Unravelling the shift: exploring consumers’ adoption or resistance of E-Pharmacy through behavioural reasoning theory

Abstract

In the ever-evolving nature of the healthcare sector, the advent of electronic-Pharmacy introduces a dynamic shift in how consumers acquire and access medical and pharmaceutical products. The research utilized the behaviour reasoning theory. The study evaluated the reasons for adopting and against adopting electronic-Pharmacy. By employing the qualitative approach, this study unravels rich contextual and narrative insights, shedding light on the complexities of individual decision-making processes. The study received responses from 28 through an in-depth interview, and thematic data analysis was employed for the data analysis. The outcome of the research is summarized as follows. The respondents indicated that essential reasons for adopting electronic pharmacy services include convenience and accessibility, prescription management, cost and affordability, logistics, and timely delivery. On the other hand, the reasons against adoption include trust and security concerns, regulatory challenges and legal uncertainties, lack of internet access and privacy concerns. As technology changes healthcare delivery, this research closes the knowledge gap between theory and practice by offering crucial insights into the behavioural aspects influencing electronic-Pharmacy adoption or resistance. The findings are anticipated to significantly impact the academic discourse surrounding electronic-health and the practical implementation of strategies to enhance the integration of electronic-Pharmacy services into conventional healthcare systems.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-024-20265-7.

Background

Healthcare services have undergone a significant transformation with the introduction of electronic pharmacy (E-Pharmacy), representing a fundamental shift in how individuals obtain and acquire medications [1, 2]. This change is more than a technological advancement; it encompasses a multifaceted interaction of socio-cultural, economic, and regulatory elements that shape consumers’ choices in embracing or resisting E-Pharmacy services [3]. revealed that E-pharmacy is an electronic management, automated, internet-based platform that uses database systems and related components to link consumers and pharmacies. It includes online payments, decision support tools, inventory administration and monitoring. Traditional brick-and-mortar pharmacies are encountering considerable challenges, while the emergence of E-Pharmacy platforms brings convenience, cost-effectiveness, and unparalleled accessibility to pharmaceutical products [3, 4]. Yet, the degree to which consumers’ reasons for adoption (RFA) or reasons against adoption (RAA) for this digital evolution is an intricate inquiry that demands interdisciplinary examination. This preliminary investigation delves into consumers’ attitudes and behaviours regarding adopting E-Pharmacy, incorporating insights from sociology, economics, and health communication. Prior studies have uncovered that because of the obstacles to technology, older people voiced serious concerns about implementing modern health technologies [5]. While health applications may be more convenient for older populations, there is no scientific data about their prevalence with future generations.

Moreso, comprehending the forces propelling consumers towards E-Pharmacy entails unravelling the intricate connections among technology acceptance, healthcare consumerism, and the evolving landscape of pharmaceutical services [6]. Thus, revolutionary developments like mobile applications, online consultations, and doorstep delivery services have redefined the consumer experience, presenting a landscape with both opportunities and challenges. Elements such as trust, privacy concerns, and perceived risks linked to online transactions add complexity to the decision-making process for consumers [7]. Hence, exploring these intricacies necessitates a comprehensive examination integrating theoretical frameworks from information systems, consumer behaviour, and healthcare management through behavioural reasoning theory (BRT).

Additionally, the socio-cultural context plays a crucial role in moulding consumers’ perceptions and choices regarding adopting E-Pharmacy. Cultural attitudes towards technology, health beliefs, and the impact of social networks all contribute to the intricate web of consumer decision-making [8, 9]. Utilizing anthropological and sociological standpoints enables a nuanced investigation of how cultural factors intertwine with technological developments, shaping the dynamics of adoption or resistance in diverse communities. Moreover, economic considerations, such as affordability, insurance coverage, and the potential influence on local businesses, introduce an economic layer to the analysis [10]. Furthermore, this exploratory expedition will traverse the changing regulatory terrain that oversees E-Pharmacy services. The interplay of government policies, regulatory frameworks, and the collaboration between the pharmaceutical industry and regulatory bodies delineates the parameters of E-Pharmacy operations [11]. Therefore, a thorough analysis of the legal and ethical dimensions surrounding the adoption of E-Pharmacy is crucial for understanding the broader implications on public health and patient well-being.

Accordingly, businesses specializing in electronic pharmacy have capitalized on the rapid proliferation of mobile devices and their innovative application to address health issues [12, 13]. The healthcare industry has seen a significant increase in demand for E-Pharmacy services due to the COVID-19 pandemic response [14]. Even though E-Pharmacy services are becoming increasingly popular [15], noted that the currently available literature suggests that the topic is still in its infancy, which presents a great opportunity for contributions to this study area. Most research on the intention to use e-pharmacy services and the actual usage behaviour has been conceptual, focusing on antecedent repercussions outcome interactions and addressing performance expectancy, effort expectancy, social influence, and hedonic motivation [3, 16].

By amalgamating insights from various disciplines, this study offers a comprehensive understanding of the factors influencing consumers’ choices to adopt or resist E-Pharmacy services. Amidst the ongoing global focus on digital health solutions, comprehending the determinants of E-Pharmacy adoption in South Africa can position the country at the forefront of healthcare innovation [3, 17]. This could foster a more resilient and responsive healthcare system, aligning with the needs and preferences of its diverse population. Essentially, this study has the potential to catalyze positive changes in healthcare delivery, fostering a more inclusive, efficient, and responsive approach that addresses the specific challenges faced by South Africa.

South Africa has been working on regulations to govern e-pharmacies. The Medicines and Related Substances Act, as well as the Pharmacy Act, are crucial regulatory frameworks. The South African Health Products Regulatory Authority (SAHPRA) oversees the country’s pharmaceutical regulations [18, 19]. Also [20], suggested that transitioning from the conventional reliance on paper-based methods and a singular dispensing software monopoly to the implementation of digital pharmacy community health services represents a transformative shift in enhancing primary healthcare delivery systems, fostering the evolving engagement between patients and pharmacists, and building resilience. The technological landscape in South Africa, including internet penetration and mobile phone usage, is growing. The increasing access to smartphones and the internet may contribute to adopting E-Pharmacy services [21]. Similarly, e-commerce and telemedicine have seen increased adoption in South Africa, which could influence the growth of e-pharmacies. The COVID-19 pandemic has accelerated the acceptance of telehealth solutions globally, and South Africa is no exception [22].

The healthcare sector in South Africa is currently navigating a complex landscape marked by a dual burden of infectious diseases alongside a rising prevalence of non-communicable diseases [23]. Medication dispensing is characterized by advanced pharmacy services in urban centres and the challenges of ensuring consistent drug availability in remote areas. Moreover, the country is undergoing a digital transformation in healthcare, aiming to increase access to services through telemedicine and e-pharmacy platforms [22, 24]. Efforts are also being made to integrate traditional medicine with conventional healthcare practices, recognizing the diverse medical needs and cultural practices of South Africa’s population.

