the importance of case specific risk on channel perceptions, our focus here is particularly on the link between product risk and purchase medium risk. 5.4.1.2 Risk types
As described above, risk is a sense of uncertainty, which is perceived as having potential consequences. In Hansen (2002), risk is defined as occurring in three types – financial risk, performance risk and person-­‐
related risk. These express the components and nature of the total perceived risk, and each relate to different orientations of uncertainty, and therefore, also to different consequences. Common for all is that the perceived likelihood of the uncertainty turning into consequences can be affected by so-­‐called risk relievers. In the following sections, we discuss the different types of risk presented by Hansen (2002) in an attempt to establish their relevance in our pharmacy specific framework. Since risk is perceived individually, we are not attempting to make absolute conclusions as to whether each type of risk is present during prescription purchase, but whether it is likely, and if, in that case, it may affect consumer attitudes towards online and offline pharmacies as purchase channels. First, we attempt to establish what possible uncertainties and consequences each type of risk would represent in a pharmacy context. Afterwards, we discuss aspects which could contribute to reducing these risks. 34
5.4.1.2.1 Financial risk
In his framework, Hansen defines financial risk as “the possible economic loss, which can be related to a wrong purchase decision” (Hansen 2002, p. 6). This establishes a link between the economic resources sacrificed to obtain the product and the ability of the product to meet expectations. According to Hansen, expectations are built through an assessment of quality (2002, p.5), and quality and price often go hand in hand (low price equals low quality and high price equals high quality). As such, Hansen indicates that there is a trade-­‐off between price and quality orientations. He indicates that if the trade-­‐off is perceived as reasonable, the consumer will be more likely to make the purchase. However, the consumer may still be unsure about the ability of the product to live up to expectations after all, and therefore feel uncertain of whether the product is worth the cost. This uncertainty is the perceived financial risk, and the possible consequence is the economic loss referred to in Hansen’s definition. Since we have already described that fear of loss may be a stronger indicator of behavior than expectation of value (Gensler et al. 2012), it seems that financial risk might have a great influence on behavior if this consequence is perceived as likely to occur and/or important by the consumer. As previously described, the ability to quantify product attributes may reduce perceived risk for online channels, because this provides the consumer with a more accurate pre-­‐purchase expectation. As such, financial risk is also considered increased for products where the quality of the product is difficult for the consumer to decode, because it makes the exact terms of the tradeoff of price/quality unknown. Furthermore, this means that consumers who engage in extensive search prior to purchase, and therefore have more accurate expectations about the product, are likely to experience less financial risk. (e.g. Balasubramanian et al. 2005, Elliott et al. 2012). In a prescription purchase context, product attributes are difficult to quantify, since it is a complex product with many attributes unknown to the consumer (e.g. ingredients, statistical significance of side effects etc.). Also, these attributes are difficult for consumers to assess in both online and offline pharmacies, because in the traditional pharmacy, products are kept out of reach (and sight) of consumers until a purchase decision has been made, and online, only limited information (e.g. product name and dosage strength) is available. However, since the doctor holds the role of a gatekeeper during product search and selection stages as described in previous sections, the consumer’s ability to decode the product does not come into play. Since the consumer is not the active party in these processes, the consumer does not need to exercise decision-­‐
making tradeoffs between price and quality. Therefore, with the doctor’s agency in the product choice, consumers are likely to perceive a lesser extent of financial risk. However, while the consumer is not the active part in the initial product selection, the aspect of substitution requires the consumer to make a 35
decision between the prescribed product (which is likely to be associated with quality, because the doctor has chosen this based on his professional knowledge) and a cheaper substitution. This may induce a sense of financial risk in the consumer – because on one hand, the prescribed product may not be better, and in choosing this, the consumer risks paying more than necessary for the same effect. But on the other hand, the cheaper option might not be worth the cost either, if the effect is not optimal. With this, we find that financial risk may be present during the prescription purchase, and therefore potentially affects consumer perceptions of online and offline pharmacy channels. 5.4.1.2.2 Performance risk
In Hansen (2002), performance risk is defined as “the consumer’s perceived probability that the product purchased does not fulfill pre-­‐defined expectations” (p. 6). As such, the uncertainty related to performance risk is directed towards the quality of the product in itself, with the potential consequence of realization of the uncertainty being that the product does not provide the effects desired. Thereby, while in the previous section we described the risk related to sacrificing economic resources on a product that potentially does not satisfy expectations, the performance risk, which we discuss here, is related to the other side of the price/quality tradeoff of the purchase process, and the difference between the two forms of risk is that financial risk has loss of financial resources as its consequence, while the consequence of realized performance risk is the lack of desired effect (i.e. performance) in itself. As discussed in relation to financial risk, the consumer is faced with a choice between price and quality when offered substitution. As with the potential loss of economic resources (financial risk), the consumer may perceive the likelihood of either option not meeting expectations of effects to be so great that it affects their decision. While a lack of desired effect from a prescription medicine appears to be a serious consequence, the likelihood of this risk occurring may not be perceived as very high. This again has to do with the agency of the doctor. According to Hansen (2002) performance risk is likely to be perceived as higher when purchasing products with low transparency or high variety, or when consumers do not have the competencies to assess the quality of the product. But in the case of prescription medicine, the consumer is not the one to initially assess the product quality – the doctor is. As described in the previous section, the agency of the doctor is likely to install a level of certainty about the product quality in the consumer. The doctor has access to the consumer’s medical chart and holds professional competences in the field, on which to base examination and diagnosis, and consequently product choice. Therefore, consumers may feel like a competent person has “vouched” for the product, rather than relying on their own assessment of an 36
appropriate treatment. As a consequence, the consumer is likely to perceive the prescription purchase as less risky in terms of performance. Since the purchase of prescription medicine always requires this choice/validation of the product by a doctor, performance risk is likely to be similar for both online and offline prescription-­‐based purchases. However, while the doctor is generally viewed as an authority, as described in section 5.3, not all consumers may find the doctor’s agency valuable. This has implications for the perceived performance risk, and how it is relieved by benefits of the channels. Based on this, we find that perceived performance risk may be present during prescription purchase if patients do not view the doctor as a competent authority. Furthermore, performance risk could be perceived as present during decisions about substitution. Since the consequences of such risk being realized would probably be perceived as important (since this would entail prolonged illness), we find that the perceived online and offline facilitation of information search to establish the likelihood of these consequences could affect attitudes towards prescription medicine purchase in either channel. This is elaborated in more detail in section 5.4.1.3.1 5.4.1.2.3 Person-related risk
Whereas financial risk and performance risk were related to attributes of the product (price and quality), in Hansen (2002) person-­‐related risk is related to the consumer personally. As such, Hansen mentions examples such as misuse of personal information and an unsatisfying purchase process as barriers of purchase. Since we find that these examples can be viewed as aspects of the factor accessibility, we refer to section 5.6.2 for further discussions of these issues. But Hansen also mentions a social aspect of risk, as well as a resource-­‐related risk, which we find relevant to discuss here. 5.4.1.2.3.1 Social risk
According to Hansen, social risk is related to the sense that “others do not condone (or may even criticize) your dispositions” (Hansen 2002, p. 7). We find that this indicates a great focus on acceptance of others – i.e. the question of “should I or should I not purchase this product?”. But since prescription purchase is typically based on a need for a product, we find that it is not so much a matter of acceptance of the purchase as of judgment about the need for the product. This nuance of the concept is provided in Gupta et al. (2004)’s definition of social risk as “concerned with an individual’s ego and the effect that the consumption is observable by others and has on the opinions of reference groups” (p.10). Therefore, we find that the definition provided in Gupta et al. (2004) is more applicable in a prescription purchase context. 37
In his framework, Hansen (2002) provides little direction for investigating the influence of social aspects on channel perceptions. However, in a similar line of research, Pookulangara et al. (2011) investigate consumer channel switching behavior as a function of the individual’s own attitude towards a certain behavior, normative beliefs (perception of what others would deem appropriate), and subjective norms, which are a function of normative beliefs and willingness to comply. Here, willingness to comply is related to motivations such as prestige, esteem, popularity, or acceptance, and they even conclude that subjective norms are more important than individual attitude towards a certain behavior. Gupta et al. (2004) term this willingness to comply aversion of social risk. In a study on drivers of health behavior, Finlay et al. (1997) found that 82% of respondents were normatively rather than attitudinally controlled in relation to health behavior. This indicates that orientation towards subjective norm is indeed very common among consumers of health products/services. Moreover, it is fair to assume, that to many consumers medicine is a sensitive and private product (perhaps in varying degrees according to the product purpose). In a physical pharmacy, the purchase of prescription medicine is observable by others, and might therefore increase perceived social risk. The online pharmacy, on the other hand, offers more privacy since the purchase can be carried out from home and delivered to the consumer’s address (Mäkinen et al., 2005). Moreover, a report made for the Danish Medicines and Health Authority (Epinion Capacent, 2007) shows that 14% of online medicine purchasers bought medicine online because it was more private. In our expert interview with pharmacists, Rasmus Borup and Thomas K. Nielsen, they expressed that a significant reason among consumers for buying online is privacy, mentioning potency medications and diet pills as classic examples of sensitive products (TKN & RB). We therefore expect that the online channel may hold a benefit that can decrease perceived social risk as a barrier, and thus we find that perceived social risk can affect consumers’ perceptions of the online and offline channel’s facilitation of prescription purchase. 5.4.1.2.3.2 Resource-related risk
What we label resource-­‐related risk refers to Hansen’s (2002) risk of “experiencing a waste of mental or time-­‐related resources” (p. 7). As such, resource-­‐related risk can be related to the resources that consumers must sacrifice to obtain their products. For Hansen, time resources are both time spent planning and time spent shopping (2002). Others (Kacen et al., 2013; Balasubramanian et al., 2005) further differentiate between the time cost related to distribution (waiting time) and the costs related to active shopping time. Time resources are closely linked to resources 38
of effort – that is, practical or mental activity carried out by the consumer during the purchase – because effort often requires time. When purchasing medicine in a pharmacy, some case-­‐specific attributes of the purchase may affect the perceived importance of resource-­‐related risk. First, in the context of prescription medicine, a sense of urgency may increase the orientation towards saving time (throughout the purchase), because the longer it takes to obtain the product, the more the illness is prolonged. Second, the required doctor’s consultation before the purchase of prescription medicine could entail both a greater and smaller perceived effort required (because the doctor’s agency minimizes mental efforts required, but increases practical efforts of e.g. getting to the doctor’s office). But in either case, the time required planning the purchase is somewhat disconnected from the consumer’s realm of control due to the doctor’s agency in product choice. As such, the time consumers can (perhaps) minimize through channel choice is limited to the actual purchase. But apart from this, consumers are also required to carry out a number of activities which require time and effort. In the offline pharmacy, these may include transportation to the pharmacy, queuing, waiting for the pharmacist to find the product etc. Online, on the other hand, examples of time and effort include logging in to the website, finding the product, and waiting for delivery. Offline, waiting time seems to be a great obstacle. Apart from the actual transportation to the store, according to surveys by the DPA, consumers perceive waiting time in traditional pharmacies as twice as long as is actually the case (Danmarks Apotekerforening, 2013d). And digital health expert, Mikkel Noe Westh, further stated in our interview that ”I think it is unclear to people why it is [that there is waiting time at the pharmacy, red.]” (MNW, 00:19:00). This indicates that resources of time are perceived as great, particularly in the pre-­‐purchase phase for offline pharmacies. For online pharmacies, on the other hand, consumers must wait for their prescription medicine, due to delivery time (i.e. time costs in the post-­‐
purchase phase). As such, both online and offline channels require sacrifice of resources by the consumer, but in different forms, and perhaps to different extents in the consumer’s perception. In relation to a prescription purchase, we therefore find that the time and effort required to carry out the purchase may impact channel attitudes. 5.4.1.2.4 Other types of risk in a pharmacy context
While Hansen’s (2002) definitions of the different risk types seem applicable in a pharmacy context, we find that they do not fully capture the facets of risk in a pharmacy context. Since prescription medicine 39
potentially affects the physical state of the consumer, we find that this must be addressed before proceeding. Using the same overall risk types as Hansen, Gupta et al. (2004) distinguish between physical, psychological and social risk as aspects similar to Hansen’s (2002) aggregated person-­‐related risk. We find that this distinction may be useful, because it captures the physical aspect of the pharmacy’s product on the consumer, and thus allows for an understanding of how this affects the prescription purchase. However, not all of Gupta et al. (2004)’s distinctive forms of person-­‐related risks have equal relevance, and furthermore, they do have some overlaps with Hansen’s (2002) risk types. Thus, we find that they may not be included as independent risk types, but as aspects of the risk types already suggested. Firstly, the social risk suggested by Gupta et al. (2004) was already mentioned as part of Hansen’s (2002) person-­‐related risk. Furthermore, Gupta et al.’s (2004), psychological risk refers to the purchase not reflecting the personality of the buyer. In a pharmacy context, we do not find that psychological risk is likely to have an impact on channel choice, since the consumption of prescription drugs mostly is considered a private matter not expected to reflect personality. Physical risk, however, seems highly relevant. In Gupta et al. (2004) physical risk is defined as “the potential threat to consumer safety or physical health and well-­‐being”. They find that this is generally not viewed as important in a shopping context, where the likelihood of physical injuries etc. is usually low. But in a pharmacy context, physical risk seems particularly relevant, because a prescription product can possibly cause harm or discomfort to the consumer’s physique. While this is closely related to the consequences described in relation to performance risk, physical risk could be perceived as more likely, because, even with the doctor’s agency in choosing a product, for most prescription products some level of side effects (physical risk) will be present. And if side effects occur, the consequences may be perceived as great, because they entail harm or discomfort to the consumer. We do, however, find that a substantial overlap occurs between performance and physical risk, as defined by Gupta et al. (2004). Therefore, we choose to include aspects of physical risk in the definition of performance risk. This means that performance risk will be defined as: “the consumer’s perceived probability that the product purchased does not fulfill pre-­‐defined expectations, or may even provide unwanted side effects”. 40
5.4.1.2.5 Risk in a pharmacy context
Based on the above reflections, perceived risk in relation to prescription medicine purchase is identified as the perceived likelihood that uncertainty about potential, undesired consequences turn into reality, and the importance this would be perceived as having. With this, we propose the following definitions of risk in relation to prescription medicine purchase: Financial risk: “The possible economic loss, which can be related to a wrong purchase decision”. Performance risk: “The perceived probability that the product purchased does not fulfill pre-­‐defined expectations, or may even provide unwanted side effects”. Social risk: “An individual’s ego and the effect that the consumption is observable by others and has on the opinions of reference groups”. Resource-­‐related risk: “The possible waste of mental or time-­‐related resources”. 5.4.1.3 Risk relievers
As the discussions above show, the effect of risk on channel attitude may relate to both the perceived existence of risk, and the ability to reduce it. As such, not only the risk of the purchase, but also the moderating factors of this risk, may affect attitudes about prescription purchase in online and offline channels. Hansen labels such factors risk relievers, defined as “[…]information (no matter the form), which can provide a foundation for a pre-­‐purchase expectation about product advantages and thereby bring down both pre-­‐purchase and post-­‐purchase risk”” (Hansen, 2002, p.7). He finds that the role of information as a risk reliever is dependent upon the individual consumer’s ability to find and use it. As such, the relief of risk in a purchase process seems closely related to our discussions of consumer empowerment and health literacy in section 5.3. But in relation to e.g. social and resource-­‐related risk, information alone does not relieve the consumer of risk. These risk types also have to do with the practical facilitation of the purchase, and as such, an aspect of convenience represents a mode of reducing risk. Furthermore, Hansen (2002) indicates that sometimes consumers do not make decisions based on context specific perceptions of risk, but based on more general decision-­‐making rules. In this section, we discuss these different categories of risk relievers in more detail, to provide a more elaborate understanding of what benefits provided by the online and offline channel that might reduce the barriers related to the different risk types described above. 41
5.4.1.3.1 Information as a risk reliever
In the discussions of the different risk types above, we suggested that information may provide risk relief for especially financial risk and performance risk. But this information can be obtained through different aspects of the purchase, and as such, may be perceived as facilitated differently by online and offline channels. Firstly, information can be obtained through counseling. In section 5.3, we found that counseling is considered a central part of the pharmacy’s service output (at least by the pharmacies themselves), but also that counseling may be valued to different extents by pharmacy consumers. In particular, the consumer’s perceived role in the purchase (level of perceived empowerment) and perception of knowledge and skills to make decisions (health literacy) was related to the need/desire for counseling. In a pharmacy context, counseling is available both online and offline. Offline, this is an integrated part of the purchase, because consumers are already interacting with the pharmacist, while the online pharmacy provides counseling as an option for the consumer to actively choose. Therefore, we expect the role of counseling as a risk reliever to depend upon the individual consumer, and the consumer’s perception of his/her own empowerment and health literacy. Information is also available as a risk reliever through the consumers own search activities (e.g. price comparisons, peer recommendations etc.). In section 5.3 we described how over half of consumers engage in search activities for health related issues, but that in a prescription purchase situation, the consumer’s ability to obtain information is limited, because neither of the channels provides the consumer with the opportunity to inspect the product in detail before the purchase. Offline, prescription products are kept out of reach of consumers and typically the substituting product is only offered through verbal representation of “a cheaper option”1, and online, access to information is (more or less) limited to product name and dosage strength. However, concerning substitution choice, the online channel presents all the choices available rather than the prescribed and the cheapest, which is the procedure in the offline channel. Therefore, we expect that in relation to financial risk, this may be an online benefit. We find that this difference in channel facilitation of the substitution choice could potentially affect consumer attitudes towards purchasing from an online or an offline channel respectively, and therefore, may contribute to the understanding of consumers’ perceptions of the channels’ facilitation of prescription drug purchase. 42
Concluding, while both channels may facilitate information, we expect them to be perceived as doing this in different ways, and we expect that this difference is dependent on the consumer’s perceived empowerment and health literacy. 5.4.1.3.2 Practical facilitation as a risk reliever
As suggested above, the practical facilitation of the purchase may reduce both social risk and resource-­‐
related risk. For social risk, practical facilitation of the purchase could entail physical means of separating the consumer from other consumers. While the offline channel does provide potential social risk relievers (e.g. discretion lines), the online channel inserts the computer as a medium allowing the consumer to be separated completely from the traditional pharmacy setting, and therefore ensures that no observation by peers is possible. Thereby, social risk could be reduced through both an online and an offline channel, however, we expect the online channel’s risk relief to be perceived as more sufficient, because of its complete absence of social interaction. In relation to resource-­‐related risk, convenience, as a means of practical facilitation of the purchase, may function as a risk reliever. Most authors relate convenience to the overall resources of time and effort (Hansen 2002; Goshal & Walji, 2006; Kacen, et al.2013; Balasubramanian et al., 2005), making this seem like a direct risk reliever for resource-­‐related risk. Hansen (2002) suggests that benefits of a channel, which contribute to its convenience, include e.g. physical accessibility of the channel (location), the immediate availability of the product (related to assortment and delivery), and the flexibility of e.g. opening hours. According to Hansen (2002), the online platform perhaps saves time spent shopping, but not time spent planning, since this is probably not dependent on the platform used. According to Kacen et al. (2013), the costs of waiting are typically lower in traditional stores and active shopping time lower in online due to e.g. the ability to shop from home. And both Balasubramanian et al. (2005) and Verhoef et al. (2007) conclude that online is more time consuming in total. In our expert interview with Mikkel Noe Westh, from Bysted digital agency, he suggested that the primary competitive advantage of online channels over offline is convenience – also in relation to pharmacies (MNW, 00:17:50). Convenience does seem important to pharmacy consumers, with 27% stating this as one of the reasons to shop online (Capacent Epinion, 2007). Similarly, Goshal & Walji (2006) suggest that convenience may be superior online, and that this may lead consumers to choose online pharmacies, but looking at the two pharmacy channels, clearly they both facilitate convenience as a risk reliever. In the online channel, convenience can be related to the lack of e.g transportation and queueing. This saves the consumer of resources of both effort and time. Offline, on the 43
other hand, examples of convenience include the immediate delivery of the product (saving the consumer of waiting time) and the large number of pharmacies ensuring that one is always nearby (saving resources of effort to get to one). We therefore expect that online and offline channels may be perceived as facilitating the practical aspects of prescription purchase in differing ways and thus, that the channels may be perceived as reducing resource-­‐related and social risk to different extents. 5.4.1.3.3 General psychological principles as risk relievers
Finally, Hansen (2002) describes how, when making decisions under uncertainty, consumers sometimes avoid making context specific assessments of the quality/price tradeoff, and therefore employ strategies to avoid problems of information gaps, lack of skills etc. He defines these strategies as “principles for justification”. Such principles handle risk by applying a general rule, rather than assessing and handling the risk of the specific purchase context, and might for example be always choosing the prescribed optio or choosing a particular brand name. Since psychological principles as risk relievers entail no direct involvement of the channel, these are not likely to shape channel attitudes. 5.4.2 Benefits and barriers in a pharmacy context
With this section, we have found that both perceived risk and its potential relievers may affect consumers’ perceptions of the online and offline channels’ facilitation of prescription purchases. We have provided definitions of the different risk types that contribute to the total perceived risk as well as suggested potential aspects of online and offline channels, which may reduce these risks. These definitions will be included in our pharmacy specific framework to provide an elaborate understanding of benefits and barriers in our empirical study. 5.5 Perceived Compatibility
The second factor, which Hansen (2002) proposes as affecting channel choice, is perceived compatibility. In an empirical study based on his framework, Hansen (2003) concludes that compatibility is an important construct for understanding consumer propensity to buy online, finding that (at least in a grocery context) both online and non-­‐online shoppers evaluate compatibility as important for their choice of channel. Hansen defines compatibility as the fit between online shopping and consumer “wants, needs, purchasing patterns, roles, and lifestyle” (2002, 4). While this is, on one hand, related to the reasons to shop, it is also 44
related to the ways to shop. Therefore, Hansen (2002) discusses compatibility based on the factors consumer shopping motives (reasons to shop) and individual shopping patterns (ways to shop) respectively. In the following, we discuss these constructs in relation to a pharmacy setting, to establish whether or not they may affect consumers’ perceptions of online and offline channel compatibility for prescription purchases. 5.5.1 Shopping motives
The concept of shopping motives relates to the above mentioned consumer wants and needs suggested as factors of compatibility by Hansen (2002). These indicate what drives consumer behavior – i.e. what motives consumers wish to fulfill through the shopping process. Given that Hansen (2002) relates shopping motives to the perceived compatibility of online and offline shopping, it is important to note that shopping motives are considered individual and contextual. As such, Hansen (2002) does not establish a universally valid link between particular shopping motives and the use of either online or offline channels, but rather indicates that individual motives may affect the perceived relevance of a channel in a particular context. Therefore, the understanding of shopping motives in a prescription purchase context would not in itself provide answers as to what channels consumers prefer, but only indications of what consumers use the channels to obtain. With this knowledge, however, it is possible to discuss existing features and opportunities of development for online and offline platforms. In this section, we attempt to define shopping motives in relation to a pharmacy context, and establish the relevance of this concept in relation to our framework. Our definitions will be based on Hansen’s (2002) discussions, as we find that these provide a useful distinction between different orientations of shopping motives – i.e. hedonic and utilitarian shopping motives. With this distinction, we are able to separate the functional objectives of prescription medicine shopping from other rationales that might underlie consumer behavior. This enables us to obtain a deeper understanding of what consumers seek during prescription medicine shopping, and with this, another dimension of perceived relevance of online and offline channels. Since Hansen’s (2002) definitions of shopping motives are not specifically constructed for a pharmacy context, we find it necessary to specify Hansen’s more general definitions for our empirical framework. Therefore, we engage in a discussion and refinement of the definition of shopping motives for our particular setting. 45
5.5.1.1 Utilitarian motives
With reference to Babin et al. (1994), Hansen (2002) defines utilitarian shopping motives as “Shopping behavior made necessary by the wish for certain consequences” (p. 10). In other words, utilitarian motives are directly linked to a functional need for a specific product. In relation to prescription medicine purchase, the functional objective would be the need to cure or manage a health problem or illness. In Hansen (2003), he suggests that consumers have utilitarian motives, when they buy utilitarian products. Drawing on extensive literature, he indicates that consumers put “a higher weight on utilitarian shopping value than on hedonic shopping value, for products which can be described as utilitarian products” (ibid, p.15). This is due to the fact that consumers are more cognitively driven when purchasing utilitarian products, and more affectively driven when buying hedonic products, which is related to utilitarian motives and hedonic motives, respectively. In relation to channel choice, Wolfinbarger & Jill (in Hansen, 2003) finds that online shopping is goal-­‐focused (i.e. directed at obtaining a utilitarian value). Therefore Hansen expects consumers buying utilitarian products to find the online channel more compatible. While his empirical studies are not able to conclude on this expectation, we find that this is likely to be the case, because the need for the product to fulfill certain qualities is likely to be driving behavior. Prescription medicine is a highly utilitarian product, as it is purchased in order to cure an illness, i.e. it has a functional value. According to Hansen (2003), this would indicate that the primary motive of pharmacy consumers is expected to be utilitarian, and hence that an online channel is likely to be perceived as most compatible. For prescription drug purchase, we therefore expect that the channel’s compatibility with utilitarian motives is prioritized by consumers, rather than its compatibility with hedonic motives. However, while utilitarian motives may be the primary focus during prescription purchase, we do not consider hedonic motives as non-­‐existing. Hansen (2002) (and we) considers shopping motives both dynamic and potentially co-­‐existing, and therefore, hedonic motives cannot be disregarded at this time. 5.5.1.2 Hedonic motives
In Hansen (2002), hedonic shopping motives are defined as “The positive, entertaining (and sometimes social) experience of the shopping process itself, as perceived by some consumers (for some products)” -­‐ i.e. motives caused by the wish to satisfy emotional needs. Several aspects of this definition make hedonic motives for a prescription purchase process seem counter-­‐intuitive. First, the thought of hedonic value in the form of pleasure or “entertainment” (as suggested in the definition of hedonic value) deriving from the purchase of remedies for illness seems counter-­‐intuitive, because health and disease are serious matters with high personal stakes. Second, Hansen’s (2002) 46
definition refers to socialization as a potential source of emotional gratification. In support of this, he refers to a study by Jones (1999), which finds that the most significant source of hedonic value is socializing. Since socializing is found more difficult to facilitate in an online channel, the offline channel is found more appropriate for consumers with hedonic motives. However, for prescription medicine, we find that privacy (quite contrary to socialization) is likely to be favored by consumers (see section 5.4.1.2.3.1 on Social risk). While other consumer products may represent objects of identification, which consumers gladly expose to their peers, it is harder to imagine someone wanting to portray their eczema or erectile dysfunction as a status symbol or object of identification. This leads us to believe, that prescription medicine is a more sensitive product, which consumers would want to purchase under more private circumstances. Therefore, the activity of pharmacy shopping does not appear as a social one. With this, at a first glance, Hansen’s (2002) definition of hedonic shopping motives seems unfitting for a pharmacy setting. But emotional gratification is also related to other factors than socialization and entertainment. To et al. (2007) point out that hedonic value may derive from the explorative, and sometimes even adventurous, aspects of an online channel. In prescription medicine shopping, describing the purchase as an adventure may be a stretch, but certainly, it would be fair to assume, that some consumers might find the quest for e.g. knowledge about documented side effects, other consumers’ experiences with it, or other information, both interesting and empowering in a manner producing emotional gratification. Hansen himself expands the concept of hedonic motives by referring to smart shopper feeling (Hansen 2002, Verhoef et al. 2007) as a source of emotional gratification. Smart shopper feeling is similar to goals of self-­‐affirmation (Balasubramanian et al. 2005), which suggest that consumers enjoy applying their own knowledge and selection skills in a shopping situation in order to make the “right” decision. For example, when choosing a substituting product, consumers deviate from what the doctor has prescribed, and thereby obtain autonomy. According to Schroeder et al. (2008), this sense of independence (along with convenience) is the most significant motive of online (single-­‐channel) users. As such, the consumer finds gratification – and a hedonic motive -­‐ in being an active part in a successful purchase. In our case context, we would expect this to be more prominent in consumers with a high sense of empowerment and health literacy. On the other hand, consumers with a low perceived empowerment might not feel this sense of gratification through smart shopper feeling and exploration. We do, however, suspect that these consumers could obtain a level of hedonic value through the emotional support from a pharmacist. As we have now established that hedonic motives in a pharmacy setting could be related to emotional gratification through emotional support, self-­‐affirmation or smart shopper feeling, as well as exploration 47
and knowledge building, we will continue to discuss, whether, and how, online or offline pharmacies facilitate these forms of hedonic motives. While we do not set out to provide an exhaustive list of factors which may facilitate hedonic motives in pharmacy settings, we do attempt to establish whether hedonic motives are even feasible in our case setting. Any factors found relevant will contribute to the pre-­‐understandings for our empirical work. 5.5.1.3 Facilitation of hedonic motives in a pharmacy setting
In Jones (1999; also in Hansen 2002), two general sources of hedonic value are suggested14 – retail and social factors. The first refers to factors controlled by the retailer and includes store environment, selection, price and salespeople. The other refers to factors controlled by or related to the consumer and include social aspects of shopping, tasks (problem solving), time, involvement, and financial resources available. As a subject for further research, Jones (1999) suggests similarities/differences between online and offline channels of purchase in different retail settings. As such, Jones indicates that the factors he finds as contributing to hedonic value will hold differing relevance across settings. As we are trying to determine how hedonic motives may be facilitated in online and offline pharmacies, we proceed to discuss Jones’ retail and social factors in this context. We find that the retail factor of staff is applicable in our case setting, as a facilitator of the types of hedonic motives expected to exist, as described in the previous section. Franic et al. (2008) find that staff and staff training are determining factors for channel choice in offline settings, because consumers value both their service and knowledge. In relation to prescription medicine purchase, staff is involved to different extents in online and offline settings, and therefore affects perceived hedonic value differently. For the offline pharmacy, consumers and staff interact through face-­‐to-­‐face communication during the purchase. This might represent emotional value to consumers, who enjoy dialogue and guidance (which is again potentially related to increasing knowledge and experiencing smart shopper feeling). Online, consumers can also interact with pharmacists, but here the interaction is not conducted as face-­‐to-­‐
face communication. Although chat, videos and voice-­‐calls are available to pursue knowledge about products, the mediation of the channel separates consumer and staff member, with potential lack of emotional support as a consequence. As such, staff as a source of hedonic value may be more applicable in an offline setting. 14
While Jones (1999) only studies sources of hedonic value in an offline channel, we find that the distinction between channel specific factors and consumer specific factors is equally applicable in an online channel – however, sources such as shop design and staff would naturally be converted into site design and e.g. communication for an online channel. 48
As for the social factors, we have already deemed social aspects of shopping more or less inapplicable in a pharmacy setting. In fact, these can perhaps contribute to negative hedonic value, if consumers feel violated of their privacy. However, the social factor of involvement may be present in a pharmacy setting, and this may affect the compatibility of the channels with hedonic motives. Involvement is likely to be high, in as much as prescription medicine as a product has great implications for individual well-­‐being in the purchase situation (Rajamma & Pelton, 2009). The involvement in prescription drug purchases is however limited due to the limiting nature of a prescription, but is still possible through dialogue with the pharmacists (and hence serve a emotional support motive) or online search (hence serving e.g. a smart shopper feeling motive). Involvement may therefore be a source of hedonic value that possibly exists in both the online and offline channel. Concluding, we find that the concept of hedonic motives does seem applicable in relation to prescription purchase, particularly in the form of emotional support, smart shopper feeling or self-­‐affirmation and exploration. Offline pharmacies contribute to this through e.g. face-­‐to-­‐face counseling at the pharmacy, while online pharmacies, on the other hand, seem less capable of facilitating this. Both the online and offline channels are however expected to facilitate involvement, satisfying hedonic motives. Since our discussions suggest that prescription purchase behavior may be affected by the channels’ compatibility with consumer shopping motives, and consequently affect perceptions of the online and offline channel’s facilitation of prescription drug purchase, we include these in the pharmacy specific framework. In the framework, they will be investigated in adherence with the following definitions modified from the literature: Utilitarian motives: “Shopping behavior made necessary by the wish for certain functional consequences”. Hedonic motives: “Shopping behavior carried out to fulfill emotional needs through the shopping process itself”. 5.5.2 Individual shopping patterns
In Hansen’s (2002) definition of compatibility as described at the beginning of this chapter, shopping patterns, roles, and lifestyle represent the behavior exhibited by consumers in relation to shopping of a particular product. Hansen uses grocery shopping as a case, presenting several characteristics, which form individual shopping patterns. According to Hansen (2002) patterns of grocery shopping include frequency of shopping and level of participation (which he finds to be increasing, because self-­‐service stores are becoming more popular). Furthermore, in terms of consumer roles in the shopping process, Hansen (2002) describes how grocery 49
consumers who are members of households (i.e. who purchase on behalf of others) often take part in socialization and interaction processes in relation to consumption. Thus, not only the consumer’s own preferences shape their sense of compatibility, but also their consideration for and influence from others. While the characteristics of the shopping process described provides an understanding of the actual behavior of consumers in a grocery context, it is important to note that shopping patterns can vary according to product and situation (Nunes & Cespedes, 2003). For example, grocery shopping is probably done on a far more frequent basis than pharmacy shopping for most consumers. Müller-­‐Lankenau et al. (2004) refer to this routine of shopping as “significant habitual purchase patterns that might be difficult to change”. This suggests that consumer behavior can become so integrated, that e.g. channel switching becomes inconceivable. Even though not bought on a daily basis, we find it likely that habits may also be evident in pharmacy shopping. Compared to grocery shopping, offline shopping in a pharmacy context is also likely to be far more influenced by staff interaction (since prescription medicine is not self-­‐serviced). As to the compatibility with roles and lifestyles of the consumer, we find that Hansen’s (2002) findings (e.g. that consumers sometimes act on behalf of others), contribute with little relevance in our case, and therefore, we do not investigate this further. In relation to shopping patterns, Hansen (2002) does not provide general conclusions as to the compatibility of an online or offline channel for the behavior described in his case. Therefore, the conclusions are more descriptive than analytical, and provide us with neither definitions nor empirical propositions to apply in our framework. However, in the above, we have found that shopping patterns can be related to habits. Chiu et al. (2011) find that consumer habits induce switching costs, and therefore, the adherence to habits, in our perspective, is similar to the concept of (channel) substitutability (see section 5.7.4), which arises due to switching costs. We therefore find that an overlap is present between the factors of shopping patterns (habits) and substitutability (switching costs). Consequently, we perceive the possible findings from a study of shopping patterns as likely to surface in the study of substitutability. 5.5.3 Compatibility in a pharmacy context
