Editorial Board

A Refereed Monthly International Journal of Management

Brand Positioning and Its Impact on Consumer Behavior with respect to OTC Drugs

Anurinder Kaur

Research Scholar,

School of Business Management,

Chandigarh University, Punjab

Dr. Anil Chandhok

Professor, 

University School of Business Management,

Chandigarh University, Gharuan

Dr. Saurabh Kumar Banerjee

Dean & Associate Professor,

School of Pharmaceutical Management,

IIHMR University, Jaipur

Abstract

The current study attempts to study brand positioning and its impact on Consumer behavior in the pharmaceutical sector in context to OTC drugs. The paper used a systematic review approach and investigated in depth study of 200 papers published from 2000 to 2021 using PubMed, Scopus, and Web of sciences, Springer, Science direct and Emerald databases. Screening of articles was done based on keywords, and then inclusion and exclusion criteria were performed to extract 45 papers which were read in full.  The paper systematically reviewed literature related to brand positioning and consumer behavior for OTC drugs and put light on positioning of brands along with various factors or attributes responsible for brand positioning in consumer mind. Study also provided insight for consumer purchase behavior and relation of positioning factors, with consumer behavior. Moderation and mediation of factors influencing brand positioning and consumer purchase behavior were also studied. The Results of this research will be helpful for manufacturing and marketing firms dealing with OTC segments. Companies and managers make their marketing strategies. The study has figured out important factors and attributes which consumers consider before buying any product which will be further helpful for companies to modify their products to get greater market share. With this study companies will get an idea about the negative and positive aspects of products, which will be helpful for them to survive and grow, exist in a competitive market.

Keywords:  Consumer Behavior, Brand Positioning, OTC drugs, Band Attributes, Positioning Factors.

Introduction

Brand positioning is a term that relates a product or service and its attributes with consumers. Each customer is different and has a different bent of mind; based on their thought process they make their decisions (Schiff man& Kanuk, 2007). As defined by (Kotler et al.) A brand is a name, symbol, term, sign or combination of these, intended to identify and differentiate the goods or services from their competitors. Brand positioning (Ries and Trout, 1981) defined the term position of brand in consumer mind. (Gelder, 2003) defined the term position of a brand differentiating it from other competitor brands, So brand positioning is a technique which is used by companies to make an image and clear concept of their product or service to consumers to get a differentiated position in their mind. Companies move from traditional methods to advanced methods to create a place in the consumer mind for their products or services. Market is loaded with competitive products so to target and make a place in consumer psychology, Companies need to have differentiated; rectifiable worth and brand advantage thus a company is able to get market share and revenue. To target the required market, various positioning channels are used like TV advertising, Posters, flyers brochures, print media, and internet. Now a days Presence of the Internet and the latest digital media techniques make it very easy to create and remind consumers about a particular brand. (Aydın, 2005) described some Basic features of brand positioning  as product features,  price- quality relationship, comparing with rivals, positioning focusing on use of product, class of product and users of product. Consumer Behavior involves the use of mental, emotional and behavioral responses to select or reject any product. Consumer behavior changes with their demographics and geographical location. Consumers with varying age, education, location, gender have different perceptions toward medicinal OTC products.

For the success of any product in the market, companies need to know the consumer behavior concerned with their needs and wishes. Modern market is a consumer oriented market so companies need to know all the factors that can impact in getting a share of products in the market. With Consumer behavior analysis companies are able to find all factors that can affect their buying decision, further leading to impact on sale of the OTC products. Various factors like Cultural, Personal, Psychological, and Social factors deeply influence consumer buying behavior.OTC drugs are Over the Counter Drugs, and can be purchased directly from drug stores without any prescription from a medical practitioner.  These drugs are less risky and less dynamic hence are available in grocery stores, supermarkets, and drug stores.  OTC drugs are selected by regulatory agencies based on the safety and effectiveness of their ingredients instead of specific drug formulation. A drug under OTC generally involves cough cold, pain killers, anti-histamines, digestives, vitamins.OTC drugs are generally used to cure some diseases simply without paying a fee to doctors. Selection of OTC drugs depends upon knowledge, common sense and responsibility. Different countries have different rules and regulations for manufacturing and sale of drugs. Generally FDA controls manufacturing and sales of the drugs.

