ORIGINAL ARTICLE
Bali Medical Journal (Bali MedJ) 2025, Volume 14, Number 3 : 637-643
P-ISSN.2089-1180, 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
2
PharmD, King Khalid University, Abha, Saudi
Arabia
3
PharmD, Taif University, Taif, Saudi Arabia
4
PharmD, Qassim University, Qassim, Saudi Arabia
5
PharmD, Pharmacy Manager, Security Forces
Hospital, Riyadh, Saudi Arabia
6
Clinical Pharmacy Student, King Faisal University,
Al-Ahsa, Saudi Arabia
7
PharmD, Princess Nourah Bint Abdulrahman
University, Riyadh, Saudi Arabia
8
Pharmacist, Pharmaceutical Care Services, King
Abdulaziz Hospital, Ministry of National Guard
Health Affairs, Al-Ahsa, Saudi Arabia
9
PharmD, King Khalid University Medical City,
Riyadh, Saudi Arabia
10
Pharmacist, Najran Armed Forces Hospital,
Najran, Saudi Arabia
1

*Corresponding author:
Anas Ali Alhur;
Department of Health Informatics, College of Public
Health and Health Informatics, University of Hail,
Hail, Saudi Arabia
Email: anas.ali.alhur@gmail.com
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
36.5% and 34.2% respectively viewing generics as equal to brand-name drugs. Cost was an influential factor
for 60.6% of respondents, and 52.2% expressed willingness to use generics if assured of quality. Notably, 48.7%
reported high trust in drug regulatory authorities. A significant association was found between trust in regulation
and cost sensitivity (χ² = 1643.87, p < 0.001).
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, A.A., Alospi, A., Althobaiti, R., Alkhalify, R., Almutairi, L., Alsaghyir, H., Alsudairi, R., Albaz,
R., Alfalah, S., Alzaid, E., Alshehri, A., Alanazi, K., Haddadi, A., Alghofaili, F., Alhowaish, W. 2025. Determinants of
Public Trust and Willingness to Use Generic Drugs in Saudi Arabia: A Cross-Sectional Study. Bali Medical Journal
14(3): 637-643. DOI: 10.15562/bmj.v14i3.5724

INTRODUCTION
The increasing cost of prescription
medications is a major global public
health challenge, particularly in chronic
disease management and long-term
pharmacotherapy.
Many
healthcare
systems have promoted the use of generic
drugs—medications bioequivalent to
brand-name counterparts in dosage form,
safety, strength, quality, and therapeutic
effect.1 Generic medications can reduce

drug-related expenditures by 30–80%,
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
psychological
and
informational factors shape consumer
attitudes toward generics. Shrank et al.
reported that misconceptions regarding
quality, effectiveness, and side effects
negatively affect patients’ willingness to use

Open
access:
www.balimedicaljournal.org
Bali
Medical
Journal
2025; 14(3) : 637-643 | doi: 10.15562/bmj.v14i3.5724

generics.3 Dunne and Dunne found that
brand loyalty is reinforced by marketing,
perceived physician preference, and prior
experiences.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.6
A systematic review by Colgan and
Faasse emphasized that high health
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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 (3)
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
sections:
Demographic and socioeconomic
characteristics (age, gender, education
level, employment status, and income)
Familiarity and perception items,
including
perceived
safety
and
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
factors,
including
consultation
with
physicians
or
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
networks. The sampling strategy was nonprobabilistic and voluntary. A total of 799
complete responses met the inclusion
criteria and were analyzed.
Inclusion criteria were: (1) adults
aged 18 years or older, (2) current
638

Data Analysis
Quantitative data were analyzed using
IBM SPSS Statistics version 26. Descriptive
statistics (frequencies, percentages, means,
and standard deviations) summarized
participant characteristics and responses.
Chi-square tests examined associations
between categorical variables (e.g., trust
level vs. cost consideration). 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
status. Statistical significance was defined
as p < 0.05.