Furthermore, challenges in implementing E-Pharmacy services may include issues related to data security, regulatory compliance, and the need for a robust technology infrastructure [25]. On the positive side, e-pharmacies have the potential to enhance healthcare accessibility, especially in rural or underserved areas [26]. The burgeoning digital health pharmacy services and market expansion, infrastructure enhancements, and participatory treatment approaches present an opportunity to consolidate and leverage innovative breakthroughs in scientific, medical, technological, and care delivery realms [27]. This is particularly crucial for global population health and well-being, with a special focus on Africa.

Moreover, despite considerable research on consumer behaviour in digital markets [28, 29], there remains a gap in understanding the specific adoption or resistance mechanisms of E-Pharmacy services through the lens of Behavioural Reasoning Theory (BRT). While existing studies have explored various aspects of online consumer behaviour and health-related decision-making [30, 31], the adoption of BRT for E-Pharmacy adoption has not been sufficiently investigated. This gap highlights the need for an analysis of the reasons behind consumers’ support or opposition to E-Pharmacy, taking into account the distinct cognitive processes that BRT emphasizes, including the role of reason-based justifications and counter-justifications in shaping consumers’ intentions and actions in the context of digital health services, especially from emerging country such as South Africa.

In addition, this study’s novelty and contributions are enumerated as follows: First, this research’s uniqueness lies in exploring the intersection between healthcare innovation adoption, consumer behaviour and the contextualization of emerging economies such as South Africa. While E-Pharmacy has been studied in developed countries, this study distinguishes itself by exploring the complexities of the South African environment, characterized by a combination of evolving digital health solutions and traditional health practices. Second, applying the BRT to understand customers’ cognitive process in deciding either reasons for adoption (RFA) or reasons against adoption (RAA) of e-pharmacy, the research contributes to the theoretical knowledge gap in consumer research studies. Second, this study has practical implications for policy-makers, healthcare providers, and E-Pharmacy platforms looking to tailor their approaches to the diverse and dynamic South African market. Furthermore, the study adds to the larger debate on the global evolution of healthcare delivery by demonstrating that the widespread use of E-Pharmacy is a behavioural shift deeply anchored in consumer psychology. The research’s recognition of the essential variables influencing adoption or resistance is a roadmap for healthcare and pharmaceutical sector stakeholders to develop customized approaches that address specific issues and capitalize on drivers of E-Pharmacy acceptance. As South Africa traverses its healthcare setting, adopting these behavioural insights might encourage a more seamless incorporation of E-Pharmacy services, improving accessibility, affordability, and overall population well-being. Lastly, applying the exploratory qualitative paradigm is apt for our research on consumer behaviour towards E-Pharmacy, as it allows for an in-depth understanding of the motivations and resistances underpinning individual choices. Such a method facilitates the collection of rich, detailed data essential for applying BRT, thereby capturing the complexity of consumers’ decision-making processes in a dynamic digital marketplace. This approach effectively reveals the ‘why’ behind behaviours, which quantitative methods may not fully uncover.

The remainder of this paper is as follows: apart from the introduction above. A review of recent literature is presented in Section Two. Section three describes this study’s methodology, data, and qualitative approaches. Section four of this study covers the empirical findings and discussion. Section 5 gives an overview, including the study’s conclusion and theoretical and practical implications.

Literature review

Theoretical background- behavioral reasoning theory (BRT)

Behavioural Reasoning Theory (BRT), as proposed by [32], posits that behaviour results from intentions and the reasons for and against engaging in that behaviour. The BRT extends beyond the intent by incorporating two types of reasons: ‘reasons for’, positive justifications or beliefs that lead to a particular behaviour, and ‘reasons against’, which are barriers or negative beliefs that might prevent the behaviour [33]. BRT argues that these reasons shape an individual’s attitudes and intentions, which drive behaviour. It acknowledges that human actions are complex and often involve a reasoned thought process, where individuals actively justify and rationalize their decisions [34]. This theory includes the cognitive process of developing these reasons and the social and emotional influences that affect them, providing a comprehensive understanding of decision-making processes [35].

Hence, the BRT offers a unique and holistic framework that is particularly suited to exploring the nuances of consumers’ adoption or resistance of E-Pharmacy, as it delves into the ‘why’ behind individual actions, taking into account not only the reasons for engaging in behaviour but also the reasons against it. Unlike the Unified Theory of Acceptance and Use of Technology (UTAUT) or the Technology Acceptance Model (TAM), which primarily focus on the influence of performance expectations and ease of use, BRT allows for a more comprehensive exploration of the complex interplay of personal values, beliefs, and social norms influencing consumer behaviour [36, 37]. By utilizing BRT, our study captures a broader spectrum of cognitive evaluations, such as ethical considerations, risk assessments, and the impact of prior experience, providing a more detailed understanding of consumer reasoning in the context of E-Pharmacy adoption. This depth of analysis is crucial for a subject that encompasses not just technology adoption but also the personal health-related decisions of individuals.

Consumers’ resistance or adoption of E-Pharmacy in South Africa: a perspective from behavioural reasoning theory

Consumers may resist e-pharmacy adoption due to concerns about their personal and health information security in online transactions [38]. Perceived risks associated with online transactions can affect trust. Building trust through secure platforms, transparent information, and effective communication can positively influence adoption [22, 39]. In addition, resistance may occur if consumers perceive E-Pharmacy’s costs (financial, time, effort) as high or the benefits as low. The convenience, time-saving, and cost-effectiveness of e-pharmacy services can enhance adoption [20]. Accordingly [40], postulate that social factors, such as peer opinions or societal norms, may contribute to resistance if there is scepticism about the legitimacy or safety of E-Pharmacy. Positive word-of-mouth, social endorsements, and awareness campaigns can influence positive perceptions and adoption [41, 42]. Based on the behavioural reasoning theory (BRT), consumers may resist if they lack control over the E-Pharmacy process or lack confidence in using digital platforms. Likewise, a study suggests that consumers may resist if they find it difficult to understand or trust the E-Pharmacy system through the lens of BRT. Also, lack of awareness or cognitive barriers can contribute to resistance. Clear and simple communication, educational initiatives, and user training can address cognitive barriers and promote adoption [43].

Assessing consumers’ perspective on the resistance, adoption and factors affecting E-Pharmacy

Consumer adoption of E-Pharmacy services in South Africa may be influenced by factors such as trust in online platforms, awareness of E-Pharmacy benefits, and ease of use [44]. Research posits that consumer perceptions and behaviours can provide insights into the readiness of the population for electronic pharmacy services [22]. Hence, exploring consumers’ perceptions of e-pharmacy services in South Africa is vital. Traditional pharmacy services often involve face-to-face interactions, and some consumers may resist shifting to a more digital and remote model [45]. In addition, consumers may adopt E-Pharmacy services to conveniently order medications from the comfort of their homes and the accessibility of online platforms. Accordingly, e-pharmacies that provide transparent information about medications, prices, and potential side effects may attract more users [46]. Moreover [45], stated that their familiarity and comfort with technology may influence consumer adoption. User-friendly interfaces and apps can enhance the overall experience. Similarly, consumers may be more inclined to use E-Pharmacy services that comply with established healthcare regulations, ensuring the safety and authenticity of medications [47]. Additionally, consumers may express resistance due to concerns about their personal and health information security in online transactions [6]. Hence, assessing consumers’ perspectives on the resistance, adoption and factors affecting E-Pharmacy is essential.

