How Medicine Ads Affect What People in Saudi Arabia Think

Pharmaceutical advertising plays a crucial role in the healthcare industry, particularly as it shifts from targeting healthcare professionals to reaching consumers directly. Historically, drug advertisements were aimed primarily at healthcare professionals, but this focus has shifted significantly towards direct-to-consumer advertising (DTCA) over the past decade [1,2]. This transition has allowed pharmaceutical companies to directly engage the public, boosting medication sales and usage [3,4]. However, this shift has raised concerns about its potential negative impact on public health outcomes and increased drug expenditures, especially in regions where DTCA is restricted or not fully addressed by public policy [5]. Countries like the United States and New Zealand permit DTCA, including product claims, whereas many other countries have stringent prohibitions [6,7,8]. In Saudi Arabia, the Saudi Food and Drug Authority (SFDA) imposes stringent rules on drug advertising. Direct-to-consumer ads for prescription medications are prohibited; these ads can only be directed to healthcare professionals through scientific channels and publications. Advertising is permitted only for non-prescription drugs, and this follow strict guidelines set by the SFDA [9,10]. Saudi Arabia has rigorous regulations on online promotions for non-prescriptive pharmaceuticals, enforced by the Saudi Food and Drug Authority (SFDA), ensuring strict control over advertising content and practices [9,10]. SFDA enforces strict regulations on online promotions for non-prescriptive pharmaceuticals, requiring all advertisements to undergo approval to prevent misleading claims, ensure full disclosure of risks, and align with cultural values. Advertisers must also adhere to specific requirements when using online platforms and social media, including obtaining explicit approval and avoiding any unapproved content or claims. These regulations aim to simplify complex medical information and ensure credibility through reliable references. Despite these efforts, there remains a gap in understanding how these regulations impact public perceptions and attitudes towards drug advertisements. While regulations are designed to protect consumers, there is limited exploration of how these advertisements influence public views and behaviors, particularly on digital platforms. Social media, for instance, has become a prominent tool for pharmaceutical marketing, with companies engaging influencers to promote products directly to consumers [11,12]. This shift towards digital marketing challenges traditional regulatory frameworks and highlights the need for a deeper understanding of how these advertisements are perceived by the public [5,13]. This study seeks to address this gap by examining public awareness and perceptions of medication advertisements in Saudi Arabia. It will explore how the regulatory environment influences these perceptions and attitudes, providing insights into the effectiveness and ethical considerations of pharmaceutical advertising in the digital age.

A cross-sectional survey was conducted to explore the perspectives of Saudi citizens and residents on pharmaceutical advertising, focusing primarily on both prescription and non-prescription drugs. This online survey took place in December 2023 and reached various regions across Saudi Arabia. The questionnaire was distributed through social media platforms (Facebook, X, Linkedin, etc.) and email invitations. The main objective was to evaluate public awareness and attitudes toward drug advertisements. To ensure our findings were statistically valid, we calculated the sample size needed based on a 95% confidence interval and a 5% margin of error, considering the national population of around 32 million [14]. This calculation showed that a sample of 385 participants would provide an adequate representation of the Saudi population for our study. We selected participants using convenience sampling, targeting Saudi citizens and residents aged 18 and older. The survey was designed to be accessible online, allowing participants to engage with the questionnaire through a provided link. To develop and validate the questionnaire, we conducted a thorough literature review and consulted experts in drug advertising and pharmacy [15,16]. This validation process included pilot testing, where we assessed face validity and internal validity to enhance clarity and relevance. Feedback from 10 participants during the pilot phase led to significant improvements in the survey’s design and content, ensuring it accurately reflected community opinions on drug advertising.

Table 1 presents the demographic details of our participants. The participants, comprising mostly employees with bachelor’s degrees, had an average age of 33 years. More than half were female (51.1%), while 48.9% were male. A significant majority (96.6%) were Saudi nationals, with most hailing from Makkah province (85.2%). In terms of marital status, 46.6% were single, 46.4% were married, 3.8% were divorced, 0.9% were widowed, and 2.3% preferred not to disclose their status. Educationally, 71.1% had a bachelor’s degree, and 18.9% had completed high school. Employment status revealed that 51.1% were employed, 29.1% were students, 12% were unemployed and seeking work, 5% were retired, and 2% were self-employed. Regarding family income, 42% reported earning between SAR 6000 and 15,000; 20.7% earned between SAR 15,000 and 30,000; 17.3% had less than SAR 6000; 3% earned between SAR 30,000 and 50,000; and 1.1% earned more than SAR 50,000.

Table 2 highlights how participants encountered drug advertisements. About 25.5% frequently saw these ads, and 22.7% saw them very often. Many participants found the ads informative, but there were concerns about unrealistic expectations and overmedication. Specifically, 89.8% felt that ads set unrealistic expectations about how effective medications are. Additionally, 60.7% believed that celebrity endorsements can mislead viewers, and 91.1% thought that ads should provide more detailed information on risks and side effects. Participants preferred seeing ads on mobile apps and websites (47%) and social media (46.4%), while billboards (37.5%) and TV/radio (23.6%) were less favored. Magazines and newspapers were the least preferred (10.7%).