Demographic Characteristics of Participants (N = 799)
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 variables—such
as familiarity, trust, cost sensitivity,
and brand preference—across 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 (%)

18–29 years

349 (43.7%)

30–39 years

124 (15.5%)

40–49 years

166 (20.8%)

50 years and above

160 (20.0%)

Female

483 (60.5%)

Male

316 (39.5%)

Bachelor’s degree

513 (64.2%)

High school or equivalent

198 (24.8%)

Master’s degree or higher

54 (6.8%)

Other

20 (2.5%)

No formal education

14 (1.8%)

Employed (full-/part-time)

414 (51.8%)

Student

204 (25.5%)

Unemployed

101 (12.6%)

Retired

42 (5.3%)

Self-employed

21 (2.6%)

Other

17 (2.1%)

Average

415 (51.9%)

Prefer not to disclose

210 (26.3%)

Below average

110 (13.8%)

Above average

64 (8.0%)

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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 crosssectional survey research.
Ethical Considerations
The study received approval from the
appropriate institutional ethics committee.
All participants provided electronic
informed consent before accessing the
survey. Participation was voluntary, with
the option to withdraw at any time without
penalty. 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 18–29
years (43.7%), followed by 40–49 years
(20.8%), 50 years and above (20.0%), and
30–39 years (15.5%). Most respondents
were female (60.5%). Regarding education,
64.2% held a bachelor’s degree, 24.8% had
a high school diploma or equivalent, 6.8%
held a master’s degree or higher, 1.8%
reported no formal education, and 2.5%
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
(5.3%), self-employed (2.6%), or reported
“other” employment statuses (2.1%).
Monthly income was most commonly
reported as average (51.9%), while 26.3%
preferred not to disclose, 13.8% reported
below average, and 8.0% reported above
average income (Table 1).
Participants’ familiarity with generic
drugs varied: 42.6% were slightly familiar,
26.0% somewhat familiar, 11.5% very
familiar, 10.8% quite familiar, and 9.1%
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 (42.6%)

Somewhat familiar

208 (26.0%)

Quite familiar

86 (10.8%)

Very familiar

92 (11.5%)

Not familiar at all

73 (9.1%)

Same ingredients, equally safe/effective

231 (28.9%)

Same ingredients, but differ in quality

195 (24.4%)

Generics are completely different

168 (21.0%)

Not sure

205 (25.7%)

Equally safe

273 (34.2%)

Slightly safer

117 (14.6%)

Much safer

7 (0.9%)

Slightly less safe

160 (20.0%)

Much less safe

112 (14.0%)

Not sure

130 (16.3%)

Equally effective

292 (36.5%)

Slightly more effective

95 (11.9%)

Much more effective

24 (3.0%)

Slightly less effective

198 (24.8%)

Much less effective

69 (8.6%)

Not sure

121 (15.1%)

they may differ in quality, 21.0% perceived
them as completely different, and 25.7%
were unsure.
Regarding safety perceptions, 34.2%
considered generic drugs equally safe,
14.6% perceived them as slightly safer,
and 0.9% as much safer. In contrast, 20.0%
believed they were slightly less safe, 14.0%
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
effective. Conversely, 24.8% believed they
were slightly less effective, 8.6% much less
effective, and 15.1% were unsure (Table 2).
Cost was considered moderately
important by 32.9% of participants,
extremely important by 27.7%, slightly
important by 21.3%, very important by
13.9%, and not important at all by 4.3%
(Figure 1)
In terms of brand loyalty, 34.2%
preferred generic drugs, 26.8% preferred

Bali Medical Journal 2025; 14(3) : 637-643 | doi: 10.15562/bmj.v14i3.5724

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
generics.
Healthcare
provider
influence
was reported as moderate by 32.2%
of participants, strong by 24.0%, and
significant by 21.8%. Slight influence was
reported by 12.9%, and 9.1% indicated no
influence (Table 3).
Almost half of the participants (48.7%)
reported high trust in the regulatory
standards for generic drugs. A further
25.2% somewhat trusted, 17.4% were
unsure, 5.3% reported little trust, and 3.5%
reported no trust at all (Figure 2).
More than half of the participants
(52.7%) 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
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ORIGINAL ARTICLE

possible willingness or uncertainty, 13.6%
were hesitant, and 4.5% would definitely
not use them (Table 4).
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 χ²(27) =
228.74, p < 0.001), with a pseudo R² of
0.2071. High trust in regulation (OR 5.73;
95% CI 2.56–12.83), being quite familiar
with generics (OR 6.15; 95% CI 2.15–
17.59), and age over 40 years were strong
positive predictors. Perceiving generics
as much less safe (OR 0.22; 95% CI 0.09–
0.53) and rating cost as less important
were negative predictors (Table 5).