With reference to the previous sections, we find that while compatibility appears potentially influential for channel choice in a pharmacy setting, some modification of Hansen’s (2002) framework is found relevant. For Hansen’s factor of shopping motives, we found that his distinction between utilitarian and hedonic motives applies in a pharmacy setting, in as much as hedonic motives can relate to emotional gratification 50
from e.g. smart shopper feeling and self-­‐affirmation, emotional support, and exploration – motives found likely to be facilitated in different ways by the online and offline channel. Utilitarian motives, on the other hand, were expected to be facilitated best through the online channel, and the compatibility with these were expected to be prioritized in this case. For the factor of shopping patterns, we found that Hansen (2002) provides little theoretical and/or empirical contributions to a framework on pharmacy shopping. Furthermore, we suggested that potential findings of a Shopping patterns factor would overlap with substitutability (see section 5.7.4) Therefore, we concluded that shopping patterns should not be included as a separate factor in our framework. 5.6 Perceived complexity
Under the headline of perceived complexity, Hansen (2002) discusses the transparency of e-­‐commerce as perceived by the consumer. As one of the factors derived from Rogers’ (1983, in Hansen 2003) innovation diffusion theory, Hansen indicates that complexity may be a barrier to the adoption of an online channel. In the empirical study of online grocery shopping, Hansen (2003) finds that non-­‐online purchasers consider complexity an important factor for channel choice. This is, however, not the case for online purchasers. While it is not surprising that differences in perceived complexity are detectable across these groups, the understanding of complexity is aided by a further distinction of the elements that affect perceived complexity. Hansen makes this distinction by relating perceived complexity to consumer experience and the channel’s facilitation of the purchase through functional attributes such as navigation, delivery, payment options and returns policies, i.e. aspects of what we will call accessibility. 5.6.1 Experience
Hansen (2002) concludes that consumers are more likely to purchase online in the future, if they have already had experience with online purchases, because it reduces the perceived complexity of purchasing through an online channel, which might otherwise be a barrier. This is supported in his empirical study of online grocery purchase (Hansen 2003), which finds that consumers with no online purchasing experience perceive online shopping as significantly more complex both generally and in relation to specific issues of search (e.g. the lack of inspection) and purchase (e.g. ordering). The link between experience in online shopping and future online purchase is evident in statistics about Danes’ online usage as well. According to FDIH (Danish e-­‐commerce Association), two thirds of all Danes, who have experience with online shopping, would purchase from online channels again (Web R). 51
While experience in Hansen’s (2002) framework refers to online purchase experience as a moderator of perceived complexity during the shopping process, other authors typically refer to experience in relation to risk. Schoenbachler & Gordon (2002) state that internet experience (i.e. not restricted to online purchase, but to general use of the internet) reduces perceived risk. With the opposite approach, but the same result, Laroche et al. (2005) state that: “Consumers who do not have much Internet knowledge and experience may perceive online purchasing too mentally intangible and as a result the uncertainty of good/service evaluation may be further amplified by the feeling of insecurity in the technology used to facilitate the transaction” (p.264). Thus, uncertainty about the channel due to lack of experience may induce a sense of risk upon the entire shopping activity. With this overlap into the section on risk (5.4.1), we find that experience as a factor, though perhaps relevant for segmentation of consumers, will not produce conclusions for understanding consumer channel perceptions, beyond what we will find under Perceived risk. Also, seeing that the Danish population has relatively great internet experience (Danmarks Statistik, 2012), we do not consider complexity of e-­‐
shopping due to lack of experience a likely barrier for online prescription medicine purchase. 5.6.2 Accessibility
In relation to complexity, Hansen (2002) also briefly touches upon the aspect of, what we will call, accessibility. He identifies this as (inconveniences related to) navigation of a website or store, delivery, and payment and returns policies. If accessibility is impaired, consumers may perceive the channel as too complex and abandon the shopping process. According to Hansen (2002), this is particularly likely in the online channel where exit barriers are low. We have already discussed the ease with which consumers can obtain products in relation to the convenience of the channels (see section 5.4.1.3.2), and as such, Hansen’s (2002) understanding of accessibility somewhat overlaps with this section. The online pharmacy does, however, provide some possible case specific barriers to accessibility, which were not discussed in that context. Referring to apoteket.dk, both pharmacist, Thomas K. Nielsen (TKN & RB), and chief consultant in digital communication at Bysted, Mikkel Noe Westh (MNW), pointed out in our expert interviews, that the online pharmacy uses a large amount of systems to control the prescription purchase process. According to Thomas K. Nielsen ”Accessibility is impaired by all of these systems, and I think that could be a problem” (TKN & RB, 00:53:20). He mentions the tasks of providing personal information and choosing a physical pharmacy to trade with online as barriers to accessibility online. Mikkel Noe Westh from Bysted similarly stated that the task of logging in to the system makes the online channel more complex. He noted that 52
”Such a solution could be really easy – not with NemID, because that doesn’t work either – boom, here I am, and here is your prescription” (MNW, 00:24:18). The need for a NemID solution to purchase prescription medicine perhaps does seem to add to the complexity of the online pharmacy. There is, however, evidence that the Danish consumers are literate in using NemID in other cases. For example, Danish consumers are frequently forced to use NemID for e.g. borger.dk and their e-­‐banking solutions, and a report from NemID shows that the number of NemID transactions is continuously increasing (Web S). Furthermore, a total of 3.810.042 NemID identities exist, and they accounted for over 8 million transactions in June 2013 (ibid.). This means that each identity makes on average at least two transactions a month, implying that some experience with NemID must be present. Despite the possible complexity the requirement for NemID use might pose to the accessibility of the online pharmacy channel, we therefore find it reasonable not to include this as a significant driver of channel choice in the pharmacy setting. With these discussions, the possible implications of accessibility, as defined by Hansen (2002), are found to be either irrelevant or overlapping with other concepts in the framework in as far as they contribute to the understanding of channel attitudes in our case setting. 5.6.3 Complexity in a pharmacy setting
Based on the discussions in the previous sections, the potential findings deriving from experience or accessibility as factors of complexity are considered overlapping with other factors in the framework, and therefore would not offer essential case-­‐specific knowledge. Therefore, complexity as a factor for consumer channel choice in a pharmacy setting is not included in our framework. 5.7 Perceived Substitutability, Complementarity and Lock-in
In the group of factors that Hansen (2002) calls Perceived substitutability, complementarity and lock-­‐in, he addresses the ability to switch between channels and suppliers, and the extent to which consumers are locked-­‐in by their current behavior. When choosing shopping channel, Hansen (2002) suggests that (dis-­‐)synergies between channels can result in different perceived value of the online and the offline channel respectively. In relation to our research objective, this indicates that an understanding of the perceived relation between channels could affect perceived value of the individual channels and hence affect channel choice. As such, the ability to switch between online/offline channels, and the barriers and facilitators for this, may prove important in the investigation of channel choice. 53
In his 2003 study, Hansen has exchanged channel substitutability, complementarity and lock-­‐in with Trialability or divisibility, referring to Rogers’ (1995 in Hansen 2003) framework for the diffusion of innovations. However, Hansen himself rejects this as a relevant factor in the framework, due to the fact that most consumers have computer access allowing them to try e-­‐shopping15. In this thesis, we carry on with the original factor from his working paper, since the ability to switch between channels seems to have potential relevance in the study of online channel value in a multichannel setting. In Hansen (2002), no specific definitions are provided for the concepts of substitutability, complementarity and lock-­‐in. This chapter will attempt to provide definitions as well as discuss how and if these concepts affect consumer channel choice in a pharmacy context. But firstly, we reflect on the aspect of technological accessibility, which Hansen implies is a prerequisite for any form of channel relations. 5.7.1 Technological access
As an introductory note in this group of factors, Hansen mentions technological access, i.e. the access to computers or internet, as a prerequisite for complementarity, substitutability and lock-­‐in. Although a fundamental factor, this does not hold potential of groundbreaking findings in an empirical study, since almost all Danes have access to computers and internet. Over the decade that has passed since Hansen composed his framework, the number of Danes with internet access has increased from 71% to 86% (Web E; Web T). Therefore, we do not view technological access as a relevant research parameter in relation to our framework of channel attitudes in a pharmacy setting. 5.7.2 (Supplier) Lock-in
A central point made by Hansen (2002) in relation to the online channel is its low exit barriers. Hansen indicates that lock-­‐in occurs once the consumer has initiated a purchase through a particular channel, because switching faces them with the imperfections and inconveniences of different websites in relation to e.g. annoyances with the payment or malfunctions on the website. As a consequence, he concludes that consumers are unlikely to seek other online suppliers if they are content with previous experience with a particular supplier. With this argument, Hansen (2002) assumes that consumers become very habitual in their website choice, once they have found one they are satisfied with. As these conclusions imply, Hansen’s (2002) discussion of lock-­‐in is focused on the lock-­‐in with a particular online supplier rather than the lock-­‐in to an online or offline channel as such. While this understanding of lock-­‐in refers to why consumers choose one online supplier over the other, it fails to say anything about 15
Hansen (2002) does comment on accessibility of the internet, but regards this as a prerequisite for online complementarity or substitutability. 54
what drives consumers’ channel choice in a multichannel setting specific to one supplier -­‐ in this case Apoteket.dk by the Danish, licensed pharmacies. Therefore, though an interesting issue, it does not hold relevance in relation to our research question. We will therefore not include the factor of supplier lock-­‐in in our framework. However, the lock-­‐in to a particular channel may provide an understanding of channel choice. This issue is discussed in relation to the concept of substitutability, and the opposing concept of complementarity, in the following section. 5.7.3 Substitutability and Complementarity
In Hansen (2002), substitutability and complementarity are presented as two somewhat opposing concepts. Their applicability in a particular context (such as the pharmacy case) depends on the perceived (dis-­‐) synergies of cross-­‐channel behavior. In this section, we attempt to define both concepts and determine their relevance in our framework. While the factors described in the previous sections have been perceived as relative concepts describing differences or similarities between online and offline channels, complementarity and substitutability describe the perceived relation between the two channels. As such, these phenomena describe the interplay or lack thereof between the channels. 5.7.3.1 Substitutability
As well as being “locked in” to a supplier as described in the previous section, Hansen (2002) also indicates that consumers can be locked-­‐in to channels. He refers to this as substitutability. In referring to a study by Shim et al. (2001, in Hansen 2002), Hansen argues that information search on the internet has a significant positive influence on the propensity to make the transaction on the online channel as well. Hansen suggests that this could be due to the switching costs of using different channels for different stages of the shopping process. Therefore, Hansen suggests that the search phase and purchase phase should not be viewed as two separate parts of the shopping process, but rather as a whole. In this perspective, substitutability is the channel lock-­‐in that occurs, because it is easier to stay with the channel you are already in, than to switch. This point of view is also found elsewhere in the multichannel choice field. Both Gensler et al. (2007) and Verhoef et al. (2007) study the multichannel choices of consumers in relation to different stages of the shopping process and find effects of channel lock-­‐in. They thus define channel lock-­‐in as “the degree to which search attractiveness of channel A determines the purchase attractiveness of channel A, or vice versa” (Verhoef et al. 2007, p. 132). Gensler et al. (2007) label this spill-­‐over, saying that synergies can occur from the use of a channel employed at an earlier stage of the 55
process, because it reduces transaction costs and increases efficiency of time. Compared to Hansen, this approach seems to emphasize the benefits of staying more than the barriers of leaving a particular channel. Therefore, Gensler et al. (2007) appear to view substitutability as more of an active choice than passive habit. But both approaches indicate that advantages of a channel can be related to prior use. In a pharmacy context, the purchase process for prescription medicine starts at the doctor’s office, because a prescription is needed. Though this consultation does not take place in the pharmacy’s channels as such, it is part of the purchase process, and therefore, the doctor’s consultation can be viewed as an offline “search” channel. There is also a possibility that the consumer has started the search process online from home to determine whether to see the doctor or not. However, we do not consider this part of the actual purchase process, but a sort of pre-­‐pre-­‐purchase (as described in section 5.3), since the actual need for a prescription product is not determined before this consultation. Considering this, the pre-­‐purchase stage and search for prescription medicine will presumably not take place online, but offline at the doctor’s office. This being the rule, of course there are exceptions: First, in the case of repurchase of a prescription drug, which is regularly bought by the consumer, a visit to the doctor’s is not necessary. Therefore, a repurchase could theoretically begin with search online. On the other hand, the need to search is not likely to be extensive for a repurchase, and therefore, no search phase is present to create lock-­‐in. But since substitutability only refers to one channel substituting the other as the channel of purchase, the lack of a search phase in the purchase does not rule of substitutability. Second, for first-­‐time purchases, some consumers might engage in search activities after the doctor’s consultation, because they find value in checking up on the doctor’s choice -­‐ for example consumers with high perceived health literacy (see section 5.3). However, as the (offline) doctor is always part of this process complete substitution of the offline channel is not possible for first-­‐time purchases. Therefore online lock-­‐in, i.e. a substitution of the offline channel, could only potentially occur if it concerns repurchase of medicine. While the above discussed substitutability of the online channel for prescription purchases, we also must consider the possibility of the opposite, i.e. offline substitutability. As mentioned previously, the “offline” doctor is not per se a channel for purchase, but still the consumer is required to use this “offline channel” for the pre-­‐purchase stage (except in repurchase situations). Therefore, there is a possibility that an offline lock-­‐in is present from the doctor visit to the actual purchase, because both are considered “offline”. However, in terms of switching costs it is questionable whether the switch from doctor to pharmacy as compared to the switch from doctor to online pharmacy differs significantly. 56
On the other hand, as described previously, substitutability can also relate to passive habits. The offline channel is the channel traditionally used by consumers (given that the online channel is new compared to offline), and therefore, offline channel choice might be related to a habit resulting in lock-­‐in. Moreover, in a comparative analysis of channel lock-­‐in, Verhoef et al. (2007) suggest that levels of lock-­‐in differ online and offline. Contrary to Hansen (2002), their results show a low level of lock-­‐in in the online channel, which they indicate could be due to mental categorizations of the online channel as a search vehicle more than a purchase arena. Meanwhile, offline lock-­‐in is considered high, perhaps because consumers typically have high purchase intentions, when they have already made the trip to the store to search. In a pharmacy context, substitutability therefore provides one of the possible explanations for the lack of consumer adoption of an online channel, and will thus possibly make us able to understand consumers’ perceptions of the online and offline channel’s facilitation of prescription drug purchase. With this, we form the following definition of substitutability of online/offline channels in a pharmacy setting: “The use of one exclusive channel for an entire process, which can be caused by the benefits of staying or barriers of leaving the channel”. 5.7.3.2 Complementarity
Despite arguments about the possible substitution of one channel with the other throughout the entire purchase process have been presented, consumers may also perceive online and offline channels a complementing each other throughout the purchase process. Researching the so-­‐called research shopper phenomenon, Verhoef et al. (2007) provide a definition of channel complementarity suggesting that “attitude toward searching on channel A may influence attitude towards purchasing on channel B” (p.132). But Hansen’s (2002) framework indicates that the concept is more complex than that, in discussing two aspects of complementarity. While one refers to, what we will call, a functional complementarity, e.g. using the online channel for searching and the offline channel for purchasing, like defined by Verhoef et al. (2007), the other – what could be named a symbolic complementarity -­‐ represents the increased trust in the online channel that the existence of an offline channel can induce. These concepts are discussed in more detail and in relation to a pharmacy setting in the following. 57
5.7.3.2.1 Functional complementarity
While we described in the substitutability section that Hansen (2002) considers switching costs a barrier to cross-­‐channel behavior in the different stages of the purchase, several authors within the multichannel field of research suggest that a multichannel environment supports consumers with different functionalities during the different phases of the shopping process (e.g. Verhoef et al., 2007; Kollmann et al., 2012; Gensler et al., 2012: Wang et al., 2012).These studies have further shown that (at least some) consumers use different channels for different stages of the shopping process, e.g. researching online and purchasing offline. This is what Chiu et al. (2011) call free-­‐riding behavior. This is also sometimes referred to as “ROPO” (Google, 2011), and typically refers to research online and purchase offline. In a similar vein, Levin et al. (2003) find in an empirical study of channel choice that “online and offline features complemented each other in the mind of the consumer” (p. 90) at least for some products at different stages of the shopping process. This way, the functionalities of the two channels may in fact complement rather than substitute each other across the different shopping process stages. However, as described in the previous section, the purchase process of prescription drugs is different because of the doctor involved in the decision-­‐making. This means that the search phase is different from other products, since the doctor conducts most of the pre-­‐purchase decision-­‐making, such as search. This poses the issue of whether different channels can be useful for the consumer in different phases. When search is not used for finding the right product, because the doctor has this role, the consumer will not choose a channel for this, and therefore no complementarity is expected to exist. However, although the pre-­‐purchase phase includes a doctor’s decision on product, there are two situations in which some consumer search activities might still be present. First, “ROPO” complementarity could theoretically exist when consumers are offered substituting products, because these to some extent represent a choice made by the consumer him-­‐/herself. Though not as freely as for other products, the consumer is sometimes able to choose from several brands of the drug on the prescription. In such situations, the consumer may search online to gain information on alternatives, and later purchase in a physical pharmacy. However, for both the online and offline channel, the option of seeing the alternatives requires that the purchase has already been initiated. For example, in the offline channel, the consumer is only presented with substituting product options after asking for a specific product. Therefore one might not identify this as being part of the pre-­‐purchase phase. Theoretically, the consumer can initiate a purchase online to see an overview of the substitution products just before buying, and then cancel the purchase in order to make the actual transaction in a physical pharmacy. However, we do not view this as having significant influence on complementarity and hence channel choice. 58
Second, as discussed in the substitutability section, there is a possibility that consumers who are skeptical towards their doctors might search online after the doctor’s consultation. Therefore, there is chance, that functional complementarity with online search and offline purchase, can exist in a pharmacy setting. In relation to this, pharmacists Rasmus Borup and Thomas K. Nielsen noted in our interviews that ”Well, you can feel it when they come to the pharmacy…Many of the things they purchase are things they know they are buying in advance, or at least, what it is for -­‐ they have read that somewhere. And of course, they have used the internet for that.” (TKN & RB, 00:52:58), indicating the existence of a pre-­‐purchase stage, which does not take place through the same channel as the actual purchase in the physical store. However, this was not specifically mentioned in relation to prescriptions drugs, but it indicates a tendency in general health issues where consumers take more active part in curing themselves than before (see section 5.3). Therefore, we assume that some consumers might engage in such behavior. While the doctor has prescribed the product and thus leaves no product choice for the consumer, there is still a choice of whether or not to buy the product and trust the doctor. Therefore, we consider it part of the purchasing process to search online after the doctor visit, even though product alternatives are not an option, and therefore functional complementarity can exist in this case. 5.7.3.2.2 Symbolic complementarity and trust
Whereas Hansen (2002) seems to imply that complementarity of channel functionalities is not likely to be present in practice due to switching costs, he finds that – what we call -­‐ symbolic complementarity is likely to exist. As previously indicated, this entails that click-­‐and-­‐mortar setups can invoke a greater sense of trust, because the online channel lends credibility from the offline store – a conclusion that is also found in both Steinfield et al.’s (2002) and Saeed et al. (2003)’s studies of click-­‐and-­‐mortar synergies. According to Hansen (2002), trust issues typically occur when consumers are insecure about their own competences in choosing the right product or are unsure about the nature of the product. He mentions cars, insurance and loans as examples of the latter, because they are heterogenic products. Because heterogenic products are not as easily decoded as homogenous products, trust is needed. However, this would not be fully applicable in a pharmacy context because of the doctor’s role in the decision-­‐making. As described previously, the only situation in which the consumers need to choose without a doctor’s approval, is the potential choice between substituting products of different brands and prices. Therefore, the lack of competences to evaluate and decode the product is not necessarily as strong, as if no gatekeeper was included in the process. Hence the need for an offline source of credibility should 59
only be present in the case where consumers are asked whether they want a substitution drug (because cheaper options exist). However, in situations when consumers are not facing the option of substituting alternatives, we still believe that symbolic complementarity could have an influence on channel choice, regardless of the doctor’s role in the decision of the medicine. An issue that was raised in our interviews with the pharmacists, Rasmus Borup and Thomas K. Nielsen, was the lack of transparency online. Although we only study the Danish, licensed pharmacies and their online shop, several illegal web-­‐shops appear and disturb the picture of the safety of buying prescription medicine online. Thomas K. Nielsen suggested that ”The consumers have a lot of difficulty finding out when they are dealing with a Danish pharmacy and when it is just some..well..some web-­‐shop which is more about making some money” (TKN & RB, 00:55:40). This indicates that pharmacy consumers might be insecure about online pharmacies with no offline shop available. Therefore, despite the doctor’s role in the decision-­‐making, we argue that an offline channel holds potential as a credibility indicator for the online channel in a pharmacy context. 5.7.3.2.3 Definitions of complementarity
In conclusion, Hansen suggests complementarity is more likely to occur in the form of symbolic spillover of trust from the offline towards the online channel. While he does not perceive a high level of functional complementarity between online and offline channels due to switching costs, much literature in the multichannel field has found that this sort of complementarity is perceived to exist among consumers. In a pharmacy setting, we found arguments for the relevance of both concepts. Therefore, we will include both in the framework, based on the following definitions: Functional complementarity: “The ability of synergies to occur from the combination of online and offline channel (of not necessarily the same supplier) functionalities across the search and purchase stages of the purchase process”. Symbolic complementarity: “The ability of a supplier’s physical, offline presence/channel to act as an indicator of credibility/trustworthiness for the online channel of the same supplier, or vice versa”. 5.7.4 Substitutability, complementarity, and lock-in in a pharmacy context
With reference to the findings in the previous sections, we can conclude that technological access and lock-­‐
in (which was found to be related to suppliers rather than channel in Hansen, 2002) does not hold relevance for our framework. Instead, substitutability represents the scenario where the use of only one 60
channel is preferred (or possible). We find that both substitutability and complementarity of channels can occur in a pharmacy setting, why we proceed with both concepts as part of our framework. 5.8 Perceived communicative aspects
As the final factor affecting channel perceptions and choice, Hansen (2002) suggests perceived communicative aspects. He defines this as “the manner in which the internet is socially constructed in the consumer’s life” (p. 4). With this definition, he introduces the social environment of the individual as an influence on channel attitudes, and consequently on channel choice. In discussing social construction of the online channel, Hansen (2002) refers to a study, in which consumers who shared and received product information with peers online were more interested in the product than those who received information from manufacturers only (Bickart & Schindler, 2001, in Hansen, 2002). He concludes that the knowledge gained in social contexts is valued more, and thus, that social beliefs about a channel can affect consumers beyond the individual perceptions he relates to the areas of relative benefits and barriers, compatibility, complexity and complementarity/substitutability. In Hansen (2003), Hansen himself finds that aspects of communicability (which refer to the communicative aspects of his 2002 framework) only receive relatively low scores of importance to consumers in relation to channel choice in multichannel settings. He therefore concludes that normative social influence on online shopping in his case setting (groceries) is low. However, this may differ for pharmacy products. There seems to be a general consensus that both individuals, groups and institutions, with whom the consumer interacts, contribute to shaping consumer behavior (Hansen, 2002; Conrad & Barker, 2010; Pookulangara et al., 2011; MNW). In pharmacies, this may entail e.g. the pharmacies themselves, doctors, media, friends and family or patient communities. While a comprehensive discourse analysis to establish themes of the social construction of online/offline medicine purchase is beyond the scope of this thesis, we find that a few comments should be attached the matter at this point. According to Møldrup & Morgall’s (2001) study on modern drugs in a risk society setting, “risks associated with modem drugs are induced by socially constructed technological artefacts and are capable of producing risk on an objective as well as on a non-­‐objective global level” (p.72). Generally, it does seem that the issue of risk is a central theme in the debate about medicine in society. In relation to channels of purchase in particular, stories about prescription drugs sold online without prescription and dangerous counterfeit products are numerous (e.g. Web U; Web V; Web W; Web X), and state institutions warn about the dangers of engaging in online prescription purchase (e.g.Web Y). Though the Danish Health and Medicines Authority explicitly recommends the official online pharmacies as a purchase channel for 61
consumers who want to buy medicine online, the general image projected in the media seems to be that online purchase is a complex and dangerous endeavor. Even in our expert interviews, the pharmacists, Rasmus Borup and Thomas K. Nielsen, considered an online pharmacy highly complex because of the elaborate systems safeguarding medicine purchase (e.g. prescriptions and reimbursement structures). While all of the above provides interesting insights as to how consumer opinions occur, they all link to the concept of risk in one way or the other. With this, although communicative aspects (i.e. the social construction of pharmacy purchases) provides an understanding of why consumers may find prescription medicine and online pharmacy purchase risky, we find that this does not add substantially important knowledge to our framework, since perceived risk is already included in our framework as an independent factor (see section 5.4.1). Furthermore, a study of the social construction in relation to channel choice would preferably include a comprehensive discourse analysis of the modes of articulating medicine and medicine safety in different channels. This is beyond the scope of this thesis, and, therefore, while we acknowledge that social construction might take place, we will not study how this comes about. Therefore, perceived communicative aspects will not be included in our framework. 5.9 Conceptual framework
Based on the discussions provided in the previous section of the Theoretical Background chapter (5.0-­‐5.8) we propose the following framework as the frame for our empirical study. The framework will function as a guideline for our interview design as well as our analysis. 62
Fig. 8. Conceptual framework (Source: Own Creation inspired by Hansen’s (2002) framework) 63
With reference to the conceptual framework provided here, three sub-­‐questions are proposed for guiding our empirical research (also see Research question, section 1.2). Fig. 9. Conceptual framework and sub-­‐questions (Source: Own creation) 6. Research design
While we in the previous chapter made a revised conceptual framework, we will in the following explain how we collect the primary, empirical data. The research design will be based on the revised framework and consist of qualitative interviews with 4 consumers. 64
6.1 Qualitative versus quantitative research
For the empirical study, a qualitative approach has been chosen for the data collection. As our approach contains the dependent variable perceptions of the online and offline channel’s facilitation of prescription medicine purchase and some independent variables (the framework factors), a quantitative study could have measured the significance of each of these factors from a big sample of consumers through a questionnaire. However, this would have a restrictive effect, because the answers would be limited to our design of the questionnaire, hence allowing no new discoveries or deeper understanding of the answers. As we are researching a rather unexplored field and therefore consider this research as initial findings, measurement was deemed inadequate. Therefore, in line with our hermeneutic approach, the qualitative study will provide a deeper understanding of consumer insights and the nuances and subtleties related to this (McGivern, 2006). Moreover, the relevance of a qualitative study in the chosen problem field seems high. In a report about tendencies in consumer health behavior, Jeppesen (2009) notes that remarkably few qualitative studies with a business administration focus on a deep understanding of consumers’ perceptions about health and medicine and the resulting behavior, exist. The existing ones contribute to the sociological tradition rather than having s business administration starting point. 6.2 In-depth interviews
In-­‐depth interviews were chosen as the method of data collection. Several reasons drive this choice. Firstly, we find it likely that prescription drugs are by many considered a private matter, and therefore, focus groups were not considered appropriate. Second, in-­‐depth interviews were considered the most appropriate data collection method, because it allows thorough answers and detailed descriptions of the consumers’ lifeworlds and thoughts behind their behavior (Kvale & Brinkman, 2008). In the following we will reflect on the choice of respondents for the interviews. Each interview is transcribed in its full length and attached to this thesis on USB (see appendices 3-­‐6). As the interviews were conducted in Danish, we have translated the quotes used in the analysis, whereas the transcriptions remain in the original language. As we find that the translation of some quotes could slightly alter the meaning of the original quote, we have referred to the Danish quote each time one was mentioned. These are numbered and can be seen in appendix 7. 65
6.2.1 Respondents
Since the aim of our research is not to generalize, but rather to understand individual perceptions, we have employed a purposeful sampling approach for interview respondents (Daymon & Holloway, 2011; Harboe, 2010). This allowed us to choose respondents based on common (or differing) characteristics which make their point of view valuable to the study. The choice of respondents was first of all based on their knowledge of and/or experience with the www.apoteket.dk as a pharmacy purchase channel, because we found that consumers unaware of the online option would not perceive the pharmacy as a multichannel setting. As such, they would not have formed an attitude towards both the online and offline pharmacy, and any contributions would be formed on the basis of hypothetical and normative thinking. Therefore, consumers unaware of the online pharmacy’s existence would not contribute to a reliable understanding of channel attitudes. As a consequence of this delimitation, however, our pool of potential respondents was very limited, because so few consumers are aware of the online pharmacy’s existence. As such, the problem motivating our research also presented a significant constraint for it. With these limitations, we found that a criterion of at least two users and two non-­‐users (who, however, should all be aware of apoteket.dk’s existence) was reasonable, since this would allow us to explore multiple perspectives on the issue, while still going in depth with each respondent’s perceptions (Daymon & Holloway, 2011). The respondents were found through social media sites, such as LinkedIn and Facebook. The respondents are therefore part of our extended network, but not direct acquaintances. With this distant relation, consumers were not distracted by the fact that their medical history could be exposed to their social circle, but also felt that we could be trusted. Due to the limited pool of potential respondents, the four chosen respondents are rather homogenous, all being females, and either younger than 26 or older than 54. We did, however, manage to include both respondents with serious, continuous prescription needs (e.g. with chronic treatment-­‐requiring illness), respondents with continuous, but less severe prescription needs (e.g. birth control pills) and respondents with only sporadic prescription needs. As such, our pool of respondents includes different consumer types, providing us with a broad perspective on channel perceptions among consumers. 6.2.2 Interview design
In order to support our explorative approach to the research, the in-­‐depth interviews were conducted in a non-­‐directed form. In non-­‐directed interviews the respondent is given the freedom to respond, within the bounds of topics of interest to the interviewer (Schmidt & Hollensen, 2010). In order to get an unbiased 66
picture of the thoughts and opinions behind the respondent’s behavior, the beginning of the interview focused on introductory and open questions with focus on short questions and long answers (Kvale & Brinkman, 2008). The respondents were encouraged to talk freely and from the top of their heads about online shopping habits, prescription medicine, and online prescription purchase. Due to this free form of the interview, the interview guide (see appendix 8) only consisted of the themes from the framework that we needed to cover, as well as some suggested questions to support our direction of the interviews. However, no strict order was followed, as the respondent’s initial stories laid the foundation for the sequence of topics. The majority of questions asked during the interview were spontaneous, probing questions, such as ”Can you tell us a bit more about that situation?”, in order to get a detailed understanding of the introductory answers (Kvale & Brinkmann, 2008). The interview only later included follow-­‐up questions, interpreting questions and only few direct questions (ibid.). The success of a non-­‐directive interview depends on three things according to Schmidt & Hollensen (2010). First, a relaxed and sympathetic environment should be established in the interview situation. In order to meet this criterion, we conducted the interviews at home, or in the respondent’s own home. Furthermore, before starting the actual interview, we initiated a conversation about something else than the interview topic, in order to make the respondent comfortable. Moreover, we initially told the respondent that they were anonymous, that no answers were wrong, and if they felt uncomfortable answering a question, they should feel free to refrain from answering it. Secondly, the interviewer should be able to clarify and elaborate on the respondent’s stories without bias (ibid.). In the interview sessions, we were therefore aware of letting the respondents explain themselves, and only intervene if the respondent was unclear. It did however prove difficult in cases when the respondent was not very talkative, and therefore some paragraphs of the interviews, became more structured. Moreover, considering our hermeneutic approach, a pre-­‐understanding from the interviewer is inevitable, and completely unbiased questions are therefore not a possibility. Lastly, the interviewer should be able to guide the discussion back to the topic when digressions are unfruitful (ibid.). The interview guide ensured that all topics were covered, and guided the discussion so that the respondent did not talk about irrelevant issues. However, in order to ensure new discoveries or aspects we did not expect to come up, we allowed for a certain amount of off-­‐topic content, before directing the respondents in other directions. It should be noted here that this interview strategy was affected by our inexperience as interviewers. We have therefore also conducted a pilot interview, as well as rehearsed the interviewing together, which we describe further in the following section. 67
6.2.3 Pilot interview
In order to test the interview guide’s practical usefulness, and our own skills as interviewers, we firstly rehearsed the interview technique with each other in order to become comfortable with it before doing the interviews. Moreover, we conducted a pilot interview. The respondent was initially meant to be part of the respondents, but as we found out that he had bought his prescription products on a foreign website, we decided that the interview with him should serve as a pilot interview. We found that during the pilot, the respondent often referred to what was ”politically correct”, rather than answering from his own perception. With the following respondents, we therefore followed up on general or normative statements and phrases, and asked respondents to describe their own perceptions about the subject. 6.3 Quality of research
Validity and reliability are terms commonly used to describe and secure quality (Kvale & Brinkman, 2008). The validity of the research concerns whether the thesis investigates what it intends to investigate (ibid.). According to Yin (2003), the validity of a study can be divided into three types: Construct validity, internal validity, and external validity. We will therefore discuss validity in each of these three areas. Second, the reliability deals with the consistency of the research, which means that we in this respect will reflect on whether the study can produce the same results if carried out by other scientists (Kvale & Brinkman, 2008). 6.3.1 Construct validity
Construct validity describes whether or not the research was carried out on the basis of a sufficiently operational set of measures (Yin, 2003). In order to reach a convergent line of inquiry, and hence construct validity, the factors included in our framework for empirical study all have clear definitions that were reached through discussion of the factor in a pharmacy context. Qualitative studies often include research of unobservable phenomena and abstract constructs (Schmidt & Hollensen, 2010). In order to secure construct validity, these phenomena need to be studied by less abstract constructs. According to Schmidt & Hollensen (2010) research has construct validity ”if it measures an observable phenomenon that an underlying theory correlates with the construct of interest” (ibid., p.129). Therefore, we have broken down unobservable phenomena into more observable ones that are theoretically demonstrating the presence of the abstract construct (ibid.). For example, perceived risk is an abstract construct composed by less abstract constructs such as financial, social, performance and physical elements, that are theoretically demonstrated as constituting perceived risk. According to Yin (2003), another tactic to increase construct validity is to use multiple sources of evidence. In the creation of our conceptual framework, our deductive reasoning was based not only on our own pre-­‐
68
understanding, but also on expert interviews. Furthermore, we used theoretical and empirically tested literature about channel choice and multichannel environments, as well as literature from the pharmacy field, and statistics and reports about the subject. Therefore, our deductive approach based on multiple sources will increase the likelihood of valid factors and hence construct validity. 6.3.2 Internal validity