As per the analysis report by (Research and Markets) of 30^th April 2021, global over the counter market was 361 billion US$ and is expected to grow to US$ 539 by 2025, growing at a CAGR of 8.35%. Market analysis report on (9 Aug 2020, by express pharma) as India is the largest OTC drug market, having US $ 6.38 in 2019, is expected to grow by US $15.48 by 2024 with estimated CAGR of 19.4%.

From the literature search it was noted that there is a lack of literature related to brand positioning and consumer behavior in the pharmaceutical field for OTC drugs so the aim of this article is to review the existing empirical articles, literature, and related relevant literature to understand the brand positioning concept and its relation with consumer behavior. Specific objectives that were focused are to study brand positioning and its factors, also covering consumer’s behavior, its consumer demographics, mapping consumers purchase behavior especially for OTC category of drugs.

Review Strategy

Systematic review approach was adopted to review articles. Based on marketing stimuli, brand positioning factors, consumer purchase behavior for over the counter drugs, empirical studies, some pilot studies and secondary studies were reviewed to give insight to a wide range of questions that were not fully explored in existing literature. For the systematic review publications from 2000 to 2021 were undertaken.

Material and methods

Search strategy:

Study used the databases PubMed, Google Scholar, Research Gate, Science direct, Web of sciences, Emerald for the publications based on brand positioning and consumer behavior for OTC drugs. Some research was also conducted directly on Google search. Some references were also picked from selected articles. Study research was conducted using keywords brand positioning, consumer behavior, awareness, perception and over the counter drugs. Additional searches were done to find articles based on positioning of products and factors influencing buying behavior of consumers in different domains.

Data abstraction:

Inclusion and exclusion of articles were done through screening techniques. Selected articles were extracted for study area, author, publication year, country, sample size, Study design, sampling technique, findings and factors associated with study.

 Literature review findings:

Literature search from database PubMed, Google Scholar, Research Gate, Science direct, Web of sciences, Emerald provided 200 articles involving empirical studies, secondary studies, pilot studies related to brand positioning in different fields and consumer behavior for OTC drugs. 

 After removing duplicates, studies left with 135 articles.  Review of title and abstract 90 studies were removed. Finally 45 articles were studied in detail. 45 articles include Empirical studies(Carmina Fandos and Carlos Flavia´n, 2006), (M Babu, 2007) (Merja Halme, Kari Linden and Kimmo Kaaria, 2009), (R.K. Srivastava, Aarti T more. 2010), review articles (MubeenM. Aslam, 2006), (SyedIlyasShehnaz,M.B.B.S.,M.D.,AnoopKumarAgarwal,Ph.D.,andNeloferKhan,Ph.D., 2014), (RICHARD J. COOPER, 2013), one Thesis (Aarti J. Mhatre, 2010).  Eight countries India, USA, UK, China, Australia, Jordan, Estonia, Finland, and Ghana were included in empirical studies. Many studies included primary data collection and some used secondary data collection techniques (Noopur Sapatnekar, 2015, Dr. Santosh Ram Pagare2019), using a wide range of methods for data collection and scales were used for measuring responses. Some studies were reported from pilot studies (Dr. Dr. R.K.Srivastava, 2017). As per the review study conducted consumer behavior for OTC medicine was extensively studied in many countries, covering factors influencing consumers behavior (Priyanka Dubey, Puja Kumari, Anupam K Sachan,  Neelkanth M Pujari, 2016), (Pankaj Kumar Tiwari, 2016), (M Babu 2007). Variations found were related to geographic variations, differences in methodology and design factors were also included.  Brand positioning factors, marketing stimuli and their relation with consumer behavior, were also targeted by many studies (Erol Kohli, MD, MPH and Allison Buller,2013), (M.M. Khan, R. Razzaque 2019), (K. Santhana Lakshmi,K. Mohamed Jasim, 2017).

