ORIGINAL ARTICLE
Bali Medical Journal (Bali MedJ) 2025.
Volume 14.
Number 3 : 637-643 P-ISSN.
E-ISSN: 2302-2914
Determinants of Public Trust and Willingness to Use Generic Drugs in Saudi Arabia:
A Cross-Sectional Study Anas Ali Alhur1*.
Aroob Alospi2.
Raghad Althobaiti3.
Raghad Alkhalify4.
Lina Almutairi4.
Hatem Alsaghyir5.
Ragad Alsudairi6.
Razan Albaz7.
Sarah Alfalah8.
Esaam Alzaid9.
Amani Alshehri2.
Khalid Alanazi4.
Abeer Haddadi10.
Fatimah Alghofaili4.
Wasan Alhowaish4 Department of Health Informatics.
College of Public Health and Health Informatics.
University of Hail.
Hail.
Saudi Arabia PharmD.
King Khalid University.
Abha.
Saudi Arabia PharmD.
Taif University.
Taif.
Saudi Arabia PharmD.
Qassim University.
Qassim.
Saudi Arabia PharmD.
Pharmacy Manager.
Security Forces Hospital.
Riyadh.
Saudi Arabia Clinical Pharmacy Student.
King Faisal University.
Al-Ahsa.
Saudi Arabia PharmD.
Princess Nourah Bint Abdulrahman University.
Riyadh.
Saudi Arabia Pharmacist.
Pharmaceutical Care Services.
King Abdulaziz Hospital.
Ministry of National Guard Health Affairs.
Al-Ahsa.
Saudi Arabia PharmD.
King Khalid University Medical City.
Riyadh.
Saudi Arabia Pharmacist.
Najran Armed Forces Hospital.
Najran.
Saudi Arabia *Corresponding author:
Anas Ali Alhur.
Department of Health Informatics.
College of Public Health and Health Informatics.
University of Hail.
Hail.
Saudi Arabia Email: anas.
alhur@gmail.
Received: 2025-05-26
Accepted: 2025-07-16
Published: 2025-09-14
ABSTRACT
Background: Generic drugs are bioequivalent to brand-name medications and represent a key strategy in reducing pharmaceutical expenditure.
Despite clinical evidence supporting their safety and effectiveness, public skepticism and misconceptions continue to limit their acceptance in many regions, including Saudi Arabia.
Objective: This study aimed to assess public awareness, perceptions, and behavioral tendencies related to the use of generic versus brand-name drugs in Saudi Arabia, with a focus on factors such as familiarity, perceived efficacy and safety, cost considerations, provider influence, and regulatory trust.
Methods: A cross-sectional survey was conducted using a structured, self-administered online questionnaire targeting adult residents across Saudi Arabia.
A total of 799 valid responses were collected.
Descriptive statistics summarized demographic characteristics and perception metrics.
Chi-square tests and logistic regression were employed to explore associations between trust in regulatory systems and cost-based decision-making.
Results: While 80.
9% of participants reported at least slight familiarity with generic drugs, only 28.
9% correctly identified generics as equivalent in safety and efficacy.
Perceptions of effectiveness and safety were mixed, with 5% and 34.
2% respectively viewing generics as equal to brand-name drugs.
Cost was an influential factor 6% of respondents, and 52.
2% expressed willingness to use generics if assured of quality.
Notably, 48.
reported high trust in drug regulatory authorities.
A significant association was found between trust in regulation and cost sensitivity (NA = 1643.
87, p < 0.
Conclusion: The study reveals considerable misconceptions and mixed attitudes toward generic drugs among the Saudi public.
Trust in regulatory bodies and healthcare providers plays a pivotal role in shaping medication choices.
Educational campaigns, enhanced provider-patient communication, and regulatory transparency are essential to promoting the rational use of generics and supporting national cost-containment goals.
Keywords: Generic drugs, brand-name drugs, public perception.
Saudi Arabia, cost sensitivity, regulatory trust, medication safety, health communication.
Cite This Article: Alhur.
Alospi.
Althobaiti.
Alkhalify.
Almutairi.
Alsaghyir.
Alsudairi.
Albaz, .
Alfalah.
Alzaid.
Alshehri.
Alanazi.
Haddadi.
Alghofaili.
Alhowaish.
Determinants of Public Trust and Willingness to Use Generic Drugs in Saudi Arabia: A Cross-Sectional Study.
Bali Medical Journal 14.
: 637-643.
DOI: 10.
15562/bmj.
INTRODUCTION
The increasing cost of prescription medications is a major global public health challenge, particularly in chronic disease management and long-term Many systems have promoted the use of generic drugsAimedications bioequivalent to brand-name counterparts in dosage form, safety, strength, quality, and therapeutic 1 Generic medications can reduce drug-related expenditures by 30Ae80%, making them vital in cost-containment strategies2 Nevertheless, public skepticism and negative perceptions often limit their uptake, despite robust clinical evidence supporting their efficacy.