Research gaps

Despite the substantial body of research exploring consumer adoption and resistance to E-Pharmacy underpinned by BRT, a gap exists in understanding consumers’ specific cognitive and emotional reasoning processes within South Africa’s unique socio-economic environment. Previous studies have concentrated on the functional aspects of E-Pharmacy adoption, such as trust, convenience, and technology familiarity. However, research is scarce that deeply investigates the interplay of personal health beliefs, ethical considerations, and socio-cultural norms articulated by BRT, particularly how these factors collectively shape consumer attitudes towards E-Pharmacy in South Africa. This gap suggests a need for an investigation that extends beyond the established frameworks of technology acceptance models to a more contextually rich understanding of consumer reasoning in the domain of E-Pharmacy.

Methods

Research design

This paper applied qualitative research to explore the adoption of e-pharmacy platforms by RAAs and RFAs among consumers and buyers in South Africa. The qualitative approach can help provide a comprehensive understanding of individual behaviour, perception and attitudes and enable the study to delve into the complexities of the adoption process [48, 49]. In addition, the use of the qualitative method is well justified, given the explanatory nature of the study, which aims to understand consumers’ complex decision-making processes. Qualitative analysis allows for a rich, contextual examination of the subjective experiences, thoughts, and feelings that quantitative data alone cannot capture [50]. This approach aligns with the principles of BRT and prior studies, which posits that qualitative analysis offers the flexibility and depth required to delve into the personal and societal narratives that drive consumer behaviour towards e-pharmacy services [51, 52]. The study applied an in-depth interview and thematic assessment to explore the contextual and subjective experience shaping consumers’ decisions to adopt e-pharmacy. Hence, the qualitative technique provides the avenue for identification of the unique economic, socio-cultural and technological factors that influence the RAA and RFA of E-Pharmacy in South Africa. This approach’s detailed and rich insight can facilitate understanding the multifaceted indicators affecting consumer adoption, providing a solid foundation for targeted initiatives and interventions to improve the successful operation and implementation of e-pharmacracy platforms [53].

Study setting

This research focused on residents living in the Western Cape region of South Africa. The rationale for selecting South Africa for this research can be enumerated as follows: First, South Africa faces unique challenges in the healthcare industry, which is related to the accessibility of health products, especially in the remote areas of the country [22, 54]. Respondents living in the Western Cape region were selected for this study due to the region’s high internet penetration rate, which provides a robust context for e-pharmacy adoption. Additionally, the Western Cape has a diverse demographic reflects various consumer behaviours, making it an ideal setting for examining the nuances of e-pharmacy platform usage. Assessing the adoption of indicators and variables of E-Pharmacy adoption platforms can help shed insight on how technology can bridge this gap. Thus, this research provided initiatives that will help make essential medications and healthcare services more accessible to a broader section of the populace in South Africa. In addition, South Africa grapples with health disparities and different economic conditions, which can impact the RAA and RFA of digital health solutions differently across demographics. Hence, examining these factors will contribute to the customization of E-Pharmacy services and help craft policies that ensure equitable healthcare access for all citizens. In addition, some of the frequently used e-pharmacy platforms in South Africa have significantly streamlined the healthcare industry. For example, platforms such as Dis-Chem Online are reputed for their extensive range of products and the convenience of door-to-door delivery. Right e-Pharmacy has been highlighted for its innovative solutions like the Collect&Go Smart Lockers and the Tele-pharmacy services, which offer added flexibility and accessibility to users. Services like Pharmacy Direct, Clicks, and Netcare Pharmacies are also acknowledged for seamless online prescription management and home delivery services. Users have commended the user-friendly interfaces and the robust customer support these platforms provide, further reflecting the increasing reliance on digital solutions for healthcare needs in South Africa.

Sampling approach and participants

As indicated by [55], the sampling technique plays an essential role in ensuring the representation of diverse perspectives within the targeted population of the study. Given the varied socio-economic and demographic factors in South Africa, the study applied the stratified sampling method to ensure a proportional representation of different income levels, age groups and geographical locations. The stratified sampling approach was used in this research because prior studies have indicated this approach improves the study’s outcome and reliability [56, 57]. By stratifying the sample size, the paper can provide insights into the factors influencing RAA and RFA of E-Pharmacy within different geographical contexts in South Africa. Respondents for this study consisted of customers or consumers who actively engaged with E-Pharmacy channels, capturing their opinions, challenges and experiences. The selection criteria for respondents in this study included individuals with direct experience with e-pharmacy services, showcasing their capacity to provide informed insights into their adoption or resistance. Criteria encompassed familiarity with online purchasing, personal interaction with e-pharmacy platforms, and a history of medication usage requiring prescriptions. To ensure the participants met these criteria, we screened for prior e-pharmacy usage. We gathered demographic data to confirm diverse experiences with digital health services, ensuring a rich understanding of the behavioural reasoning behind their choices. In addition, given the multifaceted nature of the E-Pharmacy platforms and the technological process involved, respondents with varying degrees of familiarity with digital healthcare systems and digital technologies were asked to answer the interview questions. The study interview was conducted in three major cities in the Western Cape region (George Local Municipality, Laingsberg Local Municipality, and Mossel Bay Local Municipality). The study initially contacted 43 participants to provide answers to the interview question. Out of that, 35, representing 81% of the respondents, were interviewed. However, 28 responses were used for the final analysis because of incomplete information from the rest of the responses. Table 1 contains the stratification criteria based on socio-demographic for the initial 43 respondents contacted. Table 1 presents the stratification of our study’s sample across various demographic categories. Age groups are evenly distributed, with the largest group (45–54 years) accounting for 25% of respondents. The sample is predominantly male (58%) and balanced between urban (50%) and non-urban residents. Educational levels vary, with high school graduates forming the largest subgroup. The majority of participants are employed and from the middle-income bracket. The sample is diverse in terms of ethnicity, with a majority being Black African and health status, where a sizable portion reports occasional medical needs.

Table 1.