The internal validity concerns whether the inferences made in the study are valid (Yin, 2003). However, as we are not conducting an explanatory study measuring significance of causal relationships, but rather doing an explorative and descriptive study, Yin’s tactics to ensure internal validity are not applicable in our research (ibid.). However, an explorative and descriptive study must also have internal validity in its execution, although it does not concern inferences about measurable relationships. A qualitative study must be conducted in a manner that rules out extraneous factors, and thereby studies what it is meant to study. We will therefore draw on Kvale & Brinkman’s (2008) tactics to ensure internal validity in a qualitative study. They suggest a process validation, indicating that validation permeates the entire process (ibid.). In order to meet the internal validity in all steps of the process, several aspects have been considered. First, in the thematization phase, we have ensured logic in the derivation of the study’s theoretical prerequisites, which was described in the section about construct validity (section 6.3.1) (ibid.). Furthermore, we ensured an appropriateness of research design as reflected on in section 6.1 and 6.2. In terms of validation in the interview phase, we used interpretative questions (ibid.) to increase internal validity (such as ”so you mean that…?”), when the meaning of the answer was considered ambiguous or when respondents used general terms to answer our questions. As the aim of the study was to investigate the perceptions of the respondents, we further ensured that this was the case, in order to increase internal validity in the execution of the interview. As mentioned in the section about our pilot interview, it became clear to us that the pilot respondent very often answered questions beginning with expressions like ”one should”, instead of answering from his own point of view and way of doing things. This indicated to us that the topic of medicine purchase was a sensitive topic, in which the respondent found that ”politically correct” answers existed, and that his own actions probably deviated from this. This is often termed social desirability bias (McGivern, 2006), indicating that respondents’ responses will express what they think is the correct answer according to social norms. As we found that this term was evident in our pilot interview, we were very aware of this issue in the following 69
interviews. In order to ensure ”real” answers, we made sure to ask about their own opinions if we found that their answers were biased by social desirability, and thereby increasing internal validity. In the transcription phase, validation was done through carefully transcribing every word in the interview, and all transcripts were done by the same person to avoid differences that would influence internal validity (Kvale & Brinkman, 2008). On the basis of the above we have therefore installed precautions throughout the research process, in order to minimize risk of internally invalid research. 6.3.3 External validity
The external validity describes the generalizability of the research. Yin defines it as “whether a study’s findings are generalizable beyond the immediate case study” (Yin, 2003, p.37). In general, results of case studies, and in particular qualitative case studies, can be difficult to generalize to other cases, because of their case-­‐specific nature. However, the aim of generalizing stems from a positivistic tradition, in which one strived towards truths that were universally generalizable (Kvale & brinkman, 2008). In the postmodern tradition, a shift from generalization to contextualization has occurred. This means that with our hermeneutic approach, we do not primarily seek to be able to generalize these findings beyond the case, but rather understand the case in itself. Flyvbjerg (2006, in Kvale & Brinkman, 2008) note that a general misunderstanding about case studies is that they are not useful, because general, context independent knowledge is more important than concrete, context dependent knowledge. However, when operating with a hermeneutic approach, a universal truth and objective world is non-­‐existing, and hence context dependent knowledge becomes of more value than general knowledge (Kvale & Brinkman, 2008). The Danish, licensed pharmacies should through this case study gain useful insights and knowledge about consumers’ channel choice. Therefore, whereas generalization is not the goal due to our hermeneutic approach, we do however wish to get a deep understanding of consumer attitudes towards the online and offline pharmacy channel. This concerns the practical implications, i.e. the deductive conclusions. The Danish, licensed pharmacies should through this case study gain useful insights and knowledge about consumers’ channel choice. However, we are also testing whether the revised framework is deemed appropriate for this type of context (Daymon og Holloway, 2011). The inductive part of our research concerns the revision of the framework on behalf of the case-­‐specific empirical findings. In that respect, the strength of the revised 70
theoretical framework needs to be considered, because the aim of revising a framework to a case-­‐specific context is that it can be used for cases with similar characteristics. It has however not been possible to reach a number of interviews that allowed a point of saturation where no variation was present, due to the scope of the thesis. We have however obtained the following precautions to increase external validity. As described in section 6.2.1, We have been careful in selecting respondents. By choosing both respondents who have chosen the online channel, and respondents who have chosen not to use the online channel, we have obtained knowledge about both types of channel choice. Moreover, we chose respondents that we to some extent knew had differing perceptions of the case, in order to get a broader spectrum of answers. Despite these precautions, the findings are to be perceived as initial, and further testing is needed to ensure external validity (see section 9.0 in which we will elaborate on this). 6.3.4 Reliability
The reliability of a research concerns the consistency, and hence the replicability of the research (Kvale & Brinkman, 2008). In a quantitative study, surveys should be designed in a way that enables other scientists to reach the same answers. However, in a qualitative study the interviewers are the data collection instruments and hence the objects of replicability. It therefore becomes more difficult to obtain reliability (ibid.). This is due to the assumptions of our hermeneutic approach, because we acknowledge that we as interviewers have different backgrounds and pre-­‐understandings, and thus are part of the knowledge creation ourselves. Therefore, reliability is not as salient as validity in a qualitative study (Daymon & Holloway, 2011). A tactic to pursue reliability in a qualitative setting is, however, to follow and explicate an audit trail (ibid.). In this respect, we recorded the interviews (please find the sound files attached on USB) in order to document our interview style. A possible issue in relation to this is that while we both were present at the interviews with Villads and Pernille, Katrine carried out the interview with Karen, whereas Anne Sofie carried out the interviews with Julie and Lise. This might have affected the responses, but because both participated in the pilot interview, we were able to establish an overall interview style which we attempted to replicate in the other interviews. However, as the interviews were unstructured and to a large extent formed by the respondents initial stories, the interviews were very much characterized by being led by the respondents rather than the interviewers. This might actually be a benefit in a hermeneutic study, because this allows the interviewer to ”follow up on promising new feelings” (Kvale & Brinkman, 2008, p.272), 71
which, according to Kvale & Brinkman, is important in qualitative studies. A too strong focus on reliability might therefore in fact be harmful to creativity (ibid.). 7.0 Analysis
In this section, we present a cohesive analysis of our qualitative data from the interviews. In this, our findings are presented and related to the pharmacy specific framework presented in section 5.9. The analysis is structured according to the categories of the framework, and we therefore discuss respondents’ perceptions of first benefits and barriers, then compatibility, and finally complementarity/substitutability of online and offline channels in the purchase process for prescription medicine. Since each of these categories relates to one of our sub-­‐questions, we will provide a preliminary conclusion for each category. Based on these three overall parts of the analysis, we attempt to establish possible relations between the consumer attitudes towards online and offline purchase of prescription medicine and the factors of our framework. Before we begin the analysis related to the framework factors, we provide a characterization of the respondents based on our interviews. The characterizations provide basic demographics, but also information about general purchase patterns and online usage, as well as understandings of their perceptions of empowerment and health literacy in relation to medicine. This provides knowledge about the respondents, which allows us to gain further understanding of their behavior. This way, we can relate our findings to the respondents’ perceptions of roles and responsibilities during prescription purchase. 7.1 Respondent characterizations
To initiate our analysis, we use our interview data to characterize our respondents. In table 1 these characteristics are presented thematically trough demographics, online shopping habits, patient profile, and purchase through Apoteket.dk. 72
Name Lise Karen Julie Pernille Age Occupation Residence Housewife, Nyborg former nurse Lives with Frequent, husband foreign shops, and son (15) large quantities, personal care, clothes, food, dietary supplements, Generally price oriented, Retired with Lyngby Parkinson’s Lives with husband, 2 grown kids 54 56 24 Household Patient Online shopping profile No chronic illness, purchases medicine sporadically Frequent Diagnosed search/purchase, with price oriented Parkinson’s, purchases medicine regularly Purchase through apoteket.dk No experience, but knows about apoteket.dk 2 experiences (neither successful), ordered for pick-­‐up at local pharmacy Student and Frederiksberg Lives alone, Rare, seeks working in no kids human advertising interaction, price oriented No chronic illness, purchases medicine sporadically, (birth control regularly) Student Chronic 1 experience illness, (non-­‐
purchases prescription) medicine sporadically (birth control regularly) Frederiksberg Lives with boyfriend, no kids 26 Frequent (60/40 online/offline), information search, pass-­‐
time activity No experience, but knows about apoteket.dk Table 1. Characterizations of respondents In the following, we first present the respondents separately and then summarize their perceived empowerment and health literacy, to provide a contextual understanding of the respondents’ perceptions of prescription purchase. 73
7.1.1 Lise
7.1.1.1 Online shopping in general
Lise purchases many different products online, ranging from clothes to food. She often buys from foreign websites and/or in big quantities in order to save money. She considers herself a loyal and ethical consumer, and also describes these traits as guiding of her shopping habits. 7.1.1.2 Perceived health literacy and perceived empowerment
Lise’s background in the health industry is apparent throughout in the interview. She uses professional jargon (e.g. “ketogan”, “morfika”, and “tetracyklin”), and mentions herself that this perhaps affects her interaction with health professionals. Referring to a visit at a dermatologist she says that: “I may have used language or terms which have made her think that perhaps I was part of “the system””(Q1). However, throughout the interview, Lise’s answers are not extreme as compared to the other respondents, and for example, she states that “you think that you are able to sort it [information, red.], but perhaps you are not”(Q2). As such, her background seems to make her neither more nor less confident during the shopping process. Though Lise generally has confidence in health professionals, she considers it her responsibility to evaluate side effects and take a critical stance, because “people are different”(Q3), and her perceptions of acceptable side effects may differ from someone else’s. Lise therefore feels that she needs to know more than the doctor tells her, and uses statistics to obtain this. Therefore, Lise’s perceived health literacy and perceived empowerment are high. However, while perceived empowerment is high because she thinks she has the responsibility to check up on side effects herself, she does not question the pharmacist’s competence. Therefore, her perceived empowerment has to do with knowing what is going on, rather than knowing better than the pharmacists. 7.1.2 Karen
7.1.2.1 Online shopping in general
Karen is used to buying products online, and buys for example books and electronics online. She is generally price-­‐oriented in her online shopping, and always looks for free delivery when comparing different websites. 7.1.2.2 Perceived health literacy and perceived empowerment
Because Karen is chronically ill with Parkinson’s disease, she is very knowledgeable about the prescription medicine she takes regularly and about the process of purchasing it. When in need of a new prescription, 74
Karen is the one asking her doctor to make the prescription for the medicine on her own initiative, because she believes she knows more about her own illness than the doctor. She also often feels she needs to correct or control the pharmacists, because they seem somewhat incompetent to her. She describes herself as a “control freak”(Q4) in relation to this. Karen engages in search online every time she has purchased a medicine product, and does not take the medicine prescribed by her doctor if she finds out that there are disadvantages related to the drug. For example, her doctor had prescribed her hormone pills, which she decided not to take, without notifying her doctor. She says that this is due to the fact that she “questions what I put in my mouth, and that I not at any cost want something against what is wrong with me. It could be that there was another solution that was the right one, right”(Q5). On the basis of the above, we consider both Karen’s perceived empowerment and perceived health literacy as high. 7.1.3 Julie
7.1.3.1 Online shopping in general
Generally, Julie describes herself as an extremely price-­‐oriented and worried consumer, who rarely shops online. She is aware of the opportunity, but likes to be able to inspect the products before purchase. Therefore, when she on rare occasions purchases something online, she has typically seen the product in real life first. She finds comfort and security in the human contact in a purchase situation, and therefore often calls the online shop during a purchase. She is very conscious of her perceived deviation from other young people, but explains it with: “Well, I’m old-­‐fashioned. (…) I’ like things that are in physical shops”(Q6). 7.1.3.2 Perceived health literacy and perceived empowerment
Julie trusts her doctor’s decision and says that ”I would never say ”well, you said so and so, but now I am going to try and find an alternative solution””(Q7). However, she does seek information both prior to a doctor’s consultation and after she has purchased the product, to “take a critical stance – or try to, at least”(Q8). For example, if she has seen something in the media about her birth control pills, she confronts her doctor to get his assessment of the case. However, she blindly trusts her doctor’s judgment in this. In the patient-­‐consumer dichotomy, Julie therefore can be seen as more of a patient. She has a firm belief that it is the doctor who should assess her health as an expert, and that the pharmacist ”takes over” after the doctor consultation and does not hold the same level of competence. This indicates that she wants someone to “look after her” throughout the entire purchase process of prescription drugs. Therefore, both her perceived empowerment and her perceived health literacy are low. 75
7.1.4 Pernille
7.1.4.1 Online shopping in general
Pernille is a very frequent online shopper. Her own estimate is that 60% of everything she buys is online. She likes to search online and finds it entertaining, and she can use a lot of time browsing different websites before purchase. She buys almost everything online, except for shoes. She finds it convenient to purchase online, because it does not require the same effort in the search phase, and she considers herself impulsive and thus want to be able to search and/or purchase immediately, which she finds the online channel provides the opportunity for. 7.1.4.2 Perceived health literacy and perceived empowerment
Pernille generally only goes to the doctor if she can’t fix it herself at home. This indicates that her perceived empowerment is high. Apart from a recent bad experience, in general, she trusts her doctor and his choice of prescription drug. During the interaction with the doctor, she does not feel particularly empowered. But she has a different experience of the pharmacy: “I don’t necessarily think that the people at the pharmacy seem like they just have the truth about these products”(Q9). Moreover, she finds that the pharmacist is just trying to sell her something, indicating that she sees herself as a consumer, and not a patient, at the pharmacy: ”But I do know that things are being stocked at the pharmacy, that it is not necessarily because the pharmacist-­‐lady thinks that ”uh, I want to do what is best for you, so I recommend this product”. It is because someone is selling something to the pharmacy, which she has an interest in re-­‐selling”(Q10). On several occasions, Pernille describes the pharmacist as “irritating”(Q11) and herself as “skeptical”(Q12), and she does not find the pharmacists competent, because, she believes, they go to the same website as she would do for information. As such, she does not have great trust in the pharmacists, and therefore goes online for further information. However, at the same time, she says she would be “one big question mark”(Q13) if she had to search for information about prescription products. Therefore, Pernille seems very ambiguous about her own role and the role of the pharmacy in prescription purchases. On the one hand, she perceives herself as an active party in the purchase, but she also confirms that she takes on this role out of need rather than out of desire, when asked. And she clearly does not feel competent for this role. Thus, while she feels (forcibly) empowered, she also finds her own health literacy too low to fill this role. 76
7.1.5 Perceived empowerment and perceived health literacy
In the matrix below, the respondents have been placed according to their perceived empowerment in a prescription drugs context, and their perceived health literacy. These placements are based on the above characterizations, and will provide the further analysis of factors with a deeper understanding of the respondents’ answers in relation to the framework factors. Table 2. Respondents’ perceived empowerment and health literacy (Source: Own creation) 7.2 Perceived benefits and barriers of online and offline purchase
In our framework, we found that attitudes towards online and offline pharmacies may be affected by the perceived benefits and barriers of the channels. Different types of risk were discussed as possible barriers, and a number of potential risk relievers were suggested as benefits potentially outweighing the barriers. This section is directed towards answering sub-­‐question 1 of our research question: What relative benefits and barriers does the consumer perceive the online and offline channels as having? 7.2.1 Perceived risk
In our interviews, we found that all respondents seemed to link prescription purchase and risk, but in relation to different types of risk and with varying perceptions of likelihood and importance. We proceed with an analysis of the possible linkages between prescription purchase and each of the risk types from our framework. We identify possible risk relievers first for perceived performance risk, then for perceived financial, social, and resource-­‐related risks. With this, we attempt to determine the effect benefits and barriers are perceived as having on the channels’ abilities to facilitate prescription purchase. 77
7.2.1.1 Perceived performance risk
Performance risk was defined as “the consumer’s perceived probability that the product purchased does not fulfill pre-­‐defined expectations, or may even provide unwanted side effects” in the theoretical background. In our interviews, all respondents express concerns about side effects related to prescription drugs, and hence all perceive a performance risk as being present. It seems, however, that they relate it to differing levels of likelihood and importance. Julie questions whether prescription medicine is harmful to her, and if it is ”smart” to use it. In that respect, she mentions the word ”consequences” continuously throughout the interview. While Julie is also in general a concerned consumer, this is also the case for Karen, who is generally less concerned. Karen states that ”Of course it is also important, if I purchase a washing machine online, that it works, but the consequences are not so severe. I mean, I won’t drop dead from washing my clothes in it. But I can drop dead if I get the wrong pill”(Q14). Their wording indicates that Karen and Julie both consider the consequences of the performance risk very serious. While Lise does not directly mention consequences, she is still very aware of the side effects of different prescription drugs. She expresses that she feels “a great responsibility […] deciding if you want to risk the side effects”(Q15), more than a need to do it. Whereas Karen and Julie are quite dramatic in their description of performance risk, Lise’s description is more moderate and factual – she seeks “a sense of whether this is something that has happened once or if it has happened thousands of times”(Q16) and even for serious consequences, she uses more rational language (e.g. “systemic side effects”(Q17)) rather than the more dramatic “death”, as Karen. Pernille also talks about side effects, and expresses concern that a prescription drug she has purchased for a skin rash may make the rash worse. She mentions that the fear of these side effects makes her skeptic about the advice (and prescription) she has been given, and says that she considered not using the product. However, the risk was not considered so important that it actually changed her behavior, because she did use it anyway. Therefore, while different perceptions of the severity (importance) of performance risk are expressed, all seem to find it present. But while Karen’s and Julie’s statements seem to indicate that they both perceive the likelihood and importance of side effects as high, Lise finds that risks of side effects seem more severe and likely in the product leaflet than what she perceives as the reality. As such, she is very reflective about the difference between her own risk perception and the formal risk. Pernille seems more ambiguous about the likelihood of performance risk, as she on one hand says that she feels very skeptic about her skin rash 78
product, but on the other says that she is using it “in lack of a better option”(Q18). This indicates that she does not find the performance risk particularly immediate. 7.2.1.1.1 Perceived risk relievers for performance risk
The respondents refer to different sources of risk relief in relation to performance risk. For Julie, her perceived risk of side effects is moderated substantially (if not completely) through professional counseling. While the respondents all express that counseling is important, Karen, Pernille and Lise view the professional (pharmacist) as less of an authority than Julie, and question the pharmacist’s ability to make “the right” decision for them. Lise refers to the fact that “people are different”(Q3), to explain why she feels she needs to apply her own knowledge to reduce risk, rather than accept what she clearly feels is a “generic” risk assessment from the doctor. In this context, her professional background in medicine probably also contributes to her sense of risk relief, because her perceived health literacy is high and she feels able to assess available information from product leaflets and online sources. In spite of Pernille’s view of the pharmacist as a partner, who supplies her with knowledge, she does not find the pharmacist sufficiently knowledgeable to fulfill this role. Therefore, the professional counseling does not relieve her of uncertainty, but quite contrarily, seems to increase it: “I felt like the pharmacist-­‐
lady, she was like “oh, you want this lotion?”, like, “wow, are you sure this is what you want?”. And of course, that makes me a little “well, what is it?””(Q19). She directly states that she does not feel like the pharmacist has “the truth about these products”(Q20). Therefore, she also searches for additional information, and applies her own knowledge to reduce uncertainty about performance risk. Similarly, Karen feels that the pharmacist is not competent. Though she says that she trusts the pharmacists if they “swear” or “guarantee”, she also feels that she must be in control of the situation at all times, and as such uses control as a method of risk relief, especially when it concerns her regular medicine. To obtain control, she inspects the product during purchase, and thus uses her own health literacy to evaluate information on the package. Furthermore, she finds that getting the order into writing instead of speaking to the pharmacist may reduce performance risk, because this increases the chance of getting the right product. 79
7.2.1.1.2 Performance risk in online/offline channels
Julie does not want to ”put her life in the hands of” someone she has not interacted with physically. Therefore, the face-­‐to-­‐face counseling in an offline pharmacy provides her with value in terms of eliminating or minimizing perceived physical risk: “You can sort of spar a little. Have a living being, who sort of confirms or invalidates the thoughts you might have about it”(Q21). An online chat function with the possibility of talking to someone would not provide the same value for Julie, only for minor questions where the ”consequences are not high”. Therefore Julie favors the traditional pharmacy. Even though the others also describe counseling as important, the “human side” of the pharmacist seems to leave both Karen and Pernille doubting the abilities of the pharmacist, i.e. the opposite reaction of Julie’s. Karen is afraid of human errors and therefore finds the online channel attractive: “Well, I thought it was really smart, because here we have on writing what I need to have. I don’t need to call them and say “Hello, I need 10 mg” and “did she then say 10 or did she say 100”. It simply says, I need this and that medication, I want it at that pharmacy, and it should be ready like this and this. That’s what attracted me”(Q22). Whereas Karen is skeptical towards the advice in the pharmacies because she feels she knows better than the personnel (i.e. because she has a high perceived health literacy), Pernille, on the other hand, is skeptical because she has a low perceived health literacy, and cannot assess if the pharmacist is telling her the truth. In some manners the direct interaction even seems to increase her perception of risk by allowing her to sense the body language and (lack of) conviction of the pharmacist. Therefore, in Pernille’s and Karen’s case, the performance risk may be a barrier to the offline channel, because they do not find it relieved properly. For Pernille, but also Karen and Lise, this means that the natural next step when having visited the offline pharmacy, is to search online on her own: “..and then of course I go home and look it up online”(Q23). However, both she, Lise and Karen refer to other sites than apoteket.dk, when asked about this search behavior (e.g. google.com and netdoktor.dk). Only Karen seems to use apoteket.dk as a reliever of performance risk, in using it to control the process. She feels that this is a way for her to make sure that the pharmacists do not make mistakes, leading to unintended effects on her health. But while the online channel is perceived as allowing her to control the process, she also goes to the offline pharmacy to pick up her order, so that she can control the product before she gets home. As such, the direct inspection of the offline channel in combination with the ability to put the order into writing online makes Karen feel less performance risk. With this, performance risk seems to affect the respondents’ perception of the channels’ facilitation of prescription medicine purchases. Whereas Julie finds the performance risk to be a barrier to the online 80
channel, Karen and Pernille experience that it is a barrier to the offline channel, and therefore use the online channel in combination with the offline. Lise does this too, but more out of obligation/responsibility than out of a perceived need to reduce risk. 7.2.1.2 Perceived financial risk
In the framework, we defined financial risk as “The possible economic loss, which can be related to a wrong purchase decision”. In the following we seek to examine the respondents’ perceptions of this. While all of the respondents mention price considerations when asked about substitution, most of them also seem to focus on the quality of the product, rather than the price, when making this trade-­‐off. Karen only views price as a secondary factor, stating that “usually I have asked the doctor to note that it (her medicine, red.) cannot be substituted, because I have heard there can be small differences”(Q24) and that she only accepts substitutions when the pharmacy does not have the prescribed product in stock. Therefore, it is not her own choice to get the substitution drug, but rather a necessity. This, however, only seems to be the case for the product she usually takes (for chronic disease). For other products, she has “started saying yes”(Q25) to substitution, because it saves her money, and she does not consider the performance consequences as important as with the medicine she takes regularly. This means that the weighing between performance consequences and financial consequences is done continuously with new products. This is also the case with Pernille who says she accepts a substituting product because: ”I find myself thinking, how can the price difference be so big, but you’re also like, that “I am not paying so much for some product””(Q26). She mentions a situation where the price difference was 1.900 DKK between products, which made her choose the cheaper option. This indicates that when she finds the economic consequences high, she weighs financial risk. However, for repeat purchases, Pernille might not always choose the cheapest, as she has experienced that a new type of birth control pills did not have the same performance as the original ones. But she has always agrees to try the cheapest, in order to test the performance herself. Therefore, she seems to weigh financial risk. This is not the case with Julie. For her, price is by no means an object in relation to prescription medicine. She perceives substitutions as alternatives ”that cost half as much, and work maybe nearly as well”(Q27), and directly states that ”price is not a factor in this”(Q28). This indicates that she finds the consequences of the financial risk smaller than the consequences of the performance risk. Therefore, she has never accepted substituting options, and thus weighs performance risk more than financial risk. For Lise, the trade-­‐off seems more related to price versus ethics, than price versus quality. She herself mentions that this is due to her background in the pharmaceutical industry, because she feels those who 81
put in the effort to develop the product, should also get her money. Whereas this indicates that she does not weigh financial risk, she does, however, show a financial concern in that she perceives delivery costs problematic, because she does not find delivery valuable. She suggests that this could be a reason not to shop online for her. Similarly, Karen finds that the cost of delivery would only be worth it if she really needed a product, and could not get to the pharmacy. 7.2.1.2.1 Perceived risk relievers for financial risk
As Julie weighs performance risk, she chooses the product chosen by the doctor, which is usually the most expensive. She justifies the high price, and thus decreases financial risk, by believing that the product chosen by the doctor provides a better performance and therefore, that it is worth the extra cost.. When it concerns the medicine Karen takes regularly, she employs a similar justification principle. She is certain that she pays for a better product by not substituting it, and therefore decreases financial risk by justifying the quality. Lise weighs ethics over price, and feels she gets value for money by doing ”the right thing”, ethically. Therefore she uses ethics as a justification principle to decrease perceived financial risk. For first-­‐time purchases, Karen is more price conscious and therefore decreases the financial risk by choosing the cheaper option. This is the case for Pernille as well. However, as described, she does not always choose the cheapest, if she has experienced that the performance was too low previously. Therefore, for repurchase, the financial risk is decreased by experience of performance, in cases where she does not choose the cheapest option. To avoid delivery costs online, Karen has picked up the products herself at the pharmacy after purchasing them online. Thereby, she has decreased the financial risk of paying for a delivery she did not find valuable. 7.2.1.2.2 Financial risk in online/offline channels
Whereas a central benefit of the online channel would normally be perceived as the ability to easily compare products compared to offline, this is not the case in this context. The interviewed respondents do not compare medicine products and prices online, even though this is possible at for example medicinpriser.dk. Therefore, comparison is not viewed as a risk reliever by our respondents. As Julie, Karen and Lise use decision-­‐making rules to justify a higher price, the online and offline channels do not provide any facilitation towards financial risk relief. Since Pernille either chooses to decrease financial risk by choosing the cheapest option, or based on her experience with the product, her relief of financial risk does not have to do with channel facilitation either. Therefore, financial risk is considered a barrier to an equal extent for the online and offline channel, and thus, does not seem to affect attitudes 82
towards either of the channels. However, as the delivery might be part of an online purchase, some financial risks may exist for the online channel specifically. While this is the case for Lise, who perceives delivery costs as a barrier online, Karen uses the option of relieving this risk by picking up her order at the pharmacy. This way, financial risk is eliminated for her in relation to delivery. 7.2.1.3 Perceived social risk
In the framework, social risk was defined as being “concerned with an individual’s ego and the effect that the consumption is observable by others and has on the opinions of reference groups”. In relation to social risk, Julie and Pernille express concern about the lack of privacy in the pharmacies, and both find that this is worse if they meet people they know. Pernille feels that this represents a big (and important) difference between the doctor and the pharmacy, because the doctor’s consultation takes place in full privacy, whereas in the pharmacy “you just talk about it openly in front of everyone”(Q29), and she finds this “strange”(Q30). This also results in her not wanting to ask questions. Julie feels that it is very intimate matters you have to talk to the pharmacist about, and therefore states: “I can feel that when 11 people are standing right behind me, who are waiting for their number to be called, well, it has an impact”(Q31). This indicates that Julie and Pernille find the risk of judgment by peers very likely and also important. Lise spontaneously talks about discretion in relation to other customers, but states that she does not “feel intimidated”. Karen does not feel that privacy is an issue for her: “I have become too old for that”(Q32). But she acknowledges that some products are more intimate than others, and that she would not “go in and buy hemorrhoid creme yelling out loud”(Q33). This is also Pernille’s attitude – to her it “depends on what I am buying. It is not very often that I buy something that is like “uh, super secret””(Q34). 7.2.1.3.1 Perceived risk relievers for social risk
Both Julie and Lise talk about the physical aspect of a pharmacy in relation to relief of social risk. Lise finds that she is not intimidated by other people in the pharmacy, because a discretion line is present. Therefore, a discretion line is viewed as a risk reliever of social risk. Furthermore she thinks that “people are very good at staying away”(Q35). This indicates that also the space between people in the pharmacy has an impact on the perceived social risk. Julie experiences this as well, but because her local pharmacy is small, she perceives a high level of social risk. This indicates that she, similarly to Lise, would find that space fostered a relief of social risk. In relation to the space of the physical pharmacy, both Karen and Pernille furthermore find that speaking in a low voice can alleviate the discomfort of talking about sensitive matters, and thus minimize social risk. 83
7.2.1.3.2 Social risk in online/offline channels
For all the respondents, social risk seems clearly more related to the traditional pharmacy than to the online pharmacy. They speak about being within earshot of the customer at the next counter (Pernille), and meeting people they know, indicating that the physical presence in the pharmacy is what facilitates social risk. Therefore, social risk may be a barrier for the offline channel, but as described by the respondents, also relieved by space, discretion lines and low voices. Julie however mentions that social risk ”would of course be alleviated online. There, you can sort of sit and hide a little bit more”(Q36). 7.2.1.4 Perceived resource-related risk
In the framework, resource-­‐related risk was defined as “the possible waste of mental or time-­‐related resources”. We therefore separate the analysis of this factor into respondents’ perceptions of mental effort and perceptions of time resources required for prescription purchase. 7.2.1.4.1 Mental effort
Neither Julie nor Lise indicate in the interviews that they feel that the required mental effort for prescription purchase is great. However, Karen generally finds that the whole process is troublesome; especially for the prescription drugs she takes regularly. Both she and Pernille actually choose the word ”troublesome”16, when asked to put just one word on the process of purchasing prescription drugs. Pernille finds that the entire process is troublesome when she buys prescription drugs: “It is annoying that I have to go down there, and there is always 1000 people, and it is always hot, and it is difficult to find a place for your bike, and actually I just think it is troublesome”(Q37). On the other hand, Pernille has experienced a low mental effort online, and finds that it was ”surprisingly easy”(Q38) to shop from apoteket.dk, indicating that she had expected to find it difficult. However, Pernille further says that it was ”a bit overwhelming”(Q39), because so many products were available. It is important to note that she in this case is referring to the purchase of a non-­‐prescription product bought on Apoteket.dk, which means that more products may have been available than for a prescription drug purchase. Karen further notes a mental effort in terms of controlling her medicine purchases. She says that she does not mind this in general, but as a matter of principle, she finds this problematic. “what if I was 85 years old and couldn’t remember and.. Would I then be able to plan this process, or would I time and again be left 16
In Danish the respondents used the word: ”Besværligt” 84
without medication?”(Q40), indicating that she perceives the resource requirement as above what could be expected by ordinary consumers. 7.2.1.4.2 Time
A number of references were made to resources of time in our interviews. In relation to the early stage of purchase, the handling of the prescription is mentioned by Julie and Lise. Whereas Julie finds that she can arrive at the pharmacy before it is even in the system, Lise generally experiences that it is always ready when arriving at the pharmacy, and hence they perceive no risk in relation to waiting time. Pernille similarly finds that the pharmacist quickly orders the medicine if they have run out. But Karen experiences that it takes several days for the product to be available in the pharmacy: “If you haven’t called ahead and ordered your medicine, they may say ”we don’t have that, it won’t be here till tomorrow at 10”(Q41). This is not Lise’s experience: ”Then…they actually usually have it right away…so you don’t have to wait any longer. So you just pay and leave right away. I think it is pretty simple”(Q42). Pernille also feels that there is a risk of sacrificing resources in order to go to the pharmacy in their limited opening hours – she feels that it is ”really irritating”(Q43) and elaborates: ”You can go into Netto every day till 22, but the pharmacies, they are just a bit more old fashioned…and run these very strict rules”(Q44). Karen expresses a higher flexibility towards opening hours and does not see it as an inconvenience. During the purchase, while all referring to queueing, none of the respondents seem to consider it a risk with significant consequences, even though they experience queues as existing, and hence perceive a high likelihood of the risk occurring. Pernille expresses concern about the online queueing time, because she experiences a perceived risk of waiting too long for the chat function, for example: ”Well, it shouldn’t be like ”there is a half hour wait”, or ”the chat is not functioning at the moment”, that just doesn’t work”(Q45). In the physical shop, Pernille finds that she is forced to spend time on receiving counseling, and thus the risk of using too much time is increased. Part of time spent shopping also concerns transport or delivery of the product. All of the respondents find that transport to the pharmacy is no inconvenience, but relate it to the fact that their local pharmacy is close by or on the way home from their doctor. All of the respondents express a concern about urgency. Lise says that ”If you need penicillin, then you want to get started right away. So if you bought it online, it would take 24 hours”(Q47). Pernille expresses the same view, when it comes to non-­‐regular medicine: ”If I have a bad throat, of course I don’t want to wait three days to get it in the mail”(Q48). This indicates that they feel that the consequences of the time risk are too big, and also that the likelihood of it happening is almost certain. 85
7.2.1.4.3 Perceived risk relievers for resource-related risk
As a means of minimizing effort in a prescription purchase, Lise and Pernille both refer to the automatized process when using their health insurance card. So does Karen: “then I show my social identification card, because they find my prescription on my CPR-­‐number. And then they find the medicine. Push a button and then it comes flying through a tube. And that actually works well, if it is relatively common medicine”(Q49). Lise generally does not experience any risks related to effort and time resources. The only matter she is concerned with is the required time to wait for the delivery in online purchases. This is relieved by the instant delivery offline. The same applies for Julie. Julie furthermore finds that there is a high likelihood of having to wait for the prescription to be in the system of the pharmacy, and she minimizes the consequences of this risk by going home while waiting. Pernille finds it a bit overwhelming to get an overview in the online channel, but has not tried to minimize this risk related to effort. She generally perceives it as troublesome and requiring many resources to go to the physical pharmacy, but she does not try to minimize the likelihood or consequences of that risk. She furthermore accepts the resources related to opening hours and counseling, requiring time and effort of her, but indicates that she would like to minimize it. Only Karen seems to actively try to minimize the inconveniences she experiences. She tries to minimize the potential risk and inconvenience of ordering time for prescription medicine by controlling the process herself through ”putting in a certain margin”(Q50) of time. However, as she finds this control to be a mental effort, the minimizing of the perceived risk of time is at the expense of effort. This means that the reduction of time as a risk increases the risk of effort for her. To relief likelihood of both, Karen has tried ordering online twice, but experienced errors in the process both times, and thus did not succeed in relieving either. 7.2.1.4.4 Resource-related risk in online/offline channels
As already indicated in the sections above, our respondents find that different resources are required of them by the online and offline pharmacy. Both Julie and Pernille perceive the online channel as time saving, and thus perceive no risk of time resources as existing online. Although Julie has not tried the online channel for prescription drug purchase, she considers it “so easy and time saving”(Q51), indicating that she does not see resource-­‐related risk as a barrier to the online channel. 86