As per the review study conducted consumer  behavior for OTC  medicine was extensively studied in many countries, covering factors influencing consumers behavior (Neelkanth M Pujari, Anupam K Sachan, Puja Kumari, Priyanka Dubey ,2016), (Pankaj Kumar Tiwari, 2016), M Babu 2007). Variations found were related to geographic variations, differences in methodology and design approaches.

In India, studies related to brand positioning (K. Santhana Lakshmi, K. Mohamed Jasim in 2017) found influence of brand positioning factors like price, availability of product, diet regulation, availability of specialist, availability of product in small sachet and response time having higher influence on overall positioning for Ayurveda medicine as compare to other factors like permanent relief, quality of service, quality of product, physical evidence. Advertisements should convey a proper message which will improve the awareness of urban and rural consumers toward the therapy. (RK Srivastava, and Sanjiwani Jayant Kumar, 2015) focused on patients and surveyed 442 patients for finding the awareness of consumers for prescription drugs. His study reported repeat buying for the same product was greatly influenced by income of consumers. The study analyzed many positioning factors like brand personality, brand identity, brand image, and brand communication that were influenced by brand awareness which gave a specific space in consumer mind that had a role for brand recall by consumers for a Particular brand, so pharmaceutical companies need to focus on positioning factors creating awareness about the particular product. This study identifies the factors and suitable conditions required to be focused before promotion and targeting patients. (Dr. Pinaki Ranjan Bhattacharyya & Joy deep Das in 2020) explored some packing characteristics of brands like manufacturing date, expiry date, price of product, instructions for use and quality mark were the most important factors generally consumers  consider before making a purchase decision. Brand names give identity to brands which forces the consumers to make their purchase decision. Consideration of factors by marketing managers will influence the brand image of products. Pharmaceutical companies use aesthetic components of drugs as positioning factors, which are further responsible for making purchases for a particular drug. (R.K. Srivastava, 2010) investigated aesthetic attributes like color shape, smell and taste that have a great contribution for the selection of any product by consumers. Further these attributes can be a useful source for positioning of drug products to get greater market share and competitive position. Study found Age, gender affect perception and their decision making process for their choice for OTC products. Secondary study from existing literature (Noopur Sapatnekar, 2015), declared that if positioning of brands targeted in an effective and productive manner it can lead to buying decisions of consumers. (Dr. J.H.Vyas, Imran Nadeem Siddiqui, and Jay Kumar Dewangan, 2015), used convenience sampling, snowball sampling and collected data from 1200 consumers.  Extracted conclusions for brand influence, effect of advertising, subjective norms on consumers buying behavior for OTC drugs and suggested advertising significantly impact the buying decision of consumers. Quality of products provides value to brands which will create loyal consumers. Monthly income influences the consumers to make purchase decisions for the products. Companies should focus on brand positioning of brands that have great influence on consumer purchase decisions. (Celine Yanar, Lisa Aufegger, Colin Bicknell and Ara Darzi and 2021) published a research article in J of Pharm Policy and Practices, in London with the focus to study impact of positioning factors price and brand information on consumer purchase decision for OTC drugs through direct advertising. Analysis through sensitivity analysis found age, gender, income, education significantly influences the purchase behavior of consumers. Low Price and brand information positively influence decision making of consumers. Perceived quality, perceived value, and risk value significantly predicts the purchase intentions of consumers.