Profile information of respondents

Stratification Criteria	Sub-Categories	Respondents	Percentage
Age Groups	18–24	3	10.71%
	25–34	6	21.43%
	35–44	5	17.86%
	45–54	7	25.00%
	55–64	4	14.29%
	65+	3	10.71%
Gender	Male	16	58.00%
	Female	12	42.86%
Geographic Location	Urban	14	50.00%
	Suburban	9	32.14%
	Rural	5	17.86%
Education Level	No formal education	1	3.57%
	Some secondary	3	10.71%
	High school graduate	7	25.00%
	Diploma	6	21.43%
	Bachelor’s degree	7	25.00%
	Postgraduate degrees	4	14.29%
Income Level	Low	5	17.86%
	Middle	15	53.57%
	High	8	28.57%
Employment Status	Employed	18	64.29%
	Unemployed	6	21.43%
	Economically Inactive	4	14.29%
Ethnicity	Black African	18	64.28%
	White	7	28.57%
	Indian/Asian	3	10.71%
Health Status	Chronic conditions	6	21.43%
	Occasional medical needs	12	42.86%
	Healthy	10	35.71%

Data collection approach

Since the research relied on qualitative analysis, the data collection involved in-depth interviews to delve into customers’ RFA and RAA E-Pharmacy. During the data collection phase, the study initially employed open-ended questions tailored to elicit responses from the participants. In the next phase, the authors interviewed two main modules (face-to-face and telephone conversations). Extant studies have reported that face-to-face interviews and telephone conversations provide an in-depth and personalized approach to gathering data and responses for qualitative studies [58, 59]. These data collection methods enable the research to explore respondents’ perceptions and experiences in greater detail, identifying contextual and individual factors facilitating the adoption of E-Pharmacy among consumers. In addition, face-to-face and telephone conversations provide an enhanced communication and interaction avenue for the participants and interviewers to clarify responses and probe deeper into complex issues affecting E-Pharmacy adoption in South Africa. The research adhered to ethical principles by obtaining verbal informed consent from all participants and ensuring anonymity and confidentiality. The ethical standards committee of Jiangsu University School of Management approved and reviewed the study’s design to ensure no respondent rights were infringed upon. In addition, the interview questions structured by the authors for this study are attached in Appendix 1. Table 2 provides an overview of the responses from the participants. As indicated in Table 2, fifteen (15) respondents were contacted through telephone, while thirteen (13) were contacted by face-to-face interaction. Out of the 28 participants, 16 agreed to adopt e-pharmacy platforms, while twelve (12) indicated non-adoption of e-pharmacy.

Table 2.

Synopsis of interviews conducted

Respondent	Municipality	Interview Method	E-Pharmacy adopter
R1	George LM	Telephone	Yes
R2	George LM	Face to face	Yes
R3	George LM	Telephone	No
R4	George LM	Face to face	Yes
R5	George LM	Telephone	No
R6	George LM	Telephone	No
R7	George LM	Face to face	Yes
R8	George LM	Telephone	No
R9	Laingsberg LM	Face to face	Yes
R10	Laingsberg LM	Telephone	Yes
R11	Laingsberg LM	Face to face	No
R12	Laingsberg LM	Face to face	Yes
R13	Laingsberg LM	Telephone	No
R14	Laingsberg LM	Telephone	No
R15	Laingsberg LM	Telephone	Yes
R16	Laingsberg LM	Face to face	Yes
R17	Laingsberg LM	Telephone	Yes
R18	Laingsberg LM	Face to face	Yes
R19	Laingsberg LM	Telephone	No
R20	Laingsberg LM	Face to face	Yes
R21	Mossel Bay LM	Telephone	No
R22	Mossel Bay LM	Face to face	No
R23	Mossel Bay LM	Telephone	Yes
R24	Mossel Bay LM	Telephone	Yes
R25	Mossel Bay LM	Face to face	No
R26	Mossel Bay LM	Telephone	Yes
R27	Mossel Bay LM	Face to face	No
R28	Mossel Bay LM	Telephone	Yes

Note LM-Local Municipalities

Data analytical approach

The research employed the Atlas.ti tool to explore the thematic areas in the study. Atlas.ti is a powerful qualitative analytical approach which assists researchers in navigating the complexities of qualitative research [60, 61]. Using this analytical tool, the study systematically analyzed the audio data, text, and visuals to uncover the dataset’s themes, patterns, and connections. Erstwhile studies have recognized that the Atlas. The software can facilitate identifying the essential variables influencing the adoption of e-pharmacy [62, 63]. The research applied to the Atlas.ti software because it opens new frontiers in qualitative research, making it an indispensable tool for those seeking to extract meaningful information from qualitative data efficiently and insightfully. This technology opens new frontiers in qualitative research, making it an indispensable tool for those seeking to extract meaningful information from qualitative data efficiently and insightfully.

Moreover, this research achieved data saturation through iterative rounds of data collection, where interviews were conducted until no new themes emerged, ensuring comprehensive coverage of consumers’ perspectives on e-pharmacy adoption. The coding procedure was systematic, involving two qualified researchers with expertise in behavioural science independently analyzing the transcripts using NVivo software to ensure reliability. Extensive note-taking was performed throughout the analysis to track the evolution of coding and theme development. These notes were then used in collaborative sessions where coders discussed and refined themes, grounding our thematic analysis in the data. The qualifications of the coders were critical, as both hold degrees in behavioural psychology and have prior experience with qualitative health research, which added depth to the analysis [64]. By elucidating the thematic connections between behavioural reasoning theory and consumer behaviour, the study clearly distinguished thematic analysis from mere content analysis, offering nuanced insights into the factors driving or inhibiting the uptake of e-pharmacy services. Figure 1 presents the word crowd analysis identified through the themes during the extraction process. As indicated in Fig. 2, most respondents mentioned the words e-pharmacy, adoption, resistance, convenience, accessibility, perception, management, cost, affordability, and logistics during the interview session.

Fig. 1.

Theoretical background based on BRT

Fig. 2.

Word cloud analysis

Results and discussion

Thematic analysis

In order to present the findings from the interview, the study used thematic analysis, an integral component of qualitative research. The thematic analysis helped the authors to identify, analyze and interpret the patterns and themes of the study. This approach provides an iterative and flexible process where emerging themes can be used to provide quality and precise analysis of the complexities of this research [65, 66]. Figure 3 captures the various coding themes generated from the interviews. Thus, these themes were categorized based on E-Pharmacy’s BRT (RFA and RAA). Therefore, to solve the research question and achieve the study’s objectives, the researcher identified four factors, each under the RAA and RFA of E-Pharmacy in South Africa. The RFA E-Pharmacy from the respondents included (i) convenience and accessibility, (ii) prescription management, (iii) cost and affordability and (iv) logistics and timely delivery. On the other hand, the adoption of the RAA includes (a) trust and security concerns, (b) regulatory challenges and legal uncertainties, (c) lack of internet access, and (d) privacy concerns. Table 3 organizes the themes and sub-themes and associates them with specific reasons for or against adopting e-pharmacy as extracted from the figure. Each theme is pertinent to consumer decision-making and their attitudes towards e-pharmacy.

Fig. 3.

Graphical representation of the research themes

Table 3.

Outcome of thematic data analysis

Theme	Sub-theme	Reason for Adoption	Reason against Adoption
Convenience and Accessibility (Theme 1)	- Saves time and money	E-Pharmacy offers time-saving benefits and doorstep pickup options.	-
	- Doorstep service	Facilitates busy schedules by delivering medications directly.
Prescription Management (Theme 2)	- Management of medication	Allows for easy upload, management, and reminders for medication online.	-
	- Prescribed treatment plan	Ensures that prescriptions are received on schedule.
Cost and Affordability (Theme 3)	- Less expensive options	E-Pharmacy is often a more affordable option than traditional pharmacies.	-
Logistics and Timely Delivery (Theme 4)	- Efficiency	The structure of e-pharmacies provides timely and efficient medication delivery.	-
Trust and Security Concerns (Theme 5)	- Security of health data	-	- Concerns over personal health data security and counterfeit medications cause distrust.
Regulatory and Legal Uncertainties (Theme 6)	- Legal framework needed	-	- The current lack of clear regulatory guidelines creates apprehension.
Data Security and Privacy (Theme 7)	- Cyber threats	-	- Potential data breaches and privacy issues concern personal information safety.
Lack of Internet Access (Theme 8)	- Rural internet access	-	- Limited internet access in rural areas hinders e-pharmacy adoption.