However, while the respondents perceive the online channel as requiring less of their time during purchase, the delivery time is considered a significant barrier to online purchase, and therefore, they choose an offline channel, where they receive the product immediately. This, however, is more related to acute products where they cannot plan in advance to have the product delivered. Therefore, both Julie and Pernille also consider their birth control (which is taken regularly) something they could purchase online. Whereas Karen does not find that a longer distance would bother her enough to go online, Julie notes that distance is a crucial part of her decision to go to the physical pharmacy: “The day I move, and my pharmacy is further away, then I could easily imagine questioning if it was the most effective”(Q46). Even though Lise did not try using the online channel for prescription drug purchase, she is of the opinion that she actually does not use a lot of time buying it offline, compared to what she thinks she would online. She is worried that she would not be home when the package arrives, and therefore would spend even more time on an online purchase, because a pick-­‐up would then be necessary. Therefore, she perceives the risk of time related to online as being potentially even greater than offline. While Karen theoretically perceives online purchase to require less time spent shopping, she has experienced that it takes just as much time as when she purchases it offline, because the systems for order processing do not work properly. While expecting to be able to “cut out some parts of the process”(Q52), she ends up not being able to do so, and hence finds the time and effort just as high as for the offline purchase. She does, however, find that mental effort is low online, because the order system is easy to use. 7.2.2 Preliminary conclusion: Benefits and barriers
In this section, we sought to answer the question: What relative benefits and barriers does the consumer perceive the online and offline channels as having? Based on our analysis of the empirical data, we find that a number of differences exist in the respondents’ perceptions of benefits and barriers of prescription purchase in online and offline channels. Firstly, while financial risk was found present (in relation to choice between prescription product and substitution), the respondents did not perceive any benefits in the online or the offline channel, to make either more facilitating of risk reduction than the other. Therefore, our respondents did not rely on the choice of either channel to make a tradeoff between price and quality, but on general principles of justification. Only in relation to delivery costs did some of the respondents find that there was a difference between channels. A financial risk as a barrier was therefore perceived by some, whereas others did not perceive it as a barrier, because of the ability to pick up orders physically. 87
Performance risk was perceived as a barrier in both the online and offline channel, but by different respondents. Online it was perceived as a barrier because some found that only the benefit of offline counseling could relieve it. Offline it was perceived a barrier by some respondents, because human errors could increase the performance risk instead of relieving it. For resource-­‐related risk, all respondents found benefits and barriers for both online and offline channels. While different types of effort were found as required in each channel, it seemed that time is the more important barrier. This was due to the fact that some products are acute and thus the consequences of time were considered big. Therefore, delivery from the online channel was considered an important risk, and therefore it was a barrier to the online channel. This was not the case for repurchase products, because urgency was not perceived as present. For Julie, Pernille and Lise, the urgency of the product was not perceived as facilitated through benefits of the online channel. But to Karen, the option to pick up the product herself was a benefit which circumvented the barrier of urgency online. Finally, while two respondents experienced social risk, neither channel was regarded as having greater benefits to reduce it. Therefore, their perception of social risk was not considered a barrier to either channel and did not affect their attitudes towards either channel. 7.3 Perceived compatibility
In the theoretical background discussions, we found that perceived compatibility of online and offline channels with prescription purchase was likely to be linked to consumers’ shopping motives during the purchase process, and we found that both utilitarian and hedonic motives could theoretically be present in a pharmacy context. In this section, we analyze our empirical data with these as guiding concepts of the analysis. We conclude the section by answering our sub-­‐question 2: How is the online versus the offline channel compatible with the shopping motives of the consumer? 7.3.1 Utilitarian shopping motives
In the framework, utilitarian motives were defined as: “Shopping behavior made necessary by the wish for certain functional consequences”. All of our interviews confirm that the respondents purchase prescription medicine because they are interested in curing a disease or ridding themselves of symptoms. Lise appears to be very focused on the utilitarian motive of buying a prescription drug. Her objective in the purchasing process is finding out how much a normal dose is, as well as the possible side effects. Julie also expresses a functional orientation. 88
When buying new prescription drugs (which she has not taken before), she needs information and direction about the use of the product: ”In that situation, I probably had a stronger need for a talk about, how this is going to take place”(Q53). And when choosing among substitution products for the prescription drugs that she usually takes, she also expresses a need to meet a functional objective: ”I just need the product that works”(Q54). In the interviews, the respondents did not make explicit statements that implied that either the online or the offline would be more compatible with utilitarian motives. Therefore, we find that these utilitarian objectives can be compatible with both the online and offline channel. However, surrounding aspects of the prescription drug purchase may result in other motives being in focus, and thus different motives may exist, that are more compatible with one channel more than the other. 7.3.2 Hedonic shopping motives
In the framework, we defined hedonic motives as: “Shopping behavior carried out to fulfill emotional needs through the shopping process itself”. In our interviews, we found evidence of the existence of several hedonic motives as described in our theoretical discussions. Overall, we found that our respondents’ answers indicated hedonic motives related to emotional support, smart shopper feeling, and exploration. 7.3.2.1 Emotional support
In Julie’s case, the utilitarian motive, which we described above as her wanting just ”the product that works”, is juxtaposed with what is usually given to her – i.e. what she is used to. She describes this as somewhat caused by habit, but even “more security than habit”(Q55). Therefore, Julie seems to be looking for more than just utilitarian value in her purchase. Julie links her need for security directly to the interaction with staff at the pharmacy, but also a need for safety and emotional support when purchasing prescription drugs. This hedonic motive is expressed by Julie as being facilitated by the physical pharmacy through ”(…) a security of standing face-­‐to-­‐face with an expert”(Q56). Pernille’s statements also indicate that her motives in prescription purchases are not merely utilitarian: ”You feel like ”I don’t spend time – take time out – to go to the doctor, just to, you know, ”you just take this”””(Q57). She further states that it is important to her to talk about what is wrong. Although she thus expresses a need for emotional support, she does not perceive this as being met at the physical pharmacy: ”I was promised that it would be exactly the same, but I could feel on my own body that it definitely wasn’t, and I was met by someone (at the pharmacy, red.) who wasn’t quite understanding about it”(Q58). 89
Therefore, whereas emotional support is a hedonic motive compatible with the physical pharmacy in Julie’s case, the opposite is the case for Pernille. While the retail factor of staff helps Julie meet her hedonic motive in the offline channel, this is not Pernille’s experience, because she is skeptical towards the pharmacist and does not feel consoled by their counseling, which leaves her still thinking: ”Then I am like ”but, what is it” (Q59). 7.3.2.2 Smart shopper feeling
Apart from her motive for emotional support during the purchase, Pernille seems dissatisfied with the fact that the pharmacist administers her purchase: ”you are just handed something across the counter, which they basically choose for you”(Q60). As such, Pernille’s high perceived empowerment, as described in section 7.1.4.2, appears to influence on her motives, and results in a desire for independence and self-­‐affirmation, i.e. smart shopper feeling. This contributes to her engaging in her own search for knowledge online. On the other hand, Pernille states that she engages herself in the purchase more because she feels she has to, than because she wants to. This could imply that it is in fact not a hedonic motive, but more of a way to circumvent perceived risks – as discussed in section 7.2.1. Karen’s statements also seem to imply this ambiguity. She too feels she needs to be independent when purchasing prescription drugs. She expresses this as: ”I must be able to control that there is enough medicine”(Q61). But the fact that she uses the wording ”must be able to…” rather than ”I want to be able to…” indicates that her motive is not hedonic. On the other hand, she states that she doesn’t mind the role as a controller of the process, because she is ”somewhat of a control freak, who in other contexts as well, like to control my own things”(Q62). With this, Karen seems to be emotionally fulfilled through self-­‐affirmation and smart shopper feeling when applying her own skills in the prescription purchase. While Lise, as previously found, expresses a utilitarian motive as overshadowing all goals in the process, she does however also indicate that independence, and thus smart shopper feeling, is a motive, by stating that it is her own responsibility to find information about the products. For both, their skills and knowledge are applied in information search online, but Karen also uses the direct inspection of the product at the traditional pharmacy to for example “catch”, and thereby obtain smart shopper feeling. Julie is the only respondent who clearly distances herself from a smart shopper feeling motive in saying that ”I don’t have the guts or need to go in and think ”I wonder if there is exactly the same in it, and whether it’s just another copy product”…I don’t throw myself into that”(Q63). 90
With this, our findings indicate that smart shopper feeling does indeed seem present in the prescription purchase process for some of our respondents. While this feeling is obtained through online search activities for Lise and Pernille, Karen obtains smart shopper feeling through an overall sense of controlling the process, which is facilitated by both the online channel’s written format for orders and the offline ability to inspect products. 7.3.2.3 Exploration
Exploration is closely related to the independence and smart shopper feeling motive. Pernille’s desire to be independent is also expressed in her exploration motive: ”The one (pharmacy, red.) on Nørrebro is very light, it is very open, you can look at things, I can go and look at the whole assortment, without having to, like, stand almost over the desk and feel that I am doing something wrong”(Q64). This indicates that her motive includes exploring the assortment by herself. However, it is likely that she is talking about pharmacy shopping in general, because prescription drugs in particular are not available outside the counter for consumers to look at. Exploration for prescription drugs could possibly also take place online. Lise expresses that she wants to know more than the pharmacist can tell her: ”there can also be some things where you ehm… want to know a little bit more”(Q65). A utilitarian motive could have been met by the pharmacist telling her the dosage and side effects, but she wants to explore these herself, and does so by searching the internet (and reading the leaflet). However, the search is not carried out on apoteket.dk, but sites such as netdoktor.dk, and google.com. This indicates that an online channel may be compatible with explorative motives, but that our respondents do not specifically view apoteket.dk as doing so. 7.3.3 Preliminary conclusion: Compatibility
How is the online versus the offline channel compatible with the shopping motives of the consumer? In the analysis of the empirical data, we have found that both utilitarian and hedonic motives exist among the respondents. Being a highly utilitarian product, prescription drugs were bought with utilitarian motives by all respondents. However, hedonic motives were present as well, and only in this category was there an indication of one channel being more compatible than the other. Whereas the online and offline channels were considered equally compatible with utilitarian motives, as well as smart shopper feeling motive and exploration motives, this was not the case for the hedonic motive of emotional support. For this motive, only the offline channel proved compatible, but only for some respondents. 91
7.4 Perceived substitutability and complementarity of channels
In the framework, substitutability and complementarity are described as opposing concepts, which refer to the combination of channels during the purchase process. In the following, we link our empirical findings to first substitutability and then complementarity in order to establish whether the online and offline channels are perceived as synergetic with or cannibalizing of each other. This will allow us to conclude upon the possible effect of the multichannel setting on the respondents’ attitudes towards each of the channels. We will conclude the section by answering sub-­‐question 3: Does the consumer perceive the online and offline channel as complementing or substituting each other? 7.4.1 Channel substitutability
In the theoretical discussions, we defined substitutability as: “the use of one exclusive channel for an entire process, which can be caused by the benefits of staying or barriers of leaving the channel”. In this section, we first discuss the potential substitutability perceived by consumers for the online channel, and then for the offline channel. 7.4.1.1 Online substitutability
As described in the theoretical background for substitutability, online substitutability could occur in a repurchase situation because no offline doctor is present here. Both Karen, Pernille, and Julie conduct regular repurchase of prescription drugs. However, only Karen and Pernille have done so online. In Karen’s online repurchase, she did not exclusively use one channel for the entire process -­‐ she picked up the products at the physical pharmacy after having purchased them online. Therefore online substitutability was not present, indicating that it potentially does not hold value. Lise also expresses this opinion, although she has not purchased prescription drugs online: ”There is also the issue about it that if you buy it online, then it comes by post, the day after or the day after that, and then if you’re not home at that time, then ehm… then you have to pick it up anyway”(Q66). With this quote, Lise indicates that although purchased online, one might not be sure to have it delivered, and hence, there is a possibility that one adds complexity and more switching costs. Therefore, she does not believe that online substitutability is necessarily practically feasible. 7.4.1.2 Offline substitutability
We found in the theoretical background that offline substitutability could occur for a first-­‐time purchase (as opposed to repurchase), because the doctor’s (offline) consultation is part of the pre-­‐purchase stage of the 92
purchasing process. Second, it could also be present if it has become a passive habit to use the offline pharmacy. We will go through these situations separately. 7.4.1.2.1 Doctor as offline pre-purchase stage
All respondents express a connection between being physically at the doctor and going to the pharmacy directly afterwards. Pernille describes the situation after the doctor as ”Well, then I just go directly to the pharmacy”(Q67), and elaborates: ”Now, it’s also because I live close to a pharmacy – it fits perfectly with just going to the doctor and then just stopping by the pharmacy”(Q68), indicating that the physical pharmacy is a natural stop on the way home from the doctor, which therefore demands no switching costs, because she is out of the door already. Lise also expresses an offline lock-­‐in from doctor to pharmacy: ”But I have never bought prescription medicine on the internet… and thaaat maybe has something to do with that, like if you are at the doctor’s and in town anyway, and can drive by the pharmacy on the way home”(Q69). This is also expressed in the interview with Karen: ”[…] Then you go down there when you are already at the doctor’s, and hand them the prescription and get the pills”(Q70). Julie also sees the pharmacy visit as a natural post-­‐doctor activity: ”Yes, as far as I remember it just takes around an hour, before you…before the prescription is in their system, so I guess I went for a walk, or just went home shortly – as I said it’s very close to where I live”(Q71). However, Pernille does show some skepticism towards this offline lock-­‐in. She is of the opinion that the substitutability happening from the doctor to the pharmacy stems from the short distance to the pharmacy: ”(…) If it wasn’t because it is located… If I only had to go to the pharmacy (and not the doctor, red.) or go to Runddelen, then I would like to have it sent home” (Q72). This indicates that the switching costs from doctor to online purchase would be perceived less if the costs of going further away were greater. 7.4.1.2.2 Passive habit
The respondents furthermore express that offline substitutability is a passive habit. In relation to that, Julie says about her purchase of birth control pills: ”I handle it completely on routine”(Q73), and elaborates: ”Well, I think it has become very automatized now, because it is something that has been repeated so many times, so it is basically just to go down to the pharmacy”(Q74). She is aware herself, that it is a habit, and concludes that she might as well do it online, because she knows the product and doesn’t need advice: ”You could say that, now that it’s something I buy regularly, then it is crazy that I have the need to… somehow it’s crazy that I need security, so it’s probably turned a lot into a 93
habit with just that. So you could say that if you take the birth control pills versus other things that I would buy like once, then the birth control pills could be ordered online” (…) So it has probably become a habit, yes”(Q75). This further underlines the presence of a passive habit, because she is aware that it could be different and sees no obstacles to buying it online. For Pernille, a passive habit is also part of the reason for the offline channel lock-­‐in. Even though she finds it “annoying”(Q76) to go to the pharmacy, she says: ”Well now it is on the way, but I think it’s annoying that I have to go in there, and there is always 1000 people, and it’s always hot and it’s difficult to find somewhere to put your bicycle, and I just think it’s troublesome”(Q77), indicating that a passive habit is present. Lise’s and Karen’s opinions underline how difficult they perceive it as being to break the passive habit of using the offline channel. Firstly, Lise describes a situation where she has to buy medicine for her dog. At the veterinarian, she was told to order the medicine, because the pharmacy would not have it in stock. She chose to go to the pharmacy to make the order, and then come back again the day after to pick it up, rather than making the order at home and having it delivered (and thus saving her two trips to the pharmacy). This indicates that the habit of going to the physical pharmacy is strong. This is evident in the interview with Karen as well. When asked whether she would be inclined to buy online again, she responds: ”No, actually I probably wouldn’t, to be honest, because it’s not an incorporated habit to buy my things on the internet. Pharmacy things, that is. So even if it was a more natural thing, and even if it wasn’t as fatal if an error occurred, then I don’t think I would do it. Then I would just go down and hand in my prescription and get my pills. That’s actually what I think”(Q78). 7.4.2 Perceived complementarity
In the theoretical discussions, we defined channel complementarity as when: “attitude toward searching on channel A may influence attitude towards purchasing on channel B”. In the discussions of the construct, a distinction was made between functional and symbolic complementarity, as we found these concepts to be fundamentally different, and thus, as having potentially differing consequences for consumer perceptions of the channels. In this section we discuss these two types of complementarity in relation to our empirical data to establish if perceptions of complementarity could be affecting our respondents’ attitudes towards online and offline pharmacy channels. 7.4.2.1 Functional complementarity
Functional complementarity was defined in the theoretical background as: “The ability of synergies to occur from the combination of online and offline channel (of not necessarily the same supplier) functionalities 94
across the search and purchase stages of the purchase process”. As the doctor is considered more or less responsible for the pre-­‐purchase search, complementarity was only deemed plausible in a situation where consumers conducted search after the doctor’s consultation, but before the purchase. We found that none of our respondents did this. However, some interesting findings occur due to our explorative approach. Karen has purchased her regular prescription medicine only twice, but, as previously mentioned, rather than having it delivered, she picks it up herself at the physical pharmacy. Since we thought of complementarity as the combination of search in one channel and purchase in another, within the same purchase, we had not expected repurchases of medicine applicable in a complementarity context, because a search stage of the process is unlikely to exist. But Karen’s experiences lead us to new ways of seeing complementarity. Although a search phase is not present, different channels are used across stages of the process. Here, the complementarity arises between the actual purchase and the delivery. As explained in section 7.2.1.1.1 on risk, Karen purchases online and picks it up offline because she finds it decreases risk. Therefore, safety is in fact obtained best through complementary use of the two channels, in Karen’s opinion. This finding indicates that for repurchase situations, complementarity may in fact be a possibility, and that a synergy between the channels may hold value for different stages of the purchase. Although none of the respondents have conducted search online after the doctor’s consultations, and thus, are not engaging in typical “ROPO” activities (Research Online, Purchase Offline), some indications in the interview with Pernille proved that the opposite might be a possibility: Complementarity through offline search and online purchase. She says: “Now, it’s also because I live close to a pharmacy – it fits perfectly with just going to the doctor and then just stopping by the pharmacy, but if it wasn’t because it is located… If I only had to go to the pharmacy (and not the doctor, red.) or go to Runddelen, then I would like to have it sent home”(Q77). This indicates that she does not perceive any switching costs from offline (doctor) to online (apoteket.dk) – in fact the perceived costs of her purchase may be smaller this way, than if purchasing from a traditional pharmacy that is located far away from her. This means that convenience is the only barrier to complementarity (and hence, only reason for substitutability). Thus, if the doctor is considered an offline ”search” channel, then complementarity is possible for non-­‐repurchase prescription drugs. To sum up, due to our explorative approach, we have found new aspects of complementarity. For repurchase of prescription products, the channels might complement each other across the purchase and delivery stages. For non-­‐repurchase of prescription drugs, complementarity might exist through an inverted 95
”ROPO” process, where no switching costs are perceived from the search stage in the doctor’s consultation to online purchase. 7.4.2.2 Symbolic complementarity
In the framework, symbolic complementarity was defined as: “The ability of a supplier’s physical, offline presence/channel to act as an indicator of credibility/trustworthiness for the online channel of the same supplier, or vice versa”. In our interviews, the existence of an offline shop was not deemed important to the credibility of the online pharmacy channel. In Pernille’s case, the link between apoteket.dk and the traditional pharmacies was not even made, since she did not know that it was the Danish licensed pharmacies’ website she purchased from, indicating that symbolic complementarity was not a factor. This was also the case with Karen. Though she did realize that her purchase was ordered to her local pharmacy, she did not make the mental connection between the two platforms: “But I don’t even know who is behind apoteket.dk”(Q79). However, standing out from this was Julie, who in general was less used to purchasing products online. In general, she did find it to be more trustworthy to buy from websites that had an offline presence as well: “Well, if you take a shop like H&M which is both online and offline, in that case it gives me credibility that I know that it is all there down in the shops, but now I’m just buying it here [online, red.] because it’s easier. I would say that was more credible than a shop that was solely online-­‐based”(Q80). This was, however, not mentioned in relation to purchase of prescription drugs, and the hypothetical opportunity to inspect products, which she indicated as the reason why she felt a greater sense of credibility for the online channel, seems very close to being a more functional form of complementarity. 7.4.3 Preliminary conclusion: Substitutability and complementarity
Our empirical results show that online substitutability was not present, since no consumers used only the online channel for the entire purchase process. It furthermore did not seem to hold value to any of the respondents and one respondent even found it infeasible due to delivery circumstances. Offline substitutability was however clearly present for all respondents, due to the fact that they were already ”offline” at the doctor’s, or the fact that they were locked in by habit. Therefore it seems that only the offline channel is perceived as being able to substitute the online, and not vice versa. Some respondents did however find some of the online features valuable in combination with the offline, and therefore functional complementarity was present. This was found exploratively: For repurchase situations, purchasing online and picking up offline was considered valuable. For first-­‐time purchase, the channels were considered complementary in that an inverse ”ROPO” could occur with the offline “search” 96
at the doctor and an online purchase, but only if the perceived convenience of the offline pharmacy was not present (and therefore only considered hypothetical). None of the respondents found that the channels were symbolically complementing each other. 8. Discussion
With our research question we set out to investigate what affects consumers’ perceptions of the online and offline channel’s facilitation of the prescription medicine purchase. In this section we discuss the results of our analysis in terms of both the framework’s applicability and usefulness (theoretical implications, section 8.1), and possible means of implementing our results in practice (practical implications, section 8.2). 8.1 Theoretical Implications
In the theoretical background, our pre-­‐understandings formed expectations that were structured in a conceptual framework. Our empirical study has led to new knowledge, which influences these pre-­‐
understandings. In this section we discuss our empirical findings according to our expectations, in order to rearrange our pre-­‐understanding. 8.1.1 The factor Perceived benefits and barriers
As one of the factors affecting consumers’ perception of the online and offline channel’s facilitation of prescription purchase, we identified benefits and barriers. We anticipated 4 different risk types and the factors relieving them to be possible barriers and benefits. First, we expected that financial risk could be a barrier, and that online purchase might facilitate price comparisons as a risk reliever more willingly, because prices are visible to consumers during the purchase online, but not offline. However, we found that the (limited) financial risk perceived by our respondents to be related to the products, was relieved through justification principles rather than by benefits of the channel. In the theoretical background, we found that justification principles are not facilitated by channels, but more general “rules” for behavior employed by individuals. Therefore, financial risk did not provide insights about the respondents’ perceptions of the channels. Only for delivery costs did consumers take specific actions to relieve risk – such as picking up products themselves or choosing the offline channel entirely. Therefore, financial risk directly related to the product did not seem to provide indications as to their perceptions of the channel’s facilitation of the purchase, but the service required to finalize the purchase (delivery) posed a potential financial risk, which was relieved by benefits of the offline channel. 97
Second, we expected to find social risk affecting channel perceptions, in that an online channel would be preferred because it offers the separation in space from the purchase situation, allowing consumers to buy from the privacy of their home. This was, however, not shown in the empirical data. While two respondents felt that social risk was present, they found that the offline channel facilitated sufficient relief through e.g. discretion lines. Though theoretically, they found that the online channel’s facilitation of privacy is better, in practice, this did not affect their relative perceptions of the channels’ facilitation of prescription purchase. Third, resource-­‐related risk was expected to affect perceptions of channel facilitation of the purchase both due to risk related to time and effort. For time, we expected waiting time to exist in both channels, because of queueing offline and delivery online. However, our data show that only delivery time is perceived as an actual resource-­‐related risk due to the perceived urgency of the product. Therefore only delivery affects channel perceptions. A possible explanation might be that the perceived urgency of the product is more affected by a 2 day delivery time than 10 minutes of queuing, leading respondents to find the waiting time a smaller barrier than delivery. For effort as a barrier, we expected the doctor’s agency to reduce perceived effort of the purchase in general. However, this was not entirely the case. One respondent (Karen) found that her required effort was still substantial, because she had to use her extensive knowledge to control the doctors and pharmacists throughout the purchase. As such, her perceived empowerment and health literacy seemed to affect her perceived resource-­‐related risk as compared to the less empowered/literate respondents. She preferred the online channel for prescription purchase, because she perceived the effort smaller here. Finally, we expected performance risk to be present as a barrier, and this was confirmed in our interviews. We found that a link between perceived empowerment and perceived health literacy was likely to affect perceptions of performance risk and its potential risk relievers, because these traits affected the respondents’ trust in the health professionals’ advice. For the consumers with a high sense of empowerment and health literacy, the offline channel was considered less relieving of performance risk than online, because the counseling of the pharmacist was not considered a risk relieving benefit. Instead, they relieved this risk through their own search and control of the situation. For those with low perceived empowerment and health literacy, the opposite was found – the online was considered more relieving because of the counseling. For this risk type in particular, the perceived health literacy and empowerment of the respondent therefore seemed moderating of risk perceptions, and therefore also for perceptions of the channels. 98
With this, we found that all four types of risk could be related to a prescription medicine purchase, and that although some risks affected channel perceptions in other ways than expected, only social risk did not seem to affect the respondents’ perceptions of the channels’ facilitation of the purchase process. 8.1.2 The Factor Perceived Compatibility
Based on our framework discussions, we expected that a channel’s compatibility with utilitarian motives would be of most importance to consumers, as prescription drugs first and foremost are bought with the functional objective of curing a disease. Based on the theory, we therefore expected consumers to be more prone to shop online. However, in the empirical study, we found that respondents were in fact more focused on hedonic motives than utilitarian. And in terms of channel perceptions, the respondents were more inclined to shop offline, because they found that emotional support was better facilitated there. A possible explanation for this discrepancy to our expectations could perhaps be found in the fact that we found that utilitarian motives are perceived equally facilitated in both channels, and therefore, hedonic motives become more determining for channel perceptions. Furthermore, prescription products are highly sensitive products with perceived important performance risks (as seen above), which could possibly affect respondents to feel a need for security and emotional gratification during the purchase. 8.1.3 The Factors Substitutability and Complementarity
We argued in the theoretical background that online substitutability was a factor possibly affecting consumers’ perceptions of the channels, because if it was perceived possible to do the entire process online, then consumers’ might be more inclined to use the online channel. However, we only deemed online substitutability possible for repurchases where the entire purchase process could be conducted online, theoretically. We did not find any empirical evidence that this was occurring. At the same time, respondents expressed no value in online substitutability, and some did not believe it was even feasible (due to delivery in particular). For example, even though Karen purchased her regular medicine online, she chose to pick it up at the physical pharmacy instead of letting the online channel take over the process completely. Therefore, our empirical findings indicate that consumer perceptions of an online channel may be affected by a perceived inability of the channel to stand alone as a channel of purchase. Contrarily, the empirical data confirmed that offline substitutability is present, in that all of our respondents expressed strong offline habits and effects of post-­‐doctor proximity. Therefore, some respondents found it valuable to carry out the entire purchase offline. These results indicate that perceived substitutability of the channels may influence perceptions of the channels’ facilitation of the prescription purchase. 99
In the theoretical background, we further argued that symbolic complementarity could affect consumers’ perceptions of the online and offline channel’s facilitation of purchase. Because there is a lack of transparency online (due to e.g. illegal prescription drug web-­‐shops blurring the general picture of prescription purchase), we argued that increased trust through the offline channel’s role as a ”credibility indicator” could affect the consumers’ perceptions of the online channel. However, we found that none of the respondents expressed that the existence of an offline channel co-­‐existing with the online channel was of any importance in relation to trust in the online channel. For example, Karen and Pernille did not even know that they were buying from the official and licensed pharmacy web-­‐shop, when they used apoteket.dk. In our interviews, the respondents were in general very internet literate, and purchased a lot of products online. This might explain why the existence of an offline shop was not deemed important in lending credibility to the online pharmacy channel. Another possible explanation for this is the monopoly of the licensed pharmacies, because Danish consumers might be used to the fact that the term ”apotek” is somewhat protected and heavily regulated. The web-­‐shop’s name ”Apoteket.dk” could thus possibly in itself indicate a trustful source, because the ”brand” of ”Apotek” is wellknown, resulting in that Pernille and Karen do not have concerns about purchasing from there, and thus do not care about symbolic complementarity. With this, symbolic complementarity did not seem to affect perceptions of the channels’ facilitations of prescription purchase in our study. In relation to functional complementarity, we argued that it could affect the consumers’ perceptions of the online and offline channel’s facilitation of purchase. We argued that functional complementarity could only exist when consumers searched online after a doctor’s consultation, and then purchased offline, i.e. conducted ”ROPO” (research online, purchase offline). However, in the analysis we found that none of the respondents did this. What we did find in relation to functional complementarity was however, that other types of functional complementarity were present. We had argued that functional complementarity was not applicable for repurchase of prescription drugs, because a search phase was not present. But our explorative approach uncovered that for such repurchases, the complementarity of channels might occur not in between search and purchase, but between purchase and delivery. This way, what we would term ”POPO” could exist instead: ”Purchase online, Pick-­‐up Offline”, which also constitutes a form of functional complementarity. We find this complementarity to be likely to be very context specific, because the high need for control caused by performance risk in a prescription context, results in a willingness to go offline to obtain a product, which 100
has been purchased online. While internet shopping is often perceived as the more convenient choice, this finding suggests that it might in fact be less convenient, but value-­‐adding in other ways. To accommodate this explorative finding, we therefore find that the concept of functional complementarity should include all stages in the definition of the construct: “The ability of synergies to occur from the combination of online and offline channel (of not necessarily the same supplier) functionalities across the stages of the purchase process”. Another explorative finding that we did not expect beforehand, showed the possibility of an inverted ROPO – research offline and purchasing online, indicating that the offline research was done at the doctor, and the purchase was done online afterwards. This was however only perceived as being valuable if the physical pharmacies were not located close by. While today the regulation of the pharmacies ensures that all consumers do live in relative proximity to a pharmacy, one could argue, that this finding might become more relevant if this regulation was abolished and the market was liberalized, because then consumers might be more inclined to purchase their prescription medicine online. To conclude, we find that the framework developed in this thesis sheds lights on several interesting aspects of consumers’ perceptions of the online and the offline channel’s facilitation of prescription purchase, but a number of factors in the framework provided somewhat differing results from what we had expected. In figure 10 our findings contribute to a revision of the framework. 101
Fig.10. Revised Conceptual Framework (Source: Own Creation) While this revision is preliminary due to our limited sample size, it provides indications as to the framework’s applicability and usefulness, and as such provides a starting point for future research. 102
8.2 Practical Implications
With the results of our analysis, several practical implications can be drawn. In this, we attempt to convert our findings from the previous chapters into suggestions for the future use of a multichannel setup in the Danish, licensed pharmacies. In the current multichannel setup of the pharmacies, apoteket.dk appears as a parallel to the traditional bricks-­‐and-­‐mortar pharmacy. As such, the pharmacies have imitated their existing value proposition and business model in a new setting. This indicates that the online and offline channel are viewed as either/or solutions -­‐ either you purchase your products at the pharmacy, or you purchase them online. Referring to our findings, this is not in accordance with the respondents’ perceptions of the channels. While none of our respondents found an online pharmacy optimal in itself, they all found that it complements the value of the traditional pharmacy – although they perceived this in different ways. This suggests that pharmacies should think in terms of synergies of the channels rather than substitution. In relation to the online channel’s value as a purchase channel, one of the key findings in our research was the fact that the respondents do not perceive the separation in time and space as particularly facilitating of the purchase. As such, the opportunity to purchase from home did not seem to provide any particular value for our respondents. Quite contrarily, they seemed to find that this represented more barriers (e.g. delivery and control efforts) than benefits. On the other hand, the online channel was viewed as particularly facilitating of empowerment and knowledge building through information search, as compared to offline, and the respondents felt more in control, when using an online channel to mediate the purchase. However, not only did the online channel seem to have both benefits and barriers – so did the offline. While counseling was seen as a benefit to some respondents, it was perceived an actual disadvantage by some. This indicates that rather than translating all benefits of the offline channel to the online channel, the online channel might in fact accommodate aspects that are perceived a barrier offline, and in that way complement the offline channel’s benefits. For example, to some of our respondents the online channel provides a safety that is not accommodated offline. This means that for them, the online channel’s benefit lies in the fact that it is a “machine”, and that they trust themselves and this electronic system more than the human pharmacists. This was also indicated offline, where they perceived the automatization of the medicine supply as positive. Therefore, instead of providing these respondents with an online chat function, which is a direct translation of the value proposition offline, the DPA could focus on providing them with what they do not feel is satisfied offline: Safety and empowerment. It appears that the DPA’s value proposition about counseling seems to stem from a mission of providing patient safety (Web Z). Taking the differing roles of consumers into consideration, our findings therefore 103
indicate that it might prove beneficial to the DPA to reconsider what patient safety is about. Rather than being about making the right decisions for the consumers, they could focus on ensuring that the consumers make the right decisions – with whatever means; machines or human counseling. These findings also suggest that the use of virtual platforms in a pharmacy context need not necessarily be confined to the purchase from home -­‐ because convenience is not the main reason for shopping online -­‐ but might as well occur by the use of online sources situated at the pharmacy. Some respondents even proposed an integrated solution in the pharmacy shop, where a machine would provide them with the medicine quickly and with no human interaction. While it is commonly stated that online shopping is favored because of convenience (Kollmann, 2012), our findings showed that convenience was not affecting the respondents’ perceptions of the channels’ facilitations of purchase in any particular degree. This has implications for the marketing of the offer as well. Rather than focusing on the easy and convenient aspects of online purchase of prescription drugs, the DPA could benefit from marketing it with a focus on the complementary aspects of the channels combined. To sum up, our findings indicate that the DPA and the licensed pharmacies could benefit from applying a strategy focusing on the synergy of the channels. Being pharmacies of bricks-­‐and-­‐clicks they have the possibility to take advantage of the benefits of the online channel, while simultaneously diverting the disadvantages of the offline channel. 9. Limitations and Future Research