(Hannele Kauppinen-raisanen, 2010), studied how extrinsic attributes and design of packages are related with purchase decisions of consumers.  Design of packages and other attributes of packaging contribute toward the position of the product in the consumer mind. Study focused on very few samples of 18 consumers for pain killers and sore throat drugs. It was found that respondents consider brand name, country of origin, color, price, taste, shape, producer name, letter font, number of pills while purchasing any medicinal product. All these attributes were selected by consumers before buying any drug product. Color, taste, and smell were intrinsic attributes whereas package shape design and price (highest- lowest) are extrinsic attributes. (Shamindra Nath Sanyal, 2011), studied generic drugs, targeted on randomly selected doctors and clinics. Findings suggest that positioning factors and country of origin positively influence brand equity. Analysis showed positive Correlation for mediating variables brand strength and brand awareness for country of origin for generic drugs.  (A. Owusu Bylon Abeeku Bamfo, Hannele Kauppinen-Raisanen Richard, 2012), conducted empirical study and compared brand noticing by consumers in USA, Finland and Ghana. Study suggested, colors were perceived for different functions in different counties for drugs. Gahan preferred sore throat medicines in red color coz of effectiveness whereas the US and Finns considered it a pain in communicating.

Packaging should be kept in mind when targeting domestic and international markets. Previous studies found packaging of OTC drugs directly influenced the buying behavior of consumers.  (Kanupriya Adlakha,  Sanjeev Sharma,2019) measured perception of consumers for herbal products and found strong brand image and quality perception was gained by Dabur and Himalaya than  Zandu, Patanjali and Hamdard, torable effect of price was found for herbal products whereas (Jennilyn Castillo Mina, 2020) perceptual map for shampoo, bar soap and toothpaste found, showing the reason and  selection criteria by consumers for Shampoos. Shampoo attributes included gentle hairs and antibacterial activities of bar soap and clean teeth for Colgate.  Study by (Gautam Srivastava, 2013) found a positive correlation between price and buying behavior of consumers whereas quality and accessibility were negatively related with buying decisions. (Sung-Ho Oh, Bo-Young Kim, Jeong-Tae Bae,  2019) described brand asset attributes as more important than selection attributes and compared Korean and Chinese consumers. Korean consumers look at the economic and emotional value of products, influencing purchase intentions whereas Chinese consumers are influenced by economic, emotional and social value. (Dr. Aparna J Varma, Kotresh Patil, Ravishankar S Ulle, (2018), studied comfort, image factor, looks, and safety played a major role in positioning of brands in the minds of the customer. Occupation and income influences brand benefits, values and positioning. (Afrina Yasmin, 2017). A strong relationship was found between satisfaction and brand image. (Albari, Indah Safitri, 2018), Discriminant analysis results found price (fixed price and fair price) and brand image simultaneously influence purchase decision, partially and positively whereas Multiple linear regression analyzed that price (relative price and fixed price) simultaneously have a partial and positive effect on brand image. (M.M. Khan, R. Razzaque, 2019), investigated signaling variables like brand image, prestige and credibility of any brand forces the consumers to make purchase decisions. Through influencing factors like information costs saved, perceived quality, perceived value for money, and perceived risk.(Farrah Merlinda Muharam, Nor Haslinda binti Mohd Lawi Zuraidah Sulaiman Adaviah Mas’od, Thoo Ai Chin, 2019), found attractiveness of consumers toward green brands. Consumer knowledge and green brand positioning respectively influence the prediction and purchase decision of consumers.

