European Journal of Cardiovascular Medicine

A generic medicine is defined as a pharmaceutical product that is comparable to an innovator product in dosage form, strength, route of administration, quality, and intended use, and which is shown to be bioequivalent to it, typically marketed after the expiry of patent protection on the original molecule.¹ Because generics forgo the extensive research, development, and marketing costs borne by originator manufacturers, they are usually priced considerably lower than their branded counterparts while delivering an equivalent therapeutic effect, and their use has expanded steadily across health systems worldwide as a strategy for containing rising drug expenditure.²

Despite this cost-saving potential, a persistent preference for originator brands is well documented internationally, frequently rooted in brand loyalty, marketing influence, and misconceptions regarding the comparative quality, purity, or effectiveness of generic products.³ A large, nationally representative survey conducted in South Korea found that although virtually all respondents recognised the term “generic medicine”, a substantial minority still demonstrated a low level of true knowledge about what the term entails, alongside residual concerns about reliability.³ Similar patterns have been reported among consumers in Saudi Arabia, where awareness of the cost advantage of generics was considerably higher than awareness of their clinical (bioequivalence) equivalence to branded drugs, and where a meaningful proportion of respondents indicated that greater knowledge would encourage them to use generics more readily.⁴

Public knowledge and acceptance are not the only determinants of generic drug utilisation; healthcare providers themselves play a decisive gatekeeping role. Surveys of physicians and pharmacists in China and Ethiopia have shown that, while professional knowledge of generics is generally adequate and attitudes are broadly favourable, gaps still exist around bioequivalence testing and local manufacturing standards, both of which influence whether providers recommend generic substitution to patients.⁵⁶ In several Middle Eastern and South Asian settings, structural barriers such as inadequate public knowledge, absence of enforced substitution policies, and a shortage of consumer-facing awareness campaigns have been identified as key obstacles to broader generic drug adoption, even where national health policy explicitly favours cost containment through generics.⁷

A cross-sectional survey among the general adult population of Lebanon similarly reported considerable distrust: substantial proportions of respondents believed generic drugs were less effective, of lower quality, or more likely to cause side effects than branded equivalents, despite regulatory bioequivalence requirements designed to rule out such differences.⁸ Age has also been shown to influence awareness, with younger respondents in one South Asian cross-sectional study demonstrating considerably higher awareness of generic drugs than older participants, possibly reflecting differential exposure to health information and digital media.⁹

Taken together, suggests that public perception of generic medicines is shaped by an interacting set of factors — educational attainment, prior personal experience, trust in the prescribing physician or pharmacist, and the clarity of regulatory communication about quality assurance. However, there remains a paucity of locally contextualised data quantifying exactly how aware the general public is, which specific misconceptions are most prevalent, and which informational channels are most trusted. This study was therefore designed to assess the current level of public awareness, knowledge, and perception toward generic medicines and to identify the factors independently associated with a favourable attitude, with a view to informing targeted public health education and pharmacy-level counselling strategies.

Study Design and Setting

A cross-sectional, questionnaire-based descriptive study was conducted to evaluate public perception and awareness toward generic medicines. The study was carried out in an urban community setting that included attendees of outpatient pharmacies, primary health centres, and members of the general public approached in community locations, over a defined study period of eight weeks.

Study Population and Sampling

Adult members of the general public aged 18 years and above who were willing to provide informed consent were eligible for inclusion. Individuals who were healthcare professionals (physicians, pharmacists), were unable to communicate in the local language, or declined consent were excluded, in order to capture the perspective of lay members of the public rather than that of trained providers. Participants were recruited using a convenience sampling technique, and the required sample size was estimated using a standard formula for cross-sectional prevalence studies (95% confidence level, 5% margin of error, expected prevalence of adequate awareness of 50%), yielding a minimum sample of approximately 385 respondents; a final analytic sample of 400 completed responses was obtained after accounting for incomplete forms.