DISCUSSION
This study examined public trust and
willingness to use generic versus brandname drugs in Saudi Arabia, identifying
notable gaps in knowledge and confidence.
Although more than 80% of participants
reported some familiarity with generic
medicines,
fewer
than
one-third
correctly recognized them as equivalent
to brand-name products in terms of
active ingredients, safety, and efficacy.
This limited awareness reflects broader
concerns about medication safety and
rational use in the Kingdom, as previously
observed in studies on high-risk behaviors
toward prescription painkillers11 and
insufficient public understanding of
medication toxicity.12
Trust emerged as a critical determinant
of willingness to use generics. Participants
with higher confidence in Saudi regulatory
authorities were more likely to consider
cost in their medication decisions,
suggesting that strong regulatory
credibility can mitigate hesitancy toward
lower-cost or unfamiliar brands. This
aligns with evidence from Europe23 and
Southeast Asia24 indicating that acceptance
of generic substitution increases when
patients trust the systems responsible for
product approval and quality oversight.
Internationally,
persistent
misconceptions about generics continue to
shape patient choices. Common concerns
640

Figure 1.

Distribution of Participants’ Perceptions on the Importance of Cost When Choosing
Between Generic and Brand-Name Medications

Table 3.

Preferences and Influences on Generic Drug Use

Variable
Brand Loyalty

Healthcare Provider
Influence

Response

n (%)

I prefer the generic drug

273 (34.2%)

Prefer brand-name, but sometimes choose
generic

214 (26.8%)

No preference

192 (24.0%)

Always choose brand-name

66 (8.3%)

Always choose generic

54 (6.8%)

Moderate influence

257 (32.2%)

Strong influence

192 (24.0%)

Significant influence

174 (21.8%)

Slight influence

103 (12.9%)

No influence

73 (9.1%)

include reduced therapeutic effectiveness,
higher risk of adverse effects, and lower
manufacturing quality,15,16 despite clear
regulatory definitions establishing generics
as bioequivalent to branded medicines.17
Even individuals with high health literacy
may resist generics due to negative past
experiences, emotional beliefs, or brand
loyalty.18 In the present study, over onethird of respondents reported negative

experiences with generics, consistent
with reports from South Africa21 and
Malaysia.22
Healthcare providers also play a pivotal
role in shaping public perceptions. In
our findings, more than three-quarters
of respondents reported moderate
to high influence from physicians
and pharmacists on their medication
choices. This is consistent with evidence

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ORIGINAL ARTICLE

showing that prescriber preferences can
significantly impact patient acceptance of
generics.26,27 However, provider hesitancy
to recommend generics—whether due to
personal bias or patient pressure—remains
a barrier to wider adoption.28
Affordability was another prominent
factor, with over 60% of participants
identifying cost as an important driver
of choice, consistent with global trends
linking lower prices to increased generic
use.29 Yet, our results suggest that cost
alone is insufficient to drive substitution;
perceptions of quality and trust in
oversight remain decisive.
Encouragingly, over half of participants
indicated they would be willing to use
generics if assured of their quality. This
finding mirrors evidence that pharmacistled counseling, targeted education
campaigns, and transparent regulatory
communication can shift public opinion
positively.31 Such interventions may be
particularly impactful in Saudi Arabia,
where strategic engagement with both
patients and healthcare providers could
address misconceptions and promote
confidence in generic medications.
Although the study offers valuable
insights, its generalizability is limited by
the demographic profile of respondents—
primarily younger, educated individuals
with internet access. Nevertheless,
these groups may serve as influential
change agents in promoting evidencebased medication choices within their
communities.
Table 5.

Figure 2. Participants’ Levels of Trust in Generic Drug Regulations
Table 4.

Experience and Willingness to Use Generic Drugs
Variable

Response

n (%)

Negative Experience with Generics

No

421 (52.7%)

Yes

271 (33.9%)

Not sure

107 (13.4%)

Definitely yes

417 (52.2%)

Maybe yes / Not sure

237 (29.7%)

Maybe not

109 (13.6%)

Definitely no

36 (4.5%)

Willingness to Use Generics

Multivariable Logistic Regression Predicting Willingness to Use Generic Drugs (N = 798)
Predictor

Odds Ratio (OR)

95% CI

p-value

Interpretation

High trust in regulation

5.73

2.56–12.83

<0.001

Strong positive predictor

Quite familiar with generics

6.15

2.15–17.59

0.001

Strong positive predictor

Generics perceived as much safer

1.72

1.01–2.93

0.045

Positive predictor

Generics perceived as much less safe

0.22

0.09–0.53

0.001

Strong negative predictor

Cost “slightly important”

0.22

0.11–0.42

<0.001

Strong negative predictor

Cost “moderately important”

0.33

0.19–0.58

<0.001

Negative predictor

Cost “not important at all”