 A study in Nepal by (Dr. Pinaki Ranjan Bhattacharyya & Joydeep Das in 2020) explored, packing has an impression that influences the decision making of consumers. The study explored manufacturing date, expiry date, price of product, and instructions for use and quality mark were the most important factors generally analyzed by consumers. Brand name pushes the consumers to make purchase decisions. (Erol Kohli, MPH and Allison Buller, 2013). (Raeda Habash and Hani Al-Dmour, 2019) suggested, role of doctors, pharmacists influence the buying behavior. Family and friends' advice too influence buying behavior. (Deepa Damodaran, N Sambandam, 2019) found color of product packing has capabilities to attract consumers that further create a place for products under consumer choices. Effective selection of color for packing can positively influence consumers' purchase intention.  (JohnR.Doyle, PaulA.Bottomley, 2006), study suggested color of logo or symbol for functional (problem solving) and social (sensory pleasure) colors. Properly followed Color selection criteria influence the consumer attraction toward brands. Higher price of product was found to be a symbol of product quality and prestige.  (Sang-Eun Byun & Byoungho Jin, Brenda Sternquist Professor, 2004) studied price perception for Korean and Chinese consumers. The study found Chinese consumers were more price conscious than Korean consumers. Generic products are copies of original brands that become available in the market only after expiry of patent. (Merja Halme, Kari Linden and Kimmo Kaaria, 2009), study suggested preferences and choices of consumers for OTC pain killer drugs. Marketing factors like price, brand and attributes of brands were the most targeted market factors that consumers consider before purchasing any OTC or generic product. Perceived quality for intrinsic attributes like color, smell, taste positively influence the purchase behavior of consumers whereas perceived quality of extrinsic attributes shows no effect on satisfaction and loyalty (Carlos Flavia´n,Carmina Fandos, 2006).

Table.1: Summary of empirical studies.