Several informational factors shape consumer attitudes toward generics.
Shrank et al.
reported that misconceptions regarding quality, effectiveness, and side effects negatively affect patientsAo willingness to use Open Bali Medical Journal 14.
: 637-643 | doi: 10.
15562/bmj.
3 Dunne and Dunne found that brand loyalty is reinforced by marketing, perceived physician preference, and prior 4 In Saudi Arabia.
Alrasheedy et al.
noted that trust in regulatory oversight and physician guidance strongly influences consumer choices.
5 Similarly.
Alghadeer et al.
found that many Saudi participants mistakenly believed generics to be inferior in efficacy and safety.
A systematic review by Colgan and Faasse emphasized that high health
ORIGINAL ARTICLE
literacy does not necessarily lead to generic drug acceptance, as beliefs and emotions often override factual knowledge.
7 Similar skepticism has been reported in other Middle Eastern countries.
8,9 Hassali et al.
demonstrated that targeted educational interventions significantly improved perceptions and acceptance of generics among Malaysian consumers,10 indicating that attitudes can be modified.
Most existing research is concentrated in Western contexts or clinical settings.
Few studies integrate public awareness, cost sensitivity, brand loyalty, trust in healthcare systems, and actual medication use, particularly in Saudi Arabia, where cultural, regulatory, and prescribing practices differ.
This study examines public awareness and perception of generic versus brandname drugs in Saudi Arabia, focusing on familiarity, perceived safety and effectiveness, cost considerations, brand loyalty, healthcare provider influence, and trust in regulatory systems.
The findings aim to inform educational campaigns, regulatory initiatives, and clinical communication strategies to promote rational use of cost-effective medications.
residency in Saudi Arabia, and .
provision of electronic informed consent.
Respondents who did not complete the full questionnaire or did not meet these criteria were excluded.
Measures and Instruments The questionnaire was adapted from previously validated instruments to suit the local context and consisted of four Demographic and socioeconomic characteristics .
ge, gender, education level, employment status, and incom.
Familiarity and perception items, effectiveness of generics, brand loyalty, and trust in healthcare providers and regulatory authorities Cost considerations and medication choice behaviors, assessing the influence of cost on decision-making Behavioral Table 1.
Data Sources and Participants Data were collected through a structured, self-administered online questionnaire distributed between 9 May 2025 and 23 June 2025 via social media platforms, university mailing lists, and community The sampling strategy was nonprobabilistic and voluntary.
A total of 799 complete responses met the inclusion criteria and were analyzed.
Inclusion criteria were: .
adults aged 18 years or older, .
current Data Analysis Quantitative data were analyzed using IBM SPSS Statistics version 26.
Descriptive statistics .
requencies, percentages, means, and standard deviation.
summarized participant characteristics and responses.
Chi-square tests examined associations between categorical variables .
, trust level vs.
cost consideratio.
A binary logistic regression model was constructed to identify predictors of high trust in generic drug regulation, adjusting for demographic covariates such as age, gender, education, and employment Statistical significance was defined as p < 0.
Demographic Characteristics of Participants (N = .
Variable Age
METHODS
Study Design This study employed a cross-sectional observational design to investigate public awareness, perceptions, and behavioral factors related to the use of generic versus brand-name drugs in Saudi Arabia.
This design enabled the simultaneous assessment of multiple variablesAisuch as familiarity, trust, cost sensitivity, and brand preferenceAiacross a broad population sample without manipulating exposures or outcomes.
pharmacists before switching medications A panel of subject matter experts reviewed all items to ensure face and content validity.
The instrument was pretested with 30 participants to confirm clarity and reliability.
Gender Education Level Employment Status Monthly Income Response n (%) 18Ae29 years 349 .
30Ae39 years 124 .
40Ae49 years 166 .
50 years and above 160 .
Female 483 .
Male 316 .
BachelorAos degree 513 .
High school or equivalent 198 .
MasterAos degree or higher 54 .
Other 20 .
No formal education 14 .
Employed .
ull-/part-tim.
Student 204 .
Unemployed 101 .
Retired 42 .
Self-employed 21 .
Other 17 .
Average 415 .
Prefer not to disclose 210 .
Below average 110 .
Above average 64 .
Bali Medical Journal 2025.
: 637-643 | doi: 10.
15562/bmj.
ORIGINAL ARTICLE
Reproducibility and Validity The full questionnaire, coding scheme, and analysis syntax are available from the corresponding author upon request.
The survey was administered in a standardized digital format with controlled skip logic and response validation to minimize data entry errors.
Analytical procedures followed established protocols for crosectional survey research.