Table 3 explores participants’ opinions on drug ads and their reasons for these views. Table 4 shows that many participants were aware of FDA regulations on drug advertising, but 82.3% thought it was permissible to advertise medicines according to the Saudi Food and Drug Authority’s regulations. The credibility of the source was seen as the most important factor in evaluating pharmaceutical ads (78.2%), followed by information on side effects and risks (55.7%) and content quality (43.4%). Celebrity influence (14.8%) and ad design (14.5%) were rated as less important. About two-thirds (67.7%) preferred ads that featured success stories or real-life experiences. To improve pharmaceutical advertising, 68.2% suggested a greater focus on medical and scientific information, 59.8% wanted more awareness about safe medication use, 48.6% called for better transparency about risks and side effects, 40.2% supported discussing non-pharmacological treatment alternatives, and 36.1% preferred real-life examples. Only 15.5% felt that stricter rules were necessary. Regarding social media’s role, 46.6% thought it plays a significant role in directing attention to drug ads, while 30.2% saw it as having a mediating role. About 43.2% of participants lacked confidence in the information provided in social media ads, and 15.2% had negative experiences with medications promoted online. To improve public understanding of drug advertising and safety, participants suggested using simple language (75.5%), engaging in social media awareness campaigns (68.9%), organizing interactive sessions (53%), and showcasing safe, inspiring medication success stories (34.5%). Most participants (93.2%) believed that laws for social media drug ads should be stricter, and 96.4% thought regulatory bodies should more actively monitor online ads. Additionally, 78.6% reported using other sources, like medical review sites, to verify medication information before use. No statistically significant relationships were reported between the various factors examined and participants’ perceptions of pharmaceutical advertising.

This study provides a comprehensive view of public perceptions and the impact of medication advertisements in Saudi Arabia. Out of 440 participants, approximately half reported regular exposure to direct-to-consumer ads and deemed them informative. Nonetheless, a substantial number of respondents raised concerns about these advertisements potentially fostering unrealistic expectations regarding the effectiveness of medications. The concern is further amplified by the significant influence of celebrity endorsements, acknowledged by 60.7% of participants as having a major impact on their perceptions. This underscores important ethical considerations regarding the role of celebrities in pharmaceutical marketing and its potential consequences for public health. These findings are in line with existing literature on public attitudes toward DTCA [15,17]. DTCA carries some risks even when it is informative; it can foster unrealistic expectations among consumers and create conflicts of interest for healthcare providers [18,19]. Our study also revealed that consumers demand more detailed information in drug advertisements, including non-medical alternatives, lifestyle changes, and full disclosure of risks and side effects, reflecting a broader public demand for transparency and a holistic approach to medication communication. Several studies highlighted that DTC advertising could misinform patients by overemphasizing benefits, underemphasizing risks, and promoting drugs over healthy lifestyle choices, leading to overutilization and inappropriate prescribing [20,21]. To address social media-based DTCA, regulatory agencies should work on a regulatory framework that focuses on balanced, accurate, and non-misleading advertising communications, requiring manufacturers to disclose benefit and risk information, responding to off-label information requests, and correcting misinformation about products [22]. While over one-third of the participants are aware of the regulations set by the Saudi Food and Drug Authority (SFDA), a significant 82.3% believe it is acceptable to advertise medications within these regulations. This indicates a gap between the awareness of regulations and perceptions of their adequacy, underscoring the need for clear and effective communication about regulatory frameworks [15,22].

Customers’ perceptions of pharmaceutical advertisements in Saudi Arabia are also influenced by the quality of the content, the credibility of the source, and the presence of information about adverse effects. These findings point to a public preference for authenticity and factual content in marketing, such as real success stories and experiences. Other studies have shown that consumer-targeted drug advertising can sometimes contain misleading information, contradicting the primary purpose of drug promotion, which is to inform consumers about pharmaceutical products [16,23]. The results of the study also showed that 93.2% of the participants demanded stricter controls on drug advertisements on social media emphasizing the need for enhanced oversight to ensure the accuracy and reliability of information disseminated in these digital platforms. Customers’ demand for strict regulation may be due to social media’s influence on drug marketing and the resulting distrust towards the information presented [22,24]. The SFDA has clear policies in place for penalizing companies or online advertisers that violate advertising regulations, including fines and other punitive measures for non-compliance with their strict guidelines. A potential limitation of our study is the sample’s age range, which may not fully capture the diverse perspectives across all age groups. Additionally, while the convenience sampling method was used, it may not represent the entire population, potentially influencing the study’s generalizability. A large portion of the participants in this study had a bachelor’s degree. This overrepresentation of educated individuals may affect the generalizability of the results, as it might not reflect the views of the wider public. This study sheds light on the intricate nature of pharmaceutical advertising in Saudi Arabia, emphasizing the need for more ethical marketing strategies, ensuring advertising practices align with public expectations and needs while adhering to strict regulatory standards to protect public health and trust. Future research should evaluate the effectiveness of current regulatory frameworks and explore consumer reactions to different types of drug advertising across various media platforms. Investigating methods to enhance public trust and ensure transparency in drug advertisements will be key to developing more ethical advertising practices. Strengthening oversight and improving communication about regulations are essential to aligning advertising practices with public expectations and safeguarding public health.

Pharmaceutical advertising must strike a balance between clear communication and education. The public expects straightforward, accurate details, especially on social media, where tighter regulations are essential. Collaboration with pharmaceutical companies is vital to ensure ads reflect health guidelines. Key actions include stronger oversight of digital ads and raising public awareness about the limitations and risks of these advertisements.