This study has contributed with preliminary indications of what might affect consumers’ perceptions of the online and offline channel’s facilitation of prescription drug purchases. However, as discussed in the theoretical implications (see section 8.1), we were not able to confirm all of the expectations we had prior to the empirical study. In this section we therefore seek to point out limitations of the study, and in the light of this consider its contributions. These will open up for future avenues of research, which could contribute to a further understanding of consumer channel perceptions.
Firstly, as explained in section 3.5.3, the external validity of the study is affected by the very narrow empirical sample used in the thesis. Only four respondents were interviewed, and all were women. Therefore, a broader sample of respondents including broader demographic profiles might contribute to gaining further insights as to what influences the perception of the channels’ facilitations of prescription drug purchase. A larger sample would also have made it possible to reach a point of saturation in the interviews. In this context however, the narrow sample of respondents was caused by sampling obstacles. 104
Only few people were found to hold knowledge about the existence of prescription drug sales on apoteket.dk, and even fewer had purchased prescription drugs from the site. Therefore we also find that a significant issue with the online channel is the lack of awareness of its existence. While the focus in this thesis has been to identify aspects of online and offline channels which affect consumers’ perceptions of their ability to facilitate a prescription purchase, future research might examine strategies for increasing awareness about the possibility to purchase online – both in terms of value propositions (as mentioned in section 8.2 on practical implications) and means of communication with pharmacy consumers. Moreover, we found that the results were clearly influenced by the distinction between first-­‐time purchases and repeat purchases. Since we did not look for this distinction in our data collection, our results were somewhat muttered by the different perceptions held by consumers with reference to these two types of purchase. In a future study, we find this distinction central. Another limitation to the applicability of the conceptual framework is the fact that the case studied is very specific and complex due to the many discrepancies compared to a regular purchase process, as described in section 5.3. We found that the agency of the doctor in combination with the respondents’ perceived health literacy and perceived empowerment had implications for the perceptions of the factors in the framework. As these conditions are very case-­‐specific, great reservations should be taken as to the applicability in other contexts. However, we do find that an interesting avenue for future research could be the application of the framework in other contexts where a professional person has a gatekeeper role similar to the doctor. In these contexts, concepts similar to the perceived health literacy and patient empowerment might be moderators to the framework. For example, a consumer could have the same feeling of (potentially lack of) literacy and empowerment when purchasing construction supplies for a house. Here, a professional craftsman can obtain the role as a gatekeeper, and as such, the situation somewhat resembles that of our case. Moreover, in this thesis we have reached indications as to what factors that might affect consumers’ perceptions about channels, and were focused on gaining knowledge about the unexplored phenomenon of multichannel medicine sales. We did however not reach an understanding of the intricate interrelations between these constructs. Therefore, an interesting future study could investigate the weighing and prioritizations of the factors in consumers’ perceptions of the channels, based on the indications of factors provided in our (pilot) study. To sum up, in light of the limited empirical sample and the specificity of the case, the thesis should be considered an explorative, qualitative pilot study that holds potential as a starting point for future research of the unexplored phenomenon of consumer channel choice in a prescription medicine purchase context. 105
10. Conclusion
With the potential liberalization of the prescription medicine market, pharmacies are faced with increasing pressure to justify their role as the primary distributor of health care products in Denmark. The pharmacies have made a strong case for the importance of their professionalism as a gatekeeping quality between consumers and prescription products, but have also acknowledged the importance of renewing their value proposition to consumers. This is the background of the development of apoteket.dk – the common online channel of the licensed, Danish pharmacies. In this thesis, our purpose was to investigate, how come consumers are not adopting this online channel as a channel of purchase for prescription medicine, when today they have turned to online sources for so many other products. With this, the purpose of the thesis was not only to describe behavior, but also to understand why it occurs. Therefore, we presented the following research question: What affects how consumers perceive the online and the offline channel’s facilitation of prescription medicine purchase from the Danish, licensed pharmacies? To answer this question, a combined deductive and inductive qualitative approach was employed. Since no theoretical framework specifically developed for a pharmacy/prescription context was found, Torben Hansen’s (2002) more generic framework of channel choice in multichannel retail contexts was used as a theoretical background of the study. To contextualize this framework, a brief review of pharmacy specific literature was conducted. Based on this, we found that perceived empowerment and health literacy may affect consumer perceptions of the purchase process. As a result of our theoretical discussions, three overall categories were found as potentially affecting consumer perceptions of online/offline channels for purchase of prescription products: The benefits and barriers of the channel, the compatibility of the channel with shopping motives of the consumer, and the perceived substitutability or complementarity between the channels. These constituted the conceptual framework, developed to form the basis of our empirical study. The empirical study consisted of four explorative, in-­‐depth, and unstructured interviews. The respondents were consumers with varying degrees of experience with online purchase of prescription medicine and differing medical profiles and consumer profiles. With the data obtained in the interviews, we performed an analysis to uncover effects of our framework factors on respondent perceptions of online and offline pharmacies in relation to prescription medicine purchase. 106
First, we examined four types of risk and potential risk relievers to establish what benefits and barriers our respondents perceived present in online and offline channels in relation to purchasing prescription medicine. Our respondents did not rely on the choice of either channel to make a tradeoff between price and quality of a prescription product, but on general principles of justification, that were not facilitated by either of the channels. Only in relation to delivery costs did some of the respondents find that there was a difference between channels. Therefore financial risk directly related to the product did not seem to provide indications as to the perceptions of the channel’s facilitation of the purchase, but the service required to finalize the purchase (delivery) posed a potential financial risk, which was relieved by benefits of the offline channel. Performance risk was, as expected, affecting perceptions of channels as facilitators of purchase. It was perceived a barrier in both the online and offline channel, but by different respondents, and different channels were experienced as facilitating a relief of these barriers. Online it was perceived as a barrier because some found that only the benefit of offline counseling could relieve it. Offline it was perceived a barrier, because human errors could increase the performance risk. These perceptions were found to be affected by the perceived health literacy and empowerment of the respondents. Also resource-­‐related risk was, as expected, found to affect perceptions of the two channels’ facilitation of purchase of prescription medicine. While different types of effort were found as required in each channel, it seemed that time is the more important barrier. Delivery from the online channel was considered the most important risk in this context, and constituted a barrier to the online channel. The offline channel was perceived as having more benefits to relieve this. In terms of effort as resource-­‐related risk, we found that the online channel was perceived as requiring less mental effort. In relation to social risk, two respondents experienced it, but neither channel was regarded as having greater benefits to reduce it. Therefore, their perception of social risk was not considered a barrier to either channel and did not affect their attitudes towards either channel. With this, we found that all four types of risk could be related to a prescription medicine purchase, and that although some risks affected channel perceptions in other ways than expected, only social risk did not seem to affect the respondents’ perceptions of the channels’ facilitation of the purchase process. In terms of compatibility, our study showed that, contrary to our a priori expectations, only the compatibility with hedonic motives rather than utilitarian motives affected consumers’ perceptions of the 107
online and offline channel’s facilitation of purchase. We found that both utilitarian and hedonic motives existed among the respondents. Being a highly utilitarian product, prescription drugs were bought with utilitarian motives by all respondents. However, hedonic motives were present as well, and for these motives was there an indication of one channel being more compatible than the other. Whereas the online and offline channels were considered equally compatible with utilitarian motives, as well as smart shopper feeling motive and exploration motives, this was not the case for the hedonic motive of emotional support. For this motive, only the offline channel proved compatible, but only for some respondents. Concerning perceived substitutability, our empirical results showed, in line with our expectations, that it could influence perceptions of the channels’ facilitation of the prescription purchase. The online substitutability was not perceived as holding value to any of the respondents and one respondent even found it infeasible due to delivery circumstances. Offline substitutability was however clearly present for all respondents, due to the fact that they were already ”offline” at the doctor’s, or the fact that they were locked in by habit. Therefore only the offline channel was perceived as being able to substitute the online, and not vice versa. In terms of complementarity, only parts of it were found to affect perceptions of the channels’ facilitations of prescription purchase in our study. None of the respondents found that the symbolic complementarity was important, and therefore this was not affecting perceptions of the online and offline channel as purchase channels. However, in terms of functional complementarity, our study indicated that it did affect these perceptions, but not in the expected way. Rather, due to our explorative approach, we found that the online and offline channel were perceived to be complementing each other in repurchase situations, where a “POPO” tendency was present: Purchasing online and picking up offline. Moreover, for first-­‐time purchase, the channels were considered complementary in that an inverse ”ROPO” could occur, but only if the perceived convenience of the offline pharmacy was not present. With these findings, we suggested a revised framework, which we found provided a starting point for future research. Based on our findings, we suggested some practical implications. We argued that the Danish Pharmacy Association and the licensed pharmacies could benefit from applying a strategy focusing on the synergy of the channels. Based on our findings, we found that being pharmacies of bricks-­‐and-­‐clicks, the Danish, licensed pharmacies have the possibility of taking advantage of the benefits of the online channel, while simultaneously diverting the disadvantages of the offline channel. 108
Finally, in light of the limited empirical sample and the specificity of the case, the thesis was considered an explorative, qualitative pilot study that holds potential as a starting point for future research of the unexplored phenomenon of consumer channel choice in a prescription medicine purchase context. 11. Perspective
While this thesis has focused on the consumer side of multichannel business models, and what affects their attitudes towards online and offline channels of purchase for prescription medicine, we find that consumers alone do not determine the future of the multichannel pharmacy. In order for the multichannel business model to become a strategically valuable asset for the licensed pharmacies, they themselves must fully grasp the potential, as well as the obstacles of the online channel. In our case description we described the pharmacy industry as a proud institution in the Danish society. They assume a central role as a distributor of health solutions in the Danish health sector, and in exchange for filling this role they are afforded with a position as a national monopoly. With this common role, the pharmacies exhibit a group mentality, for which a common vision is provided by the law – to ensure all consumers equal access to treatment. While this mentality on one hand creates coherence and consistency in the way pharmacies provide services and products to consumers, it does, on the other hand, face some challenges in an industry that still consists of individual businesses. Because while common initiatives (such as apoteket.dk) are installed, no incentives or repercussions are in place to ensure that the individual pharmacies adhere to them -­‐ only the law must be abided, and this does not state anything about multichannel pharmacies. An example from our own experience illustrates this well: A recent pharmacy visit revealed that the pharmacist at our local pharmacy was completely unaware of the opportunity to purchase prescription medicine online. In fact, she seemed both dumbfounded and somewhat shocked by the request. At return home, apoteket.dk, however, confirmed that this pharmacy is in fact listed on the web-­‐shop. This speaks for the same lack of implementation, which our respondent, Karen, experienced with the online pharmacy. Twice she failed to receive a product purchased at apoteket.dk, and when asked, her pharmacists explained that they did not have procedures in place to handle the online orders. With this, the perceived consistency and ability of the pharmacies to fill their societal role may be at stake. This does not only have potential consequences for the consumer’s perception of benefits in the online channel, but also potentially holds legal consequences. 109
According to the Danish Pharmacies Act (Consolidate act no. 855, 04/08/2008), the pharmacies must provide medicines to consumers within a reasonable timeframe (“hurtigst muligt”, ibid., §41, 2), and according to rulings from the Pharmacists’ Board (The Pharmacists’ Board, 2012), this implies a maximum of 24 hours – and even less for acute medicines. But if the pharmacies do not have procedures in place to handle online orders, which therefore strand in a central ordering system, it seems evident that their obligations to supply consumers with medicine are not being accommodated. Furthermore, questions could be raised about the involvement of third parties such as postal carriers in relation to both safety and service obligations. These points seem to imply that the online channel presents new organizational and legislative challenges, which must be addressed for the online pharmacy to truly realize its potential. However, the pharmacies seem to have approached the shift to online with a laissez-­‐faire attitude that does not account for such problems. They appear to be turning down a potentially profitable business opportunity in order to protect a monopoly, but in reality, as these perspectives indicate, they may be supplying wood for the fire of liberalization, if they do not. Based on these perspectives, the question is whether the consumer orientation that our study encourages, is even possible in an industry where professional pride, as well as rules and regulations, seem to limit their every move. 110
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af/2013/sundhedsagenda-­‐2013/slides/uffedambmann.pdf All websites were available on October 1st 2013: Web A: http://www.nets.eu/dk-­‐da/Om/nyheder-­‐og-­‐presse/Pages/nordisk-­‐e-­‐handel-­‐2012.aspx Web B: http://www.business.dk/markedsrapporter/internethandel-­‐fortsaetter-­‐voldsom-­‐vaekst Web C: http://www.dr.dk/Nyheder/Viden/Tech/2013/07/15/110848.htm Web D: http://apotekerforeningen.dk/politik-­‐og-­‐
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monopol.html/?utm_source=relatedright 117
Web J: http://www.business.dk/detailhandel/sass-­‐opgoer-­‐med-­‐apotekermonopol-­‐skydes-­‐ned Web H: http://www.apotekerforeningen.dk/om-­‐apotekerne.aspx Web I: http://www.apotekerforeningen.dk/fakta Web J: http://www.dr.dk/P4/Sjaelland/Nyheder/Guldborgsund/2012/12/18/145716.htm Web K: http://apotekerforeningen.dk/om-­‐apotekerne/regulering-­‐af-­‐apotekerne/bruttoavance.aspx Web L: https://www.retsinformation.dk/Forms/R0710.aspx?id=10268 Web M: http://www.apotekerforeningen.dk/om-­‐apotekerne/strategi.aspx Web N: http://www.a-­‐apoteket.dk/default.asp?Action=Details&Item=543 Web O: http://www.apoteket.dk/Webshop/Ehandel/Recepter/S%C3%A5dan%20k%C3%B8ber%20du%20receptme
dicin%20p%C3%A5%20apoteket,-­‐d-­‐,dk.aspx Web P: http://www.regionh.dk/menu/Uddannelse/Kompetenceudvikling+for+fagpersoner/Videre-­‐
+og+efteruddannelse/Sunddialog+en+effektiv+metode+til+patientinvolvering+der+giver+resultater.htm Web Q: http://www.laeger.dk/portal/page/portal/LAEGERDK/Laegerdk/Om%20L%C3%A6geforeningen/Arrangementer/Tidlig
ere%20arrangementer/Konference%20Patientinvolvering%20-­‐%20november%202011 http://www.dr.dk/Nyheder/Indland/2013/08/10/165058.htm Web R: http://www.fdih.dk/media/870371/fdih__rsrapport_2012_basis.pdf Web S: https://www.nemid.nu/dk-­‐
da/om_nemid/aktuelt/statistik_om_nemid/NemID_statistik_ekstern_rapport_juni_2013.pdf Web T: http://www.eu-­‐oplysningen.dk/fakta/tal/internet/ Web U: http://www.dr.dk/Nyheder/Indland/2013/08/10/165058.htm Web V: http://www.dagens.dk/sundhed/medicinalgiganter-­‐kopimedicin-­‐er-­‐farligt-­‐patienterne Web W: http://politiken.dk/tjek/sundhedogmotion/ECE1021804/eu-­‐beslaglaegger-­‐mere-­‐farlig-­‐
kopimedicin/ 118
Web X: http://www.b.dk/danmark/farlig-­‐kopimedicin-­‐vaelter-­‐ind-­‐i-­‐danmark Web Y: http://laegemiddelstyrelsen.dk/da/topics/detail-­‐-­‐og-­‐nethandel/medicin-­‐paa-­‐nettet/nyheder-­‐om-­‐
medicin-­‐paa-­‐nettet/pas-­‐paa-­‐dig-­‐selv,-­‐naar-­‐du-­‐koeber-­‐medicin-­‐-­‐paa-­‐nettet?main-­‐top= Web Z: http://apotekerforeningen.dk/apoteket-­‐i-­‐sundhedssektoren/patientsikkerhed.aspx Sound files: TKN & RB, 8/8/2013, 1:55:31, Interview with Thomas K. Nielsen and Rasmus Borup, Pharmacists and Ph.Ds at Department of Pharmacy, Copenhagen University MNW, 13/8/2013, 00:46:59, Interview with Mikkel Noe Westh, Chief digital consultant, Bysted digital communication agency, Copenhagen 119
Appendix 1: Expert profiles Below, profiles of the experts interviewed for the thesis are provided. Interview #1 Thomas K. Nielsen: Research Assistant, Cand. Pharm., Faculty of Health and Medical Sciences, University of Copenhagen Rasmus Borup: PhD fellow, Cand. Pharm., Faculty of Health and Medical Sciences, University of Copenhagen Both Thomas K. Nielsen and Rasmus Borup are trained pharmacists and currently research within the field of pharmacy at University of Copenhagen. Rasmus Borup is a PhD fellow specialized in the area of counterfeit medicine. The interview is attached to the thesis as a sound file on USB. Marked (TKN & RB) for references throughout the thesis Interview #2 Mikkel Noe West: Chief digital consultant at Bysted digital agency, Copenhagen Mikkel Noe Westh is an experienced digital consultant with a specialty in health care solutions. In 2013 he facilitated a workshop on e-­‐Health at the SundhedsAgenda 2013 conference in Copenhagen. The interview is attached to the thesis as a sound file on USB. Marked (MNW) for references throughout the thesis. 120
Appendix 2: Hansen’s original framework in Danish 121
Appendix 3: Transcription of interview with Lise I = Interviewer L = respondent (Lise) I: Hvis jeg lige introducerer det først, så handler det om øøhm at vi gerne vil tale lidt om sådan din generelle købsadfærd på nettet og din købsadfærd med medicin og apoteksvarer og den slags. Så det bliver sådan til at starte med rimelig ustruktureret til at starte med, hvor du bare får lov til at fortælle så meget du kan øh og der er ikke nogen forkerte svar og der noget du ikke har lyst til at svare på senere når jeg begynder at stille spørgsmål så skal du bare lade være med at svare på dem. Fordi det kan jo godt være at det er lidt privat, noget af det. I: Først skal jeg bare bruge din alder og beskæftigelse og hvor du er bosat. L: 54, og jeg bor i Nyborg og jeg er hjemmegående. I: Ja ok, og hvad er din oprindelige, altså har du været hjemmegående hele tiden? L: Jeg er uddannet sygeplejerske og har arbejdet som sygeplejerske og som, med klinisk afprøvning I: Hvordan er din husstand? L: Vi er to voksne og et barn på 15. I: Først vil jeg gerne høre lidt om dine indkøbsvaner på nettet, hvis du kan fortælle mig lidt om hvad du sidst har købt på nettet, hvor tit du gør det, bare fortælle lidt om hvordan du generelt handler på nettet og hvad det er for nogle produkter. L: Jeg køber en del tøj til den 15-­‐årige på nettet. Og Det er både sko og sportsudstyr og tøj. Og så køber jeg engang imellem, eller jeg køber faktisk en masse te på nettet, men det er fordi det er billigst i England, hvor jeg så køber store mængder ad gangen. Øhm, fordi det koster det halve af hvad det koster i Danmark. Så køber jeg sommetider kosmetik også i England, fordi det er billigere, også i store mængder, fordi det’ selvfølgelig dyrt at få sendt, men øh det opvejer øh prisforskellen. Og så køber jeg… jeg har en enkelt gang købt øh varer i supermarkedet, i Superbest på nettet, øhm og det er måske noget jeg godt kunne tænke mig at gøre lidt mere. Men jeg tror man skal være en husstand større end 3 før det kan fungere. Men jeg var meget positivt overrasket over hvor frisk varerne var i forhold til hvad man kunne forvente, så det det var en positiv overraskelse I: Så du var nervøs for at det ikke sku’…. L: Altså jeg tænkte jo lidt at man måske fik den mælk der kun kunne holde sig til dagen efter eller noget i den stil. Men det var slet ikke tilfældet, nærmest tvært imod synes jeg. Så det er ikke sidste gang vi har gjort det. I: Er der nogle bestemte sider du plejer at bestille fra, eller har du nogen vaner i forhold til det, hvordan går du ligesom til det, hvis du skal købe noget på nettet? L: Øh, jeg har købt på, altså det der te det køber jeg på en engelsk hjemmeside som hedder pukka som ikke sælger andet end det og nogle andre ayurvediske produkter, øhm og tit så går jeg også ind og undersøger – jeg har købt nogle få gange i Tyskland hvor det viser sig at være billigere at købe deti Tyskland selvom man skal have det sendt. Blandt andet har jeg købt nogle havemøbler øh som var meget billigere selvom de skulle sendes til Danmark. Men nu kom jeg lige fra det du spurgte om? I: Det var om der var nogle bestemte sider du plejer at bruge, altså hvis du skal købe øh tøj til din søn, er det så …? L: Ja det er de her sport-­‐ jeg kan ikke huske hvad de hedder, der er nogle bestemte nogen som han lige viser mig og går ind på og så kommer jeg bare med kortet. Jeg kan ikke huske hvad de hedder de der sportssider… 122
I: Det gør heller ikke noget. Det er bare om der er nogen bestemte. Nu siger du te, det er for eksempel en bestemt side, men hvis du skal købe kosmetik, er det så en bestemt side du går ind på hver gang eller er det forskellige? L: Ja det er en bestemt én, som har mange forskellige mærker blandt andet Dermalogica. Jeg tror det hedder Beauty shop. I: Og hvordan kan det være du lige er endt med den side? L: Det er fordi jeg har søgt på Dermalogica produkter i England og set på hvad de koster online og så er det det jeg har fundet frem til øh er det billigste sted. I: Hvordan kan det være du kommer tilbage til den? L: Fordi det har fungeret godt, de har sendt det meget hurtigt, og præcis det jeg har bestilt og… ingen problemer, så vender jeg tilbage. I: Det lyder som om du køber meget fra udlandet, er det øh ligeligt fordelt mellem danske sider, og tyske og engelske og…? L: Øøøhm… nej jeg køber nok mest fra engelske. I: Er det noget du har tænkt over, at der var nogen… L: Det’ billigere. Jeg ville også købe, hvis der ikke var de der afgifter, fra amerikanske hjemmesider. Øhm men der er det jo problemet med de der… I: Men det gør dig ikke nervøs, at det ikke er en dansk side? L: Nej slet ikke. I: Er der noget du ikke ville kæbe på nettet L: Hmm…… øhm ja jeg tror ikke jeg vil købe sko mere, det har jeg gjort, sko til mig selv, som jeg ikke hvad hvad størrelse er. Jeg købte nogle Nike Free sko som jeg fik byttet to gange, fordi det var en forkert størrelse. Fordi det der med pasform, det er meget svært at vurdere på … jeg har købt noget tøj på Zalando, hvor jeg var overrasket over hvor præcist de kan beskrive størrelserne i beskrivelsen af deres tøj og sådan noget. Så det synes jeg ikke er noget problem men sko det synes jeg faktisk er lidt svært. Øhm og så ville jeg heller aldrig købe sådan meget dyre ting eller… mmm I: Hvordan kan det være? L: …ja det ville jeg så måske alligevel… altså hvis man har mulighed for at sende det tilbage, så ville jeg måske alligevel egentlig. I:Da du skulle bytte dine sko, hvordan foregik det? L: Jamen det foregik på den måde at jeg skulle sende dem tilbage og det skulle jeg desværre selv betale for. Det var ikke ligesom på Zalando hvor man ikke skal betale for at sende tilbage, fordi det er jo virkelig genialt at man kan returnere varerne ti gange og så stadig ikke betale, hverken for forsendelse eller noget som helst. I: De sider du køber fra, er det nogen som også har en, altså hvor man også kan købe det i en butik, eller er det rene online sider? L: Mm….. det ved jeg faktisk ikke. I: Altså nu nævner du fx Zalando.. L: Det aner jeg jo ikke… de har vel ikke en butik går jeg ud fra. I: Men det gør dig ikke noget? L: Nej det gør ikke noget. I: Du føler at det er reelt nok at købe fra dem? L: Ja ja. I: Så vil jeg gerne tale lidt om receptmedicin, og dine indkøbsvaner inden for det. Kan du huske sidste gang du købte noget receptmedicin og kan du beskrive processen? L: Jamen det var fordi min hund var syg og skulle have noget meget dyrt kvalmestillende medicin, som de ikke havde ude på dyrehospitaler, så derfor skulle det bestilles hjem på apoteket. Så jeg gik ned med recepten på apoteket og fik dem til at bestille det hjem, så jeg kunne hente det den efterfølgende dag. I: Så det var noget de simpelthen skulle bestille? 123
L: Ja. I: Kan du huske andre gange du har købt? L: Øh ja. Det kan jeg godt. Og der har det været på den måde at jeg har været ti lægen og har fået ordineret noget medicin til mig selv eller til mine børn, og så er jeg gået ned på apoteket, og har de… så kan de trække recepten øhm elektronisk når man kommer med sit sygesikringskort. Og så får man det udleveret på den måde der. I: Er det noget nyt at de gør det sådan? L: Ja det plejede jo i gamle dage at være sådan at man skulle have sin egen recept med og så skulle man tit vente længere på det end normalt, ik’? Men det synes jeg ikke er så galt mere. I: Så hvad sker der når du er nede hos lægen og de udskriver en recept, hvis det er en recept til dig? L: Jamen de udskriver den jo rent faktisk ikke, de laver den, og så bliver den sendt elektronisk til apoteket, og så øhm går jeg ned på apoteket med mit sygesikringskort og siger at der er, der gerne skulle ligge en recept til mig fra den og den læge, og så øhm siger de ja det er der, og så får jeg tingene udleveret. I: Og det er sådan du plejer at gøre altid? L: Ja. I: Hvordan oplever du det, når du kommer ned på apoteket? Hvis du skal sætte lidt ord på den oplevelse? L: Øhm… der er jo tit mange mennesker nede på apoteket, men jeg synes det er blevet bedre. Og når man trækker et nummer så er det sjældent der går mere end tre minutter før man kommer til. Det er blevet meget meget bedre end det har været tidligere. Og jeg synes det er ok, jeg føler mig ikke intimideret ved at gå ned og få udleveret medicinen der. Der er sådan en diskretionslinje eller hvad det hedder, hvor man øh… jeg synes folk er meget finke til at holde sig væk. I: Så det er ike fordi du føler, at der er noget du ikke har lyst til at købe? L: Nej det ville jeg ikke føle mig generet over. I: Hvad sker der så når du kommer op til kassen? L: Jamen så øhm, så øhm… beder jeg om at få min øh medicin via den recept som nu er sendt elektronisk, og øhm, så øh plejer de faktisk at have det med det samme. Eller få det markeret med det samme, eller mærkeret, hvad hedder det, få sat mærkat på! Sådan at man ikke skal vente yderligere. Så man bare betaler og går med det samme. Så jeg synes det er meget enkelt. I: Har du nogen form for kommunikation med dem der står i kassen? L: Ja, jeg tror at de, det virker som at de skal være uddannede famraceuter hvis de skal, hvis de skal udlevere receptpligtig medicin, jeg er ikke sikker men jeg tror at de er uddannet i at de altid skal spørge patienten eller kunden om de har fået den her slags medicin tidligere, og om de ved hvordan de skal tage den og sikre sig at det ved kunden. I: Er det også det du oplever de gør? L: Ja det synes jeg faktisk. Og hvis man så siger, det har jeg prøvet før, eller det ved jeg godt, eller et eller andet, så øhm så siger de ’ok’, og så er der ikke mere der. Altså hvis man for eksempel får medicin for blærebetændelse, så siger de ”du ved godt at du skal drikke en hel masse”, eller et eller andet. I: Hvad synes du om det? L: Det synes jeg er fint nok. I: Er der nogen gange hvor du har kunne bruge det til noget?’ L: Altså jeg ved det jo godt i kraft af at jeg er sygeplejerske, men det ved de jo ikke. Så jeg tror der er rigtig mange mennesker, som fx når de spiser penicillin, så tror de at når de har spist tra tabletter og har fået det bedre, eller når de har spist det i tre dage, så er det fint og så tager de ikke mere. Så det tror jeg da er ret vigtigt at folk lige får at vide at de skal fortsætte, uanset hvordan de får det, ik’. I: Har du oplevet at de har fortalt dig noget du ikke vidste? L: Hmm…. Ja, men jeg kan ikke lige komme i tanker om hvad lige nu. Det tror jeg. I: Hvis vi snakker lidt om dit lægebesøg igen. Hvilken opgave synes du at han/hun skal løse? Hvordan oplever du lægens rolle i det her? L: Altså i forhold til medicinen eller? I: Ja i forhold til det medicin du skal købe? Altså stoler du på det der bliver udskrevet? 124
L: Ok, nu forstår jeg. Øhm… ja det gør jeg stort set, men jeg tjekker da altid lige indlægssedlen når jeg kommer hjem. Og ser hvordan dosis er for voksne, og hvad der er normalt og hvad der er bivirkninger og sådan noget. Jeg læser altid indlægssedlen faktisk. I: Er det så fordi du er usikker på lægens anvisning? Eller føler du ikke du har fået nok information fra lægen eller? L: Jo man får jo information fra lægen også, og som regel så fortæller lægen jo også hvordan man skal tage medicinen. Men der kan også være noget hvor man øøh gerne vil vide lidt mere. Der står jo alt i de der indlægssedler. Fx så fik min søn han fik tetracyklin for uren hud her for nylig og øhm, det fik han udskrevet fra en speciallæge, en dermatolog, og øhm, når man så… da jeg kom hjem læste jeg så indlægssedlen og blev i tvivl om det nu også var en god idé at han fik det her medicin. Så på den måde der… I: Hvordan kan det være du blev i tvivl om det? L: Øh jamen det fordi nogle af de bivirkninger der er listet, de er ret voldsomme ,ik’. Øh, mulighed for at, altså kraftige, systemiske bivirkninger som jeg synes måske var lidt voldsomme. I: Det var ikke noget lægen havde været inde på? L: Øhm, den dermatolog vi var hos, hun spurgte, hun spurgte mig om han må få lov til at få tetracyklin, og det studsede jeg lidt over. Men jeg tror også der er mange læger, som, når de ved at jeg er sygeplejerske, så behøver de ikke sige så meget, eller… I: Vidste hende her at du var sygeplejerske? L: Det ved jeg faktisk ikke. Det tror jeg, fordi jeg har måske brugt nogle vendinger eller nogle terme som har gjort at hun har tænkt at ”jeg var nok inden for systemet”. I: Fordi det jo umiddelbart, altså jeg ville ikke, hvis jeg taler ud fra mig selv, jeg ville ikke vide hvad tetracyklin var, hvis jeg blev spurgt om det. L: Nårh nej… det er sådan et kraftigt virkende antibiotika, sådan et meget bredspektret et, som slår ret meget ihjel, udover bumserne. I: Ok, men kunne du fx i den situation… var det kun indlægssedlen du læste, eller var det fordi du vidste noget om det i forvejen, eller hvad var det der gjorde dig mest skeptisk? L: Altså jeg har selv taget det engang for mange mange år siden. Og øh… jeg tror dengang var det, der var det ikke lovpligtigt med indlægssedler, og der kunne man jo heller ikke lige gå på nettet og google sig frem til alt muligt. I: Ok, så du har også været på nettet? L: Nej det har jeg ikke, jeg har kun læst indlægssedlen med det her. I: Er der andre ting du kunne finde på at google i forbindelse med medicin? L: Med medicin? Ja, helt klart. Det kunne jeg godt finde på …. I: Hvordan er dine vaner med hensyn til det? L: Jamen der kan man jo gå ind på øh, på altså jeg tror det hedder ikke Netdoktor mere gør det? Men altså alle mulige patientsider hvor man kan få forskellige oplysninger om medicin, som også står på indlægssedlen, ik’. I: Så hvad er det du føler du kan få mere på nettet? L: Altså nu er det jo producenten der har skrevet indlægssedlen må man sige, ik’. Og det kan sommetider være svært at få overblik over hvad der er… altså de skal jo liste alle bivirkninger ik’, og hvis du så læser om det på nettet, så kan du bedre få en fornemmelse af, om det her er noget der sket én gang eller om det er noget der sket tusindvis af gange, ik’. Og det er så ulempen. Men det er også fordi jeg selv har arbejdet inden for branchen, og man ved at de der indlægssedler, de skal simpelthen indeholde alt, så hvis der tilfældigvis er en der har haft hovedpine samtidig med at de har taget nogle tabletter, så skal det også stå der. I: Så det du mener er, at man kan godt blive unødigt bekymret, eller? L: Ja, jeg tror at man kan… måske sommetider hvis man kombinerer det med noget information øøøh på de her hjemmesider der er beregnet til patienter, så tror jeg man kan få et mere nuanceret billede af øh, hvad med bivirkninger og sådan noget. I: Ok, så der føler du også at du ligesom selv er i stand til at sortere i det? 125
L: Ja… ja… det er man måske ikke, men man tror man er. (grin) I: Nu siger du har søgt i forbindelse med lægen, er det så typisk før du går til lægen, eller efter du har været til lægen, eller efter du har købt medicinen, eller hvornår ville de typisk indgå i processen? L: Altså det ville være efter, fordi som regel ved man jo ikke hvad man skal have inden man går til lægen, vel. I: Altså når du kom hjem fra apoteket? L: Ja… det ville det være, ik’. Men altså der er et tilfælde hvor jeg har gjort det inden, og det er blandt andet i forbindelse med min søns urene hud der. Og der havde jeg hørt fra en jeg kender, hvis bærn havde uren hud, havde fået et meget kraftigere middel, faktisk sådan et kemoterapi-­‐agtigt, for uren hud, hvor jeg havde været inde og sætte mig ind i det inden vi var hos den hudlæge der, hvor jeg faktisk havde besluttet at det skulle han i hvert fald ikke ha’. I: Så det var ligesom for at have nogle forudsætninger for at kunne snakke med lægen? L: Ja… Jaer.. I: Føler du det er vigtigt at du kan tale med lægen om det på den her måde? L: Ja helt klart. I: Så du stoler ikke sådan blindt på lægen? L: Nej! det gør jeg ikke! I: Hvordan kan det være at du ikke gør det? L: Jo, men folk er jo forskellige. Og der er nogen der vil sige ”jamen min søn han skal bare have ren hud, ligemeget hvad øhm og andre de vil måske ligesom jeg tænke på at det er selvfølgelig slemt i den periode det varer, men det er også rart at kunne være sikker på at , eller ikke være sikker på, men have gode chancer for at kunne få børn senere hen, eksempelvis, ik’ altså. I: Du sagde det her med at det typisk når du kommer hjem fra apoteket, er det så fordi du tager direkte fra lægen til apoteket? L: Ja. Det er det. Typisk. I: Og det gør du hver gang? L: Ja det tror jeg faktisk egentlig jeg gør. I: Og recepten er klar når du kommer derned? L: Ja det vil jeg tro den er i det øjeblik den bliver skrevet. Og jeg tror faktisk at den er tilgængelig på alle apoteker, fordi sidst, det var i Odense hos den dermatolog hvor øhm jeg så spurgte om jeg kunne hente den i Nyborg, og så sagde hun ”jaja”, så det er sådan set ligegyldigt hvor. I: Så det er sådan meget, hvis du har været til lægen så tager du direkte på apoteket? L: Ja. I: Nu siger du at du har søgt meget på medicin på nettet, hvordan kan det så være at du ikke har valgt at købe noget på nettet? L: Øhm… jeg har købt noget øh, hvad hedder det, helsekost, eller nej naturmedicin på nettet. I: Hvad var det for noget? L: Det var tranebærpiller, er det ikke det de hedder de røde der? For at forebygge blærebetændelse, og så sådan nogle fiberpiller. I: Hvor købte du det henne? L: puh.. det kan jeg ikke huske, en eller anden side, der kun forhandler naturmedicin. Men jeg har aldrig købt receptpligtig medicin på nettet… og deeeeet har måske noget at gøre med at altså, hvis man nu er til lægen og alligevel er i byen, og kan jo køre forbi apoteket på vej hjem, så kan man jo komme i gang med medicinen, og typisk så er det jo noget akut når man skal have receptpligtig medicin, så er det jo en akut behandling. Altså hvis man nu skal have penicillin, så vil man jo gerne i gang med det med det samme. Så hvis man nu skulle have det på nettet, så ville der jo gå et døgn. I: Man kan faktisk få det med bud. L: Nå, det vidste jeg ikke! I: Så du tror den overvejende årsag til du ikke valgte det, det er fordi det simpelthen er en vane, og du vil gerne have det hurtigt? 126
L: Ja… men det lyder dyrt det der med bud. I: Jeg tror det koster omkring 50 kr. L: Nå, okay. I: Men jeg ved ikke om de gør det i Nyborg, det skal jeg ikke kunne sige. Kunne du forestille dig i situationer hvor du skulle købe medicin igen, hvor det ikke var så akut, kunne du så forestille dig at købe det online? L: Ja det kunne jeg da godt. I: Du ser ikke nogen risiko ved det? L: Nej nej. Jeg tænker lidt: øh, hvordan man kan sende sådan lidt, ja nu kan jeg ikke lige kommer i tanker om, men kraftigt smertestillende medicin for eksempel, hvordan man kan egentlig sende det med post. I: Hvad mener du med det? L: sikkerhedsmæssigt. I forhold til bare at gå ned og hente det, ik’, på apoteket hvor der er sikkerhed. Altså nu hørte jeg om en masse postbude der var blevet bestjålet ude i Vollsmose. Altså det er jo ikke hvad som helst man kan sende med posten. Altså hvis jeg nu skulle have Ketogan tabletter for eksempel, det kan man vel ikke sende med posten… I: Hvad er det for noget? L: Det er sådan noget morfika. Altså, morfin-­‐lignende præparat. I: Så der er altså en mellemmand der. Er det så i forhold til dig selv, eller er det sådan i forhold til samfunds-­‐
… L: Ja i forhold til samfund, men altså det kan selvfølgelig løses det problem, jeg kan bare ikke lige se hvordan man... gør det. I: Er det noget du selv ville være, altså hvis du nu skulle købe den der slags medicin, er det noget du ville være nervøs for din egen sikkerhed, at der var en mellemmand? L: Næ.. nej nej. I: Så du føler ikke at det er et risikofyldt produkt? L: Nej.. .næ I: Kunne du finde på at købe fra nogle sider, som ikke er officielt apoteket, det danske apoteks hjemmeside? L: Nej, ikke udover det der naturmedicin jeg nævnte før. Nej, jeg ville aldrig købe rigtig medicin fra andet end et apotek. I: Altså med rigtig medicin, der mener du receptpligtigt? L: Ja… Eller også panodil fx. Jeg ville aldrig købe panodil…ej det er jo ikke rigtigt, jeg kunne godt finde på at købe panodil i et supermarked fx, fordi … men det er jo også fordi jeg kender Panodil. Hvis jeg skulle købe noget jeg ikke havde købt før, så ville jeg nok gå på apoteket. I: Så det er sådan lidt brandet panodil, der gør det? 127
L: Ja, det tror jeg… I: Hvordan, i forhold til, nogen gange så bliver man jo spurgt om, om man kunne tænke sig et substituerende produkt på apoteket, hvordan forholder du dig til det? L: Det er jeg meget meget meget ambivalent overfor. Fordi, jeg har arbejdet inden for branchen og ved hvor mange penge medicinalbranchen bruger på at udvikle et produkt, og det er jo fristende at kunne købe Pamol eller hvad de hedder i stedet for panodil, til jeg ved ikke, er det halvdelen de koster. Men jeg har det også sådan lidt, det er jo de firmaer der har udviklet produkterne og har brugt penge på det, der skal tjene penge på det også, og ikke dem der laver kopiprodukterne. I: Så det er sådan rent etik-­‐spørgsmål for dig? L: Ja.. Jaer. I: Har du så prøvet at købe nogle af de her substituerende produkter, eller køber du mest de originale? L: Nej jeg køber de originale. Især så længe de er til at betale. Altså, det er jo, nu spiser jeg heller ikke så meget medicin så det gør noget. Så fordi jeg skal betale ti kroner mere en gang hver halve år, det går nok. I: Du føler ligesom de økonomiske konsekvenser, er ikke… L: Nej, nej, men det kan da godt være jeg ikke var så hellig, hvis jeg var nødt til at købe en masse medicin. Fordi det er jo beviseligt at det er mindst lige så godt, ik’. I: Nu ved jeg ikke hvor meget du har kigget på nettet, men tror du, at du kan få det billigere derinde? L: Øh… næ, jeg vil jeg tro det er de samme priser, men det er bare et skud. I: Fordi når du så siger det her med at du ved andre varer, typisk så lød det som om at mange af dem er nogle du køber i store mængder for at få det billigere og så videre, øh, så hvis du ikke opfatter det som noget du kan ved medicin, vil det så være noget du tror du kan komme til at bruge i fremtiden? L: Njaarh, det tror jeg ikke. Altså jeg tror godt jeg kunne finde på at bruge nettet til medicin uden, fordi jeg kommer forhåbentlig ikke til at købe de store mængder, så det der med volumen, det er jo ikke lige aktuelt ved medicin for vores vedkommende i hvert fald. Men derfor kunne jeg godt finde på at bruge nettet til at købe medicin. Det er helt sikkert. I: Hvis vi kommer tilbage til det her naturmedicin du købte på nettet, fibertabletter, og hvad var det, tranebærpiller, følte du dig sikekr på at købe det online, eller hvordan kan det være at du valgte lige at købe det online? Fordi det kan man jo også købe i butikker. L: Ja, øøøh… Det kan jeg faktisk ikke rigtig lige… det var så nemt at sidde at læse om det der og kigge på det og så… øh. I: Så det var fordi du fandt selv ud af at det var noget du synes du kunne bruge? L: Ja det tror jeg. Det er måske især for naturlægemidler rigtig nemt at finde oplysninger, som så ikke nødvendigvis er dokumenterede, men det er nemt at finde oplysninger om præparatet på nettet, ik’. 128
I: Følte du at det var nogle produkter der hjalp dig? L: Ja, helt klart. Det er faktisk noget jeg køber jævnligt ja. I: Så det er noget du ”tror på” eller hvad man skal sige? L: Ja. Men nu er det også videnskabeligt bevist, både med fibre og tranebær at det virker. I: Så vil jeg gerne tale lidt om det her med tid. Du siger du køber det fordi du også skal bruge det med det samme. Men føler du at du bruger meget tid på det, i forhold til hvis du skulle købe det på nettet? L: Nej det synes jeg faktisk ikke jeg gør. Der er også det issue ved det, at hvis man køber det på nettet, så kommer det ud med posten, dagen efter eller dagen efter igen, og så hvis man ikke lige er hjemme der, så øhm… så skal man alligevel ned og hente det. I: Så du føler at det faktisk er lige så besværligt. L: Ja. Der er vist noget med at man kan bestille og få lagt i en postkasse hvor man selv kan hente det eller et eller andet, men et er jo det samme. I: Ligger dit fysiske apotek tæt på hvor du bor eller tæt på hvor du bor? L: Det ligger både tæt på min læge og der hvor jeg bor. Cykelafstand. I: Okay. Har du så nogensinde, i forhold til at du siger det her med at du godt kan finde på at gå hjem og søge efter du har fået produktet, har du så nogensinde oplevet at det ville du faktisk ikke have alligevel, eller du var uenig i det du have fået? L: Altså at jeg var uenig i de oplysninger jeg havde fået? I: Ja eller du var i tvivl om det lige pludselig, eller at du faktisk lige pludselig ikke havde lyst til at tage den her form for produkt. L: Altså jeg var det jo lidt med det der tetracyklin som min søn fik. I: Hvad ville du gøre ved det bagefter, når du havde fået produktet? Ville du gå ned på apoteket, eller ville du ringe til din læge, eller ville du selv søge om det? L: Nej jeg ville føle lidt at det var mit eget ansvar at jeg ikke havde spurgt nok ind til det, og så tage den derfra. I: Så du ville ikke ringe til din læge? L: Nej. I: Det her med naturmedicin, du sagde du kunne ikke lige huske hvorfor du havde købt det online, men du køber det alligevel online jævnligt. Har du nogen vaner med det – nu siger du at med receptmedicin der har du en vane hvor du bare går ned på apoteket. Er der så også en vane for naturmedicin, at du gør det online? 129