Reasons for adoption (RFA) of E-Pharmacy

Theme 1: convenience and accessibility

This section of the study focused on the first theme that supports the adoption of E-Pharmacy among consumers in South Africa. Thus, the thematic convenience and accessibility emerged to play a pivotal role in affecting the RFA of E-Pharmacy. Accordingly, the study presents responses from respondents highlighting their perspectives on the convenience and accessibility aspects of E-Pharmacy adoption. The participants underscored the importance of E-Pharmacy in addressing geographical challenges, especially in rural centres where physical access and pharmacy usage are scanty or limited. For instance, one response espoused that:

“I live in a distant area, so getting to the closest drugstore takes a while. E-Pharmacy has completely altered my life because it saves me money and time on travel by enabling me to get my prescription medications online. It’s a blessing for those of us who don’t have convenient access to actual pharmacies.” R_7.

Conveniently placing orders from home saves time and relieves pressure on individuals who might find it challenging to visit conventional pharmacies. This illustrates how E-Pharmacy advances healthcare equity by reaching underserved populations.

In addition, some of the respondents emphasize the effect of E-Pharmacy on the lifestyle of the working class, indicating how the flexibility of online services aligns with the hectic schedules of professionals. Thus, access to round-the-clock pharmaceutical services may meet the needs of those who cannot visit a physical pharmacy during regular business hours. E-pharmacies meet the demands of modern, busy lifestyles. This point was emphasized by one respondent who echoed that:

“As a working professional, I usually find visiting a pharmacy during regular business hours challenging. I can order my medications from E-Pharmacy after work or on weekends. It is really handy and works well with my busy schedule.” R_4.

Some responses emphasize how E-Pharmacy might be tailored to the specific needs of individuals managing chronic medical conditions. In addition to accessibility, convenience comes with discreet and confidential services, which are especially important for those who want privacy while maintaining their health. For those who need regular medication, doorstep delivery adds even more convenience by minimizing annoyance. An adopter of E-Pharmacy buttressed this point:

“People with chronic diseases need to take their medications consistently. Online pharmacies not only make sure I never run out of prescription medications, but they also offer discreet and private services. I appreciate the ease and privacy that doorstep pickup provides.” R_26.

These qualitative responses from respondents in South Africa demonstrate the intricate role that convenience and accessibility play in promoting the use of E-Pharmacy. E-pharmacy in South Africa’s healthcare system is growing because it satisfies several needs, such as providing discrete treatments for chronic disorders, bridging geographic gaps, and accommodating busy lifestyles. The findings from this analysis support prior studies that have argued that individuals or customers may adopt E-Pharmacy based on convenience and accessibility [3, 4].

Theme 2: prescription management

Effective prescription management guarantees that people receive their drugs without interruption. This is a qualitative answer from a participant about how prescription management influenced their choice to use E-Pharmacy services. This remark illustrates the real-world difficulties people encounter when juggling several prescriptions, particularly for long-term illnesses. Prescription management solutions like automated reminders improve drug adherence while streamlining the process when integrated into E-Pharmacy platforms. This becomes more important when dealing with chronic illnesses, as preserving health requires regular drug management. Thus, one respondent asserted that:

“I had trouble managing a lot of prescriptions for chronic conditions before I started utilizing E-Pharmacy services. Every now and then, at traditional pharmacies, I would forget to get a prescription filled, which would throw off my regimen. I can upload and manage all of my medications online using E-Pharmacy. Reminders to refill on time have also been sent to me. Finally, my overall health has improved, but it has also had a big impact on my ability to follow my prescribed treatment plan.” R_18.

Prescription administration is made easier using E-Pharmacy services, which address privacy and accessibility concerns. Some respondents shared their perspectives on how these factors influence their decision to use E-Pharmacy services. One of the respondents reiterated that:

“Getting access to pharmaceuticals used to require a significant amount of travel to the closest pharmacy. This was changed for me by E-Pharmacy. In addition, unlike traditional brick-and-mortar pharmacies, I don’t have to worry about my health information being compromised because the service is discreet.” R_1.

The above response shows the significance of e-pharmacy in addressing prescription management and healthcare access. Managing medicines online is convenient and lessens travel stress for those who live in rural places. Furthermore, E-Pharmacy services’ emphasis on privacy is in line with people’s increased importance of maintaining the privacy of their health information. These indicators work together to make E-Pharmacy services more appealing and widely used in South Africa, supported by these erstwhile studies [3, 38, 67].

Theme 3: cost and affordability

Moreover, the respondents highlighted the significance of cost and affordability in determining the use of E-Pharmacy services. Reductions in expenses attract those searching for accessible healthcare solutions and make prescription medications more widely available. This response suggests that one major factor driving the adoption of e-pharmacies in South Africa is cost and affordability, which aligns with these comments.

I started using E-Pharmacy services mostly because it was less expensive than buying my prescription medications from traditional brick-and-mortar pharmacies. Besides their lower prices, online retailers often provide additional discounts and incentives. This has significantly reduced the cost of managing my chronic illness; therefore, for me, it’s a practical and affordable option.

Some respondents clarified the significance of affordable rates and flexibility in decision-making. The capacity to readily compare costs and identify more affordable solutions helps customers make well-informed decisions. According to this response, e-pharmacies provide consumers with the knowledge they need to make wise financial decisions about their healthcare in addition to cost savings. One participant spoke about this issue:

“I was starting to get concerned about how much prescription drugs were costing at neighbourhood pharmacies. I could compare rates to discover more affordable solutions when I learned about E-Pharmacy offerings. The pharmacies’ upfront cost structures and reasonable rates significantly influenced my switch.” R_26.

These responses support erstwhile studies demonstrating the significance of cost and accessibility in adopting E-Pharmacy services [4]. Individuals seeking accessible and reasonably priced healthcare options are attracted to the apparent financial advantages, such as open-cost structures, discounts, and lower expenses [6]. noted that affordability is becoming a more crucial consideration for those searching for sensible and economical ways to obtain their prescription medications due to the evolving nature of healthcare.

Theme 4: logistics and timely delivery

The effectiveness of logistics and prompt delivery are important factors impacting adoption. In this regard, we collected qualitative feedback from participants to learn about their viewpoints on how prompt delivery and logistics enhance the attractiveness of E-Pharmacy services in South Africa. The response from the interview emphasizes how E-Pharmacy helps close the accessibility gap in rural areas. For residents living in areas where physical pharmacies are scarce, the promptness of delivery assumes a crucial role, underscoring the significance of logistics in augmenting healthcare accessibility. One of the respondents highlighted that:

“Going to a physical pharmacy can be difficult if you live in a remote place. In addition to delivering the pharmacy right to my house, E-Pharmacy’s dependable delivery service guarantees that I receive my prescriptions on schedule. For those like myself who live distant from cities, it’s a game-changer.” R_15.