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(Allison Buller, Erol Kohli, MD, MPH 2013), studied consumer purchase patterns for generic and brand name OTC drugs. Survey results found factors: advertisements, preferable form of OTC medication, relief of multiple symptoms, duration of the OTC drug’s effectiveness, relief of multiple symptoms, severity of sickness, safety of the OTC, and preferred manufacturer plays a major role for the selection of generic drugs. Study also found price has a significant effect on purchase behavior of consumers. Factors like look of the package, taste of the OTC, advice from family and friends, from healthcare providers, degree of sickness (mild), and greater effectiveness of the OTC has the least effect on purchasing behavior of consumers. (Dr. Abhishek and Dr. Kavaldeep Dixit, 2017), identified consumer perception and effect of various marketing strategies on purchase behavior of OTC consumers in Jaipur city. Study analyzed pharmacists, doctors, friends, family TV advertisements, Internet newspapers playing a major role for providing information to the consumers. Marketing factors like price, packaging, brand name of drugs were primary factors that were generally considered by consumers before making their purchase decision for OTC drugs.  Involvement of pharmacists, physicians, effective promotional activities boost up the awareness level of consumers for OTC drugs. (R. K. Srivastava & Sadhna Wagh, 2017)  found awareness,  Influencers, price and value, aesthetics of the product, corporate image, advice from friends, testimonials from users, promotion,  are the important  factors that  impact consumer purchase behavior in Mumbai, Nasik and Pimaplgaon. Comparative study in three cities found price, accessibility and availability plays a major role in case of Nasik and Pimpalgaon whereas promotion plays a major role in purchase behavior of consumers.  Contributions by this research can help to improve aesthetic attributes during product development.  (Vani Nikhil Laturkar) illustrated consumer behavior for OTC herbal drugs and found company image, easy availability, brand image, price of product, convenient packing had great influence on decision making of consumers.  Free gifts and coupons attract female consumers’ more than male consumers. (Aniruddha Bhowmick, Dr. Mridanish Jha, 2017) used Integrated behavioral model and found thoughts, strength of consumers, feelings, thoughts, role of emotions actively participated in consumers decision making process whereas market factors like promotions, assess ability, affordability, availability, price, advertisements were also considered by consumers for making their purchase decision. (C. Moldovan-Teselios, S.D. Cirstea, and A.I. Iancu, 2016)  in Romania  found experts’ advice, own experience , opinion of people, college friends, relatives, has more and significant influence whereas price, brand producer, information on advertising, and quality of advertising has small effect on consumer purchase behavior. (Raeda Habash and Hani Al-Dmour, 2019) detected, the role of doctors, pharmacists influences the buying behavior. Family and friends' advice, too, influences buying behavior. (Neelkanth M Pujari, Puja Kumari, Priyanka Dubey, Anupam K Sachan, 2016), found consumer selection for prescription and non-prescription drugs. Study explained factors like physicians, pharmacist advice influence consumer purchase behavior, whereas cost of medicine is the main factor for them to select or reject any brand or generic drug. Study declared consumers go for home remedies too for self-medication. (Pankaj Kumar Tiwari, 2016), explained the role of advertisements in creating awareness on OTC drugs. Consumers also lie on pharmacist’s advice. The study advised companies to educate pharmacists to promote OTC products. A focus group study (Sanjeev verma, 2009) studied consumer attitudes using OTC healthcare supplements. He found promotional activities play a major role in creating awareness for healthcare supplements. Demographics had varying perception levels towards health supplements. Consumers less than 30 don’t prefer to use supplements, whereas female consumers have less focus as compared to male consumers. Choice of consumers is greatly affected by the price of products. A Pilot study (Dr. Dr. R.K.Srivastava, 2017) investigated consumer perception for pharmaceutical products in Nasik and Mumbai. 200 respondents were analyzed for their perception for OTC drugs. Analysis showed perception was greatly influenced by age and gender. Friends/family and Doctor/pharmacist advice is of great importance for consumer purchase behavior. Brand Name directly influences perception of consumers. Secondary study (Dr. Santosh Ram Pagare2019), found brand name, role of advertising, shopping site, type of disease and course of action were responsible for positive behavior of consumers for medicines. Brand name is the most targeted factor by consumers for making their purchase decision. Research work by (Tomasz Bocheneka, Brian Godmanb, Katarzyna Lipowskaa, Karolina Mikruta, Sandra Zuziaka, Magdalena Pedzisza, Aneta Nowaka and Andrzej Pilc, 2016) analyzed  purchasing behavior of consumers were greatly influenced by location of store, convenience stores and drug stores.  The study results found product information attracts females more than male. Advertising has very little influence on students of medical background. (Mangesh Patil, 2019), suggested age and convenience of product was related with type of medicine and type of consumers interested to purchase. TV advertisements, past experiences had an immense effect on awareness and consumer purchase behavior. Similar study (Dr. Nilesh Berad, Nasik, 2014) explored 50% consumption of OTC drugs occurring in daily life. Advertising plays an important role in mediating consumers' purchase behavior. (Peeter Villako, Daisy Volmer and ain raal, 2012), found purchase of OTC drugs was majorly influenced by income, education whereas physicians/pharmacist and, family advice motivates consumers for making purchase for OTC drugs. Varying nature of consumers was extracted in different states. (Syed Tabrez Hassan, 2018) studied behavior of OTC consumers in Punjab state. The study described Brand Image, Perceived as safe to use, Self-Awareness about diagnosis, Time saving, Peer Pressure were the factors which influence consumer purchase behavior for OTC drugs. (Vincent CHAN, Hung Tran, 2016), reported care, high levels of trust, sense of altruism, and confidence were the key factors influencing consumer purchasebehavior for OTC drugs from a pharmacy, regardless of costs or existing levels of stress andhealth and time pressures.(Maja Mesko, Andrej Bertoncelj, Mirjana Pejic Bach, Vasja Roblek, and 2018), investigated consumer behavior for online consumers and suggested education influences purchase behavior to a large extent as compared to location. Age has a significant effect on purchase behavior. (M Babu,  2007),  in his research in  Bangladesh, found awareness, brand identity,  prior assumption of physician's prescription, corporate image and past experiences of consumers for OTC drugs  positively influence the purchase behavior. Past experiences and own knowledge generally impact rural consumers because of accessibility. 

Discussion

Explored review of literature provided different types of data and themes that discussed marketing signals and brand positioning, its factors and consumers' buying behavior. As per the literature explored and studied existing literature lacking:

• Brand positioning in the pharmaceutical sector with respect to regions.
• Brand positioning and its relationwith consumer behavior.
• Factors influencing brand positioning for selected categories of drugs.