L: Næ ikke andet end at når jeg er ved at løbe tør så går jeg bare ind på den hjemmeside hvor jeg plejer at købe det og så får jeg det sendt. Hvilket minder mig om pludselig, at jeg køber også kaffe på nettet. I store mængder. Og rigtig god kaffe. Og det er i Århus, så det er lidt langt at køre efter. I: Hvis vi kommer lidt tilbage til det, er det så noget med at du føler du har kunnet finde den bedste kaffe? L: Ja simpelthen. Jeg tror ikke der findes bedre kaffe. Det er samme sted jeg købte kaffemaskinen, så jeg tror ikke at øhm… det er en fantastisk kaffe, og hver gang jeg har prøvet noget andet, så vender jeg tilbage til den her. Og så køber jeg det i store mængder hver gang. I: Så der er du egentlig som kaffeforbruger, rimelig… L: Loyal! I: Ja, og det virker som om du har øh, det er noget du selv har gjort dig umage for at finde og brugt din egen, hvad skal man sige, forbrugerintelligens? L: Ja! I: Jeg tror egentlig vi er kommet rimelig godt igennem, nu skal jeg bare lige tjekke. Er der nogen produkter, hvis vi ikke taler medicin, som du ville købe på nettet, hvor du køber dem på nettet, men går ned i butikken og ser dem først? L: Øøøh, nu skal jeg tænke mig godt om. Ej, det vil jeg ikke sige der er. Jeg synes øhm…. Jeg har det lidt sådan at jeg synes nogle butikker de er utroligt servicerende. Jeg har spillet golf tidligere, og der er en golfklub her i Nyborg og der er en butik. Og den her butik den bliver så hjemsøgt af alle øh medlemmerne, for at afprøve nye køller og se hvordan de ser ud og de får en fantastisk service i forhold til at afprøve tingene og så går de typisk hjem og køber på nettet fra udlandet. Og det bryder jeg mig ikke rigtig om. Det synes jeg ikke er helt fair, selvom jeg kan godt se at det er fristende, hvis man kan få det billigere. Øhm… I: Hvordan kan man sige at der anderledes… altså det er jo sådan en loyalitet du har også i forbindelse med at du kender til branchen og derfor ikke vil købe kopimedicin. Hvordan kan det være at det er anderledes for fx teen, eller kosmetikken eller noget som du køber i store mængder fordi det er billigt, hvordan kan det være at du ikke føler der er nogen loyalitet i forhold til det? L: Jo men jeg går jo ikke ned i en butik og afprøver dernede og får smagsprøver. I: Så det er selve den service du får? L: Det forstår jeg ikke. I: Når du ikke går ned og afprøver teen, så er det fordi du føler ikke du har fået en service nede i butikken, som du skylder dem noget for? L: Nej det gør jeg ikke. Altså jeg har set at man kan få teen hernede i den lokale helseshop, og så koster den det dobbelte. Men jeg hr jo ikke søgt hjælp og råd og vejledning til hvad er det her for en te, og kan jeg få en smagsprøve som det der eksempel med golfklubben. I: Lige kort, et kort spørgsmål omkring det her med et produkt, nu snakkede du meget om bivirkningerne ved det her produkt som din søn skulle tage mod acne. Er det, føler du der er en fysisk risiko, som du selv 130
skal tage stilling til? Det lyder som om du i den situation ikke helt havde samme opfattelse som lægen. Følte du at du havde en anden indstilling til hvor skadeligt det her skulle være? L: Ja jeg føler et stort ansvar i den sammenhæng. Jeg synes det er mig, forældrene, der skal tage stilling til om man vil risikere de bivirkninger i forhold til behandlingen, og ikke lægen der skal. Som jeg sagde før, vier forskellige alle sammen og der er nogen, de kaster sig ud i mange forskellige ting uden at bekymre sig, og andre de gør det ikke. I: Så det er ansvaret over for din søn? L: Ja det synes jeg selv man har stort ansvar. I: Hvad så hvis det var dig selv, ville du have det anderledes med det? L: Altså jeg skal ikke have flere børn, så det ville være anderledes ja. I: Nårh, jeg mener, hvis det var dig selv skaden kunne gå ud over, ville det så være anderledes? L: Øhm…De her skader handler specielt om reproduktion, så på den måde kan man ikke helt sammenligne det.. Men jeg ville da også selv sige fra ved nogle.. altså for eksempel hormonbehandling og sådan noget, der tror jeg da også jeg ville sige fra. Altså når man kan se på statistikkerne, hvor større end risiko man har for at få nogle følgesygdomme… I: Nu siger du statistikker. Så det er ikke nødvendigvis kun på grund af at du har noget viden fra din tid som sygeplejerske? L: Nej nej, der er jo offentliggjort viden. I: Og dem tror du at du ville kigge på, selvom du ikke var uddannet inden for det? L: Ja.. Ja, helt sikkert. I: Ja så tror jeg vi fik det hele med. 131
Appendix 4:Transcription of interview with Karen I = Interviewer K = respondent (Karen) I: Først så skal jeg høre sådan lidt om dig selv, om din alder og lidt om hvad du laver og sådan, så hvis du kan fortælle mig lidt om det. K: Jeg er 56 år, og førtidspensioneret pga. parkinsons, og har i øvrigt et relativt aktivt liv med forskellige fritidsaktiviteter, som jeg har udvidet til også at omfatte resten af tiden. I: Ja, og din husstand, kan du lige beskrive den kort? K: Jeg bor sammen med min mand i et rækkehus i Lyngby I: Og hvad laver han? K: Han er sekretariatsleder I: Og har i nogen børn? K: Ja men ikke hjemmeboende I: Så har jeg lidt spørgsmål omkring dine indkøbsvaner på nettet – jeg kunne godt tænke mig at høre, hvis du tænker tilbage, har du nogensinde købt noget på nettet? K: Masser I: Hvad er det sidste du har købt på nettet? K: En bog. I: Kan du fortælle lidt om hvordan det foregik at du købte den bog? K: Ja, det foregik på den måde at jeg først undersøgte bogens pris på forskellige internetsider. Altså internetforhandlere. Og så fandt jeg ud af at der var mere end 100 kroners forskel på en bog til 450 kroner, så jeg fik den til 350 kroner i stedet for ved at undersøge internettet. Og så valgte jeg selvfølgelig den udbyder. Og så gik der der en uge og så fik jeg den bragt..portofrit..til min dør” I: Og det her med at sammenligne priser, er det noget du altid gør, når du handler på nettet? K: Ja I: Og du siger også i forhold til fragten, du siger det var fragtfrit, er det noget du kigger efter? K: Ja, det er klart, hvis man køber en ting som er relativt billig..hvis du køber en ting til 150 kroner og du så skal give 45 kroner i fragt, så er det jo ikke billigt længere. Så skal man samle sine indkøb så man kun får en enkelt fragt, ikke I: Hvad så når du nu købte den her bog ud fra hvor den var billigst – var der andre ting du tænkte på, da du valgte at købe den der hvor du gjorde? K: Jah, nu var det en.. det var en forhandler som jeg ikke umiddelbart vidste forhandlede bøger. Så derfor så tænkte jeg ”gad vidst om de nu kan håndtere det”. Men det kunne de godt, fordi jeg har handlet hos dem før og købt andre ting I: Også på nettet? K: Ja I: Men er det en forretning der har en almindelig forretning også uden for nettet? K: Nej, de har ingen fysisk forretning I: Øh, da du så købte den her bog – var der nogen andre involveret i processen, eller var det kun dig og hjemmesiden havde jeg nær sagt. Hvem kan du forestille dig har været involveret i den proces? K: Der er jo også nogen der tager sig af betaling, jeg mener det er jo ligesom et mellemled mellem mig og butikken. Det håndterer de jo Dips eller Pips eller hvad det nu er de hedder (griner). Øhm.. sådan så ens oplysninger på kontokort og sådan noget ikke bliver snuppet af de forkerte I: Hvad med sådan i forhold til det her med at du ikke rigtig vidste om de kunne håndtere at sælge bøger. Var du i kontakt med dem for at få noget hjælp? 132
K: Nej, øh, jeg kendte dem godt i forvejen, havde handlet andre produkter, og der har aldrig været noget i vejen, så jeg tænkte, hvorfor skulle de ikke kunne det også, hvorfor skulle de ikke kunne tage et produkt mere ind. I: Så det var måske i virkeligheden relationen til forretningen..? K: Det var erfaringen med at de leverer hvad de lover I: Så kunne jeg godt tænke mig at høre om dine indkøbsvaner for receptmedicin – og der skal du selvfølgelig bare være opmærksom på, at hvis du ikke har lyst til at svare på noget, så siger du selvfølgelig bare til. Kan du huske sidste gang du købte noget receptmedicin? K: Altså generelt købte, ligegyldigt hvor? I: Ja ligegyldigt hvor.. K: Det kan jeg sagtens I: Det kan du sagtens – kan du prøve at fortælle lidt om det? K: Jamen det gjorde jeg nede på apoteket..men jeg ringer så altid i forvejen for at spørge om de har medicinen hjemme, for det har de nemlig ikke altid I: Okay, er det noget specielt medicin? K: Åbenbart (griner) øhm I: Det er noget du tager ofte? K: Det er noget jeg tager dagligt I: Og hvor ofte køber du det så? K: En gang hver anden måned cirka I: Og køber du det som regel samme sted? K: Jeg handler som regel på det samme apotek, ja I: Og hvorfor gør du det? K: Fordi det ligger i nærheden og fordi det er det største og det mest velassorterede I: Og hvad så når du kommer ned på apoteket for at købe den her medicin, hvad sker der dernede – hvordan plejer det at foregå? K: Det plejer at foregå ved at man skal have god tid, fordi man trækker et nummer og så kan der godt gå et kvarter-­‐tyve minutter før man er nået frem i køen, øh..hvis man så ikke har ringet i forvejen og bestilt sin medicin, så kan det godt være de siger ”den har vi ikke hjemme, den kommer først i morgen efter 10, eller hvis det er om fredagen, så er det først mandag efter 10, så man er nødt til at lægge en vis margin ind, sådan så man har piller til nogle dage når man går ned og bestiller. I: Øh..og når du så køber de her piller dernede, snakker du så med nogen? K: Ja, så fortæller de mig hver gang om jeg nu er klar over hvordan jeg skal tage mine piller I: Og hvad tænker du om det? K: (griner) jeg tænker, at jeg er kroniker, og jeg har fået pillerne i 100 år og en søndag, så jeg ved godt hvordan jeg tager mine piller, men de skal selvfølgelig fortælle mig det. Det har de fået at vide at de skal og det gør de også..troligt.. I: Og før du kommer ned på apoteket er der så noget..nu siger du at du ringer derned, men hvad med i forhold til at få recept på de her piller? K: Altså recepten får jeg enten i ambulatoriet hvor jeg går eller også hos min praktiserende læge, hvis jeg ikke lige skal på besøg i ambulatoriet, så ringer jeg ned til min læge og beder om at få det jeg mangler. I: Og du ringer altid derned, du tager ikke ned til lægen? K: Jeg har sommetider ærinder om andre ting, men det er sådan lidt op og ned I: Tager du altid det samme produkt, eller får du nogen gange substituerende produkter? K: Det er hændt at jeg har fået et andet produkt end det sædvanlige I: Og er det fordi du har valgt det selv? K: Nej, det er fordi de ikke har haft det hjemme I: Så det er pga. apoteket, det er ikke pga. lægen? K: Næ, altså som regel har jeg bedt lægen om at sige at der ikke må substitueres, fordi der kan være små forskelle hvis det er, har jeg ladet mig fortælle.. 133
I: Af hvem? K: Det er noget med at der er to forskellige slags..nogen hvor det er fuldstændig samme indholdsstoffer og nogen hvor det måske bare er næsten det samme, så derfor har jeg ikke rigtig turdet.. Men øhm.. I: Hvad er det du er bekymret for at der skal ske? K: Hvis det nu ikke er 100% det samme, altså den balance..som jeg er nødt til at have i indtaget af de stoffer jeg skal have, den kan meget nemt blive forrykket, øh..og derfor er jeg nødt til at være sikker på at det er fuldstændig det samme jeg putter i hovedet I: Men vil det sige at det er et spørgsmål om at du er bange for at det ikke virker, eller at du får en forkert virkning eller..? K: Jamen, jeg vil vel helst have at det kører som det plejer at køre..at man ikke begynder at pille for meget..pille haha (griner) øhm.. jamen det er sådan, jeg mener, man putter noget kemi i hovedet og så vil man helst have at det er det man ved man kan tåle. I: Du sagde at du beder lægen om at skrive recepten på noget bestemt..er det…det er jo en lidt sjov formulering, at du ”beder” lægen om det. Er det..hvad tænker du om det? K: Du mener at det vil være mere naturligt at lægen siger ”du skal have den her slags medicin”? Og så sagde jeg ja tak. Jamen det er jo fordi jeg i virkeligheden ved mere end min praktiserende læge (smiler og griner lidt) om min egen behandling I: Okay. K: Fordi jeg går på en specialafdeling, hvor de fortæller mig hvad der vil være godt for mig. Og min praktiserende læge ved at jeg er et fornuftigt menneske, som hvis jeg kommer og siger at jeg skal bruge 1,25 mg af det der, så er det fordi det er sådan. Altså og det ikke ser fuldstændig sindssygt ud i forhold til det jeg fik sidst. Men i princippet er det mig som siger til min praktiserende læge ”jamen jeg er gået op i dosis til sådan og sådan efter aftale med ambulatoriet”, og så skriver han det ud hvis jeg mangler det. Han kan jo altid ringe og spørge, hvis han ikke troede på mig (smiler). I: Ja, men det vil så også sige, når du snakker lægen der udskriver recepten, så har du én der ligesom har sagt hvad du skal have, og så har du én læge som så rent faktisk udskriver eller fornyer recepterne for dig? K: Ja I: Hvis nu, at jeg bad dig om at sige ét ord, der beskriver det at købe receptmedicin – det er fuldstændig ligegyldigt hvilken type ord, men hvad ville du så synes? K: Besværligt I: Besværligt? K: Ja. I: Og hvad tænker du om det – hvorfor besværligt? K: Jamen det er kun min erfaring med at jeg er nødt til hele tiden at tænke fremad og sige ”hvor mange dage har jeg nu til – jeg har nok til tre-­‐fire dage, jamen så må jeg nok hellere se at komme ned nu sådan de kan nå at bestille det hjem, hvis de nu ikke har det hjemme”. Tænk hvis jeg var 85 år, og ikke kunne huske så godt og sådan noget. Ville jeg så kunne planlægge det her forløb, eller ville jeg gang på gang stå uden medicin, og noget af det er faktisk ikke så godt at mangle. Altså det kan have alvorlige konsekvenser. Så jeg synes det er sådan lidt besværligt I: Og hvad tænker du om din egen rolle, sådan hvis du skulle beskrive, hvad du ligesom selv har at gøre i den der købsproces, hvad synes du så du ville beskrive dig selv som? K: Jamen jeg ville vel.. jeg skal jo kunne styre processen. Jeg skal selv kunne kontrollere at der er nok medicin og at de giver mig det rigtige og.. for jeg har også været ude for at få det forkerte ikke.. Så jeg skal ligesom selv kontrollere og ”jamen hov, har I nu..” og ”husker I nu” og det synes jeg er bøvset. I: Så det er ikke en rolle du er specielt glad for? K: …Altså nu har jeg ikke noget imod den, for jeg er nok lidt af en kontrolfreak, der måske på andre punkter også godt kan lide at have lidt styr på mine egne ting. Men hvis jeg nu var en gammel dame på 85, så kan det jo ikke nytte noget at man stiller de krav til mig, fordi det ville jeg ikke kunne honorere. Der er jeg nødt til at stole på, at hvis jeg nu bestiller noget medicin, at hvis den så kommer med bud, eller jeg går ned og henter den, ja så kan jeg bare tage den og putte den i hovedet. Sådan ville jeg helst have det, ikke.. 134
I: Jamen så tror jeg at jeg vil gå videre med dine erfaringer med online medicinkøb – du har meldt dig til det her, fordi du har vist nogle erfaringer med at købe medicin på nettet, er det rigtigt? K: Ja, det er faktisk rigtigt I: Har du prøvet det mere end en gang? K: Jeg tror jeg har prøvet det to gange I: Og kan du huske begge gange? K: Ja det kan jeg – det kan jeg faktisk godt I: Hvis du nu prøver at tænke tilbage på en af de gange, kan du prøve at beskrive hvad der gjorde at du valgte.. K: Jamen jeg tænkte at det var jo rasende smart, fordi her har vi på skrift hvad det er jeg skal have. Jeg skal ikke ringe derned og sige ”goddag jeg skal have 10 mg” og sagde hun så 10 eller sagde hun 100. Der står simpelthen jeg skal have den og den slags medicin, jeg vil gerne have det udleveret på det der apotek, og det skal ligge klart sådan og sådan. Det var det der tiltalte mig I: Og hvad skete der så? K: Jamen, så kom jeg derned og så var der ikke nogen der havde set det I: Okay, så det vil sige at du har været igennem en eller anden købsproces på nettet, og så har du bestilt det til levering nede på apoteket, og så var det ikke. K: Og så var der ikke nogen der havde eksekveret den der ordre I: Øh..det er jo et problem. K: Ja det var noget af et problem – jeg blev også lidt ophidset I: Var det noget du talte med dem om? K: Ja, jeg bad om at tale med apotekeren selv I: Og hvad sagde han.. eller hun? K: Ja altså han kom med med en forklaring om at ”jah, og det var jo.. og nye procedurer og der var..og det..” Det var sådan lidt svært at få hoved og hale i, hvad det var han egentlig sagde. Jeg spurgte om ikke det var et tiltag som man støttede dernedefra, fordi det var jo smart for os kunder. Men det kan jo ikke nytte noget, hvis man så står dernede, og så er der ikke sket en skid med ens ordre. Og han lovede at stramme op på procedurerne, men jeg har ikke rigtigt forsøgt mig sådan med det helt store.. I: Og det er pga den oplevelse? K: Det er pga. den oplevelse og en enkelt mere, ja I: Og hvad skete der i den anden oplevelse? K: Jamen, der var sket det samme faktisk. At den havde stået i systemet, men der var ikke nogen der havde kigget på den.. Så øhm.. så bliver man jo lidt træt af det og tænker at det duer nok ikke det her system, for som sagt er jeg afhængig af min medicin, og det kan ikke nytte noget at den ikke er der når jeg skal have den I: Kan du prøve at beskrive det du kan huske af selve købsprocessen da du går ind på selve hjemmesiden. Var det apoteket.dk du brugte? K: Det var noget med at først skulle man logge ind…jeg kan sgu ikke huske.. Det er over et år siden. I: Okay, kan du huske – skulle man oprette en bruger, eller hvordan gjorde man det? K:..neej..jeg er ikke sikker på andet end at man loggede ind med..jeg kan simpelthen ikke huske det. Om det var sundhed.dk eller om det..næh.. der var en kobling med et eller andet så vidt jeg husker. På det tidspunkt i hvert fald I: Jeg kan fortælle dig at som det er nu i hvert fald, skal man logge ind med NemID. Kan du huske om der var..altså hvordan det foregår.. Er det ligesom en normal webshop – husker du det sådan? K: ..det er svært. Det er søreme svært at huske når det er så længe siden.. Nej, det var noget med at den receptpligtige medicin kører for sig selv I: Ja? K: Øhm…….og man kan se, hvad man har fået af udleveringer, hvad der er åbne og lukkede. Lidt ligesom sundhed.dk………så kan man bestille en udlevering, og så kan man bestemme hvilket apotek man gerne vil have det på. 135
I: Og kan du huske hvilket apotek du valgte? K: Jeg valgte svane apoteket i Lyngby I: Det er det du plejer at købe på? K: Det er det jeg plejer at købe på ja I: Og hvorfor gjorde du det? K: Fordi det ligger lige i nærheden, det er nemt for mig når jeg alligevel er i byen I: Så det var simpelthen fordi du ville samle det op selv dernede? K: Ja, det kunne jeg lige så godt, for ellers ville det koste mig noget i udbringning I: Så du synes udbringning, det var et problem hvis man skulle have det sendt? K: Jeg synes ikke det var et problem, hvis man stod og manglede det og ikke havde tid til at komme ned i byen. Så ville jeg ikke synes at det var et problem I: Så du opfatter udbringning som noget der faktisk får det til at gå hurtigere end hvis du skal ned og hente det selv? K: Det ved jeg ikke, for jeg har jo aldrig prøvet det. Men jeg kunne forestille mig hvis jeg nu en dag ikke skulle den vej, at jeg måske skulle ad Herlev til og ikke lige vidste hvor apoteket lå, så ville jeg tænke ”det kunne da godtvære meget smart måske at få det leveret” jeg ved det ikke. Jeg er ikke helt sikker på at jeg ville prøve det I: Og hvorfor er du ikke helt sikker på det? K: Fordi hvad nu hvis jeg ikke lige var hjemme eller jeg kunne ikke lige tjekke medicinen så..altså der ville være mange ting I: Hvor lang tid ville du tro der gik før man fik sådan noget leveret? K: Det har jeg ingen ide om. Øh, jeg tror nok man kan bestille det altså både ekspres og almindelig levering. Jeg ved ikke om det er med post eller med bud eller hver sin ting. Det mener jeg at man kunne på det tidspunkt i hvert fald. Kunne bestille udbringning med bud samme dag. Eller også med post. I: Og synes du det er rimeligt at det kommer samme dag – det er indenfor? K: Jaja, det synes jeg absolut. Hvis jeg kunne være sikker på at det kom til min dør og jeg stod og manglede medicinen, så ville jeg synes det var fint. Jeg kunne også igen være en gammel dame på 85 som ikke fløj ned i storcenteret hele tiden.Så ville det også være rart at kunne sige ”nå ja, men så samler jeg mine medicin indkøb og så får jeg det hele på en gang I: Hvad ville du synes var mest anderledes i forhold til at købe det på det normale apotek – altså nede i butikken? K: Altså ved at få det bragt ud? I: Ja altså ved at købe på nettet – hvad er det mest forskellige ved de to ting? K: For mig? I: Ja? K: ………..jamen, det er jo at du ikke har den direkte dialog med en som er i gang med at ekspedere din ordre. Når du står nede på apoteket, så kan du sige ”hov, der er en lyserød stribe på, det er de forkerte du har givet mig”. Det kan du ikke når du bestiller det på nettet. Men når man gør det sådan som jeg gjorde det, hvor man går ned og henter det, altså hvor man bare bestiller det via nettet, så er forskellen ikke så stor. I: Hvis du skulle prøve at knytte et enkelt ord til online receptkøb – hvad skulle det så være for et ord? K: Ustabil I: Ustabil? Og det er i relation til de ting du har fortalt? K: Ja I: Okay. Øhh ja…sådan i forhold til apotekeren, når du er nede på apoteket – hvordan opfatter du deres rolle? K: Apotekeren? I: Ja? K: Det kommer da an på om vi snakker apotekeren eller farmaceuterne I: Er der forskel? 136
K: Ja, der er forskel, for apotekeren er ham der ejer biksen, og farmaceuterne er dem der er ansat. Og så er der apoteksassistenterne nedenunder dem. Og der kan godt være meget forskel I: På hvilken måde? K: Nu tænker jeg selvfølgelig ud fra et enkelt apotek med en enkelt lille apoteker, men øh….det ved jeg ikke…………..det ved jeg ikke hvad jeg skal sige om..øh..der skulle jo helst ikke være nogen forskel i den måde de behandler den enkelte kunde på, og det tror jeg heller ikke der er.. jeg er lidt tom i hovedet I: Okay, jamen vi går bare videre så…..man kan sige, når du..når du køber apoteksvarer, i forhold til når du køber andre varer på nettet, ville du så sige at der forskellige hensyn? Er det to helt forskellige ting i din verden eller er det rimelig meget det samme? Hvis du nu forestiller dig den bog vi snakkede om tidligere, er det så..? K: Jeg synes det er to meget forskellige ting. Selvfølgelig er det også vigtigt hvis jeg køber en vaskemaskine på nettet, at den så også virker, når den kommer frem, men konsekvensen er ikke så voldsom. Jeg mener, jeg falder ikke død om af at vaske mit tøj i den. Men jeg kan godt falde død om, hvis jeg får en forkert pille. Så derfor føler jeg at mit eget ansvar for at kontrollere at det er rigtigt det jeg får, er langt større. Fordi jeg ved at det er mennesker der står dernede og ekspederer mine ordrer, og det kan godt være de måske laver en fejl. Der er umådelig mange produkter på markedet og umådeligt mange der ligner hinanden. Og man tager nemt fejl. Det er et meget komplekst marked. I: Hvad var det jeg tænkte på at jeg ville spørge dig om…jo, nu har vi snakket meget omkring noget receptmedicin som du får meget ofte, faktisk dagligt, at..hvis du nu forestiller dig et receptprodukt, som du ikke får så ofte. Hvis du fx har fået ondt i halsen eller sådan noget og skal have noget penicillin. Er der så nogen ting du synes de..ja, nu er det et meget åbent spørgsmål, men er der noget du synes er anderledes, hvis det er penicillin du skal have, i stedet for det du køber til daglig? K: Altså du mener, om jeg vil være mere tilbøjelig til at købe det på nettet I: For eksempel? K: Nej, det ville jeg nok egentlig ikke, hvis jeg skal være helt ærlig, fordi det er jo ikke nogen indarbejdet vane, at jeg køber mine ting på nettet. Altså apoteksting. Så selvom det var en mere almindelig ting, og selvom det ikke var så fatalt hvis der skete en fejl med det, så tror jeg ikke jeg ville gøre det. Så ville jeg bare gå ned og aflevere min recept og få mine piller. Det tror jeg faktisk I: Og det er simpelthen fordi du opfatter det som en vane at du køber det på det almindelige apotek? K: Ja, fordi når man har ondt i halsen, så står man jo og så skal man bruge det her og nu, så går man derned når man alligevel er nede hos lægen, og stikker dem recepten og får pillerne. Så..vi har vist lige dødsdømt deres projekt.. I: Hvad siger du? K: De har vist lige dødsdømt deres projekt (griner) I: Øhm..ja, jeg tænkte på noget andet i forhold til det her med…..med nogle andre typer receptmedicin..hvad pokker var det..jo også i forhold til lægens rolle i i dine medicinkøb. Nu snakkede vi om det der med at du også opfatter din praktiserende læge som en der bare udskriver recepter på…ud fra hvad man nu får at vide at man skal have. Er det anderledes for..hvis du nu har fået ondt i halsen, hvad sker der så? K: Ja, så går jeg ned til min læge og så glor han mig i halsen og poder mig og så siger han ”du skal have noget bredspektret penicillin” og så skriver han – nej han skriver ikke en recept – han sender en recept ud på receptserveren, sådan så apoteket har den med det samme, ikke. Som det foregår i dag I: Så du får aldrig en papirrecept i hånden? K: Jo, det sker alligevel en gang imellem, lidt afhængig af hvad det er for en læge I: Og når du så kommer ned på apoteket, hvad sker der så, når du har sådan en normal recept på noget penicilliin, som ligger ude på serveren, hvad sker der så når du kommer op til skranken? K: Ja, så viser jeg mit sundhedskort, fordi de søger min recept ud på CPR-­‐nummer. Og så finder de medicinen frem. Trykker på en knap og så kommer den fisende ned gennem et rør. Og det fungerer egentlig meget godt, hvis det er sådan noget relativt almindelig medicin 137
I: Hvad med i forhold til..nu findes der jo sådan nogle regler om at apotekeren skal spørge dig, hvis der findes et billigere produkt, har du prøvet det? K: Ja I: Og når du bliver tilbudt det, hvordan..siger du så ja tak til det? K: Jaah.. I: Det trækker du på..? K: Det trækker jeg på ja, jeg prøver at huske hvad jeg har sagt. Altså jeg er begyndt at sige ja en gang imellem, hvis det er.. I: Hvis det er hvad? K: Hvis de garanterer mig at det er helt det samme produkt I: Altså hvis apotekeren – eller farmaceuten – gør? Ja. Øhm..så er jeg begyndt at sige ja I: Okay, og hvad gør du det ud fra? K: Ja, at jeg stoler på at det er sandt hvad de siger, og at jeg så sparer nogle penge I: Okay. Så der synes du at hvis de ligesom siger god for det, så kan du godt vælge ud fra pris? K: Hvis de står og siger amager og halshug, så må jeg jo tro på dem I: Er der nogen produkter, hvor du ville tænke ”det tror jeg sgu ikke på, at det er helt ligeså godt” – kan du forestille dig det? K: Nej, det kan jeg ikke umiddelbart forestille mig I: Så så længe de står inde for det så..? K: Ja I: …..jo, sådan i forhold til, når du er nede på apoteket, hvis du så rendte ind i nogen du kendte dernede, hvilken følelse ville du så have dernede? K: Jeg ville vel bare hilse og sige dav I: Og du ville ikke sådan have lyst til at gemme dig bag hylderne eller..? K: Nej nej. Det er jo ikke pinlige ting jeg køber dernede I: Nej. Hvis du nu skulle købe et eller andet du syntes var pinligt eller var sådan noget privat, ville du så bare snige det om på ryggen eller..? K: Næ det tror jeg ikke jeg ville. Det er jeg blevet for gammel til I: Har du nogensinde nogen med når du køber medicin? K: Jah, men ikke for at have nogen med altså så er det fordi vi følges ad i anden sammenhæng I: Og kunne du finde på ligemeget hvem du var med på gaden og sige ”hey, jeg skal lige et smut på apoteket” og så tage dem med ind, eller er der nogen situationer hvor du ville tænke ”ej, det er ikke lige det sted vi skal..der går man alligevel ikke ind sammen”? K: Altså man kunne måske godt fejle noget der var så utrolig pinligt..jeg ved ikke om jeg ville gå ind og købe hæmoridecreme sådan højt råbende. Det er jeg ikke sikker på (griner). Der ville jeg nok sige ”ved du hvad, jeg stikker lige ind, du behøver ikke gå med” I: Men hvis du nu var ude og shoppe med en veninde eller dine børn eller et eller andet, og du så tænke ”gud, der ligger for resten apoteket og der skulle jeg jo faktisk have nogle hovedpinepiller”? K: Jamen der ville jeg da til hver en tid tage dem med I: Så det er en naturlig ting for dig? K: Ja I: Og det er det samme når du køber på nettet, at du er ligeglad om der står nogen og kigger dig over skulderen? K: Fuldstændig I: …Jo i forhold til, nu sagde du at du når du tager den medicin du tager hver dag, du siger at nu ved du rimelig meget om det produkt – hvad med andre produkter? Når lægen udskriver en recept til dig på et eller andet, går du så hjem og undersøger hvad det er for noget, eller spørger du i detaljer nede på apoteket om det eller..? K: Jeg går hjem og søger på nettet (smiler) og prøver at se hvad det er for noget og hvordan det virker sammen med de piller jeg får i forvejen 138
I: Gør du altid det? K: Det gør jeg altid – jeg kunne ikke finde på at putte noget i hovedet, som jeg ikke først havde testet? I: Og gør du det inden du køber produktet..? K: Nej, jeg gør det når jeg står med det i hånden – inden jeg putter det i munden I: Og det er simpelthen fordi du lige skal krydstjekke om der kunne være nogen uhensigtsmæssige..? K: Ja, jeg har været ude for det et par gange I: Hvad gjorde du så, når du har været ude for det – er der nogen du kontakter eller er det ligesom bare at du tager til efterretning at det vil du ikke fortsætte med? K: Jeg har sagt det til min læge. Begge gange, og jeg har også sagt det på apoteket I: Og er det sådan at du ringer derned eller bare næste gang du..? K: Det er næste gang jeg kommer. I: ….jo vi har været lidt inde over det, men når du køber noget nede på apoteket. Hvad er det den oplevelse tilbyder dig, som du ikke kan få online på webapoteket? K: Hvad det er for en oplevelse jeg kan få nede på det fysiske apotek? Ja, der er alle de der lækre æsker og flasker og dåser og noget der dufter. Til jul er det små poser med lækre krydderier i og..øh.. så er der også den der med at have fat i medarbejderen i selve processen, fordi det er gået galt nogle gange ikke. Hvor man så kan sige ”hov hov, man kan ikke knække en kapsel” (griner) – hvis man skal have en halv pille så har de sommetider kommet til at give mig kapsler i stedet for piller, og så kan man jo ikke dele det. Det er lidt svært. I: Det er lidt svært ja. Men det vil så sige, at så er det sådan en..hvad skal man sige..faglig snak du ligesom får ud af det. Er der også et element af..når man er ude at shoppe, kan du så godt lide at snakke med ekspedienter? Synes du ligesom det bidrager til en god oplevelse eller..? K: Altså mit sociale liv går nok i andre retninger… (Griner) Men jeg synes da det er meget hyggeligt, hvis nu man skal snakke med en ekspedient, så er det da meget hyggeligt hvis hun er sød og gider snakke. I: Men det er ikke sådan at du er typen, der står og hænger over disken i tøjforretningen? K: Nej, jeg går ikke på apoteket fordi jeg keder mig og gerne vil have nogen at snakke med (griner) I: Nej, okay.. Øhm. Hvis jeg spørger dig om det samme for online – er der ligesom en oplevelse der, eller nogle ting ved købet du ikke kan få offline – nede på apoteket? K: Et rush I: Et rush? K: Nej det gør jeg ikke..Men jeg kastede mig jo frådende over det fordi jeg troede at jeg kunne skære nogle led væk af processen Men det kunne jeg ikke. I: Og var det kun fordi det gik galt eller var det også sådan..? K: Jamen jeg opdagede jo at jeg alligevel blev nødt til at kontrollere det. Jeg sparede ikke ret meget. Jeg sparede ikke noget tid i virkeligheden. Det involverede mig ligeså meget som på det fysiske apotek. I: Okay….hvis du nu sådan..det er lidt i relation til det også. Hvis du tænker på den tid du bruger på at købe på det almindelige apotek og på nettet, hvor tror du at du ville bruge mest tid, sådan minutter, timer, dage, år? K: Altså hvis jeg skulle købe det enten det ene sted eller det andet sted? I: Ja, hvis du skulle gennemføre det samme køb nede i butikken eller..al den tid du så lægger i det, hvad ville du? K: Jamen jeg bruger da helt klart mest tid på at gå fysisk derned, stå i køen, og være på apoteket og tale med dagen og sige til damen ”nej det er forkert” altså..det bruger jeg da helt klart mest tid på. Øhm.. men..altså hvis det så er sådan så man på det..på nettet siger, nu trykker jeg på knappen for 100 af de tabletter og så sker der nul og en skid i den anden ende. Der er ikke nogen der siger ”hov hun skal have 100 tabletter hende der”, øhm..og så tænker man at det var da godt nok sjovt at der ikke sker noget der, og så ringer man derned og siger de at ”vi har ikke set noget” (vrænger) og så skal man derned alligevel, (griner) så, ja der kan man så måske springe ventetiden over ved at skælde dem frygteligt ud, men øhm, jeg ved egentlig ikke rigtig hvad jeg skal sige, for man kommer til at bruge tid på begge dele. Og det er måske også ondt at tage det ene eksemple der, men det har dog afholdt mig fra at gøre det igen, for jeg kan ikke.. 139
I: Nej..Men jeg tænker det..altså det lyder jo så også som om at det i et eller andet omfang også er relateret til at de kræfter du bruger så også er større ved at skulle følge op på at de ikke har..? K: Ja, og det at man også slipper den.. Altså selvom man nu sagde at der var en der kiggede på skærmen dernede og gik hen og tog pillerne og puttede dem ned i en pose og sendte dem ud til mig og så kiggede jeg i posen og sagde ”hov de er forkerte” og så skulle jeg sende dem tilbage igen (griner) eller sådan et eller andet… altså jeg mener..usikerhedsmarginen er for stor. I: Øh……..jo, har du nogensinde prøvet, hvis du nu har fået en recept fra lægen, og du så gik hjem og tjekkede og så ligesom sagde, ”det synes jeg ikke lyder som det rigtige valg for mig det der”, kunne du så finde på at ringe ned til lægen og sige ”ved du hvad, det der, det vil jeg slet ikke have” eller hvordan gør du. Altså du sagde tidligere at du ligesom tager stilling til i hvert fald om det er noget der..? K: Ja, altså jeg.. ja, øhm, hvis det er noget som..ikke er…livsnødvendigt, men som er noget som jeg forevnter vil bedre en tilstand en smule eller sådan noget, og jeg så finder ud af at det er helt ad helvede til sammen med det jeg tager jamen så lader jeg være med at tage det. Så tænker jeg, at så vil jeg hellere leve med halsbrand end jeg vil fylde nogle tabletter i hovedet som gør mig gørn eller sådan noget (griner) I: Ja det er skidt I: Men så lader du simpelthen bare være, det er ikke sådan at du går ned til lægen og snakker om at du ved nærmere eftertanke ikke har syntes at det var det rigtige? K: Nej det gør jeg ikke. Men øhm. Jeg er kommet til på et tidspunkt at få nogle hormonpiller som lægen syntes jeg skulle prøve at tage fordi jeg nok var i overgangsalderen og øhm..så gik jeg hjem, og så gik jeg rundt om dem, og så tænkte jeg ”arh” og så læste jeg en hel masse om, hvor dårligt det var at spise sådan nogle, og så spiste jeg dem ikke. Og så på et tidspunkt kom jeg så ned hos ham, og så sagde han ”ja, du har jo fået de der piller, og dem har du jo spist” og så sagde jeg ”nej men det gjorde jeg altså aldrig” og så blev han så tosset på mig I: Nå? K: Men øhm.. så fik jeg forklaret ham hvorfor. Altså sådan noget kunne man godt forestille sig at jeg ligesom.. Man får skrevet dem ud når man står dernede ”ja, nu skal du se, dem får du et eller andet for” og når man så kommer hjem og får undersøgt hvad det er for noget så tænker man at det vil man ikke udsætte sin krop for. Men så går jeg ikke ned og siger ”Du er dum, du har sagt jeg skal tage nogle grimme hormoner” eller altså.. det gør jeg ikke. Han har jo gjort det i den bedste tro. At jeg så er sådan en..stædig rad..det skal han jo ikke undgælde for. I: Og når du siger han blev tosset på dig, er det så i sådan en..? K: Nej, altså han blev bare lidt irriteret, fordi nu havde han jo ligesom udskrevet dem i den bedste mening, og så går han jo ud fra at det er den behandling jeg følger. Når jeg så ikke gør det, så er det jo klart at så bliver han lidt sådan øh, så bliver hans autoritet jo sat lidt til vægs, ikke I: Men er det sådan i andre sammenhænge at I diskuterer mere hvad du skal have, eller er det som regel sådan at han bestemmer, og så i nogen situationer så vælger du det bare fra, når du er gået derfra Eller bliver du involveret i nogle situationer? K: I nogle situationer bliver jeg absolut involveret i det. For vi diskuterer.. han er også blevet klar over, efterhånden som han har lært mig at kende, så er han blevet klar over at jeg stiller nogle spørgsmål ved det jeg putter i munden og at jeg ikke for enhver pris vil have noget for det jeg nu fejler. Det kunne også være en anden løsning der var den rigtige ikke. I: ….øhm, i forhold til..når du nu…hvordan skal man sige..hvis du ligesom, hvis du søger på nettet – søger du nogensinde før du går til lægen? K: Altså prøver selv at finde frem til nogle præparater? I: Ja? K: Nej. Det synes jeg ikke jeg gør I: Er det sådan så du overordnet opfatter det som at der på en eller anden måde – at online apoteket og det normale apotek på en eller anden måde supplerer hinanden? Er der noget man kan bruge dem til i samspil eller er det mere bare sådan et enten eller valg? 140
K: …….jamen….hvis man kunne nå frem til at man kunne bestille sin medicin, pling og så var det den rigtige der stod dernede, så kunne man jo spare den der ventetid, så kunne man have en udleveringskø, hvro det ikke skulle ekspederes, men hvor man bare kom og trykkede sit nummer ind og plut, så kom det ind. Altså for eksempel ikke. Har jeg lige opfundet et systemet I: Det er jo genialt. K: Ja det er ret genialt ikke – så på nettet fik man en recept her og så gik man bare ned her – ligesom postboksen..hvor man kan gå ned og hente sin post – det synes jeg er så vidunderligt. Døgnboksen hedder det. Så kunne det være døgnapoteket. At man døgnet rundt kunne gå ned og trykke sit nummer, dutteluttelut, og så fik man den medicin man havde bestilt. Det kunne da simpelthen være smart I: Så der ville du opfatte det som at man ligesom tog derned og så var der en stander hvor du selv kunne..? K: Ja, hvor man så bare trykkede sit rigtige nummer ind, ligesom et reservationsnummer. Og så bliver den medicin sparket ud. Der skulle selvfølgelig være en medarbejder knyttet til lige præcis den funktion, som ikke laver andet end at sidde og tjekke og kontrollere at det er de rigtige ting der kommer ned i de rigtige numre. Det synes jeg kunne være fantastisk. I: Jamen der er jo noget at tage med videre. Nogle gode ideer. Jo, jeg tænkte på.. K: Ja ved hjælp af nemid simpelthen. Eller sådan noget i den stil I: Hvad med i forhold til – bruger du sådan noget som mobilepay fx? K: Ja I: Og hvad synes du om det? K: Fantastisk I: Hvad er fantastisk ved det? K: Jamen det er fantastisk at det er så nemt at overføre penge – og at man ikke skal luske rundt med at logge ind først og skrive 117 ting først, men at det bare er dut dut og afsted med det. Det synes jeg er smart I: ….jo, i forhold til det her med at købe medicin på nettet. Ville du opfatte det som et alternativ at købe det gennem en hjemmeside som ikke var apotekets.dk? K: Som ikke havde noget at gøre med de apoteker du kender nede fra butikkerne? Det ville jeg da opfatte som lidt grænseoverskridende lige umiddelbart I: Hvorfor det? K: Jamen hvordan ved man hvem de var og hvem der stod bag og hvordan det blev håndteret og om det var fagfolk der havde med det at gøre . Det skulle jeg være sikker på, før jeg ville.. I: Hvis der nu kom nogle nye apoteker på nettet som i en eller anden grad var kontrollerede og man kunne ligesom godt spore hvad det var for et sted og det virkede legitimt nok. Ville du opfatte det som lige så meget en mulighed som webapoteket eller ville du være tilbøjelig til at vælge webapoteket? K: Jamen jeg ved jo ikke engang hvem står bag apoteket.dk – er det alle apoteket og apotekerforeningen? I: Ja, men det er altså ikke noget du har været bevidst om, da du købte det? K: Jeg har gået ud fra at det har været dem. Jeg mener at jeg har læst at det var dem. Men..det ved jeg søreme ikke.. Altså hvis det var fuldt ud lige så fagligt velfunderet så ville jeg vel ikke have noget imod det.. I: Hvis det nu var sådan nogen som Matas der fik lov til at sælge receptmedicin – det må de jo ikke som det er lige nu – men ville du opfatte det som en lige så god mulighed, hvis de solgte sådan noget på nettet? K: …ja, det ville jeg måske nok. Hvis man vidste de havde fagfolk, som man evt. kunne chatte med eller et eller andet. Det synes jeg også man savner på det andet. At man har den mulighed for lige at kunne stille et spørgsmål. Om ikke andet så bare i en del af åbningstiden, ikke I: Ville du synes det gjorde en forskel i forbindelse med sådan en chat, om det bare var en skriftlig chat, eller om det var fx en video eller lyd? K: Det ville være ligemeget for mig – bare jeg får et svar af en eller anden art, så er det ligemeget om jeg kan se vedkommende. Det er jeg faktisk ligeglad med I: Hvad med i forhold til hvem der sidder i den anden ende – er det noget der er en overvejelse for dig? K: Man finder hurtigt ud af om det er nogen der ved noget om det man spørger om. Det gør man altså. Nu har jeg ikke prøvet det af gode grunde på apoteket, men jeg har prøvet det i andre sammenhænge, og der finder man altså lynhurtigt ud af når folk ikke ved hvad de snakker om. 141
I: Og tror du du ville gøre det nu hvor apoteket.dk er Apotekerforeningen så ville det nok være nogen fra foreningen – fra et hovedkontor eller sådan der ville stå for sådan en chat. Gør det nogen forskel i forhold til at du ikke kender dem? K: Nej det gør ikke noget, bare de er faglige. I: Jamen så tror jeg faktisk at vi har været rimeligt meget rundt, så jeg vil bare sige tak. 142
Appendix 5: Transcription of interview with Julie I = Interviewer J = respondent (Julie) I: Okay, først vil jeg lige fortælle dig lidt om, hvad det er det kommer til at handle om. Vi kommer til at tale sådan rimelig ustruktureret. Det bliver ikke sådan at jeg stiller dig et spørgsmål og så svarer du hele tiden. Jeg vil bare gerne have dig til at tale så meget du kan. Og du siger bare lige hvad du vil – der er ikke nogen forkerte svar eller noget. Alt hvad du oplever i den sammenhæng jeg spørger dig til. Og det kommer til at handle om først dine sådan generelle forbrugsvaner på internettet og så noget med medicinforbrug og sådan noget. Og hvis der er noget du ikke har lyst til at svare på, så siger du bare det, for der kan jo være noget du ikke lige synes skal ud. Og du er selvfølgelig anonym I: Vil du fortælle din alder, din beskæftigelse og hvor du er bosat? J: Ja, jeg er 24 år gammel, jeg bor i København, nærmere betegnet Frederiksberg, jeg studerer og er ved at så småt starte et speciale og ved siden af arbejder jeg på et reklamebureau I: Bor du alene? J: Ja, det gør jeg I: Og du har ingen børn? J: Nej, jeg har ingen børn I: Okay. Først vil jeg gerne høre lidt om dine indkøbsvaner på nettet. Hvad er fx det sidste du har købt på nettet og hvordan foregik det? J: Øhm, det sidste jeg har købt, det var faktisk en lysestage og det var på sådan et – jeg kan ikke huske om det var sweetdeal, men det var i hvert fald noget lignende, hvor jeg netop opdagede et godt tilbud på en flot lysestage til mit hjem og den købte jeg så, og så købte jeg faktisk også en til min søster i fødselsdagsgave. I: Okay, er det typisk sådan nogle boligting du køber? J: Ja, det kan det godt være. Det er sådan ting der ikke skal prøves på eller ikke har den store konsekvens, hvis det der kommer frem det ikke lige var det helt rigtige. I: Okay, og det følte du ikke der var med den der? J: Der var ikke de store konsekvenser nej og faktisk tror jeg at jeg havde set den offline i virkeligheden inden jeg købte den I: Hvad køber du ellers på nettet? J: Jamen jeg er jo nok ikke en af dem der køber så supermeget på nettet. Jeg foretrækker primært at købe ting i butikker – altså det ville jo være oplagt for min målgruppe at tøj for eksempel på nettet, men det har jeg aldrig prøvet, så jeg køber ikke.. I: Du har aldrig prøvet tøj?.. J: Nej I: Så der er vel mange ting du ikke køber på nettet? J: Ja, det er der. Jeg køber heller ikke mad – altså diverse madleverancer man kan få på nettet osv. det gør jeg ikke I: Så hvad har du prøvet at købe – du har købt en lysestage..? J: Altså ting til hjemmet og så selvfølgelig altså flybilletter og hoteller og sådan noget som man reelt jo nok også stadig kan købe i..på gaden havde jeg nær sagt. Det ville jeg også købe på nettet. I: Hvordan kan det være du ville købe sådan nogle ting på nettet? J: Jamen det har jeg aldrig tænkt over ikke at gøre, så jeg tror bare det er sådan en automatisk tanke man får, fordi det er sådan vi gør i dag. Jeg gik engang på et rejsebureau for at købe en ferie, og der grinede alle mine venner af mig, fordi de syntes det var fuldstændig åndssvagt at jeg ikke bare havde booket det på nettet, men der syntes jeg der var en tryghed ved at der var nogen man kunne tale med og spørge om nogle spørgsmål og få det at vide fra en fysisk person i stedet fra en stjernevurdering-­‐ranking i en boks på nettet 143