Additionally, the majority of the adopters of E-Pharmacy recounted that the tracking feature of E-Pharmacy applications underscores the importance of delivery process transparency. For instance, one respondent mentions that:

“I value the tracking feature offered by e-pharmacies.” Knowing where my order is and when it will be delivered provides me peace of mind. It’s not only about convenience; it’s about knowing that my prescriptions will arrive on time.” R_28.

Frequent updates and real-time tracking enhance the overall user experience and address uncertainty-related concerns, contributing to increased confidence in the E-Pharmacy system. This finding aligns with the outcome of these prior studies [68, 69]. These themes delve into the responses about the time delivery and logistics involved in online pharmacy platforms. Most participants acknowledge that the assurance offered via tracking characteristics and features and the time efficiency compared with traditional pharmacies contribute to the increasing preference for E-Pharmacy services. Addressing and enhancing these logistical issues will likely remain crucial if E-Pharmacy adoption in the region is to be maintained as the healthcare environment shifts [8, 9]. Table 4 summarises the open and axial codes supporting the adoption of E-Pharmacy.

Table 4.

Summary of reasons for adoption of E-Pharmacy

Open codes	Axial Codes	Reasons for Adoption of E-Pharmacy
E-Pharmacy has completely altered my life because it saves me money and time. It is really handy and works well with my busy schedule. I appreciate the ease e-pharmacy provides for pickup at my doorstep.	It saves me money and time. Convenient access to actual pharmacies Provision of doorstep pickup	Convenience and Accessibility
I can upload and manage all of my medications online using E-Pharmacy. Reminders to refill on time have also been sent to me. I don’t have to worry about my health information being compromised because the service is discreet.	Management of all medications Prescribed treatment plan Prescription medications are more widely available.	Prescription Management
It was less expensive than buying from traditional brick-and-mortar pharmacies. It’s a practical and affordable option. The pharmacies’ upfront cost structures and reasonable rates	Reductions in expenses Less expensive It has significantly reduced the cost.	Cost and Affordability
I receive my prescriptions on schedule. It’s a game-changer I value the tracking feature offered by e-pharmacies	Effectiveness of logistics and prompt delivery Dependable delivery service Tracking feature	Logistics and Timely delivery

Reasons against adoption of E-Pharmacy

Theme 5: trust and security concerns

In South Africa, using E-Pharmacy has elicited various reactions, with some raising worries about trust and security. This analysis looks into some comments raised by the participants that emphasize these concerns, offering light on the factors causing scepticism toward E-Pharmacy services. For instance, some non-adaptors provided responses that illustrate a widespread worry about the security of personal health information. In the digital age, protecting sensitive data is critical, and many are concerned about the risks of sharing health-related information online. One of the participants echoed that:

“I’m concerned about the security of my health data.” I’m unsure whether these internet pharmacies can sufficiently protect my sensitive information with the rise of cyber risks. It’s a major deterrent for me.” R_27.

Furthermore, there were concerns about the essence of interpersonal relations and the trust people built through face-to-face communication in the conventional pharmacy environment.

Respondent 3 from George local municipality remarked, “I like traditional pharmacies because I can connect with the pharmacist in person. Face-to-face interactions concerning my health have built a level of trust. It feels impersonal online and raises concerns about the medication’s authenticity.” R_3.

Furthermore, counterfeit pharmaceuticals pose a substantial hazard to public health, so this reaction is understandable. To verify the validity and quality of pharmaceuticals, e-pharmacies must apply severe checks [70, 71]. To bolster this argument, most respondents indicated that:

“I’m mindful of fake drugs.” How can I be certain that what I purchase online is real and secure? “Because of the lack of physical verification, I am doubtful of the quality of medications sold through e-pharmacies.” R_22.

According to the exploratory assertions, trust and security concerns are major reasons South Africans are reluctant to adopt E-Pharmacy. E-pharmacy suppliers must improve cybersecurity, establish individualized connections, and ensure pharmaceutical validity to overcome these obstacles. Addressing these concerns is critical for promoting customer trust. E-pharmacies need to find ways to bridge this gap, possibly by incorporating teleconsultation services or other forms of virtual communication to provide a more personalized experience and establish trust with users [1, 2].

Theme 6: regulatory and legal uncertainties

E-Pharmacy has emerged as an innovator in medicine, providing consumers with ease and accessibility. However, in South Africa, the introduction of E-Pharmacy faces regulatory difficulties and legal concerns that may inhibit its general acceptance. Here are some detailed opinions from interviewees that cite regulatory constraints and legal uncertainties as reasons for not adopting E-Pharmacy. For example, most non-adopters stress that the absence of clear regulatory rules is a major problem because it creates an atmosphere in which the authenticity and quality of pharmaceuticals may be jeopardized. The reluctance of healthcare professionals to promote E-Pharmacy implies that regulatory certainty is critical for obtaining the trust of professionals who play critical roles in the healthcare ecosystem. Another respondent espoused that:

“Considering the lack of clear regulatory guidelines, I am apprehensive of E-Pharmacy.” Complaints have been raised concerning the safety and legitimacy of drugs offered online due to a lack of strong oversight”.

In addition, some participants draw attention to regulatory concerns, emphasizing E-Pharmacy’s broader legal consequences. Discussing topics such as responsibility and data security emphasizes the complexities of legal ambiguities [11]. support this assertion by demonstrating that the lack of a well-defined legal framework impacts the operational aspects of E-Pharmacy and raises concerns regarding the protection of both consumers and service providers in a legal dispute. Some of the participants noted that:

“The legal uncertainties surrounding E-Pharmacy pose a significant barrier to its widespread acceptance.” The absence of a stable legal framework creates ambiguity concerning accountability, prescription validation, and data protection. It is difficult to resolve potential conflicts and protect the interests of consumers and service providers without established legal rules.” R8 reckoned.

“While I value E-Pharmacy’s ease, the lack of clear restrictions makes me wary as a consumer. It’s difficult to believe that my personal and health information will be treated responsibly without proper oversight. I believe that a strong legal framework is required to safeguard consumer rights and guarantee that E-Pharmacy services prioritize privacy and ethical standards.” R_14 asserted.

These responses collectively buttress prior analysis that illustrated the apprehensions of healthcare professionals, legal experts, and consumer advocates regarding the regulatory challenges and legal uncertainties associated with RAA E-Pharmacy [72, 73]. Addressing these concerns through clear and comprehensive regulatory frameworks is crucial for building trust among stakeholders and fostering the responsible growth of E-Pharmacy services in the region.

Theme 7: lack of internet access

Internet access is a significant factor impacting the acceptance of e-pharmacy services, particularly in locations with diverse degrees of digital infrastructure. In South Africa, internet connectivity can significantly impede the widespread use of E-Pharmacy. Qualitative responses from respondents who expressed concerns about a lack of internet access were gathered to obtain insight into this issue. Most non-adopters reiterate the frustration of those living in remote areas with inadequate internet access. The digital divide between urban and rural areas remains a significant impediment to the potential benefits of E-Pharmacy reaching all parts of the country. For example, one of the participants mentioned that:

I live in a rural area with very limited internet access.” It upsets me that I can’t simply utilize E-Pharmacy services. I prefer visiting a local pharmacy to interact with the pharmacist in person. The absence of internet access here is a significant barrier for people like us.