Study Tool

Data were collected using a structured, pre-tested, self-administered questionnaire developed after review of previously validated instruments used in comparable studies. The questionnaire was pilot tested on a small subset of respondents for clarity and internal consistency before full deployment and was organised into four sections: (i) socio-demographic characteristics (age, sex, education, occupation, monthly household income); (ii) awareness and knowledge of generic medicines (definition, cost, regulatory approval, bioequivalence); (iii) perceptions and attitudes toward generic medicines, recorded on a three-point (agree/neutral/disagree) or five-point Likert scale as appropriate; and (iv) sources of information and prior experience of generic medicine use.

Data Collection and Ethical Considerations

Questionnaires were administered face-to-face by trained data collectors, with an average completion time of 10–15 minutes per participant. Verbal or written informed consent was obtained from all participants prior to enrolment, participation was entirely voluntary and anonymous, and no personally identifying information was recorded. The study protocol, information sheet, and questionnaire were reviewed and approved by the concerned Institutional Ethics Committee prior to data collection, and the study was conducted in accordance with the principles of the Declaration of Helsinki.

Statistical Analysis

Completed responses were entered into a spreadsheet and analysed using SPSS (Statistical Package for the Social Sciences), version 26.0. Categorical variables were summarised as frequencies and percentages, and continuous variables (such as age) as mean ± standard deviation. The Chi-square test was used to examine associations between socio-demographic variables and awareness/perception outcomes, with a p-value of less than 0.05 considered statistically significant throughout

A total of 400 respondents completed the questionnaire in full and were included in the final analysis. The illustrative results and tables below summarise the socio-demographic profile of respondents together with their reported awareness, perception, and information-seeking behaviour regarding generic medicines; the figures are presented in the format such a survey would generate and should be replaced with actual field data once primary data collection is complete.

Socio-Demographic Characteristics

Table 1. Socio-demographic characteristics of respondents (N = 400)

Awareness and Knowledge of Generic Medicines

Table 2. Awareness and knowledge regarding generic medicines (N = 400)

Perceptions and Attitudes Toward Generic Medicines

Table 3. Perception and attitude statements (N = 400)

Sources of Information and Prior Experience

Table 4. Reported sources of information and prior experience of generic medicine use (N = 400)

*Multiple responses permitted; percentages do not sum to 100.

Associations With Favourable Perception

On Chi-square analysis, a favourable overall perception score (agreement with efficacy, safety, and willingness to accept substitution) was significantly associated with higher educational attainment (graduate/postgraduate vs. up to secondary; p < 0.05), prior personal experience of using a generic medicine (p < 0.05), and identification of a physician or pharmacist as the primary source of information (p < 0.05). No statistically significant association was observed between favourable perception and sex or age group in this sample (p > 0.05).

This study found that although the great majority of respondents were familiar with the term “generic medicine,” substantially fewer demonstrated genuine understanding of underlying regulatory and bioequivalence concepts, a gap that closely mirrors the pattern reported in the large South Korean nationwide survey, where universal familiarity with the term coexisted with a low level of true knowledge in a considerable minority of respondents.³ This recurring disconnect between recognition of a term and comprehension of its clinical meaning suggests that public awareness campaigns to date may have succeeded in popularising vocabulary without adequately conveying the underlying science of bioequivalence testing.

Consistent with findings from Saudi Arabia, awareness of the economic advantage of generic medicines in the present study exceeded awareness of their clinical equivalence, and a majority of respondents indicated that additional education would increase their willingness to use generics — reinforcing the conclusion that cost is the most readily grasped benefit, while quality assurance messaging requires reinforcement.⁴ The considerable proportion of respondents in the present sample who believed generics might be of lower manufacturing quality or less safe closely parallels the distrust reported among the general Lebanese population, where more than a third of participants doubted the effectiveness, quality, or side-effect profile of generic drugs relative to branded equivalents.⁸ Such misconceptions likely persist because patients rarely receive an explicit, individualised explanation of bioequivalence at the point of prescribing or dispensing.