I: Og det føler du giver dig noget værdi? J: Ja der er jeg nok lidt gammeldags, ja I: Øh..så det her med at du..at du føler at der skal være nogen..at du ikke kigger på de her stjerner eller hvad man skal sige, hvad er det der gør ved de her reviews og stjerner at du ikke stoler så meget på dem? J: Jamen for mig er det ikke håndgribeligt, det er ikke face-­‐to-­‐face, så jeg kan ikke spørge ind til hvad den person mente med at give den 4,5 i stedet for 5 og uddybende spørgsmål, noget som et ansigtsudtryk eller.. For mig er en personlig og face-­‐to-­‐face anbefaling langt stærkere end..hvilket i virkeligheden lyder lidt mærkeligt kan jeg godt høre når jeg siger det, men ikke desto mindre, er det sådan det er I: Tror du det kunne ændre sig eller tror du at..hvad skulle der til for at det ville ændre sig for dig, og købe nogle andre ting på nettet? J: Jamen jeg tror sagtens det kunne ændre sig, jeg tror det er en vane for mig, at jeg er ikke vant til at gribe købsprocessen an foran min computer. Som sådan tror jeg ikke jeg har noget imod det, jeg tror sagtens det kunne ændres, også fordi jeg er jo ikke skræmt over teknologi og online medier osv. Så det tror jeg godt det kunne I: Når..da du købte den her lysestage, hvordan foregik det så helt konkret, hvis du tager mig igennem at du opdagede at du havde brug for sådan en lysestage, eller sad du og kiggede på nettet efter en og browsede eller? J: Jeg får jo de her mails fra, altså man kan jo få fra alle mulige af de her udbydere, men jeg har så valgt den der hedder deal24, tror jeg den hedder, som samler alle tilbud der kommer fra dag til dag, og der scrollede jeg ned og fandt netop den her lysestage, som jeg så også før sagde at jeg havde spottet før hos enten hos en veninde eller i en butik, jeg kan ikke huske det. Og der var jo så halv pris på den her, og der gik jeg så bare igennem, altså klikkede ind på tilbuddet, oprettede en profil på udbyderens side der, og bestilte den så bare. Og et meget godt eksempel for mig er nok også at jeg stopper ikke bare der (griner) jeg ringer til dem der står for det her tilbud og spørger ”hvordan fungerer fragten, hvornår skal jeg være hjemme” i stedet for bare at ligesom at have tiltro til at den her proces jeg ikke har noget med at gøre, og uden at tale med nogen den nok skal fungere som den gør. Men jeg har lige af en eller anden grund behov for at skulle interagere med en eller anden levende I: Og hvordan foregik det så da du ringede? J: Jamen så ringede jeg og sagde ”hej og hvornår kommer den her”, jo også primært fordi den anden var en gave til min søster, så kunne jeg nå at få den inden hun havde fødselsdag og skulle jeg være hjemme. Og det var bare en sød mand der svarede på mine spørgsmål, og så kom den så en dag hvor jeg var hjemme I: Men følte du dig så, altså det var ikke sådan så du var utryg ved selve processen? J: Nej, det er jeg ikke, det er bare skørt, men jeg er nok lidt mere obs end andre ville have været og burde være også. Men det er smart, og jeg anerkender at jeg synes det er dødsmart I: Hvorfor synes du det er smart? J: Jamen det er fordi det kommer til døren, altså det skal jo som sådan ikke, det kræver ikke en aktiv handling for mig at skulle ned og hente noget eller skulle cykle ind til byen for at finde lige præcis der hvor den står. Altså det kommer til min dør, og det er jo convenience i allerhøjeste grad. I: Okay, så vil jeg gerne tale lidt om dine indkøbsvaner for receptmedicin generelt. Kan du huske hvornår du sidst har købt receptmedicin? J: Jamen, det har jeg gjort for en måneds tid siden I: Hvad skulle du købe der? J: Jamen det er jo sådan den klassiske unge kvinde ting for at købe p-­‐piller, og det har jeg gjort i mange år I: Kan du beskrive lidt om, hvordan det foregik? J: Altså jeg tror det er blevet meget automatiseret nu, fordi det er noget der har gentaget sig så mange gange, så det er jo bare at komme ned på apoteket, som ligger, det skal nok også siges, ti meter fra min lejlighed har jeg et apotek. Der går jeg bare ned, trækker et nummer, kører mit sygesikringskort igennem og siger jeg har det liggende på det her kort. Og så spørger damen om jeg har nogen spørgsmål, og om det fungerer som det skal, og så siger jeg ”ja, det gør det” og så betaler jeg og går igen I: Og du føler det er hver gang de spørger om det? 144
J: Det gør de altid, ja I: Er der nogen gange, hvor du så har spurgt om noget eller..? J: Aldrig. De har nogle gange spurgt ”vil du have samme funktion i et billigere mærke” osv., for det tror jeg de får at vide at de skal, så det gør de. Og så siger jeg ”nej tak” og så går jeg igen og så I: Hvad gør at du siger nej tak til et billigere mærke? J: Jeg kan godt lide bare at få det jeg ved der fungerer, og få det min læge har sagt jeg skal have. Og har ikke mod til og behov for at gå ind og tænke ”gad vide om der er fuldstændig det samme i og om det bare er et kopipræparat til..”. Det kaster jeg mig ikke ud i. I: Også selvom der står en farmaceut og siger det? J: Ja I: Føler du at du stoler mere på din læge? J: Ja, jeg stoler mere på min læge end jeg gør på dem, men jeg føler stadig de er en vejledende, rådgivende faktor, helt klart. Men lige med sådan noget der er jeg bare ikke villig til at tage chancer. Og det er måske skørt, men sådan er det. I: Den her recept, hvor tit får du fornyet den, og hvordan foregår det? J: Jeg får den fornyet en gang om året, så vidt jeg husker, og det foregår hos lægen – der skal jeg op, og sige ”nu vil jeg gerne have en omgang mere her” I: Okay, du skal op til lægen? J: Ja, det skal jeg I: Kan du huske nogen gange, hvor du har købt receptmedicin, hvor det ikke var sådan en ting du køber ofte, som p-­‐piller? J: Ja, det kan jeg nok godt, det var sådan noget – altså nu får vi alle detaljerne her – men det var sådan en ret slem blærebetændelse, som ikke bare var sådan nogle tranebærkapsler man kan købe i håndkøb, men som var noget hvor det havde jeg ikke prøvet før I: Og hvordan var det – du gik op til lægen? J: Jeg var til lægen, fik recepten og gik ned på samme apotek her, og kom så ned, og der havde jeg nok i højere grad brug for en snak om, hvordan og hvorledes skal det her foregå og I: Snakkede du med din læge om det? J: Det snakkede jeg med farmaceuten om I: Gik du direkte fra lægen og ned til..? J: Ja, der går lige en lille time, så vidt jeg husker, inden man..inden recepten er i deres system, så jeg gik vel en tur, eller var lige hjemme – som sagt ligger det jo meget tæt på I: Og hvad snakkede du med farmaceuten om så? J: Jamen jeg tror bare det var sådan en generel snak om, hvornår på dagen skal de tages, skal jeg fortsætte hvis det forsvinder mine symptomer, og sådan nogle ting I: Var det dig, der indledte den samtale eller? J: Jeg er ret sikker på at hun spurgte om jeg havde spørgsmål I: Har du nogensinde købt medicin online? J: Nej. Det har jeg aldrig gjort I: Hvordan kan det være? J: Jamen, jeg tror det er det her med, som sagt, en tryghed ved at stå face-­‐to-­‐face med en ekspert, som det jo er når man kommer ned på apoteket. Altså jeg tror også jeg ville have vanskeligt ved, lad os nu sige at Matas fik lov til – altså man ser jo i stigende grad at de får lov til at sælge ting som før hørte apotekerne til og jeg ville bare have det sværere ved at stå og tale med en person, som jeg vidste ikke havde den relevante baggrund for at kunne rådgive mig om ting indenfor det her område I: Og hvis du nu vidste at der var..hvad hedder det.. på den online kanal.at der var faktisk en chat-­‐funktion, hvordan ville du have det med det – ville det hjælpe dig? J: Det ville hjælpe mig, og det kan også godt være at det sådan til mindre betydningsfulde spørgsmål ville være rigtig fint. Men jeg tror stadig at hvis det var ting hvor jeg sådan tænkte at ”det her det kan godt betyde noget, det kan godt have konsekvenser” så ved jeg ikke om jeg ville… 145
I: Nej, så ville du hellere gå ned ti..? J: Ja, det ville jeg. Men det passer nok også meget godt med den historie jeg fortalte før. At jeg er ikke så tillidsfuld og lægger ikke mit liv – det lyder så voldsomt – men i hænderne på noget jeg ikke har fysisk kontakt med. Men jo, jeg kan da sagtens se en chat-­‐funktion i den forstand at, lad os nu bare sige i p-­‐pille tilfældet ”hov nu har jeg taget to på samme dag eller nu glemte jeg en, hvad gør jeg”, sådan nogle ting, som dem kan du reelt slå op i en manual, men altså mere dybdeliggende ting, nej der ville jeg nok have brug for…måske bare at ringe til en og høre stemmen I: Har du nogensinde prøvet sådan at søge på sådan nogle medicinrelaterede ting? J: Ja det har jeg gjort, ja det gør jeg. I: Hvordan foregår det? J: Jamen, altså det er jo, hvis der er et eller andet man tror man kan fejle eller jeg har nogle symptomer på noget, så går jeg ofte ind på nettet først, inden jeg konfronterer en læge og ligesom prøver at spore mig ind på ”gad vide hvad det kan være det her”. Om det så er smart eller skidt altså – læger taler jo ofte en fra at skulle gå ind og diagnosticere sig selv på nettet, men ikke desto mindre går jeg ind på -­‐ det er jo ofte netdoktor man bliver ledt ind på, når man starter hos google I: Hvordan kan det være du gør det, før du skal til lægen? J: Ja, det er et godt spørgsmål. Det er jo nok en eller anden form for jeg vil godt lige selv vide om jeg er på vej til højre eller venstre, inden jeg kommer op, for ikke bare at komme og sige at det gør ondt dér. Så det er nok også sådan lidt, at jeg vil egentlig gerne tage sagen i egen hånd, men der skal være nogen til at sige ”det er det du fejler” I: Så du vil gerne være informeret, før du går til lægen? J: Ja, sådan i hvert fald selv have gjort en indsats for sådan at finde ud af, hvad der mon kunne være I: Kunne du finde på, når du så kommer hjem fra lægen, at begynde at søge alternativ information eller hvordan føler du ligesom..? J: Der tror jeg at jeg er ret autoritetstro, så hvis jeg har fået en besked fra lægen, så tror jeg ikke at jeg gør så meget mere. Men jeg kunne sagtens forestille mig – lad os nu sige at jeg fik at vide at ”du fejler sådan og sådan”. Så ville jeg da gå hjem og undersøge mere om ”hvad er det her”. Men jeg ville aldrig gå ind og sige ”du sagde godt nok sådan, men nu prøver jeg lige at finde en alternativ løsning”. Nej det ville jeg aldrig gøre. I: Så du stoler ret meget på din læge? J: Ja, der er jeg nok ret autoritetstro I: Og hvis du så ikke oplever – lad os sige at du ikke oplever det her receptprodukt virker som det skal – hvad ville du så gøre? J: Så går jeg til lægen igen I: Så ville du gå til lægen igen? J: Ja, og sige ”det er stadig ikke løst” I: Du ville ikke gå på apoteket? J: Nej I: Hvordan kan det være, tror du, at du stoler så meget på din læge – hvad er der gør at du er så autoritetstro overfor ham eller hende? J: Det er et godt spørgsmål. Det er jo den instans man er opdraget til har styr på tingene. Det er jo lægen der, i forhold til en farmaceut ville jeg mene at lægen har en længere uddannelse, ved mere om tingene. Det er jo lægen der går ind og pinpointer at det er det her vi skal ind og gøre noget ved og så kan farmaceuten enten tage over i den forstand at hun giver dig det præparat han har sagt du skal have, eller kan ligesom tage over og sige ”okay, diagnosen var det og det, jeg ved at vi har de og de ting”, så jeg tror bare at det ligger helt dybt i mig, at det er lægen der skal gå ind og ekspertvurdere hvad jeg fejler I: Øhh…så det her med at du stoler på at det er det rigtige du har fået, tænker du nogensinde over sådan konsekvenserne ved et receptprodukt eller..? J: Ja, det gør jeg 146
I: ..og føler du dig sikker på at du så har fået det rigtige af lægen eller..er der nogen ting du sådan selv bekymrer dig om hvis du har fået et receptprodukt? J: Ja altså det..jeg kan jo tage eksemplet igen med p-­‐pillerne – jeg har også prøvet at konfrontere min læge med at sige ”jeg så fx det og det program i TV. Er det smart at du bliver ved med at forny min recept på det og det præparat, for jeg har en ide om, at det går ind under den kategori, som jeg har hørt skulle være ekstra risikofyldt. Så på den måde går jeg ind også og sætter spørgsmålstegn og har da også brug for nogle gang at lægen så siger ”I det her tilfælde, det er helt okay, den udsendelse forvrængede egentlig billedet af det” Og igen er jeg så så autoritetstro og siger ”okay, jamen det må så være som det skal være”. Men jeg er ikke bare fuldstændig blank og så siger at alt jeg bliver pålagt her det er lige som det skal være. Så jeg tager da kritisk stilling – eller forsøger i hvert fald. I: Du siger fx sådan en udsendelse der – du bliver påvirket af sådan noget? J: Ja, absolut, det gør jeg I: Så det er også meget medierne? J: Ja, det kunne sagtens påvirke mig I: Hvad kunne ellers påvirke dig? J: Bekendte, venner, har de haft en god/skidt oplevelse. Har de haft de samme symptomer som mig og så fået det og det. Altså, det ville da også være en. Men jeg ville aldrig gøre noget uden at have konsulteret en læge, hvis vi er oppe i noget der.. I: Tror du at det også påvirker det at du går ned på apoteket – at du føler at du kan snakke med en? J: Ja, for man kan ligesom lige sparre lidt. Have et levende væsen der ligesom be-­‐ eller afkræfter en i de tanker man går og har I: Så hvis du skulle beskrive apoteket med ét ord, hvad ville det så være?.....lige hvad der falder dig ind? J: Ja. Altså det er jo nok sådan noget, det er jo nok noget service, tror jeg at jeg ville sige I: Bekymrer du dig nogensinde om pris i forbindelse med de her medicinkøb? J: Nej. Der skal jeg bare have det de siger er bedst I: Så der er du ret ligeglad? J: Ja, det betyder ikke noget. Lige præcis med medicin, det er jo nok det I interesserer jer for nu, men jeg er ellers ret fokuseret på pris, og vælger ofte ting der måske er billigere end andre – lad os sige inden for madvarer eller tøj. Men lige præcis med medicin, der har jeg prøvet mange gange at sige, at jeg skal bare have det der fungerer, og jeg skal ikke have det der koster det halve, og måske fungerer næsten lige så godt, eller et nyt produkt af det samme. Nej pris betyder ingenting i det I: I de her situationer hvor du bliver spurgt om de her substituerende produkter, som man bliver, hvordan foregår det, bliver du spurgt om et enkelt der er billigere eller hvordan har du oplevet det? J: De gange jeg er blevet spurgt i forbindelse med p-­‐piller, der er det ét substituerende produkt de spørger til. De siger ”vil du ikke have et tilsvarende bare et kopipræparat som koster lad os sige 80 kroner mindre, og der siger jeg nej I: Og hvad, har du nogensinde bedt om at få en forklaring fra dem? J: Jeg tror jeg siger at jamen hvad er forskellen, men der er ikke den store dialog for jeg siger ret hurtigt, at jeg vil gerne fortsætte med det jeg synes fungerer rigtig godt I: Så der er det også meget en vane og tryghed? J: En vane og klart tryghed – mere tryghed end vane I: Når du står nede på apoteket..nu ved jeg hvilket apotek du snakker om, for det snakkede vi om tidligere, det er et meget lille apotek – er det noget der betyder noget for dig, når du står dernede? J: Altså det kan betyde noget for mig i den forstand at jeg synes folk står voldsomt tæt på en, når man står og snakker om ting man måske ikke er interesseret i at resten af Frederiksberg kender til. Så ja, det kan godt betyde noget for mig. Og nu er jeg ret sådan..jeg har det..jeg er sådan rimeligt åben omkring ting, så jeg kunne forestille mig at der er mange der har det langt værre end mig. Men jeg er tit på apoteket for..altså det er jo ikke hovedpinepiller jeg går ned og køber, så jeg føler det er jo sådan meget intime ting man er nede og skal snakke om, og det kan jeg da godt mærke, at når der står 11 mand lige bag mig, som står og venter på at deres nummer bliver råbt op, jamen det har da en betydning 147
I: Generer det dig? J: Ja, det er i hvert fald distraherende I: Har du nogensinde mødt nogen du kendte? J: Nej, gudskelov, det havde været forfærdeligt I: Det ville påvirke dig? J: Ja, det ville det. Det ville jeg synes var ret akavet, uanset hvad jeg havde været inde og hente faktisk. Jeg tror bare jeg ville sige hej og skynde mig at gå udenfor. Hvis man skulle snakke med vedkommende ville det i hvert fald nok være udenfor. Altså, jeg ville sige, hvis det var en veninde jeg mødte, okay, men der var mange andre hvor jeg ville tænke at ”det var ikke lige her jeg havde drømt om at møde dig”. Så hellere i Netto. Det var jo så selvfølgelig afhjulpet online. Der kan man ligesom sidde og gemme sig lidt mere I: Kan du nogensinde være bekymret for, om de her medicinprodukter du køber, om de ligesom er skadelige eller..? J: Ja, det kan jeg da godt I: …om det er noget der, for det første om det kommer til at virke, og for det andet, om det er noget der er skadeligt? J: Ja, jeg synes sagtens jeg kan bekymre mig om, om noget er skadeligt. Og jeger jo generelt en type, der tænker meget over ting, og jeg, så ja, jeg kan da godt tænke om det er smart at bruge det her jeg nu bruger, så ja det kan jeg da sagtens. I: Er det en bekymring du ligesom snakker med lægen om, eller gør du noget ved den bekymring? J: Jeg gør ikke noget ved den bekymring, men man kan sige, jeg bruger også kun de medicinprodukter som jeg virkelig behøver. Altså jeg er ikke sådan fan af alle mulige piller og præparater, så det er kun de absolut nødvendige jeg benytter mig af, og der er selvfølgelig altid en risiko og der er altid bekymringer, men det er så opvejet ved de fordele der er ved at benytte sig af tingene I: Hvis vi taler generelt om online og offline – altså online shopping og shopping i butikker – hvad er de væsentligste fordele? J: Altså ved at gøre det online eller? I: Ja altså generelt, ikke kun for medicin, men altså alle former for shopping online i forhold til shopping i butikker – hvad er forskellen for dig – hvad synes du der er af ulemper og fordele? J: Jamen altså hvis vi tager offline først, altså der er jo en kæmpe fordel idet du står fysisk med, med produkterne, og om det er den ene eller den anden kategori så kan du jo fx få tøj eller ting til din bolig eller hvad, du kan stå og mærke, du kan mærke kvaliteten, du kan se det in front, altså det her med at stå og røre ved det og kunne se det, det synes jeg er en kæmpe fordel offline. Der er jo også det her serviceorgan i en tøjekspedient eller en farmaceut eller en dame i Matas der kan give en gode råd altså. Så service og så det her med at du kan se hvad du får. Online er der selvfølgelig, der er jo kæmpe tidsbesparende faktor, altså du kan overskue meget mere på én gang, du kan jo simpelthen bare sidde og scrolle, og så har du set alle bukser i H&M, eller du har set alle de mascaraer Matas har eller hvad ved jeg. Og så er der jo det her med, at du kan bare klikke på en knap, og så kommer det i din kurv, og så er det det. Altså, det er jo vildt nemt og tidsbesparende. Til gengæld, altså det ved jeg ikke, der er jo sådan lidt adventure både online og offline altså. Du går ud og kigger i butikker og det er en sjov oplevelse. Men der er jo også mange der får et sus af at sidde med deres computer og køre rundt på de forskellige online shops. Jeg er ikke nået dertil endnu, men jeg kan godt se det er dødnemt og overskueligt I: Så når du siger alle de her ting der er ved det, så går jeg ikke ud fra at du er nede og røre ved dine p-­‐piller fx – hvad er det så der gør at du ikke køber p-­‐piller på nettet? J: Nej der er det jo.. Ja, jeg tror simpelthen det er den her tryghed, og så er der også bare noget vanebaseret over det. Man kan sige, i og med at det er noget jeg køber regelmæssigt, så er det jo skørt at jeg har brug for..det er jo et eller andet sted skørt at jeg har brug for tryghed, så der er jo nok gået meget vane lige præcis i den. Så man kan sige hvis man tager p-­‐pillerne versus andre ting jeg ville købe sådan engangsbaseret, så kunne p-­‐pillerne jo sagtens blive bestilt online, som jeg ser det, for jeg har jo ikke brug for farmaceuten til at stå og spørge om det går godt, og om jeg vil have andre ting, for jeg siger jo bare ”det kører”. Så det er nok blevet vane, ja 148
I: Nu skal jeg lige se her..jeg skal lige følge med i de spørgsmål vi har..ja, hvis vi kommer tilbage til det her med, når du står nede på apoteket, hvad er det for en fornemmelse der slår dig i forhold til hvis du står i en normal butik. Hvordan vil sammenligne det med en anden form for service-­‐butik – hvad er det du føler er specielt ved et apotek, hvis du synes der er noget? J: Jeg synes der er en form for ekspertise. Altså, et apotek kommer du jo netop ned på fordi de specialiserer sig i at sælge de her ting til dig, så det er jo meget specifikt, meget konkret, og så er der meget ekspertise. Det er jo sjældent at du kommer ind i en anden butiksform, hvor der står decideret veluddannede mennesker bag disken. Det er nok den største forskel jeg kan se på det versus at gå ind i en tøjforretning I: Da du købte den her lysestage, var der så en, altså var det udelukkende en online website, eller havde de en butik også? J: Det var en online website, hvor de havde lavet en eller anden aftale med en, formoder jeg, en offline forretning eller et lager eller whatever, hvor de fik de her produkter fra. Men det var 100% online. Jeg kunne ikke være gået ned i deres offline del og have kigget på tingene – det kunne man ikke. I: Betyder det noget for dig generelt om der er en rigtig butik? J: Jamen altså jeg vil sige det sådan, om der er en rigtig butik eller hvad nu, hvis jeg har set den ting jeg køber på nettet, hvis jeg har set den i virkeligheden, om det så har været i en venindes hjem, eller i en anden forretning, så gør det en kæmpe forskel. Så kan jeg bare klikke på den knap og vide at jeg har jo set det jeg gerne vil have, så det har en betydning at jeg kan se det offline, det har det I: Men giver det dig nogen sådan – hvis vi skal tænke på troværdighed – i forhold i den her online shop, giver det dig nogen sådan større følelse af at de er troværdige? J: Ja, altså hvis man tager sådan en forretning som H&M som jo både er online og offline, der giver det mig troværdighed at jeg ved at det hele hænger nede i forretningerne, men nu køber jeg det bare her, fordi det er nemmere. Det ville jeg sige var mere troværdigt end en udelukkende online baseret forretning. I: Hvorfor tror du det? J: Jamen jeg er gammeldags. Jeg tror simpelthen det er det eneste jeg kan forklare det med. Jeg er tilhænger af ting der er i fysiske butikker, fordi jeg er til det der lidt..men på den anden side så vil jeg så sige, at jeg har lige købt et computer-­‐sleeve, på nettet, og der var ikke nogen offline butik, men det var sådan noget med, at det er lidt noget særligt det her, der er en god historie på deres website, det ser spændende og unikt ud. Det gør jeg. Og så bliver der jo også noget unikt og troværdigt over at det så kun er offline, fordi så er det noget særligt, og noget for..ja det ved jeg ikke I: Hvorfor tror du det opleves som noget særligt eller unikt? J: Jamen det er jo fordi at vi har ikke lige en masse-­‐kæde på 70 butikker i Danmark, hvor der er 10.000 af det samme item I: Hvordan fandt du det her computer-­‐sleeve? J: Jamen jeg gik ind og skrev simpelthen ”sleeves til macbook air” og så kom det frem og så syntes jeg det var dødflot, og på den måde kom jeg fra billedet og ind på den side Jeg anede ikke at det eksisterede I: Og der søgte du lidt rundt? J: Ja, der var jeg nok lidt explorative der (smiler) I: Men var du..hvordan kan det være at du lige med denne her vare ikke valgte at gå ned i en butik? J: Jamen jeg har også været i butikker, men der har bare ikke været noget, så man kan sige jeg startede i en butik, men jeg må have vurderet, at der var ikke nogen store konsekvenser ved at købe online. Jeg kunne se hvad målene var, og jeg kunne se at den var lavet lige præcis til en computer som min, så der var ikke det store der kunne gå galt. Og jeg kunne se ”godt det har han lavet fint, og der er en lille strop på i læder – det kan ikke gå helt galt”. Så der vurderede jeg at det var fint. I: Ringede du til nogen der? J: Det gjorde jeg ikke. Men jeg ringede til mine forældre og sagde at jeg ønskede mig den i julegave, og jeg ved at de ringede til fabrikanten I: Okay, men det var der ikke noget galt med, da du fik den? J: Nej, det var perfekt 149
I: Øhm, nu skal jeg lige kigge her, orientere mig hvor jeg er…kunne du så finde på at søge på nettet for at finde det her, og så finde en rigtig butik – altså en fysisk butik der havde det? J: Ja det kunne jeg godt. Mht tøj kunne jeg sagtens finde noget og blive inspireret på nettet og så gå ned og prøve det i en butik. Jeg kunne også godt finde noget smart til min bolig, og så gå ned i en butik, hvor jeg kunne se at de forhandlede det, for at se, hvad er det her i praksis – ja, det kunne jeg sagtens I: Nu talte du tidligere om de her tranebærpiller i forbindelse med det her blærebetændelse – der fik du så rigtig medicin? J: Ja, det var så decideret recept I: Men har du prøvet at købe sådan nogle tranebærpiller fx? J: Ja I: Så du kunne godt finde på at købe nogle af de her ting som er lidt mere alternativ medicinering? J: Altså, er du på nettet nu? I: Nej, bare generelt? J: Ja, det kunne jeg sagtens finde på. Jeg ville jo gå på apoteket og gøre det og jeg ved man også kan få dem i Matas I: Men der vil du helst gå på apoteket? J: Ja det ville jeg nok lige i det her tilfælde. Jeg kunne faktisk også godt købe det i Matas, men det er fordi jeg ved det sort på hvidt med dobbelt understregning bare er tranebærpiller man skal have, hvis man er ved at få blærebetændelse. Altså, det er fordi det ved jeg bare, der er ikke noget at være i tvivl om I: Hvordan ved du det? J: Fordi, jamen det gør alle mine veninder, det gør min mor, og det er jo også det farmaceuten siger, når jeg så har været nede og få decideret receptmedicin ”har du tranebærpiller?”. Altså det står bare skrevet i min hjerne, at det har alle anbefalet. Så om jeg købte det i Bilka eller Matas eller apoteket, det ville ikke betyde det store I: Så prøvede du det først, før du tog medicin, før du gik til lægen? J: Ja I: Så der prøvede du ligesom..? J: Ja, der går jeg lidt udenom systemet faktisk (skælmsk -­‐ griner) I: Øhm..jeg tror faktisk vi har været inde på det meste allerede..det nåede vi jo hurtigt..jo lige et kort spørgsmål – du sagde det var, typisk når du køber på nettet så tager det jo mindre tid – føler du det tager meget tid og kræfter når du skal ned på apoteket – det fysiske apotek? J: Altså, det gør det som sagt ikke, fordi det apotek jeg benytter ligger et minuts gang fra min lejlighed, men hvis jeg havde et apotek, der lå, lad os sige, to kilometer derfra, så det krævede en decideret cykeltur eller en tur i bus eller..så kunne jeg godt forestille mig at jeg ville sætte mere spørgsmålstegn ved det jeg gjorde, men det er så let for mig lige at svinge ind der inden jeg går i netto eller hvad det nu måtte være, så det gør mig nok også doven, og det forstærker bare min vane i at det er bare det jeg gør. Den dag jeg flytter, og mit apotek ligger længere væk, der kunne jeg sagtens forestille mig at jeg satte spørgsmålstegn ved om det var det mest effektive og det mest I: Også selvom du får vejledning dernede? J: Ja for hvis det var ting jeg – ligesom p-­‐pillerne, ting jeg bare skulle fortsætte med, så ville det godt kunne rokke mig, ville jeg sige. Men det ville ikke ændre på, at hvis det var andre ting jeg ikke havde prøvet før, så ville jeg tage den tur. I: Køber du andre ting på apoteket? J: Nej jeg er ikke sådan en der køber shampoo og cremer og sådan noget – der er jeg nok ikke så.. Nej der er jeg ikke.. Jeg kan godt gå ned og købe fx hvis jeg skal på ferie, at købe håndsprit, men det kan jo også købes i Matas – jeg ved ikke hvorfor jeg går på apoteket og gør det. Men det var sådan nogle småting jeg godt kunne finde på at købe. Og til nød måske en solcreme, men det kunne lige så vel være i Matas I: Føler du, når du så er på apoteket, at du bruger meget tid og kræfter – en ting er på transporten..? J: Overhovedet ikke, jeg kører det totalt på rutine. Det eneste der kan være irriterende er, hvis der er 15 numre før mig, så kan man godt stå og tænke at det var ikke så.. 150
I: Hvad gør du så? J: Så går jeg lige ud og står lidt – som sagt er det et lille apotek, så jeg går ud og nyder lige det gode vejr, hvis solen skinner, eller tjekker min facebook eller sådan noget. Så det er ikke fordi jeg føler at det frarøver mig en væsentlig tid af min dag I: Jamen jeg tror faktisk vi er igennem det hele – det var super 151
Appendix 6: Transcription of interview with Pernille I = Interviewer P = respondent (P) I: Det er sådan et meget ustruktureret interview, så vi skal bare have dig til at snakke så meget som du nu kan, så når jeg spørger ind til et emne så fortæller du bare alt hvad du lige synes om det eller hvad der lige falder dig ind i forhold til det, så det er ikke fordi der er nogen korrekte svar eller noget som helst. Og hvis der er noget du ikke har lyst til at svare på, så lader du bare være med at svare på det. Ja, men først – eller og du er selvfølgelig anonym skal lige siges . Du hedder bare Pernille – eller noget andet, du må også vælge et andet navn hvis du vil det (griner) I: Først skal jeg bare vide din alder og beskæftigelse og hvor du er bosat? P: Jeg er 26 og er studerende og bor på Frederiksberg I: Og hvordan ser din husstand ud? P: Sådan..? I: Så du bor sammen med en..? P: Ja, jeg bor sammen med min kæreste I: Og du har ikke børn? P: Nej, ingen børn I: Godt, så fik vi det på plads – øhm, okay først vil jeg gerne spørge lidt ind til dine indkøbsvaner generelt på nettet – sådan hvor meget du køber, hvad du køber og hvordan det foregår, hvis du kan fortælle lidt om det – sådan dine generelle mønstre med det? P: Ja, men det kommer lidt an på hvad det er, men jeg tror jeg, typisk, bruger jeg enormt meget tid på at finde ting på nettet og finde info og finde ud af om det er den kvalitet og om det er det rigtige og hvor man kan få det henne og sådan nogle ting, så det kan jeg bruge ret lang tid på. Det er sådan lidt en ny vane der er kommet ind efter jeg har mødt min kæreste – før har jeg ikke været så kritisk, men nu bruger jeg ret meget tid, så det har smittet lidt af fra ham, at jeg bruger ret meget tid på at sætte mig lidt ind i tingene inden jeg gør et køb I: Så hvad kunne det fx være at du satte dig ind i ved et specifikt køb? P: Jamen altså, nu har vi fx lige været ude og rejse så bare det at skulle fx finde en rygsæk. Så går det meget op i at læse folks anmeldelser af diverse rygsække, og hvad er godt og hvad er dårligt. Umiddelbart så tænker jeg, at det er er ikke fordi…altså, det har da betydning for hvad det er jeg går ud og køber, men jeg tror lige så godt at jeg bare kunne gå ind i butikken og så gøre mig et køb som jeg ville være ganske tilfreds med, men jeg tror det er fordi jeg hygger mig med det. I: Ja, du synes det er sådan..? P: Ja, det tror jeg I: Hvordan griber du det så an hvis det er sådan med rygsækken..hvordan starter du med at søge på det? P: Jamen, først så ser jeg hvad udvalget er, og så begynder man ligesom at pege nogen ud, og så begynder man at finde ud af, jamen er der nogen der har rejst med de her rygsække, som siger det er bare vildt godt eller vildt dårligt eller den gik i stykker eller sådan noget. Og derefter går man så ind i butikken, hvor man så ser at jamen den har de ikke engang hjemme, og så ender man med en helt tredje I: Okay, så du har købt rygsækken i en rigtig, fysisk butik? P: Øh, ja I: Hvordan kan det være at du ikke købte den på nettet? P: Øhm, jeg tror bare gerne jeg ville se den, holde den i hånden, se størrelsen. Jeg synes nogen gange kan det godt være lidt svært I: Men det var så først efter at du havde været inde og undersøge den? P: Jaja I: Hvad hedder det…hvad køber du ellers på nettet? P: Så er der jo tøj, jeg er sådan rimeligt påp..altså jeg har det sådan med sko, at det gør jeg ikke, fordi det spa..altså der er chancen for at det ikke passer og at du står og skal sende det tilbage bare for stor. Tøj det 152
er lidt noget andet. Jeg købte en nespresso maskine på nettet. Der kunne man selvfølgelig også bare have gået ned i butikken, men .. øhm, ja I: Hvor købte du den henne – var det fordi.. hvorfor købte du den på nettet? P: Jeg tror jeg købte den på wupti, fordi den var billigere. I: Havde du været nede og se den først i butikken? P: Nej, det havde jeg faktisk ikke – det var faktisk et godt tip jeg havde fået af en af mine venner, at det her var en god en, at den var de glade for, så blev det egentlig bare den I: Så hvad så, køber du tit på nettet? Hvor meget af dit det du køber, køber du egentlig på nettet? P: Altså sådan ud af alt så er det nok 60% der bliver købt på nettet I: Okay, så det er sådan rimelig meget? P: Ja, også sådan hvis, fødselsdagsgaver er jeg også ret hurtig til at købe på nettet I: Hvordan kan det være at du vælger nettet der? P: Hm, det er måske nok bare fordi at man har så travlt, så hvis man er herovre , så..altså jeg gider ikke købe mine gaver i Frederiksberg centeret, og jeg hader Strøget. Så kan der godt gå lidt mere show i at sådan..årh, hvor skal jeg finde GAVEN. I: Så det er sådan lidt besværligt – du finder det nemmere at finde den? P: Ja, jeg danner mig et overblik, og så slår man ofte til I: Er der noget du ikke kunne finde på at købe på nettet? P: Altså, som jeg sagde sko har jeg det ret svært med. I: Men er der noget du godt kunne tænke dig at købe, som du ikke lige har købt – eller er du sådan lidt at du køber egentlig det hele? P: Ja, det er tror jeg egentlig. Altså selvfølgelig – der er stadig..altså jeg køber tøj, men der er det sådan, hvis det er noget, hvor jeg skal bruge lidt flere penge på tøj, så vil jeg også gerne ned og mærke kvaliteten, for det kan jeg jo ikke altid mærke på nettet I: Er der nogen situationer, hvor du, altså nu fx med den her rygsæk, som du købte i en fysisk butik, der har du været inde og søge først. Er der nogen ting som du køber, hvor du sådan både danner dig et overblik over hvad der er og køber i den fysiske butik, hvor du ikke har været online først? P: …hm, I: Eller føler du at du sådan søger ret meget først? P: Jeg tror faktisk at jeg søger ret meget . Jeg har virkelig sådan en svag side med, også hvis det ikke er til mig selv, hvis min søster lige pludselig siger at hun mangler et par jeans, så kan jeg bruge enormt meget tid på at søge på hvor hun skal finde de perfekte jeans henne. Det er virkelig en dårlig vane I: Men er det sådan fordi du synes det er underholdende? P: Ja, det tror jeg. Og fordi jeg tænker at ”ej, man kan bare gå ind i en butik og blive så skuffet nogle gange” med mindre at altså..min søster hun er mor, og lever lidt sit eget liv, så hun har måske ikke lige styr på hvor hun lige skal gå hen, så jeg føler lidt jeg har pligt til at fikse det for hende. Så det kan jeg godt..eller hvis min kæreste siger ”jeg mangler en ny skjorte”, så er jeg der også (knipser) sådan der. Det bliver rent på nettet, og så ender jeg med at sende ham fire eller fem ”og hvad med den, og den og den og den”. Og så bliver han helt sådan ”øh okay” I: Når du siger at det er en dårlig vane, at du søger på nettet, sådan formulerede du det vist..? P: Ja, men det ved jeg ikke om..altså det er nok fordi jeg bruger ret meget tid på det..øhm..ja..det er nok i virkeligheden det at jeg kan bruge virkelig meget tid på det. Sådan helt åndssvagt meget. I stedet for nu bare at gå derned hvor man er… Men det er fordi, altså, der er så mange muligheder i dag, så hvis man står i den her ene butik, jamen, hvem siger ikke, at jeg ikke kan finde noget der er federe et andet sted, det er som om..og jeg er meget sådan impulshandlende – jeg hader at sige sådan at ”såå øh, shopper vi om en uge”. Hvis jeg har lyst til det, så skal det være nu I: Så du føler faktisk, at det at du kan gå online, det er sådan lidt impuls? P: Ja, det kan lidt give mig den der ”jamen okay, så har jeg styr på det nu” I: Så selvom du finder informationer om det, så føler du godt at det kan være et impulskøb? 153
P: Jamen jeg køber det jo ikke, men jeg samler viden ind og danner mig et overblik, og så køber jeg. Men det er som om det at jeg kan bruge tid på det, det giver mig ligesom det der fix med at jeg kan ikke bare sige ”nå jamen i næste måned, der skal jeg ud og finde mig en ny vinterjakke”. Jeg skal allerede nu finde ud af hvad jeg vil have I: Og så kan det godt være du ikke køber det lige nu, men..? P: Jaja I: Da du så var nede og købe den her rygsæk, spurgte du så om noget eller købte du bare den her rygsæk? P: Jamen det sjove ved den her rygsæk er faktisk, at det endte med at de så ikke havde den, og så faldt jeg over en helt anden, og var sådan ”ej den er også fed, den napper jeg” I: Og hvad tænker du så om det du du har..altså det at du vælger noget andet end det du har søgt efter – altså fik du nogle gode råd af dem eller..? P: Jaja, altså man kan jo sige at det er jo spildt tid, men jeg følte alligevel at jeg fik sat mig godt ind i det. Og jeg kunne selvfølgelig vælge den her anden rygsæk ud fra at jeg vidste at ”jamen altså hvis jeg skal vandre rundt på et bjerg, så er det en meget god ide at den kan det her og det her frem for hvis jeg bare vælger en og tænker at den er supersmart I: Så det har givet dig noget generel viden? P: Ja præcis I: Så vil vi gerne tale lidt om dine vaner – indkøbsvaner – inden for receptmedicin, sådan uden vi snakker online – kan du huske hvornår du sidst har købt receptmedicin? P: Ja det gjorde jeg så sent som i forgårs I: Og hvordan foregik det? P: Øhm, jeg gik til lægen, fik en henvisning – eller en recept hedder det jo så – og gik ned på apoteket og hentede I: Var det fordi du var syg eller hvad? Ja, jeg skulle have noget creme for noget udslæt I: Og er det noget du har købt før, eller var det noget..? P: Ikke lige det her, havde jeg ikke købt før, men altså det eneste receptpligtige, det er når jeg kommer fra lægen.. øhm, jeg har sådan typisk halsbetændelse sådan 4-­‐5-­‐6 gange om året, så det er tit jeg skal ned på apoteket og hente et eller andet I: Og hvad når du så – hvis du beskriver den proces – du kommer så til lægen og du skal have det her creme, og hvad sker der så? P: Jamen så tager jeg bare direkte ned på apoteket, stiller mig i kø, afleverer min recept, får det, får nogle gode råd til hvordan jeg skal tage det eller hvad jeg skal gøre eller I: Okay, du plejer at spørge eller? P: Ja I: Er det fordi du ikke har spurgt oppe ved lægen? P: Narhj, men jeg synes nogen gange så, jeg synes faktisk dem på apoteket de er ret gode til også at sige det selv, lige at sige at ”du skal huske at det skal indtages med mad” eller hvad du ellers skal gøre. Fx nu fik jeg en creme, skal jeg så smøre den ud i hele ansigtet eller skal jeg smøre den ud et andet sted eller og altså..hvad er kravene og hvor mange gange og fordi..det er bare nemmere I: Lige at være sikker på at..? P: ja…men jeg tror helt sikkert at jeg kunne finde samme information på nettet I: Ja okay, men når du så får den her, altså fx da du fik det her udslæt..var det så noget du bare gik direkte til lægen med, eller var du inde og søge der eller hvad gjorde du? P: Ja, der har jeg været inde og søge, og der har jeg også været nede på apoteket og hente andre cremer, men det har ikke været på recept. Men hvor jeg vil sige, det var kun noget jeg kunne få på apoteket I: Men kunne du finde på at søge efter symptomer eller den slags? P: Det kunne jeg sagtens – helt sikkert..Og det har jeg også gjort I: Føler du så når du kommer ned til lægen at du ligesom har noget at sige, eller hvordan kommunikerer du med ham eller hende omkring sådan fx udslæt? 154
P: Jamen jeg prøver at sige at jeg har sådan og sådan, og jeg har de her tanker om hvordan det er opstået og hvad kan det være. Og altså, så synes man nogle gange at..nu var det så en lægevikar denne gang, fordi min egen læge var på ferie, men så synes man nogen gange lidt at man skal snakke sin egen sag og sige ”hallo, jeg er her ikke for sjov” I: Okay hvad mener du med det? P: Jamen, jeg synes nogle gange godt man kan komme til en læge, der er sådan lidt, du ved jeg er bare en patient, der skal køres igennem, hvor man har det sådan ”jeg bruger ikke tid – sætter ikke tid af – for at tage til lægen, for bare sådan at ja du tager bare det her” ”jamen jeg har et problem – jeg kommer til dig med et problem jeg skal have løst” I: Så du føler at det er vigtigt at der bliver snakket om det? P: Ja, præcis. Og det sætter jeg mig jo så ind i ved at søge på nettet om hvad kan det være, kan det være jeg har været ude og rejse, jeg har fået meget antibiotika der kan gøre at jeg pludselig slår ud – hvad kan det være. Og så kan det godt være lægen tænker ”du har da irriterende mange spørgsmål, kan du ikke bare tage den her creme” det ved jeg så ikke I: Kunne du så…føler du at du stoler på din læge når han så udskriver det her medicin til dig? P: Nej. Det føler jeg faktisk ikke. Nu ved jeg så ikke om det lige var den her læge, men det var lidt sådan ”nå men vi ved ikke hvad vi ellers skal gøre ved dig – prøv den her creme” I: Så du følte at de var lidt for hurtige med det? P: Ja, det synes jeg faktisk I: Hvad gør du så – du siger du tog direkte på apoteket? P: Jeg tog på apoteket og såå øhm, der havde den her creme. Det sjove var med den her situation, at jeg følte at apotekerdamen hun ligesom var sådan lidt ”nå du skal have denne her creme” som om at sådan ”uuha, er du nu sikker på at du skal have den her creme”. Og så bliver jeg jo sådan lidt ”jamen hvad er det”. Og så går jeg jo så hjem og slår det op på nettet I: Også for at vide sådan…? P: Bivirkninger, anbefalinger, andre der har prøvet det. Det finder jeg bagefter I: Og hvad fandt du så ud af, var det noget du..? P: Jamen, jeg fandt ud af at der var rigtig mange der har haft held med det, men at det også har en del bivirkninger, som gør at jeg selvfølgelig bliver lidt skeptisk I: Og hvad gør du så med den skepsis? P: Jamen det gør at jeg er sådan lidt – det er en creme jeg skal bruge i en måned, og det gør at jeg alligevel tænker ”skulle jeg alligevel prøve lige at se tingene an”, og om bare almindelig ro ville kunne gøre det, men altså jeg har jo fået den fordi jeg har noget bakterie, som skal slås ned, så jeg kan jo godt se at der er en grund til at jeg har fået den her creme, men der var bare noget ved lægen der gjorde at jeg tænkte, at det var egentlig bare fordi hun ikke vidste hvad hun ellers skulle give mig I: Men vil det så sige at du så stadig nu ikke føler dig sikker på om det er det rigtige? P: Nej..nej.. I: Men du er begyndt at bruge det? P: Ja, bare af mangel på bedre tror jeg I: Kunne du finde på at ringe til lægen eller gå ned på apoteket igen, hvis du føler at..? P: Jeg har allerede tænkt mig at gå til min egen læge igen, når hun kommer tilbage igen, fordi jeg er så usikker på det I: Og hvad er det for en usikkerhed, altså kan du prøve at beskrive den følelse du har over det her? P: Jamen det er den her med, ”nå men du siger at du har den her kløe, så skal du bare tage den her”, men der var ikke rigtig nogen forståelse for, hvad kan det komme af, altså som jeg siger, jeg er ikke typen der går til lægen bare for at brokke mig, og det skal virkelig være fordi jeg har brug for hjælp, som jeg ikke selv kunne fikse derhjemme. Så hvis jeg ikke føler at jeg er blevet lyttet til, eller at personen har taget det særlig seriøst og bare er sådan ”skift p-­‐piller til de her” ”jamen jeg har de her p-­‐piller” ”nå, men så prøv den her creme” ”jeg har prøvet den her creme” ”nå jamen så prøv den her” . Så er man lidt sådan ”er det det” og så er det jeg føler mig lidt skeptisk og vælger at gå til lægen igen 155
I: Hvad er du bange for at der kan ske, havde jeg nær sagt? P: Det er måske fordi jeg er meget sådan, altså nu er det en creme til ansigtet, og jeg er meget kritisk over hvad man smører i hovedet på sig selv. Og der er jeg sådan ”kan det her forværre det her udslæt” for jeg er stadig sådan ”jamen hvor er det kommet fra” og..ja I: Når du så er nede på apoteket, er du så blevet spurgt på noget tidspunkt, ikke bare med det her produkt, men også med andre produkter, om du vil have et substituerende produkt? P: Ja I: Hvordan, hvad svarer du så? P: Det kommer an på hvad det er. Altså, hvis det fx er for halsbetændelse, så har jeg ikke noget imod det, for det er jo trods alt billigere, og jeg tror på at det virker. Jeg har så prøvet én gang hvor at der kom et ny mærke som konkurrent til den p-­‐pille jeg tager i forvejen. Og jeg fik at vide at jamen den ville være billigere, og så tænkte jeg ”årh det kunne være rart, for den jeg tager i forvejen er ret dyr”, og der ville ikke være nogen forskel, det ville være fuldstændig det samme I: Hvor fik du det at vide henne? P: På apoteket. Og det endte så med at jeg reagerede meget voldsomt på skift af p-­‐pille. Og det ender så med at jeg går ned på apoteket I: Okay, der gik du til apoteket og ikke til lægen? P: Ja, og hun var sådan at det kunne hun ikke forstå og det gav ikke rigtig mening, og så tog jeg så kontakt til min egen læge som så sagde jamen der kunne sagtens være en forskel, for det kunne godt være at det var samme produkt, men sammensætningen af indhold kan være sammensat anderledes, så det kan godt give et udslag, men det får jeg jo så ikke at vide på apoteket, der må jeg så til lægen. For hun var meget ”arh” de havde fået at vide at det skulle være samme produkt, så jeg burde ikke være påvirket af det I: Og hvad tænker du så om det? P: Der blev jeg da også sådan lidt..fordi altså..jeg har jo ingen ide om hvordan tingene fungerer, men jeg er jo godt klar over at tingene bliver købt ind på et apotek, at det er ikke fordi at det nødvendigvis er fordi at apotekerdamen tænker at ”uh, jeg vil gøre det bedste for dig, så jeg anbefaler at du får det her produkt” det er jo fordi der kommer nogen og sælger noget ind, som hun vel også har en interesse i at sælge videre, uden at jeg kender til det egentlig I: Men føler du så at du stoler mere på din læge i den situation eller at du selv vil undersøge..? P: mm..ja, egentlig, i den situation gjorde jeg, fordi hun jo lyttede til mig og sagde at det kan godt være at det er derfor, hvor damen på apoteket var meget sådan at hun kunne ikke se at det skulle være derfor I: Bad hun dig så om at gå til lægen? P: Nej, det valgte jeg selv, fordi jeg syntes hun var sådan lidt irriterende. I: Gik du i den situation – var du selv inde og læse på nettet? P: Årh, det kan jeg faktisk ikke rigtig huske. Jeg tror det ikke, for det har været under Roskilde festival, så det hele var sådan lidt hektisk, men øh nej, det tror jeg faktisk ikke at jeg gjorde der. Jeg var bare ret bevidst om at der var noget galt I: ….hvis du sådan skal knytte et overordnet ord til altså, apotekerne, hvad skulle det så være – altså sådan apotekskøb? P: Altså det er sådan lidt besværligt ikke? I: Besværligt? P: Ja, altså jeg synes det er sådan lidt irriterende at de har bare nogen gange lidt andre lukketider. Især i weekenderne. Du kan gå ind i Netto hver dag til klokken ti, men apotekerne, det er bare lidt mere gammeldags. Øhm, og kører meget de der stramme regler. Jeg har sådan lidt..altså ja, lige overfor her hvor du også bor, apoteket ovre på Godthåbsvej, det er som om de kører, de er også lidt bagud. Hvor jeg føler at hvis jeg tager apoteket nede ved runddelen, der har jeg en helt anden følelse. Det er som om at her kan jeg få lov at kigge på tingene. Jeg havde faktisk en sjov episode en dag, hvor jeg skulle ind på apoteket og have en creme, og jeg tænker ”jeg skal nå at have fat i den her creme” fordi det var min tur lige om lidt, og jeg tænker ”nå jeg tager bare lige fat”, og den var lige bagved sådan, hvis skranken var her, så var cremen her (gestikulerer) og tænker ”jeg må vel gerne tage den og gå over og sige at jeg skal have den her”. Så har jeg 156