Moreover, some participants highlighted people’s financial difficulties while acquiring internet services. The expense of internet access, particularly in low-income neighbourhoods, is a deterrent, limiting access to E-Pharmacy services to those who can afford consistent and dependable online connections. In one such situation, two of the respondents ((R_3 and R_25) expressed that:

“The high rates of internet services are prohibitively expensive for many people, particularly in low-income areas. While E-Pharmacy may be convenient for some, it is not financially feasible for most of us. I wish there were more affordable internet options to make these services available to everyone.” R_19 remarked.

Most non-adopters were concerned about the dependability of internet services, even in cities. The lack of conviction in the internet’s reliability creates concerns regarding the trustworthiness of E-Pharmacy services, especially regarding health-related problems. This emphasizes the significance of a reliable and sturdy digital infrastructure. This point was supported by a comment made by one of the participants.

Internet access is a serious problem in some parts of South Africa.” Even in cities, there are dead zones where internet access is poor or unavailable. Because it impacts my health, I would not trust E-Pharmacy without a reliable internet connection. The government must address these connectivity challenges before pushing for more digital health solutions.

Ultimately, these substantive replies highlight the importance of developing comprehensive solutions to address the issues connected with internet access in South Africa and enrich erstwhile studies that reported the same outcome [22, 74]. Initiatives aiming at expanding internet service coverage and cost can play a critical role in making E-Pharmacy more inclusive and generally accepted across varied socio-economic and geographic settings.

Theme 8: data security and privacy

As the adoption of e-pharmacy continues to grow in South Africa, concerns about data security and privacy have emerged as significant considerations. We gathered qualitative responses from respondents who expressed reservations about E-Pharmacy due to apprehensions about data security and privacy.

This response highlights a common apprehension about the vulnerability of personal health data to cyber threats. The respondent expresses unease about the potential consequences of unauthorized access to sensitive information, emphasizing the need for robust cybersecurity measures in E-Pharmacy platforms.

I worry about my health information being online. With all the cyber threats, I’m unsure if my medical history and prescription details will be safe from hackers.

As expressed in this response, the fear of potential data breaches underscores the need for e-pharmacies to communicate and assure users of robust security measures. Public perceptions of the security infrastructure in place will influence the adoption of E-Pharmacy, making it imperative for providers to invest in and showcase advanced data protection protocols.

I’ve heard stories of data breaches in other online services. The thought of my medical records being leaked or misused is frightening. Until I’m sure that e-pharmacies have solid security, I’d rather stick to traditional pharmacies.

The response from the participants confirms prior research assessment about the non-adoption of the E-Pharmacy platform due to data security and privacy issues [75, 76]. Building trust through transparent communication about security measures, implementing robust cybersecurity protocols, and addressing public perceptions are essential for E-Pharmacy providers to alleviate these concerns and foster greater consumer acceptance. Table 5 summarises the open codes and axial codes supporting RAA online pharmacies.

Table 5.

Summary of reasons against the adoption of E-Pharmacy

Open codes	Axial Codes	RAA of E-Pharmacy
I’m concerned about the security of my health data. I can’t connect with the pharmacist in person. I’m mindful of fake drugs.	Security of personal health information Concerns about medication’s authenticity Counterfeit pharmaceuticals	Trust and Security Concerns
I am apprehensive of E-Pharmacy. It is difficult to resolve potential conflicts. I believe that a strong legal framework is required to safeguard consumer rights and guarantee.	Regulatory uncertainty Lack of clear regulatory guidelines Responsibility and data security	Regulatory and Legal Uncertainties
I live in a rural area with very limited internet access. I wish there were more affordable internet options to make these services available to everyone. Internet access is a serious problem in some parts of South Africa.	Inadequate internet access Expensive of internet Internet connectivity issues	Lack of Internet Access
I worry about my health information being online. I’d rather stick to traditional pharmacies. I’m unsure if my medical history and prescription details will be safe from hackers.	Vulnerability of personal health data Cyber threats Potential data breaches	Data Security and Privacy

Discussion

The findings of this research on adopting e-pharmacy services are corroborated by empirical studies that underline the complexity of consumer behaviour in the digital health market. The research outcome confirmed that convenience and accessibility are part of the RFA of E-pharmacy in South Africa. This outcome is supported by [77], who reported that the ability to access pharmacies online without geographic or temporal constraints significantly influences consumer adoption rates. Furthermore, as highlighted by our respondents, prescription management features echo the work of [78], indicating that streamlined digital management systems are a pivotal factor for users seeking to simplify their medication regimes. Regarding cost and affordability [79], have validated that reduced operational costs of e-pharmacies can lead to more competitive pricing, which is a compelling consumer attractor. As essential adoption factors identified by our respondents, logistics and timely delivery align with the findings of [80], which demonstrated that efficient delivery systems significantly enhance customer satisfaction and trust in e-pharmacy services.

Conversely, the study’s identified barriers to e-pharmacy adoption find support in the literature as well. Trust and security concerns are central in prior investigations into e-commerce hesitancy, which underscores the crucial role of perceived safety and the reputation of e-service providers [81, 82]. As cited by the respondents, regulatory challenges and legal uncertainties resonate with findings from erstwhile analysis where regulatory clarity was deemed essential for fostering consumer confidence [83]. Also, privacy concerns are substantiated by the extant analysis, which provides insight into the ongoing apprehensions surrounding personal data security in digital health services [84, 85]. Together, these empirical studies support our thesis findings, underscoring the multifaceted nature of consumers’ reasoning in e-pharmacy adoption and resistance, as framed by the BRT.

Hence, this research expands the scope of prior studies on adopting or resisting e-health pharmacy and innovation in the health sector in four ways. First, the research addresses and builds upon the limitation of extant studies by providing a deeper and broader analysis based on consumers’ perspectives and attitudes towards adopting or resisting E-Pharmacy. Thus, the research expands the discussion by presenting a dynamic setting where traditional healthcare practices co-exist with emerging digital trends in South Africa. Compared with other extant studies [4, 20], this study gives a holistic view of distinct end-user resistance or acceptance of e-health advancements, providing researchers with a central reference point for future works.

In addition, the research analysis was based on thematic analysis and qualitative analysis, which can serve as a coherent foundation for providing a well-defined approach for assessing RFA or RAA innovation in the health sector for the academic community and scholars to work on. Thus, by doing so, the study set forth potential research areas that enrich the insights and understanding of acceptance or resistance towards e-health and also enrich the methodological, including thematic approach and qualitative studies. As a way of making the research contribution to the field even more apparent, the study has provided a word cloud analysis and thematic graphs that collectively improve the theoretical references for researchers eager to broaden this topic of discussion.

