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Open Access Research article

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

Abubakr A Alfadl1*, Mohamed Izham b Mohamed Ibrahim2 and Mohamed Azmi Ahmad Hassali3

Author Affiliations

1 National Drug Quality Control Laboratory, National Medicines and Poisons Board, Federal Ministry of Health, Qasr Street, Khartoum, Sudan

2 College of Pharmacy, Qatar University, P.O. Box 2713, Doha, Qatar

3 Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800, Penang, Malaysia

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BMC Public Health 2013, 13:829  doi:10.1186/1471-2458-13-829

Published: 11 September 2013



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.

Counterfeit drugs; Behavior; Scale; Developing country; Arabic-speaking Sudanese population