Background
Consumers are increasingly using social media to gather information on which to base their decisions to purchase products. There are people on social media platforms called social media influencers/opinion leaders (SMI’s) who are known to hold a certain level of influence over other people [
1,
2]. Brand marketers have accelerated to approach (SMIs) to e promote and endorse their products [
3]. This has given rise to; a new trend in marketing commonly called “influencer marketing” by generating e-WOM (electronic word-of-mouth) [
4].
e-WOM is a behavior through which the message is diffused among the consumers, whereas viral marketing is a technique creating “viral infection” or “buzz” used by companies [
5,
6]. Consumers who spread awareness about product or service offerings among their social networks by using e-WOM behavior, highlight pros and cons to assist other consumers with buying decisions [
7,
8]. Conventionally, traditional marketing focused on using famous celebrities, TV and film stars, for marketing their brands, because people like and trust the advice, of people whom they like [
9]. With the social media era, the brands and marketers realized that SMI’s on commonly used social media platforms [
10] such as Meta, Instagram, twitter, tik-Tok also have a lot of people following them because they are considered influential members of the community. SMI’s usually create an “influence” over consumers by creating e-WOM messages using textual, verbal as well as video content [
11].
Despite the fact that existing literature has explored the effects of SMIs on various commercial products and services [
1‐
3,
12‐
15], there remains a noticeable gap in the literature concerning their impact on health-related products, particularly CAMs [
16]. CAMs cover a diverse array of natural and herbal products, each offering unique modalities and practices. Over the years, interest in and use of CAMs have gained popularity among individuals seeking complementary or alternative treatments to conventional medicine [
17]. With the emergence of social media, there is now a medium for attaining health information as well as purchasing products and services relative to CAMs. Although existing literature provides insights into the motivations behind CAM usage [
18,
19], the role of SMIs in shaping consumer decision-making behavior regarding CAMs has remained largely unexplored. While some studies touch upon the marketing of health products through social media channels [
8,
12,
15,
20,
21], a comprehensive understanding of the influencing factors that drive consumers to purchase CAMs through SMIs’ endorsements is yet to be established.
Advising about health-related products, including OTC medicines, medical devices, and complementary and alternative medicines (CAMs), is far different than marketing or endorsing travel destinations or convincing people to buy a box of toys. Nevertheless, for example, the pharmaceutical and nutraceuticals industry have recognized the potential power of Instagram as a social media marketing platform by assigning SMIs to market their healthcare products, creating e-WOM, which has had the tendency to increase their product sales and generate business [
13]. To that said, studies exploring influencers’ narrative strategies for various brands and industries are expanding for the advancement of social media marketing [
22‐
24]. However, the development of knowledge regarding the strategies for influencers to attract consumers to be used by the pharmaceutical industry is still in need.
Taking all this into account, there is both a managerial and an academic need to better understand the role played by SMIs in the pharmaceutical industry, especially for CAMs. To bridge the existing research gap between the motivational factors (cognitive process, emotions, and individual factors) behind CAM usage and the influence of SMI stimuli on consumers’ purchase behavior concerning CAMs, the present study seeks to develop a comprehensive model. This model will shed light on the intricate interplay between these two critical aspects, providing valuable insights into consumers’ decision-making behavior regarding CAMs on social media platforms. Our research aims to model the underlying mechanisms that shape consumer choices by providing insights into SMIs’ endorsements and motivational factors of CAM usage. Through this holistic approach, we hope to contribute significant knowledge that empowers both scholars and marketers to better understand the combined impact of motivational factors and SMI stimuli on consumers’ CAM purchase behavior in the digital age.