Furthermore, the BRT appears as a unique theoretical underpinning with the potential to transform our understanding of modern cognition mechanisms enabling consumer household decisions. The study discovered persuasive evidence suggesting BRT gives enormous options for scholars and commercial experts intrigued by behaviour-based choice-making throughout our extensive analysis. The BRT provides stakeholders, including E-Pharmacy providers, health insurance providers, healthcare professionals, technology developers, innovators, and the academic and research community, with significant perspectives, allowing them to grasp diverse consumer behaviour complexity and handle difficult circumstances with unparalleled expertise and precision. The findings highlight BRT’s enormous value for these stakeholders, establishing it as a vital instrument for enhancing understanding and implementing customer behaviour studies, particularly in marketing on e-commerce platforms.

Research implications and conclusions

Practical implications

This study offers numerous practical contributions that can guide stakeholders, governments, policy-makers, businesses and consumers. The practical implication of the study is discussed as follows. First, the study recommends that policy-makers and government derive insight from this study to shape the regulatory framework that can balance innovation with the safety of patients. Addressing the intricate psychological mechanisms that influence adoption or resistance enables the development of policies that provide a conducive environment for expanding E-Pharmacy. This includes resolving data protection and prescription verification challenges and ensuring that E-Pharmacy services correspond with the country’s healthcare goals. Policy-makers can use this information to develop policies proactively supporting responsible activities in the e-pharmacy sector. Second, the practical ramifications of this research will benefit consumers as well. The study provides a foundation for focused teaching endeavours by giving insight into the cognitive aspects influencing their actions. Consumer awareness campaigns can be created to address common misconceptions, highlight the benefits of E-Pharmacy, and emphasize the safety procedures in place. Providing accurate information to consumers can boost their confidence in using E-Pharmacy services, resulting in better health outcomes and convenience.

Third, this research delivers actionable insights about customer behaviour for businesses in the E-Pharmacy field, which may guide marketing strategies, service advancements, and user experience improvements. Businesses may establish more compelling value propositions, increase user trust, and differentiate themselves in a competitive market by matching their offers with the identified determinants of adoption. Furthermore, recognizing South Africa’s unique socio-cultural and economic elements allows enterprises to tailor their services to the specific demands of the local community, enabling a more inclusive and responsive E-Pharmacy ecosystem.

Furthermore, the findings of this study are significant for the larger public health agenda. Adopting E-Pharmacy can improve healthcare accessibility, particularly in distant locations where traditional brick-and-mortar pharmacies are few. The practical insights from this study can guide public health programs in South Africa targeted at using E-Pharmacy to improve medication adherence, chronic disease management, and overall healthcare outcomes. Again, the research’s practical contributions span multiple dimensions, providing useful knowledge for stakeholders in the healthcare ecosystem. The findings can guide enlightened decision-making in everything from corporate strategies and regulatory frameworks to consumer awareness campaigns and public health initiatives, ultimately helping the successful integration of E-Pharmacy services in the healthcare scene.

Additionally, this research recommends that E-Pharmacy platforms focus on enhancing user experience by improving convenience accessibility and integrating robust prescription management systems. These platforms should offer competitive pricing, ensure cost transparency, and maintain efficient logistics for timely delivery to address the RFA. Concurrently, it is crucial to build customer trust by reinforcing security measures, ensuring compliance with regulatory standards, and educating consumers about the legal aspects of E-Pharmacy. Addressing RAA, E-Pharmacies should advocate for broader internet access and create awareness about digital literacy while also implementing stringent data protection policies to alleviate privacy concerns. By concentrating on these areas, E-Pharmacy services can optimize their adoption rates and customer satisfaction, leading to a broader acceptance and use of online pharmacy services.

Limitations and future research perspectives

While this study aims to shed light on customers’ acceptance or resistance to e-pharmacy in South Africa using the BRT, certain limitations must be acknowledged. First, because South Africa’s population is diverse regarding ethnicities, languages, and economic inequality, the study may confront challenges in capturing the whole spectrum of cultural and socio-economic variety. Furthermore, the study’s dependence on self-reported data may include social desirability bias, influencing answer accuracy. Future studies should address these limitations using a more varied and representative sample, qualitative approaches to capture nuanced opinions, and investigating additional psychological and contextual aspects that may influence E-Pharmacy adoption. Furthermore, broadening the study to include longitudinal data could provide a better understanding of the changing nature of consumer attitudes and actions toward E-Pharmacy in South Africa’s dynamic healthcare sector. Comparative research with different areas or nations could also contribute to a more thorough knowledge of the variables driving global E-Pharmacy acceptance or opposition.

Conclusions

This paper classifies the varying reasons for E-Pharmacy into two perspectives following customers opinions and experiences: RFA comprised of (i) convenience and accessibility, (ii) prescription management, (iii) cost and affordability and (iv) logistics and timely delivery. On the other hand, the RAA includes (a) trust and security concerns, (b) regulatory challenges and legal uncertainties, (c) lack of internet access and (d) privacy concerns. This type of categorization aids in synthesizing the available literature in an enhanced, approachable and understandable way, making it an invaluable resource for subsequent research and continuing practice. The findings emphasize the significance of understanding customers’ behavioural reasoning while transferring from brick-and-mortar pharmacies to online pharmacy platforms. Perceived dangers, trust, individual views, perceived risks, and subjective norms all have an enormous effect on consumer attitudes and behaviour.

Accordingly, the new insight from this research is that RFAs—encompassing convenience and accessibility, prescription management, cost and affordability, logistics and timely delivery—embody the positive drivers that align with the increasing consumer preference for digital solutions in healthcare. Each reason is dissected to reveal the surface-level benefits and underlying behavioural motivations that lead consumers to integrate E-Pharmacies into their healthcare regime. For instance, convenience is not merely a matter of time-saving but is interwoven with the evolving expectations of healthcare delivery in a digital age. The novel proposition from this research is that the funding from this study revealed that RAA, comprised of trust and security concerns, regulatory challenges and legal uncertainties, lack of internet access, and privacy concerns, reflect the multifaceted barriers to adoption. These are not simply operational issues but are deeply rooted in the psychological interplay of trust and perceived risk, crucial to online consumer behaviour. For example, trust concerns extend beyond the immediate E-Pharmacy to encompass broader apprehensions about data security and cyber threats in online transactions. Moreover, the study proposes that regulatory challenges and legal uncertainties present both a barrier and an opportunity for policy-makers to foster a more conducive environment for E-Pharmacy adoption, ensuring safety and legality in operations. Similarly, addressing the digital divide can catalyze a more equitable adoption of E-Pharmacy services, reinforcing the importance of inclusive digital infrastructure development.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Author contributions

CL, (conceptualization and methodology). AKS (conceptualization, methodology, and formal analysis). JW (validation, and investigation).

Funding

No funding was received.

Data availability

Data will be made available on request by contacting the corresponding author..

Declarations

Ethics approval and consent to participate

The study followed the ethical standards set by the committee of Jiangsu University School of Management.

Consent for publication

Not Applicable.

Consent to participate

Informed consent was obtained from all the study participants.

Competing interests

No potential conflict of interest was reported by the author.