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01.12.2013 | Research article | Ausgabe 1/2013 Open Access

BMC Public Health 1/2013

Scale development on consumer behavior toward counterfeit drugs in a developing country: a quantitative study exploiting the tools of an evolving paradigm

BMC Public Health > Ausgabe 1/2013
Abubakr A Alfadl, Mohamed Izham b Mohamed Ibrahim, Mohamed Azmi Ahmad Hassali
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Electronic supplementary material

The online version of this article (doi:10.​1186/​1471-2458-13-829) contains supplementary material, which is available to authorized users.

Competing interests

The authors declare that they have no conflicts of interest to disclose.

Authors’ contributions

AAA participated in the design of the study, performed the statistical analysis, and drafted the manuscript. MMI participated in the design of the study and critically reviewed the draft of the manuscript. MAH participated in the design of the study and critically reviewed the draft of the manuscript. All authors read and approved the final manuscript.



Although desperate need and drug counterfeiting are linked in developing countries, little research has been carried out to address this link, and there is a lack of proper tools and methodology. This study addresses the need for a new methodological approach by developing a scale to aid in understanding the demand side of drug counterfeiting in a developing country.


The study presents a quantitative, non-representative survey conducted in Sudan. A face-to-face structured interview survey methodology was employed to collect the data from the general population (people in the street) in two phases: pilot (n = 100) and final survey (n = 1003). Data were analyzed by examining means, variances, squared multiple correlations, item-to-total correlations, and the results of an exploratory factor analysis and a confirmatory factor analysis.


As an approach to scale purification, internal consistency was examined and improved. The scale was reduced from 44 to 41 items and Cronbach’s alpha improved from 0.818 to 0.862. Finally, scale items were assessed. The result was an eleven-factor solution. Convergent and discriminant validity were demonstrated.


The results of this study indicate that the “Consumer Behavior Toward Counterfeit Drugs Scale” is a valid, reliable measure with a solid theoretical base. Ultimately, the study offers public health policymakers a valid measurement tool and, consequently, a new methodological approach with which to build a better understanding of the demand side of counterfeit drugs and to develop more effective strategies to combat the problem.
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