 All these concepts are considered in this review paper, providing suggestions for future research. Literature review found quantitative and primary studies were more focused by authors. In most of the studies cross-sectional and convenience sampling techniques were followed. Descriptive survey designs with structured questionnaires were followed with primary data collection techniques in Indian studies.

Critical appraisal was done for methodological techniques used for 45 studies conducted after 2000. Literature review explored studies were varying in geographic locations, different methodological designs (structured, open ended, close ended, dichotomous questionnaire), (Carmina Fandos and Carlos Flavia´n, 2006), (Merja Halme, Kari Linden and Kimmo Kaaria 2009), (Paul A. Bottomley, John R. Doyle, 2006).  Secondary studies (Noopur Sapatnekar, 2015), Dr. Santosh Ram Pagare2019), were also included that analyzed magazines, newspapers, and published empirical studies. (Merja Halme, Kari Linden and Kimmo Kaaria, 2009), (Neelkanth M Pujari. et al, 2016), (K. Santhana Lakshmi, et al, 2017) to get better idea related positioning factors and consumer buying behavior. Some studies have varying types of respondents (Sang-Eun Byun &Byoungho Jin, Brenda Sternquist,2004), (Aniruddha Bhowmick,Dr. Mridanish Jha,2017), (Vani Nikhil Laturkar) who had varied responses related to brand places in consumer’s mind which will be helpful for companies to consider before targeting their products in market and getting market share. Different analytical techniques by (Dr. R.K.Srivastava, 2017), (Dr. Abhishek and Dr. Kavaldeep Dixit, 2017), (Lisa Aufegger, Celine Yanar, Ara Darzi and Colin Bicknell, 2021), (Merja Halme, Kari Linden and Kimmo Kaaria, 2009) were used to analyze consumer responses.

Rare qualitative studies were found related to brand positioning and consumer behavior. Maximum literature covers empirical studies. (M Babu, 2007) used a combination of two sampling techniques as random sampling further used for snowball sampling technique. (Dr. Pinaki Ranjan Bhattacharyya & Joydeep Das, 2020) used stratified sampling technique to study packing attribute influence on consumer purchase decision. Studies by (Dr. Nilesh Bera, 2014. Dr. R.K.Srivastava, 2017, Mangesh Patil.2019, R.K. Srivastava, Aarti T more. 2010) used primary data collection as well as secondary data collection techniques. Whereas study by (Aniruddha Bhowmick, Dr. Mridanish Jha, 2017) used focus groups to collect data from pharmacists, consumers, doctors, retailers and from grocery stores.  (Colin Bicknell, Ara Darzi, Celine Yanar, and Lisa Aufegger, 2021) study conducted in London used open ended questionnaire and sensitivity analysis techniques to analyse the data. This study found educational and promotional efforts improve the perception of consumers. (R.K. Srivastava 2010), employed multiple methodologies like (focus groups, face to face interview, survey and secondary data analysis,  to get consumer preferences related  aesthetic attributes of OTC drugs whereas (Hannele Kauppinen-Raisanen, 2010), applied conjoint analysis to study the influence of external  packing size, design, font size and internal  color, taste, smell,  shape, attributes of OTC products. (Hannele Kauppinen-i Richard A. Owusu Bylon Abeeku Bamfo. 2012), compared consumers choices for internal , external  packing attributes  for three countries like Finland, Ghana and USA using conjoint analysis technique.