bare sådan lige fire kvinder bag disken der siger ”DU MÅ IKKE RØRE PRODUKTERNE” og så var jeg sådan ”nåå”, men det var så fordi de var henover skranken, hvis de havde været ved siden af, måtte jeg gerne have taget et produkt og være gået op. Og der blev jeg..der vil jeg næsten hellere have at jeg kan tage tingene selv og sige ”kan du lige rådgive mig om det her”, frem for at det bare var sådan ”du skal IKKE røre ved noget” I: Så der følte du at det var anderledes end normalt – en anden butik? P: Ja, det synes jeg. Men jeg ved ikke om det er specifikt den, fordi den er så lille, at tingene er meget sådan bag dem, hvor at, hvis du tager fx det nede ved runddelen, der er det meget åbent, du kan se hele vejen rundt og kigge på dem og læse på dem I: Så der føler du også lige at du kan gå rundt selv og lige få lidt information? P: Ja, lige præcis, den information , som man sikkert også ville finde på nettet, og jeg kan stå og kigge og læse på produktet. Også fordi på et apotek ikke, hvis det endelig skal hedde at jeg skal vente og det skal være min tur først, så kan jeg godt være sådan, altså hvis man står sådan med et eller andet pinligt problem, at man ikke har lyst til at stå og snakke henover disken, når der også står en ved siden af og også bliver ekspederet. Det kunne være rart, hvis man kunne gå hen og læse på tingene selv. I: Så det er også et spørgsmål om at det generer dig at der er andre der skal lytte på hvad I snakker om? P: Ja, eller jeg har i hvert fald tænkt tanken ofte, for nu kommer der ret mange gamle ned på det apotek hvor jeg er, og man kan nogle gange høre , altså hvor jeg tænker ”utroligt at du gider stå og fortælle det her. Jeg kan jo høre alt hvad du står og siger” Og jeg kan godt se, at de har jo ikke andet alternativ, de går jo til damen på apoteket for hjælp, men I: Så du føler også at det er det der kan holde dig tilbage fra at få gode råd – altså hvis det er noget du ikke har lyst til at stå og tale om i fuld offentlighed. Hvis det er et privat anliggende eller? P: Ja, altså nu er jeg ikke så bleg for at sige, jeg går ud fra at de har hørt massere, i og med at jeg hører de gamle sige alt muligt, men jeg synes da det er sådan lidt at man bare sådan..altså du går til lægen og snakker én ting, og så går du til et apotek og så er det meget åbent blandt ti andre, der kan høre dig sige (hvisker) ”ja jeg skal lige have det her”. Det kan godt hurtigt blive ”ja jeg skal bare have det her” I: Nu sagde du, du brugte en vending før at ”hvis man endelig skal snakke” – er det fordi du føler at det ligesom er det der bliver lagt op til, at du ikke kan undgå det? P: Ja, altså, ikke nødvendigvis kun med mig, men også når jeg hører andre altså fortælle om symptomer og hvordan det har været i din dagligdag. Og jeg kan så også høre at de gamle også bruger ret meget tid på at fortælle om de så spiste havregryn i den ene eller den anden rækkefølge med pillen. Der kan også gå lidt for meget snak i den engang imellem på et apotek, men det er mere den der med at du går fra et lukket rum og snakker med din læge om det her, og skal ned og hente noget medicin, som er en del af den proces at gå til lægen, og der snakker du bare åbent om det foran alle andre, som godt kan være..det har jeg bare tænkt over, at det synes jeg er lidt underligt I: Men det er, hvis du nu møder nogen nede på apoteket som du kender, synes du så at det er værre, end at alle mulige andre kan høre det? P: Narh, altså det kommer an på hvad jg skal have. Nu er det ikke så tit jeg køber noget som er sådan ”uh super hemmeligt”. Men alligevel..altså, et godt eksempel (griner) jeg lider af noget mavesygdom, og nogle gange når det er slemt, så skal jeg have noget for at holde tingene i gang. Så det er faktisk at gå ned og sige til sit apotek at jeg skal have nogle afføringspiller. Og jeg kan sige det her, men det er også fordi jeg er sådan ”nå ja sådan er det jo”, men det skal jeg altså også stå og sige der til en fremmed dame mens der står nogen ved siden af.. altså..det synes jeg bare er lidt underligt, når jeg ringer og snakker med min læge om det privat. Nu er jeg ikke så..altså jeg kan godt snakke om sådan nogle ting, men også for andre. Også det at jeg selv studser over det, synes jeg er sådan. Der er ikke meget privatliv på et apotek I: Men synes du der er forskel i forhold til hvis du går ned og skal have noget der er i håndkøb, og noget der er på recept. For der er vel.altså, føler du at du skal sige mere, hvis du køber det i håndkøb? P: Nej, det er ting på recept I: Det er værre? P: Ja 157
I: Det er fordi du føler..? P: Det er fordi at så er der jo noget galt I: Så du føler at du kan være bange for om at det er en mere alvorlig ting at købe receptmedicin? P: Ja, fordi så er det jo fordi jeg har en halsbetændelse der skal ordnes, hvor jeg ikke bare kan gå ned og sige at jeg skal have en pakke panodiler. Så er det noget hvor der skal fikses et eller andet, hvis det er på recept I: Er du bange for at du ikke har overblikket over om det er noget der kan skade dig, eller noget du ikke ved om virker eller., Føler du ligesom at..? P: Selvfølgelig er der det. Du får jo bare langet en eller anden henover disken, som de et eller andet sted bare vælger for en I: Ja, nu sagde du fx det her med at du ikke rigtig stolede på din læge med den creme der. An du så være bange for at der skal ske noget der ikke skulle ske? P: Ja, altså nu var det også fordi det var en læge jeg ikke kendte den her læge, fordi det var en vikar, plus at jeg kunne mærke på hende der ligesom gav mig cremen på apoteket, at jeg syntes ikke ikke hun var sådan..jeg syntes hun virkede sådan lidt at ”er du sikker på at du skal have det” altså ”hm,er du sikker på at du skal have den creme, jeg synes den er lidt voldsom” I: Men er det fordi det ikke var din egen læge, er det så fordi du føler dig tryggere ved din egen læge, fordi i princippet har de vel samme kompetencer eller hvad er det du lægger i den..? P: Jeg føler mig ikke nødvendigvis tryggere hos min egen læge, jeg føler bare at jeg kender min egen læge så godt, at jeg kan sige ”ej, hallo, du skal ikke bare feje mig af”, hvor den her var en person jeg ikke kendte, og jeg kunne godt mærke, at jeg kom ikke videre med hende, da hun ligesom fandt ud af, at alle de ting hun umiddelbart havde oppe i ærmet, det var ting jeg havde styr på, så var hun lidt sådan ”nå men så prøv det her”, hvor at hvis det havde været min egen læge så havde jeg sagt ”ej okay, helt ærligt altså, kan vi ikke lige prøve at tage det her seriøst” I: Så du følte ligesom at du godt selv kunne have fundet frem til de ting hun fandt frem til hende..? P: Ja I: Så talte vi om det der med substitution at i nogle situationer ville du gerne købe det billigere og i nogle ville du ikke – hvad er det for nogle situationer hvor du ikke ville købe det? P: Men det er jo så en situation hvor jeg kunne mærke at det gjorde en forskel. Og det er selvfølgelig svært. For hvis det er en pille mod halsbetændelse – altså nu kan man sige, nu har jeg efterhånden haft det så mange gange, at jeg begynder at blive sådan lidt resistent over for medicinen, så er det jo klart at jeg kan se, at jeg skal ikke have det samme, og det skal jeg selvfølgelig snakke med damen på apoteket om. Men i den her situation hvor det var nogle p-­‐piller, hvor jeg blev lovet at det ville være helt det samme, og jeg så på egen krop kunne mærke, at det var det overhovedet ikke, og blev mødt af en der ikke var særligt forstående overfor det, der gør det jo at man bliver lidt skeptisk I: Så du har sådan, hvad skal man sige, som udgangspunkt gik du op i pris, men så er der nogen ting, hvor du ikke længere går op i pris? P: Ja, altså fx jeg har noget andet jeg har fået til min mave engang, der kom jeg ind, og så siger hun om jeg vil have et billigere produkt, og så siger jeg ”jamen det vil jeg gerne” så siger hun ”ja fordi det jeg har fået recept på det kostede mig 2100 kroner, og det jeg kunne få det kostede mig 200 kroner”, ikke. Jeg tager mig da i at tænke, hvordan kan prisforskellen være så stor, men man er også sådan at jeg betaler ikke så mange penge for et eller andet produkt I: Nu kan jeg se at klokken bliver..så hvis vi skal..vi skal videre til det her produkt du sagde du har købt på apoteket.dk – kan du fortælle om hvordan den proces var. Det var noget, det var..hvad var det det var? P: Det var en natbøjle – noget så sexet I: Og du har været til tandlægen eller hvad..? P: Nej, altså jeg har fået lavet to hos tandlægen og de forsvinder. Altså, i mit lille bitte soveværelse på fire kvadratmeter forsvinder de, og jeg kan ikke finde dem. Og de koster lidt over to tusinde at få lavet en ny. Så når man først har fået lavet det to gange, så er man lidt sådan ”arh”, og så..det kom sig af, at jeg i USA så at man kunne købe dem, altså i deres apoteksbutikker, og så har jeg så set det i Sverige. Og da jeg så også 158
mistede den jeg havde med ud at rejse, var jeg sådan lidt ”okay, jamen jeg skal finde en ny”, og jeg ved man kan få dem i Sverige. Og så søgte jeg bare. For jeg tænkte at man måtte jo kunne bestille sådan noget hjem. Og så så jeg at apoteket.dk havde dem I: Og hvad..er det nogen der er blevet lavet til dine tænder, eller..jeg forstår ikke helt hvordan? P: Nej, altså dem jeg normalt får hos tandlægen, det er sådan en der er helt hård, fordi jeg skærer simpelthen så meget tænder. I: Så det er sådan en som dem de har på i ishockey og sådan noget? P: Ja, men den er jo meget meget lille bitte. Og gennemsigtig I: Men den er skræddersyet til dine tænder? P: Ja, men den har jeg så fået lavet hos tandlægen, og har så smidt væk ad to omgange. Dem man køber fx hos apoteket.dk – forestil dig sådan en plastik..det ligner sådan en man har på til hockey og så varmer du den op, og så formsyer du den ligesom til dine tænder, og så bliver den så kølet ned. Og den er selvfølgelig ikke i hård plast, men i gummi, men i så fald du skal have den bløde hos tandlægen koster den også over 2000 og den her kostede mig 300 kroner. I: Ja okay. Men hvordan kan det være at øhm..tandlægen er jo også en slags læge, som har været inde over første gang..hvordan kan det være at du følte at det kunne du godt selv vurdere om du kunne få den her nye..om du selv skulle? P: Altså hvis man sælger dem i et land som Sverige, så må det være fordi der også er mange andre der har det problem, og altså hvis de kun skal betale 300 kroner, hvorfor skal jeg så betale 2000. Jeg er godt klar over at der er en grund til at de har skræddersyet så meget som de har, men jeg følte ligesom første gang at jeg prøvede den, at det her løste ligesom mit behov. Altså for at være helt ærlig, første gang jeg var sådan..anden gang jeg smed nummer to væk, fandt jeg faktisk på sådan en bokseside, der bestilte jeg faktisk sådan en rigtig bokseskinne hjem. Det er faktisk det samme som du varmer op og du former den, men den fyldte jo hele munden og jeg var sådan ”det går ikke det her!”. Og jeg var samtidig også sådan ”skal jeg gå tilbage til min tandlæge” for jeg synes på den anden side også at det var lidt sådan flovt at sige at jeg havde mistet den igen. Men så var det så at jeg fandt dem der i Sverige, og så til sidst her på apoteket.dk I: Og hvordan skete..så gik du ind på apoteket? P: Jeg søgte bare..og jeg har sådan..altså den gang jeg valgte, hvor jeg så man kunne købe dem i Sverige, der søgte jeg jo også på nettet om det og fandt ud af at der var forskellige udgaver, og så søgte jeg bare på det igen da jeg kom hjem, og så dukker apoteket.dk bare op, og så tænker jeg ”det var dog overraskende nemt” og så kom den bare med posten I: Har du været til tandlægen siden du begyndte at bruge den? P: Ja, de siger ikke noget I: Har du fortalt dem at du har købt sådan en? P: Nej, de tror stadig at jeg bruger deres, og de kan ikke se forskel Og jeg har ikke hovedpine. Umiddelbart synes jeg faktisk det er bedre, fordi jeg synes det der med at jeg stadig havde den i hård plast, det syntes jeg gjorde ondt på mine tænder, fordi jeg åbenbart er meget arrig når jeg sover. Så det her med at den er blød, det foretrækker jeg faktisk, men deres argument var jeg ville slide den op, hvor jeg har det sådan lidt at det er fair nok at jeg slider den op. Måske skal jeg bruge to om året, men det er altså bedre at bruge 600 kroner frem for 2000. I: Men det er så ikke noget du har snakket med din tandlæge om? P: Nej I: Føler du at der er forskel på din tandlæge og din læge, fx når du skal købe noget på recept og så den her bøjle? P: Det kommer an på hvad det er. Nu er det kun fordi jeg har prøvet det af, og fundet ud af at det ødelægger ikke..det er ikke fordi det ødelægger noget med mine kæber eller mine tænder..Jeg risikerer ikke noget ved at købe den her bøjle frem for den hos tandlægen. Hvorimod hvis det var noget hos lægen hvor jeg tog en chance, så ville jeg jo være i tvivl I: Så der føler du at der er lidt forskel? 159
P: Ja det synes jeg. Og det er jo det samme hvis min tandlæge sagde, ”du skal bare have den her” og jeg så ikke vidste bedre. Eller det var et andet produkt, hvor de sagde ”det er bare den her du skal bruge”, hvor jeg var sådan ”jamen okay”, så tør jeg jo ikke andet, så vil man jo stadig tage tandlægens råd og sige ”nå ja”. Et groft eksempel vil være at tandlægen siger ”du har et hul” og man så tænker ”det kan jeg bare gøre derhjemme”. Det gør man jo heller ikke vel I: Så det er fordi det..? P: Det er fordi jeg kan mærke at jeg risikerer ikke noget med det, jeg ødelægger ikke mine tænder af det, i forhold til at få deres bøjle. Andet end at mit dankort måske har det lidt bedre I: Jaja, hvad hedder det..kunne du finde på at købe receptmedicin på – nu har du prøvet at købe sådan en bøjle på apoteket.dk – kunne du forestille dig at købe receptmedicin? P: Ja, hvis jeg så bare kunne få sendt det hjem – helt sikkert. Altså jeg går ud fra, hvis det var noget jeg havde fået på recept, så kunne jeg næsten se for mig at man bare gik ind tastede sit CPR-­‐nummer ind eller et eller andet, og så ligger det til en og så trykker man bestil og betal. Det ville jeg da meget hellere end at skulle hele tiden ”åh jeg skal ned på apoteket og de lukker 17.30 og det er pisse irriterende” I: Så det er mest sådan at det er tidsbesparende? P: Ja I: Eller at det er let..? P: Ja. For jeg synes det..altså nu ligger det på vejen, men jeg synes det er irriterende at jeg skal derind, og der er altid 1000 mennesker, og der er altid varmt og det er svært at finde et sted til sin cykel, og jeg synes faktisk bare det er besværligt I: Hvordan kan det så være at du ikke har gjort det? P: Jeg tror ikke jeg ved at man kan – ikke med receptpligtig. Nu fandt jeg så apoteket.dk, og jeg så at man kunne lave sådan et abonnementsordning på trusseindlæg osv. og jeg var sådan ”hold da op, det vidste jeg slet ikke eksisterede” øhm..og cremer man kunne få sendt hjem og sådan noget, så det var sådan en rimeligt ny verden for mig. Ja..men som man kan sige, fordi det så stadig ligger så tæt på, hvis det så er en creme jeg skal have, og jeg ved apoteket har det, så kan jeg ligeså godt bruge 5 minutter på bare at vade derned og hjem igen, men hvis det er sådan noget med, receptpligtig medicin, så altså..og man skal..hvis det er fx p-­‐piller, kunne det så ikke bare blive sendt hjem til min dør? Jeg er godt klar over at hvis jeg har halsbetændelse så gider jeg jo ikke ventet tre dage på at få det med posten. Altså det kommer an på hvad det er. Hvis det er et eller andet urgent, jamen så skal jeg jo have det med det samme. Øhm, men de der ting hvor at, især p-­‐piller, gad jeg godt bare kunne taste det ind og så få sendt det hjem I: Hvad hvis du nu havde halsbetændelse, og du så skulle have noget penicillin mod det eller et eller andet, ville du så synes at det var en løsning hvis det blev leveret med bud, så du kunne ligge hjemme i sengen og få det leveret? P: Ja I: Tror du at du kunne finde på at gøre det? P: Det kunne jeg sagtens. Igen nu, nu er det også fordi jeg bor tæt på et apotek – det passer lige at jeg kan gå til lægen og så lige runde apoteket, men hvis ikke det var fordi det lå..hvis jeg skulle bare ned på apoteket eller runddelen, så ville jeg da gerne have sendt det hjem I: Nu skal jeg lige orientere mig her, hvad vi mangler… hvis du nu skulle prøve at knytte et overordnet ord på det her med at købe medicin på nettet, hvad ville det så være for dig? P: At det ville være nemmere. Men jeg skulle også, altså..systemet skulle være rimelig nemt I: Er der noget du ville mangle ved at købe det på nettet? P: Nej, for jeg kan jo godt se nu, fx det produkt jeg hentede forleden dag på apoteket, jeg kunne jo se at jeg kunne taste det ind, og så kunne jeg finde på Netdoktor, eller sygdom eller sundhed – der er jo 1000 steder, hvor der står bivirkninger, som kan fortælle mig lige så meget som det hun kunne fortælle mig. Plus at der står jo på selve det klistermærke på, at du skal tage det en gang dagligt, så det var jo ikke fordi hun gav mig noget information jeg ikke kunne læse om derinde I: Nej, så du føler ikke der er forskel på at skulle læse det selv eller..? 160
P: Nej, altså nu selvfølgelig med den her creme, skal jeg bare smøre den i hele ansigtet, eller hvad skal jeg gøre med den? Og hun sagde at det skulle jeg. Men jeg gik så hjem og læste, og de ting jeg læste på nettet var også sådan lidt ”okay det behøver jeg faktisk ikke” I: Så selvom hun havde givet dig et råd så..? P: Ja, for det virkede bare som om at det var hendes holdning til det.. Jeg stolede ikke nødvendigvis på at hun havde den rette viden – prøv at tænke på hvor mange produkter de langer over disken altså – det er begrænset hvor meget de kan vide om det hele, ikke I: Ja..Det her med, når du køber ting generelt, ikke kun medicin, men generelt når du køber ting på nettet, er det så webshops, der har en fysisk butik også, eller er det bare almindelige webshops? P: Det er både og synes jeg. Sådan lige hvad jeg falder over I: Så du føler ikke det er noget der har en betydning om de har? P: Nej altså ikke de gange hvor jeg bare er sådan at jeg skal bare have det der jeg finder på nettet, så er jeg ligeglad om de har det ene eller det andet I: Det er ikke noget du tænker over? P: Nej, det er mere hvis det er et større køb, så kan det selvfølgelig være rart at der er en butik hvor jeg kan gå ned og røre ved det. Men samtidig er jeg også sådan, tingene fungerer også sådan at..det eneste der er irriterende ved at købe ting på nettet det er, at hvis du så skal sende det retur, og de så ikke har den her de betaler eller, at du har meromkostninger for at sende et produkt tilbage. Det er det eneste jeg synes er irriterende – ellers generer det mig faktisk ikke I: I forhold til sådan din rolle i det her med at købe medicin og sådan noget – i forhold til lægen og i forhold til at beslutte sig til, hvad der foregår med hvad du får af medicin eller hvordan du skal behandles for et eller andet – synes du det er vigtigt for dig at være involveret i det eller vil du egentlig hellere holdes udenfor det eller hvad..? P: Jeg synes egentlig aldrig rigtig man får medbestemmelse. Jeg synes egentlig bare lægen siger ”du skal bare have det her” og så siger man okay I: Og hvad synes du om det? P: Igen så må jeg bare stole på min læge, men igen fx den oplevelse jeg havde med min lægevikar jeg var hos, altså hun sad jo på samme side som jeg endte med at slå op på derhjemme og læse om det her produkt..og altså det var jo ikke fordi hun havde meget mere viden, en eller anden database hvor hun kunne læse noget jeg ikke kunne læse. Så det gjorde at jeg var lidt skeptisk overfor hende jo. Altså blandt andet.. Og det er jo også – når jeg går på apoteket, så tænker jeg, ”kunne der være noget bedre” I: Men det er måske mere et spørgsmål om så, at du gør det af nød end af lyst? P: Ja, hvor at hvis jeg går til lægen og skal have nogle piller, og jeg fx skulle have malariapiller da jeg skulle ud og rejse, der er jo også SÅ mange holdninger til hvilke malariapiller man skal have, og min læge gav mig en, og min kæreste sagde ”arh er det nu også det bedste”, hvor jeg var sådan ”det siger min læge jeg skal have, så det skal jeg bare have” I: Så der stolede du..? P: Der stolede jeg på min læge, ja, for jeg var også sådan at ellers kan man jo blive ved. Og jeg går ud fra at min læge vælger at give mig det rigtige alligevel. I: Så der er måske alligevel sådan en inderst inde..? P: Ja, men det er måske også fordi med medicin – hvis det nu var med den creme, så tror jeg jeg ville være interesseret i at have medbestemmelse, men der er jeg bare ikke endnu, og jeg synes heller ikke samfundet er sådan, at man har den viden som forbruger. Hvis det nu var sådan at vi snakkede om det, så tror jeg at jeg ville være mere sådan ”arh de piller tror jeg ikke jeg skal have” hvorimod i dag, det er som om det er sådan lidt hemmeligt land – du får bare det lægen siger du skal have I: Er der noget der påvirker din opfattelse af den her, af medicin, at der nogen gange er noget med at du føler, at med de her malariapiller fx, at der er mange forskellige holdninger til det – hvor hører du det fx? P: Det er på nettet, og så altså..når du møder folk der også har fået malariapiller, så er der den der ”ej, har du fået dem, ej nej nej, tør du det” og ”jeg har bare hørt folk der mister arme og ben fordi de har taget de her piller” og jeg går ud fra at min læge har valgt at give mig noget der er relevant 161
I: I forhold til sådan øh, udvalget og sådan, synes du at du normalt kan få det du gerne vil have, når du er nede på apoteket? P: Altså, skal det stadig være det receptpligtige? I: Ja plejer de at have det hjemme du skal bruge? P: Ja, eller også er de ret hurtige til at sige ”vi får det hjem”. Ja, det synes jeg faktisk I: Så er der lige en ting – det her med, når man går ind og køber receptmedicin online, så er der faktisk sådan en virtuel rådgivning, som er sådan en chatfunktion hvor man kan blive videorådgivet, eller snakke med dem elle3r skrive sammen med dem. Hvordan ville du reagere over for sådan noget – ville du bruge det, når du nu snakker med damen nede på apoteket, eller ville hellere på nettet selv gå ind og..? P: Nej det ville jeg faktisk bruge, for jeg synes det er sådan ret almindeligt i dag at man bruger de funktioner. Det eneste jeg ville tænke var, at jeg gider ikke stå i kø for det. I: Så det skulle være direkte tilgængeligt? P: Ja, altså det skulle ikke være sådan at ”ej er er en halv times ventetid,” eller ”chatten fungerer ikke lige i øjeblikket” sådan noget det fungerer bare ikke, så skal man lade være med at have den i hvert fald. Men jeg ville ikke, hvis det var ligetil, eller hvis man kunne se at man stod nummer to i køen ligesom hos lægen, så ville jeg ikke have noget imod det. Så kunne jeg sagtens stille alle mine spørgsmål der I: Hvad nu hvis du fik at vide at du skulle vente et øjeblik, og du ligesom sad og den skulle starte op den her chat – ville det være noget, hvis du nu tænkte at det gad du ikke det her, ville du så bare lukke chatten, eller tror du du helt ville forlade siden, og tænke at så gider d bare ikke købe online? P: Nej, så tror jeg faktisk bare jeg ville blive siddende. Det kommer an på hvor lang tid. For jeg har det sådan lidt, at jeg kan også hurtigt bruge en halv time på bare at komme igennem til min egen læge ikke. Så det ville ikke være noget problem, så ville jeg jo bare sidde og lave noget indtil da. Men det er mere den der, når det bliver længere tid, så bliver man at tvivle på om der overhovedet er nogen der har tid til at håndtere det i den anden ende. Altså jeg har det sådan, at hvis man laver en chatfunktion, så skal man også virkelig agere når folk stiller spørgsmål. For der er jo en grund til at folk gør det på nettet – det er jo for at spare tid I: Føler du at der er en..vi talte om i starten det her med..du synes det er sjovt at surfe lidt og sidde og browse rundt på forskellige produkter sådan når du sidder online – du får sådan et kick ud af det. Ville du synes at det var sådan lidt det samme med fx medicinske varer. Når du sidder og søger om..altså ikke at du synes det er direkte sjovt, men at du får et sådan kick ud af at finde frem til noget selv? P: Det kommer an på hvad det er. Hvis det er medicin så tror jeg ikke. For jeg ville ikke vide hvad jeg skulle se på. Nu arbejder min mor med medicin, så ville jeg gå til hende med ”hvad ved du om det her” men jeg ville ikke bruge tid på det på nettet. For jeg ville ærligt talt sidde som et stort spørgsmålstegn. Nu sådan noget med ting, når jeg siger smøre på huden og sådan, der er jeg måske mere sådan med at sidde og læse om det inden jeg bare hopper ud i det, for jeg er sådan lidt – man ved aldrig hvad der gemmer sig i sådan noget der, og vil gerne vide hvis der skulle være nogle bivirkninger så vil jeg gerne vide dem på forhånd I: Sådan i forhold til, når du kommer ned på apoteket, sådan stedet, apoteket som sted, hvad tænker du om det? P: Nu fx det hvor jeg er, det er sådan et lille apotek, og det er lidt gammelt. Jeg synes det er da hyggeligt nok, men jeg synes heller ikke det er særligt indbydende. Hvor at hvis du tager fx det på Nørrebro, det er meget lyst, det er meget åbent, man kan kigge på tingene, jeg kan gå hen og se på hele udvalget af produkter, uden at jeg skal stå sådan halvt henover en skranke og føle at jeg gør noget forkert. Det kan jeg bedre lide I: Og hvad så med stemningen – synes du der er en god stemning, eller en dårlig stemning, eller sådan? P: Altså der er aldrig en superfed stemning vel – folk er altid sådan at puha der er varmt og der er ikke så mange..der er alt for mange mennesker til stedet. Men altså det kommer an på hvor. Nu ved jeg ikke, har i været på den der ligger nede på Vesterbrogade ned mod søerne? Den er ret stor. Så der føler man at man går rundt bare ligesom i Matas. Det kan jeg bedre lide. Frem for de der hvor det hele gemmer sig bagi, og hvor man ikke rigtig kan.. I: Så det der med at det ligner en butik mere? 162
P: Ja I: Og inde på hjemmesiden hvor du var inde og købe den her bideskinne, kan du huske sådan hvad du tænkte om hjemmesiden – var den indbydende, grim, nem at finde rundt på eller..? P: Altså jeg kan huske at jeg tænkte ”nej hvor er der mange produkter”. Altså man kan søge i alt jo, og jeg syntes ikke rigtigt at det var så overskueligt. Og i starten tænkte jeg ”er det her overhovedet apoteket?”. Altså jeg var lidt sådan..Altså det er lang tid siden jeg har været der, men jeg kan huske at jeg tænkte ”er det her noget for sig selv, eller har det her med apotekerne at gøre” – det syntes jeg ikke var så tydeligt I: Så der ville du synes der var en forskel – altså ville det gøre noget for dig? P: Ja det kunne være rart at det var mere tydeligt at det her det er noget der er en forlængelse af de apoteker man kan gå ind på I: Og hvorfor synes du at det ville være rart? P: Det er måske lidt mere credibility tænker jeg.. Tror jeg umiddelbart I: Tjekkede du det så eller var det ligesom bare en åben ting for dig, at ”det ved jeg ikke rigtig hvad er for et sted det her”? P: Nå men, det er fordi det gik jo ret hurtigt sådan at ”nå okay, den kan jeg få her, så bestiller jeg den bare” og så skulle jeg videre. Men jeg tog mig selv i efterfølgende at tænke, at jeg ikke vidste om det her havde noget med apotekerne at gøre. Jeg tænkte at det var måske bare et tiltag der var dukket op for sig selv eller nogen andre. Og det gjorde selvfølgelig at jeg tænkte sådan lidt ”hvad er det”. Altså til at starte med var jeg lidt sådan..at fordi jeg var vant til at man kun kunne få den i Sverige, så tænkte jeg ”er den svensk?”. Så jeg synes egentlig at i så fald at det er en forlængelse af de apoteker jeg har, så synes jeg ikke at jeg tænkte at det kunne jeg godt se I: Men der var du sådan med andre produktkategorier, der lød det som om at du var lidt ligeglad med om de havde en rigtig butik eller..der lød du ikke så skeptisk..Var det fordi du havde en anden form for produkt eller hvad var det der gjorde at du tænkte over det? P: Altså det var håndkøb? I: Nej altså nu hvor du købte den her bøjle, det lyder som om der var du lidt mere skeptisk overfor hvad var det for en side og var den svensk, og der var nogen overvejelser du gjorde dig, hvor du ved andre kategorier af produkter måske ikke har tænkt så meget over det. Med tøj eller.. er det samme – tænker du over det i samme grad? P: Nej, men jeg tror at det lå i selve overraskelsen over at jeg kunne købe det på en dansk side, for det har jeg ikke vidst at jeg kunne. Så det var måske mere det. Og så hed den apotekerne.dk eller apoteket.dk – det kan jeg ikke huske – men det gjorde bare at jeg tænkte ”hvad er det her – jeg har ikke set det før”. Og det var en rimeligt stor side med en masse ting hvor jegtænkte ” hvis det her er apoteket, hvorfor reklamerer de så ikke mere for den? I: Du har aldrig set reklamer? P: Aldrig set nogen reklamer for at det skulle være deres. Og i så fald det er, det er jeg stadig i tvivl om, så tænker jeg da bare, kunne de så ikke reklamere mere for det I: Så du har heller aldrig oplevet nede på apoteket at de sagde til dig, at du faktisk godt kunne købe det på nettet? P: Aldrig NOGENsinde. Jeg vidste slet ikke det var en mulighed. Også bare det, så gik jeg tilfældigt ind og kiggede, og jeg kunne se man kunne lave sådan en ordning på et eller andet – bind eller whatever. Hvor jeg tænkte, det er da supersmart, men hvorfor gør de ikke mere ud af det I: Tror du så hvis de sagde det til dig, at du ville tænke ”det er det jeg gør næste gang”? P: Ja, fordi jeg tror alligevel fremtiden ligger i det. At tingene kører på den måde. At det der med at gå ned i en fysisk butik, du ser det jo allerede på andre steder, det kommer bare til at være sådan. Og i så fald at du går ned i en butik, så er det jo for at se og røre. Men man ser jo også at det nye butikskoncept hedder jo, at du går ned, ser udstillingsvaren, og så kan du få lov at røre og se og mærke og prøve, og så får du sendt en ny hjem til dig efterfølgende, som ingen har rørt ed. Det er jo det man snakke rom kommer til at være det koncept. Det er jo lidt det samme på apoteket. Det undrer mig lidt – hvorfor skulle de ikke – de må jo følge 163
med. Så derfor har jeg det sådan lidt – hvis de har lavet et tiltag, der fungerer, hvorfor så ikke fortælle folk om det I: Og hvordan tror du, hvis du mener det er fremtiden, hvordan ville du bruge det – ville du stadigbruge det fysiske apoteket til noget, eller ville du bare køre alting online? P: Jeg kunne godt køre alting online. Så er det fordi jeg skal have altså et gode råd, men det synes jeg bare ikke nødvendigvis – altså hvis der er en chat funktion kan jeg ligeså godt få det der. Jeg synes ikke nødvendigvis dem der står nede på apoteket de virker som om at de har bare sandheden om de her produkter. I: Så du føler fint at det kunne erstatte? P: Ja, for når jeg så sidder hos en læge, som slår op på samme side som jeg kunne gør derhjemme, så tænker jeg igen ”Hvad kan dem på apoteket så slå op på, som jeg ikke kan finde selv på internettet” så det kan jeg jo ligeså godt få at vide på en chat funktion, frem for at stå og bruge tid på det nede i en butik. Plus at som sagt, de ting du skal have på apoteket er ofte ting som, med mindre du er syg nu og her..hvis jeg kunne..hvis jeg fik at vide at jeg havde halsbetændelse og jeg kunne gå hjem og bestille det og have det dagen efter, så kunne jeg jo også sagtens. Det er bare det med hvis der så går tre dage, så trækker man alligevel lige sygdommen langt nok, ikke. Men hvis det kunne gå hurtigt, så ville det jo være fint. Og det ser du jo også med nogen netbutikker, at der leverer de jo nærmest samme dag. Det kunne være supersmart jo. I: Har vi -­‐ er vi ikke rimeligt godt omkring? Jo det tror jeg.. 164
Appendix 7: Quotes in Danish Q1: ”Jeg har måske brugt nogle vendinger eller nogle termer som har gjort at hun har tænkt at ”jeg var nok inden for systemet” Q2: ”Man tror man er i stand til at sortere i det, men det er man måske ikke”. Q3: ”Folk er jo forskellige” Q4: ”Kontrolfreak” Q5: ”Jeg stiller nogle spørgsmål ved det jeg putter i munden, og at jeg ikke for enhver pris vil have noget for det jeg nu fejler. Det kunne også være en anden løsning der var den rigtige, ikke”. Q6: ”Jamen jeg er gammeldags. […] Jeg er tilhænger af ting der er i fysiske butikker” Q7: ”Jeg ville aldrig gå ind og sige ”du sagde godt nok sådan, men nu prøver jeg lige at finde en alternativ løsning” Q8: ”Jeg tager da kritisk stilling – eller forsøger i hvert fald” Q9: ”Jeg synes ikke nødvendigvis dem der står nede på apoteket de virker som om at de har bare sandheden om de her produkter” Q10: ”Men jeg er jo godt klar over at tingene bliver købt ind på et apotek, at det er ikke fordi at det nødvendigvis er fordi at apotekerdamen tænker at ”uh, jeg vil gøre det bedste for dig, så jeg anbefaler at du får det her produkt” det er jo fordi der kommer nogen og sælger noget ind, som hun vel også har en interesse i at sælge videre”” Q11: ”Irriterende” Q12: ”Skeptisk” Q13: ”Et stort spørgsmålstegn” Q14: ”Selvfølgelig er det også vigtigt hvis jeg køber en vaskemaskine på nettet, at den så også virker, […] men konsekvensen er ikke så voldsom. Jeg mener, jeg falder ikke død om af at vaske mit tøj i den. Men jeg kan godt falde død om, hvis jeg får en forkert pille” Q15: ”Stort ansvar [...] at tage stilling til om man vil risikere de bivirkninger i forhold til behandlingen” Q16: ”En fornemmelse af, om det her er noget der sket én gang eller om det er noget der sket tusindvis af gange” Q17: “Systemiske bivirkninger” Q18: “af mangel på bedre” Q19: “[…]jeg følte at apotekerdamen hun ligesom var sådan lidt ”nå du skal have denne her creme” som om at sådan ”uuha, er du nu sikker på at du skal have den her creme”. Og så bliver jeg jo sådan lidt ”jamen hvad er det” Q20: “Sandheden om de her produkter” Q21: ”Man kan ligesom lige sparre lidt. Have et levende væsen der ligesom be-­‐ eller afkræfter en i de tanker man går og har”. Q22: ”Jamen jeg tænkte at det var jo rasende smart, fordi her har vi på skrift hvad det er jeg skal have. Jeg skal ikke ringe derned og sige ”goddag jeg skal have 10 mg” og sagde hun så 10 eller sagde hun 100. Der står simpelthen jeg skal have den og den slags medicin, jeg vil gerne have det udleveret på det der apotek, og det skal ligge klart sådan og sådan. Det var det der tiltalte mig”. Q23: “Og så går jeg jo så hjem og slår det op på nettet” Q24: “Som regel har jeg bedt lægen om at sige at der ikke må substitueres, fordi der kan være små forskelle hvis det er, har jeg ladet mig fortælle” Q25: “Begyndt at sige ja en gang imellem” Q26: “Jeg tager mig da i at tænke, hvordan kan prisforskellen være så stor, men man er også sådan at ”jeg betaler ikke så mange penge for et eller andet produkt” Q27: ”[…]der koster det halve, og måske fungerer næsten lige så godt” Q28: ”Pris betyder ingenting i det” Q29: “Der snakker du bare åbent om det foran alle andre 165
Q30: ”Underligt” Q31: ”[…]og det kan jeg da godt mærke, at når der står 11 mand lige bag mig, som står og venter på at deres nummer bliver råbt op, jamen det har da en betydning” Q32: ”Det er jeg blevet for gammel til” Q33: ”Jeg ved ikke om jeg ville gå ind og købe hæmoridecreme sådan højt råbende” Q34: ”Det kommer an på hvad jeg skal have. Nu er det ikke så tit jeg øber noget som er sådan ”uh super hemmeligt””. Q35: ”Jeg synes folk er meget finke til at holde sig væk.” Q36: ”Det var jo så selvfølgelig afhjulpet online. Der kan man ligesom sidde og gemme sig lidt mere”. Q37: ”Det er irriterende at jeg skal derind, og der er altid 1000 mennesker, og der er altid varmt og det er svært at finde et sted til sin cykel, og jeg synes faktisk bare det er besværligt”. Q38: ”Overraskende nemt” Q39: ”En smule overvældende” Q40: ”Tænk hvis jeg var 85 år, og ikke kunne huske så godt og sådan noget. Ville jeg så kunne planlægge det her forløb, eller ville jeg gang på gang stå uden medicin […] så jeg synes det er sådan lidt besværligt” Q41: ”Hvis man så ikke har ringet i forvejen og bestilt sin medicin, så kan det godt være de siger ”den har vi ikke hjemme, den kommer først i morgen efter 10””. Q42: ”så øh plejer de faktisk at have det med det samme. …. Sådan at man ikke skal vente yderligere. Så man bare betaler og går med det samme. Så jeg synes det er meget enkelt”. Q43: ”Pisse irriterende” Q44: ”Du kan gå ind i Netto hver dag til klokken ti, men apotekerne, det er bare lidt mere gammeldags. Øhm, og kører meget de der stramme regler”. Q45: ”Altså det skulle ikke være sådan at ”ej der er en halv times ventetid,” eller ”chatten fungerer ikke lige i øjeblikket” sådan noget, det fungerer bare ikke” Q46: ”Den dag jeg flytter, og mit apotek ligger længere væk, der kunne jeg sagtens forestille mig at jeg satte spørgsmålstegn ved om det var det mest effektive”. Q47: ”Altså hvis man nu skal have penicillin, så vil man jo gerne i gang med det med det samme. Så hvis man nu skulle have det på nettet, så ville der jo gå et døgn” Q48: ”Hvis jeg har halsbetændelse så gider jeg jo ikke ventet tre dage på at få det med posten” Q49: ”[…] så viser jeg mit sundhedskort, fordi de søger min recept ud på CPR-­‐nummer. Og så finder de medicinen frem. Trykker på en knap og så kommer den fisende ned gennem et rør. Og det fungerer egentlig meget godt, hvis det er sådan noget relativt almindelig medicin” Q50: ”[…] at lægge en vis margin ind” Q51: ”vildt nemt og tidsbesparende” Q52: ”Skære nogle led af processen” Q53: ”Der havde jeg nok i højere grad brug for en snak om, hvordan og hvorledes skal det her foregå” Q54: ”Jeg skal bare have det der fungerer” Q55: ”mere tryghed end vane” Q56: ”[…] en tryghed ved at stå face-­‐to-­‐face med en ekspert, Q57: ”Man har det sådan ”jeg bruger ikke tid – sætter ikke tid af – for at tage til lægen, for bare sådan at ja, ”du tager bare det her””” Q58: ”Jeg blev lovet at det ville være helt det samme, og jeg så på egen krop kunne mærke, at det var det overhovedet ikke, og blev mødt af en [at the pharmacy, red.] der ikke var særligt forstående overfor det”. Q59: ”Så bliver jeg jo sådan lidt ”jamen hvad er det”. Og så går jeg jo så hjem og slår det op på nettet...Bivirkninger, anbefalinger, andre der har prøvet det. Det finder jeg bagefter” Q60: ”Du får jo bare langet en eller anden henover disken, som de et eller andet sted bare vælger for en”. Q61: ”Jeg skal selv kunne kontrollere at der er nok medicin” Q62: ”Altså nu har jeg ikke noget imod den, for jeg er nok lidt af en kontrolfreak, der måske på andre punkter også godt kan lide at have lidt styr på mine egne ting” 166
Q63: ”Jeg har ikke mod til og behov for at gå ind og tænke ”gad vide om der er fuldstændig det samme i og om det bare er et kopipræparat til”… Det kaster jeg mig ikke ud i.”. Q64: ”Det [the pharmacy, red.] på Nørrebro, det er meget lyst, det er meget åbent, man kan kigge på tingene, jeg kan gå hen og se på hele udvalget af produkter, uden at jeg skal stå sådan halvt henover en skranke og føle at jeg gør noget forkert. Det kan jeg bedre lide”. Q65: ”Men der kan også være noget hvor man øøh gerne vil vide lidt mere” Q66: ”Der er også det issue ved det, at hvis man køber det på nettet, så kommer det ud med posten, dagen efter eller dagen efter igen, og så hvis man ikke lige er hjemme der, så øhm… så skal man alligevel ned og hente det” Q67: ”Jamen så tager jeg bare direkte ned på apoteket” Q68: ”Nu er det også fordi jeg bor tæt på et apotek – det passer lige at jeg kan gå til lægen og så lige runde apoteket” Q69: ”Men jeg har aldrig købt receptpligtig medicin på nettet… og deeeeet har måske noget at gøre med at altså, hvis man nu er til lægen og alligevel er i byen, og kan jo køre forbi apoteket på vej hjem” Q70: ”Så går man derned når man alligevel er nede hos lægen, og stikker dem recepten og får pillerne”. Q71: ”Ja, der går lige en lille time, så vidt jeg husker, inden man…inden recepten er i deres system, så jeg gik vel en tur, eller var lige hjemme – som sagt ligger det jo meget tæt på”. Q72: ”Hvis ikke det var fordi det lå…hvis jeg skulle bare ned på apoteket eller runddelen, så ville jeg da gerne have sendt det hjem”. Q73: ”Jeg kører det totalt på rutine”, Q74: ”Altså jeg tror det er blevet meget automatiseret nu, fordi det er noget der har gentaget sig så mange gange, så det er jo bare at komme ned på apoteket”. Q75: ”Man kan sige, i og med at det er noget jeg køber regelmæssigt, så er det jo skørt at jeg har brug for…det er jo et eller andet sted skørt at jeg har brug for tryghed, så der er jo nok gået meget vane lige præcis i den. Så man kan sige hvis man tager p-­‐pillerne versus andre ting jeg ville købe sådan engangsbaseret, så kunne p-­‐pillerne jo sagtens blive bestilt online […] Så det er nok blevet vane, ja”. Q76: ”Irriterende” Q77: ”Altså nu ligger det på vejen, men jeg synes det er irriterende at jeg skal derind, og der er altid 1000 mennesker, og der er altid varmt og det er svært at finde et sted til sin cykel, og jeg synes faktisk bare det er besværligt”. Q78: ”Nej, det ville jeg nok egentlig ikke, hvis jeg skal være helt ærlig, fordi det er jo ikke nogen indarbejdet vane, at jeg køber mine ting på nettet. Altså apoteksting. Så selvom det var en mere almindelig ting, og selvom det ikke var så fatalt hvis der skete en fejl med det, så tror jeg ikke jeg ville gøre det. Så ville jeg bare gå ned og aflevere min recept og få mine piller. Det tror jeg faktisk”. Q79: “Jeg ved jo ikke engang hvem står bag apoteket.dk” Q80: “Altså hvis man tager sådan en forretning som H&M som jo både er online og offline, der giver det mig troværdighed at jeg ved at det hele hænger nede i forretningerne, men nu køber jeg det bare her, fordi det er nemmere. Det ville jeg sige var mere troværdigt end en udelukkende online baseret forretning”. 167
Appendix 8: Interview guide Introduktion til interviewet ved interviewer Hvordan skal det foregå, muligheden for at lade være med at svare Demografi Alder, beskæftigelse, bosat, husstand Indkøbsvaner på nettet Hvad er det sidste du har købt på nettet? Fortæl os lidt om hvordan det foregik …. Historik omkring online køb Hvad er købt, hvor ofte, hvordan, hvem var involveret Indkøbsvaner for receptmedicin Kan du huske sidst du købte receptmedicin? Beskriv processen … Historik Personer involveret Overordnet ord du ville knytte til medicinkøb? Online medicinkøb Da du købte medicin på nettet – hvordan var den proces? Hvordan var processen anderledes fra køb på det almindelige apotek? Overordnet ord du ville knytte til online medicinkøb? Sammenlign med andre køb på nettet Framework faktorerne (disse spørgsmål er blot til inspiration): Risk Lægens rolle (opgaver, relationer, -­‐ autoritet, tillid osv.) Apotekerens rolle (opgaver, relationer) Din rolle (opgaver – søger du på nettet eller spørger du nogen om råd, hvor? Om hvad?) Usikkerhed/konsekvens Hvor stor en bekymring er det for dig, om du får det rigtige produkt, når du køber medicin? Hvad kunne være en negativ konsekvens ved ikke at føle sig helt sikker på at man får det rigtige? Når du har købt på nettet (i udlandet), er du så usikker på, hvad der er lovligt? Økonomisk risiko Når du køber ud fra pris, er der så nogen bekymringer der dukker op? Når du køber nede på apoteket, vælger du så også det billigste alternativ? Føler du dig så også sikker på den beslutning? – Hvorfor? Er det nemmere at få en god pris på nettet eller på apoteket? Performance risiko Er du bekymret for, om det du køber på apoteket har den effekt du gerne vil have? Er du bekymret for, om det du køber på nettet har den effekt du gerne vil have? 168
Er du bekymret for om det du køber på apoteket kan være forkert eller skadeligt for dig? Er du bekymret for om det du køber på nettet kan være forkert eller skadeligt for dig? Person-­‐relateret risiko Social risiko Ville du have noget problem med at møde nogen du kender, når du står på apoteket? Har du nogensinde nogen med, når du køber medicin? Er du alene, når du køber på nettet? Ressource-­‐relateret risiko Er der forskel på den tid og de kræfter du skal bruge på at købe medicin på nettet og nede på apoteket? (Hvilke forskelle?) Tid – tager det lang tid? Hvad tager tid? Kræfter – er det besværligt? Hvad kræver kræfter? Risk relievers Hvad sætter du pris på, når du køber offline? Hvad kan det tilbyde dig som online ikke kan? Hvad sætter du pris på, når du køber online? Hvad kan det tilbyde dig, som offline ikke kan? Tænker du over fordele og ulemper ved kanalerne, når du skal vælge hvor du køber medicin? (hvordan opvejer du det?) Sætter du dig ind i det produkt du skal have før køb, eller køber du bare det på recepten? Er det det samme, når du køber på nettet som nede på apoteket? Ved du som regel hvad det er for et produkt du skal have, og om der findes alternativer, før du køber det? Er det så det samme, når du køber på nettet og på apoteket? Shopping motives Utilitarian Synes du altid du kan få det du skal have online/offline? Har du indtryk af at der er forskelligt sortiment online/offline? Hedonic Vil du gerne selv være involveret i beslutninger omkring den medicin du tager? Hvorfor? Har du nogensinde prøvet at vælge noget andet end det lægen havde givet dig recept på (subst. Eller fravalg)? Hvordan føltes det? Hvilken følelse får du, når du får rådgivning? Er der forskel på virtuel og fysisk rådgivning? Hvorfor? Når du kommer ned på apoteket, hvad er så den første fornemmelse der slår dig? Hvad er anderledes end ved at være i en anden slags butik (din adfærd, lugten, pladsen, mængden af mennesker eller..) Når du kommer ind på apotekets hjemmeside, hvad er så den første fornemmelse der slår dig? Hvad er det der gør det? (Føler du at online eller offline kanalen gør dig i stand til at gøre et kup?) Substituerbarhed Vaner – ville du betegne det at købe på nettet som et brud med det du normalt gjorde? Hvad fik dig til at ændre din vane med at købe på apoteket og gå på nettet i stedet? Hvis du søger på nettet, synes du så det er naturligt også at købe, eller går du stadig oftest på det almindelige apotek? Komplementaritet 169
Funktionel Er der nogen produkter, som du ville købe i butikken, men hvor du søger på nettet først? Hvordan er de som/anderledes end receptmedicin? Hvad er fordelene ved at gøre det? Er der nogen ulemper? Er der nogen produkter, som du ville købe på nettet, men hvor du går ned i butikken og ser dem først? Hvordan er de som/anderledes end receptmedicin? Hvad er fordelen ved at gøre det? Er der nogen ulemper? Symbolsk Gør det dig generelt mere sikker at købe varer online, hvis der er en butik? Kræver det at du har været i den butik? Hvad er det du får ud af at der er både online og offline? Gør det dig generelt mere sikker at købe varer i butikken, hvis der er en hjemmeside du kan læse på? 170