Discussion
This study introduces a novel model that used the best fit framework synthesis approach to comprehensively comprehend consumers’ purchase behavior of CAMs influenced by SMIs. Notably, to the best of the authors’ knowledge, this research represents the first empirical evidence illustrating the significant impact of SMI endorsements on consumers’ purchase intentions of CAMs. CAMPIM has several strengths. Firstly, the model provides a holistic overview and synthesis of the SMI endorsements (stimuli) that influence consumers’ psychological and cognitive processes (organism), leading to their intentions to purchase CAMs (response). Secondly, the development of the CAMPIM model involves a synergistic integration of two relevant theories, TPB and Source Credibility Theory, amalgamating existing research from diverse disciplines, thus yielding unique insights into the underlying mechanisms and deep perspectives governing consumers’ intentional behavior towards CAM purchases under the influence of SMIs. CAMPIM offers a more comprehensive understanding of the dynamic interplay between SMIs, consumers, and purchase intentions in the context of CAMs, paving the way for future research and evidence-based strategies in influencer marketing and CAM consumption.
Legislation around CAM use differs across different countries; where some countries regulate the manufacturing, distribution, and sale of CAMs like pharmaceutical products [
109], but most governments do not regulate CAMs as medical or health products [
110]. This lack of regulation allows manufacturers of CAMs to promote their products without a scientific check on the promotional content [
111]. The endorsement of unregulated CAM products by SMIs on social media platforms raises concerns regarding potential harm to consumers. Using unregulated CAMs as adjunct or supplementary therapies could reduce efficacy, interactions, or side effects when combined with conventional medicines [
112‐
114], posing risks to patients’ well-being. Despite the potential adverse effects of CAMs reported in numerous studies [
115‐
119], the lack of statutory legislation for CAMs enables their endorsement on social media, similar to commercial products, without adhering to regulations related to health and well-being. Given the varied and ambiguous statutory legislation of CAMs worldwide, the use of SMIs to endorse these products on social media platforms has the potential to pose threats to public health. Policymakers urgently need to introduce legislation specifically addressing the marketing of CAMs on social media platforms. Evaluating the content of CAM endorsements should be the responsibility of governments and policymakers, ensuring the protection of consumers’ health and well-being.
Effectively utilizing the insights gathered from the CAMPIM model necessitates a comprehensive and targeted marketing approach to promote CAMs. As marketers in the healthcare industry embrace the use of SMIs to endorse CAMs on various social media platforms, it becomes paramount to establish clear and stringent guidelines governing their promotional activities [
111]. A crucial finding of this study highlights the need for marketers to conduct rigorous evaluations of SMI-generated content and claims before endorsement. Marketers can ensure alignment with established regulatory standards and evidence-based practices by inspecting the accuracy, validity, and scientific basis of the information presented. This thorough vetting process is paramount to safeguarding public health by preventing the dissemination of misleading or false information that could potentially harm consumers. This combined approach ensures that the promotion of CAMs through SMIs is conducted responsibly and ethically, fostering consumer trust and confidence in these products.
In implementing a successful marketing approach for healthcare products, including CAMs, prioritizing transparency and disclosure are essential. Marketers must be explicit about any affiliations or relationships between SMIs and the CAM products they promote, as honesty and integrity are crucial to building and retaining consumer trust. In today’s discerning environment, authenticity and transparency are pivotal in fostering consumer confidence.
Considering the increasing trend of people using the internet for health-related information, including medicines, products, and CAMs [
120‐
122], people tend to perceive unlicensed, non-professional SMIs as credible as licensed healthcare professionals when seeking health-related information [
123]. Information provided by SMIs with no education about healthcare can jeopardize the health of those who follow them on social media. This opens up a novel role for healthcare professionals to leverage their expertise in the realm of social media. By providing knowledge, guidance, and counseling on CAMs and Over-the-Counter (OTC) medicines available for online purchase, healthcare professionals can optimize medicine usage and effectively manage diseases. Collaborating with reputable healthcare professionals and organizations further enhances the credibility of promotional efforts. Involving licensed practitioners and CAM experts in marketing campaigns strengthens the authenticity and trustworthiness of endorsements. Testimonials and endorsements from healthcare professionals, especially pharmacists, who vouch for the effectiveness and safety of CAMs wield significant persuasive power in building consumer confidence. This collaborative approach bridges the gap in credible health information on social media and empowers consumers to make informed decisions about their health and well-being. To capitalize on this opportunity, professional organizations should explore the development of new roles as healthcare SMIs. By leveraging their expertise, these professionals can deliver reliable health information about diseases, health-related products, medical devices, and CAMs. Implementing regulated digital services for providing health-related information ensures uniformity of content and the dissemination of accurate knowledge. This approach enhances consumer trust and empowers individuals to make informed decisions about their health and adhere to medical advice, contributing to improved public health outcomes.