0.29

0.13–0.64

0.002

Negative predictor

Age 40–49 years

1.89

1.18–3.04

0.008

Positive predictor

Age 50+ years

2.07

1.27–3.35

0.003

Positive predictor

Same ingredients but differ in quality

0.6

0.36–1.00

0.048

Negative predictor

Gender, education, other equivalence and familiarity
levels

–

–

>0.05

Not significant

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641

ORIGINAL ARTICLE

Strengths and Limitations
A key strength of this study lies in its
focus on an important yet underexplored
area of public health in Saudi Arabia—
trust and willingness to use generic
drugs. By recruiting a relatively large
and diverse sample, the study provides
insights relevant to various demographic
and socioeconomic groups. The use of
a structured, pretested questionnaire
ensured clarity and consistency in data
collection, while the inclusion of multiple
predictors allowed for a more nuanced
analysis of factors influencing public
attitudes. The findings also contribute
to the growing regional literature on
medication perceptions, complementing
both local and international evidence.
Nonetheless,
several
limitations
should be considered. The cross-sectional
design limits the ability to infer causality
between the identified predictors and
willingness to use generic drugs. The
reliance on self-reported data introduces
the possibility of recall bias and socially
desirable responses. While the sample
included participants from different age
groups and educational backgrounds,
online data collection may have excluded
individuals with limited internet access,
potentially underrepresenting rural and
older populations. Finally, the study
focused on perceptions and self-reported
behaviors rather than objective measures
of actual medication use, which may not
fully reflect real-world practice.

CONCLUSION
This study highlights the ongoing
challenges surrounding public perceptions
of generic drugs in Saudi Arabia.
Although the majority of participants
reported some degree of familiarity with
generics,
misconceptions
regarding
their safety, effectiveness, and quality
remain widespread. Trust in regulatory
oversight and the influence of healthcare
providers were shown to significantly
impact attitudes and medication choices,
indicating that confidence in institutions
and clinical recommendations are essential
in driving acceptance.
While cost considerations were
important to many respondents, financial
factors alone were insufficient to overcome
skepticism. Instead, attitudes were
642

shaped by a combination of cognitive
understanding,
emotional
beliefs,
prior experiences, and institutional
trust. Encouragingly, more than half of
participants expressed willingness to use
generic drugs if assured of their quality,
underscoring the potential for targeted
interventions.
To support the rational use of
generics and improve public confidence,
policymakers and healthcare leaders
should prioritize public education
campaigns,
reinforce
regulatory
transparency, and empower prescribers
and pharmacists to advocate for evidencebased medication use. Strengthening these
efforts will be critical to ensuring costeffective, equitable access to medications
across Saudi Arabia—particularly as
the country advances its healthcare
transformation goals under Vision 2030.

ETHICAL APPROVAL
This study received prior approval
from an institutional ethics committee.
Participation
was
voluntary
and
anonymous. Informed consent was
obtained electronically before the survey,
and participants were informed of
their right to withdraw at any time. No
identifiable personal information was
collected.

AUTHOR CONTRIBUTIONS
(CREDIT Taxonomy)
Conceptualization: AA¹
Methodology: AA¹, AAo², RA³, RAl⁴
Validation: LA⁴, HA⁵
Formal analysis: AA¹, RA³, RAl⁴
Investigation: RA³, RAl⁴, LA⁴, HA⁵, RAs⁶,
RAb⁷, SA⁸, EA⁹, AAsh², KA⁴, AH¹⁰, FA⁴,
WA⁴
Data curation: RAs⁶, RAb⁷, SA⁸, EA⁹,
AAsh², KA⁴, AH¹⁰, FA⁴, WA⁴
Writing – original draft preparation: AA¹,
RA³, RAl⁴
Writing – review and editing: AA¹, LA⁴,
HA⁵
Visualization: AA¹, RA³
Supervision: AA¹
Project administration: AA¹
All authors have read and approved the
final version of the manuscript and agree
to be accountable for all aspects of the
work.

FUNDING STATEMENT
This research received no external funding.

SELF-CITATION DECLARATION
The authors confirm that relevant
previously published work by the
corresponding author has been cited
where appropriate to support the study
background and contextualize findings.
These citations were included based on
their relevance and scientific merit, not to
inflate citation metrics.

CONFLICT OF INTEREST
The authors declare no conflict of interest.

USE OF GENERATIVE AI TOOLS
No generative AI tools were used in the
preparation of this manuscript, except
for language editing and proofreading
purposes.

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