Ethical Considerations The study received approval from the appropriate institutional ethics committee.
All participants provided electronic informed consent before accessing the Participation was voluntary, with the option to withdraw at any time without Data were collected anonymously and stored on secure, password-protected servers in accordance with applicable data protection and confidentiality standards.
RESULTS
A total of 799 individuals participated in the study.
The majority were aged 18Ae29 years .
7%), followed by 40Ae49 years .
8%), 50 years and above .
0%), and 30Ae39 years .
5%).
Most respondents were female .
5%).
Regarding education, 2% held a bachelorAos degree, 24.
8% had a high school diploma or equivalent, 6.
held a masterAos degree or higher, 1.
reported no formal education, and 2.
had other educational backgrounds.
In terms of employment, 51.
8% were employed full- or part-time, 25.
5% were students, and 12.
6% were unemployed.
The remaining participants were retired .
3%), self-employed .
6%), or reported AuotherAy employment statuses .
1%).
Monthly income was most commonly reported as average .
9%), while 26.
preferred not to disclose, 13.
8% reported below average, and 8.
0% reported above average income (Table .
ParticipantsAo familiarity with generic drugs varied: 42.
6% were slightly familiar, 0% somewhat familiar, 11.
5% very familiar, 10.
8% quite familiar, and 9.
not familiar at all.
When asked about equivalence awareness, 28.
9% believed that generic drugs contain the same active ingredients and are equally safe and effective as brandname drugs.
However, 24.
4% believed Table 2.
Knowledge and Perceptions about Generic Drugs Variable Familiarity with Generics Equivalence Awareness Safety Perception Effectiveness Perception Response Slightly familiar 340 .
Somewhat familiar 208 .
Quite familiar 86 .
Very familiar 92 .
Not familiar at all 73 .
Same ingredients, equally safe/effective 231 .
Same ingredients, but differ in quality 195 .
Generics are completely different 168 .
Not sure 205 .
Equally safe 273 .
Slightly safer 117 .
Much safer 7 .
Slightly less safe 160 .
Much less safe 112 .
Not sure 130 .
Equally effective 292 .
Slightly more effective 95 .
Much more effective 24 .
Slightly less effective 198 .
Much less effective 69 .
Not sure 121 .
they may differ in quality, 21.
0% perceived them as completely different, and 25.
were unsure.
Regarding safety perceptions, 34.
considered generic drugs equally safe, 6% perceived them as slightly safer, 9% as much safer.
In contrast, 20.
believed they were slightly less safe, 14.
much less safe, and 16.
3% were unsure.
Perceptions of effectiveness showed a similar distribution: 36.
5% considered generics equally effective, 11.
9% slightly more effective, and 3.
0% much more Conversely, 24.
8% believed they were slightly less effective, 8.
6% much less effective, and 15.
1% were unsure (Table .
Cost was considered moderately important by 32.
9% of participants, extremely important by 27.
7%, slightly important by 21.
3%, very important by 9%, and not important at all by 4.
(Figure .
In terms of brand loyalty, 34.
preferred generic drugs, 26.
8% preferred Bali Medical Journal 2025.
: 637-643 | doi: 10.
15562/bmj.
n (%) brand-name drugs but occasionally chose generics, and 24.
0% had no preference.
Only 8.
3% always chose brand-name drugs, while 6.
8% consistently selected Healthcare was reported as moderate by 32.
of participants, strong by 24.
0%, and significant by 21.
Slight influence was reported by 12.
9%, and 9.
1% indicated no influence (Table .
Almost half of the participants .
reported high trust in the regulatory standards for generic drugs.
A further 2% somewhat trusted, 17.
4% were unsure, 5.
3% reported little trust, and 3.
reported no trust at all (Figure .
More than half of the participants .
7%) reported no negative experiences with generic drugs, while 33.
9% reported such experiences and 13.
4% were unsure.
Regarding future use, 52.
2% indicated they would definitely use generics if assured of their quality, 29.
7% expressed ORIGINAL ARTICLE possible willingness or uncertainty, 13.
were hesitant, and 4.
5% would definitely not use them (Table .
A multivariable logistic regression model was used to identify predictors of definite willingness to use generic drugs.
The model included sociodemographic factors and perceptions related to trust in regulation, cost importance, familiarity, equivalence, and safety.
The overall model was statistically significant (Likelihood Ratio NA.
= 74, p < 0.
, with a pseudo RA of High trust in regulation (OR 5.
95% CI 2.
56Ae12.
, being quite familiar with generics (OR 6.
95% CI 2.
15Ae .
, and age over 40 years were strong positive predictors.
Perceiving generics as much less safe (OR 0.
95% CI 0.
09Ae .
and rating cost as less important were negative predictors (Table .
DISCUSSION