Moreover, the involvement of healthcare professionals in mainstream media to deliver public health messages is not a new concept [
124,
125]. However, in the era of digitalized health, new opportunities arise, such as designing services with healthcare professionals as SMIs. The COVID-19 pandemic has accelerated the development and implementation of digitalized healthcare worldwide, including remote digital health services, which have shown improvements in public health benefits [
126‐
128]. With a growing interest in digitalized health services, understanding the factors influencing consumers’ perceptions of CAMs on digital platforms, as presented in CAMPIM, becomes crucial for implementing e-health services. Monitoring and managing medication therapy, counseling patients, and making informed decisions about treatment can be enhanced through these digital avenues, fostering better health outcomes for consumers.
Further scope of the study
The medical research council (MRC) framework of complex interventions [
129] could be used to explore contextual factors. Implementation science could be used to inform the development and implementation of patient counselling services by healthcare professionals in a digitalized format using social media platforms. Another advantage of this CAMPIM model is that it can give policy makers a baseline, for the required competencies of healthcare professionals, to deliver these kinds of services.
Considering its breadth, the CAMPIM may also be relevant and useful not just for enhancing new roles of healthcare professionals for policy makers to enable them to be more active on social media to protect public health, but also laying the foundations for marketers in the pharmaceutical sector to understand the complexity of SMIs’ influence on consumers’ intention to purchase CAMs. For example, if the aim is to decrease the risk of irrational use of CAMs, professional bodies could adopt new ways to reach consumers to influence their beliefs and attitudes on social media by increasing the argument quality of healthcare professional opinion leaders who are rather selected due to their similar background and values with consumers. Furthermore, pharmaceutical companies could tune to reach target audiences genuinely interested in exploring alternative healthcare options by effectively utilizing the insights captured from the CAMPIM.
Limitations of the study
The CAMPIM has some limitations. One limitation is that the relationships among the constructs included in the model does not apply linearity in principle. Many constructs can affect and impact other constructs simultaneously and can positively or negatively impact the other constructs and may affect the behavior to purchase CAMs. It is also important to highlight that it is impossible to understand the correlations of these constructs within the model; for example, the reciprocal relationship between trustworthiness and expertise could not be shown in the model, if any. The authors thus propose future studies to evaluate the impact of constructs, mediators, and factors with each other and their overall impact on the purchase of CAM.
Another limitation was that as there was a lack of studies reporting the influence of SMIs on the purchasing behavior of CAM thus, the model relied on studies from different fields and was constructed by triangulating the findings. Although the model uses theory to understand how the constructs lead to the purchase intention, it differs widely from a realist evaluation and does not create any program theories. The model thus lacks the power to infer causality.
The model might need to undergo a rigorous overview by an expert panel of relevant stakeholders, including but not limited to consumers, current SMIs, and policy makers to validate and clarify concepts and to determine causal pathways among constructs, which authors are already planning to design a further study to evaluate the constructs of CAMPIM using stakeholders and expert panel with mixed methods. The model has the strength to be flexible in predicting the behavior of the purchase of CAM across different social media platforms. Still, the dynamics of each social media need to be accounted for in terms of producing an impact. Another feature of interest is that the sub-construct of ‘visuality’ in the model can be differently presented in various social media platforms. For example, the visuality of SMI would be presented differently than on Twitter, but the impact of visuality remains true in influencing the purchase behavior towards CAM. The dynamics of each platform may differ, and the model should be carefully examined and contextualized for developing new roles of health SMI’s across different platforms and implementing successful marketing approaches.
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