Review of articles revealed that use of OTC drugs is common in consumers, but the place of any brand in consumer mind influences their way of thinking, they consider while buying any drug product. Review studies reported brand image (RK Srivastava, and Sanjiwani Jayant Kumar, 2015), Kanupriya Adlakha, Sanjeev Sharma,2019), (Albari,Indah Safitri, 2018),  quality of brand (Imran Nadeem Siddiqui, Dr. J.H.Vyas and Jay Kumar Dewangan, 2015), price of brand (Lisa Aufegger , Celine Yanar, Ara Darzi and Colin Bicknell, 2021), (Gautam Srivastava,2013), packing (Hannele Kauppinen-Raisanen,2010), (Hannele Kauppinen-Raisanen Richard A. Owusu Bylon Abeeku Bamfo, 2012),  of drug products and their aesthetic attributes (R.K. Srivastava 2010),  were the  marketing stimuli targeted by pharmaceutical companies to make their specific place in consumer mind. As per the studies conducted all factors influence the consumer buying behavior.In relation to other studies many studies (Dr. Abhishek and Dr. Kavaldeep Dixit, 2017), (Priyanka Dubey, Neelkanth M Pujari, Puja Kumari, Anupam K Sachan, 2016), (Pankaj Kumar Tiwari, 2016), (Aniruddha Bhowmick, Dr. Mridanish Jha, 2017), (M Babu 2007) reported factors like family, friends, doctor advice, past experiences, advertisements, degree of sickness, type of disease, shopping site influence consumer buying behavior toward OTC drugs. (RK Srivastava and Sanjiwani Jayant Kumar, 2015) identified positioning factors and suitable conditions required for the promotion of medicines in which the medicine has to be taken. (Puja Kumari, Priyanka Dubey, Anupam K Sachan, Neelkanth M Pujari, Anupam K Sachan, 2016) found physicians, pharmacist advice has less importance for decision making of consumers as compare to cost of product whereas   study by (Dr. Abhishek and Dr. Kavaldeep Dixit, 2017), (M Babu 2007) (Pankaj Kumar Tiwari, 2016), found doctors’ advice or pharmacist advice were important factors for decision making of consumers. A similar study by (Dr. Abhishek and Dr. Kavaldeep Dixit, 2017), found using promotional tools, positioning factors like (price, packing, brand name) involvement of Pharmacist and physician will improve awareness of consumers that will further influence the market share of brands for OTC drugs.

A comparative study in Mumbai, Nasik and Pimpalgaon by (R. K. Srivastava & Sadhna Wagh, 2017) found availability and accessibility majorly influences the purchase behavior of consumers as compared to price, company image and aesthetic attributes. Similar studies by (Vani Nikhil Laturkar) for herbal drugs were conducted and found company image, easy availability, brand image, price of product; convenient packing has great influence on decision making of consumers. Market share by OTC products (Aniruddha Bhowmick/Dr. Mridanish Jha, 2017) was effectively studied with market dominating and nonmarket dominating factors influencing consumer decision making process. An opposing study in Romania (A.I. Iancu, S.D. Cirstea, and C. Moldovan-Tes elios 2016)   found as price, brand producer, information on advertising has least effect on consumer decision making which were the most focused factors in some studies (Aniruddha  Bhowmick/Dr. Mridanish Jha, 2017 ), (R. K. Srivastava & Sadhna Wagh, 2017).

In most of the reviewed studies the gap was found in brand positioning factors and its relation with buying behavior of consumers with respect to demographics variations, geographic location.  Review of literature gives ideas about positioning factors and poorly explored influencing factors like influence of awareness, perception, demographic variables like income, age, gender, education, accessibility of consumers, availability and affordability of products.

Conclusion

As per the review of literature related, brand positioning and consumer behavior, there is a lack of quantitative empirical studies related to OTC drugs in the pharmaceutical field. The study provides the extent of problem and methodological lacking in existing literature. Location of consumers and choice of consumers could be a focused area which is not explored to a large extent in the pharmaceutical field. The study represents specific areas for OTC drugs, providing insight for marketing stimuli, positioning factors, consumer purchase behavior and various influencing variables which will further influence consumer behavior.  Pharmaceutical companies can make use of reviewed marketing stimuli to target specific areas to get market share in a competitive environment.

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