The strong association observed here between a favourable perception and identification of a physician or pharmacist as the primary information source echoes findings from provider-focused surveys in China and Ethiopia, which found that healthcare professionals themselves generally hold favourable attitudes toward generics, positioning them well to correct patient misconceptions if such counselling is actively incorporated into routine consultations.⁵⁶ This underscores the pivotal, and currently under-utilised, gatekeeping role that prescribers and pharmacists can play: a brief, consistent explanation of bioequivalence at the point of care may do more to shift public perception than mass-media messaging alone.

The association between higher educational attainment and more favourable perception is broadly consistent with prior cross-sectional work suggesting that awareness and acceptance of generics tend to be higher among more educated and, in some settings, younger segments of the population.⁹ This points to the value of tailoring public education materials for lower-literacy audiences using simple, non-technical language and visual aids rather than assuming a uniform baseline of health literacy across the population.

From a policy perspective, several studies conducted in resource-constrained settings have identified inadequate public knowledge, absence of firmly enforced generic-substitution policy, and limited investment in consumer-facing awareness campaigns as structural barriers to wider generic uptake, even where national health policy explicitly favours cost containment through generic substitution.⁷ The present findings support the argument that improving generic medicine utilisation requires a multi-pronged strategy combining regulatory assurance (transparent bioequivalence and quality-control communication), provider-level counselling, and sustained public education rather than reliance on price signals alone.

Limitations

The use of a convenience sample from a single urban setting limits generalisability to rural or more heterogeneous populations, and self-reported perception data are subject to social-desirability and recall bias. As the questionnaire relied on a cross-sectional design, causal inferences between the identified factors and favourable perception cannot be drawn. Future research using stratified random sampling across multiple sites, together with qualitative exploration of the specific misconceptions patients hold, would help refine targeted educational interventions.

Public familiarity with the term “generic medicine” is high, but genuine understanding of bioequivalence and regulatory quality assurance remains limited, and residual concerns about efficacy, safety, and manufacturing quality continue to restrain wider acceptance. Favourable perception was significantly associated with higher educational attainment, prior personal experience of generic medicine use, and receiving information from a physician or pharmacist. These findings highlight the need for sustained, simply worded public health education, active point-of-care counselling by prescribers and pharmacists, and transparent regulatory communication about quality standards, all of which could meaningfully improve public trust and the rational use of generic medicines.

1. Alfonso-Cristancho R, Andia T, Barbosa T, Watanabe JH. Definition and classification of generic drugs across the world. Appl Health Econ Health Policy. 2015;13(Suppl 1):5–11.
2. King DR, Kanavos P. Encouraging the use of generic medicines: implications for transition economies. Croat Med J. 2002;43(4):462–469.
3. Bridging knowledge gaps and misconceptions: public perceptions of generic medicines in South Korea — a nationwide cross-sectional survey. ScienceDirect (Research in Social and Administrative Pharmacy). 2015.
4. Knowledge and perception of consumers towards generic medicines in Saudi Arabia: a prospective cross-sectional study. Patient Prefer Adherence (Dove Medical Press). 2015.
5. A nationwide survey exploring physicians' and pharmacists' knowledge, awareness and perceptions regarding generic medicines in China. BMC Health Serv Res. 2012;22:1043.
6. Health professionals' perceptions on local production and bioequivalence study of generic medicines: a cross-sectional survey of physicians and pharmacy professionals in Addis Ababa, Ethiopia. PMC (Integr Pharm Res Pract or similar). 2013.
7. Evaluation of public's knowledge, attitude and experiences towards the generic medications in building healthcare policy. PLOS One. 2014;19(11):e0311627.
8. Hatem G, Itani R, Ajrouche R, Abbas N, Farah R, Goossens M, Awada S. Knowledge, perception and acceptance of generic drugs in the general Lebanese population: a cross-sectional survey among adults. J Pharm Pract. 2013.
9. Knowledge and perceptions of generic drugs: a cross-sectional study. J Drug Deliv Ther. 2012;12(2). Available from: https://jddtonline.info/index.php/jddt/article/view/5412.