This is the first study in Latvia that examines awareness, experience and opinions of the population about GM. The results of the study showed that the majority of the population is informed about the availability of GM as an alternative to brand-name medicines. Women, higher educated and older patient groups were more informed compared to other groups. This might be explained by the fact that women and higher-educated people tend to have higher health literacy [22,23,24,25], and older people in Latvia are more exposed to the medicines’ reimbursement system in general, which distinguishes between generic and brand-name medicines, and to the NHSRL public campaigns promoting GM. The fact that men, people with primary and secondary education and nationalities other than Latvian are less informed may suggest that public information is not reaching these groups.
Approximately 44% of respondents in our study recalled previous experience with using GM. The actual number might be higher, as users might not always be aware whether they are using generic or brand-name medicines. The results show that the majority of those who recalled using GM rated their experience as positive or neutral. Only 5.7% of those surveyed reported their experience of using generics as negative. This finding is consistent with results reported by Drozdowska and Hermanowski in the Polish population where the majority were satisfied with using GM [21]. Negative experiences with GM safety or efficacy have been reported in other studies [15, 16]. This experience is not consistent with clinical studies; systematic reviews of equivalence between generics and brand-name medicines does not confirm differences in efficacy or safety [26, 27]. It is possible that patients’ negative experience of lower efficacy or side effects with GM might be influenced by nocebo effects [28].
Despite the high awareness and positive or neutral experience of those who had used GM, only about one fifth of the total number of respondents would prefer using GM, if they had to make a choice between GM and brand-name medicines in the future. This is different from the situation in Poland, where more than a half of the respondents were willing to opt for GM [25]. A systematic review by Colgan et al. also highlighted that a significant proportion of consumers held negative attitude towards GM which is a barrier for uptake of GM [16]. The negative attitude may be related to the fact that consumers do not consider GM as equal alternatives to brand-name medicines [29] and hold different myths about them [15]. Consistently with studies from Finland and Poland [17, 21], we did not find any associations between gender and preferences towards GM.
In the Latvian context, the strongest preference for brand-name medicines was in the age group over 55 years. This finding is unfortunate as most common chronic conditions are prevalent in this age group and representatives of the group might be beneficiaries of the pharmaceutical reimbursement system which promotes use of GM. These findings of preference for brand-name medicines and less willingness to use GM among older people are consistent with findings in other European countries like Finland, Switzerland and Belgium [17, 30, 31]. It would be useful to further explore reasons and identify best solutions to address mistrust towards GM in this age group.
Similar to other researchers [21, 15], we also found that the more positive GM users rated their experience, the more willing they were to choose GM if presented with a choice.
In our study, physician specialists were found to provide more negative information about GM compared to other information sources. It would be useful to explore reasons for this in further research. Possible explanations might be lack of knowledge about the concept of bioequivalence or specialists’ close relationships with the pharmaceutical industry. Studies have suggested that the payments from the pharmaceutical industry are associated with preferences for brand-name medicines [32, 33]. The systematic review by Dunne and Dunne suggests that physicians play a particularly important role in ensuring consumers’ confidence in GM [15]. The study that examined the relationship between patient beliefs and communication about GM with their providers, also concluded that the willingness to use GM is associated with positive communication with providers [34].
This study has the following limitations – as the survey was distributed as Computer Assisted Web Interviews, it did not reach the part of the population not using the Internet. It is estimated that approximately 21% of the Latvian population do not use Internet on a regular basis. The proportion of Internet nonusers differ significantly among the age groups. Within the age group 18–44 about 4% do not use Internet regularly, while within the age group 45–64 the share constitutes 28%, and within the age group 65–74 those are 64.5% [35]. To adjust to the criteria of a representative sample, data were weighted according to four parameters (gender, age, nationality and place of residence), but were not weighted according to education, therefore, the sample included a higher proportion of population with higher education than the general population in Latvia. It might have had impact on the study results. For instance, there are studies suggesting that population with higher education have more positive attitude towards GM and are more likely to choose generic substitution [15, 36].