Fraud vulnerability in online pharmaceutical markets: An experimental study of consumer characteristics influencing recognition of illicit online advertisements

The diffusion of e-commerce has increased the availability of medicines and health-related products online, creating new risks due to deception and the diffusion of illicit products. This study investigates consumers’ ability to recognise the legitimacy of online pharmaceutical advertisements and the characteristics influencing their purchasing behaviour and vulnerability to fraud. Drawing on an integrated framework combining routine activity theory, theory of planned behaviour, and protection motivation theory, this paper argues that fraud vulnerability is actively shaped by consumers’ attitudinal orientations and their capacity to activate protective resources. Data were collected through a Computer-Assisted Web Interviewing survey in Italy and Spain ( N  = 2107). An experimental section presented respondents with images of real advertisements, both legitimate and illicit, asking them to evaluate their legitimacy. Logistic regression models analysed how socio-demographic factors, risk perception, familiarity with online purchases, convenience orientation, trust in healthcare and online sources, and regulatory knowledge affect purchase propensity and classification accuracy. Findings indicate that consumers often struggle to correctly categorise advertisements: only one in five respondents correctly classified all three images shown, and accuracy was significantly lower for illicit than for legitimate offers. Regulatory knowledge emerges as the strongest and most consistent predictor of correct classification, functioning as a concrete coping appraisal resource. Trust in healthcare professionals reduces online purchasing propensity and improves detection of illicit advertisements, acting as an indirect form of guardianship. Convenience orientation and reliance on the internet for alternative health information produce asymmetric effects, improving recognition of legitimate advertisements while reducing vigilance towards illicit ones. Older age is associated with lower classification accuracy, suggesting that digital nativity, rather than formal education, is a key protective factor. These findings support a demand-side policy approach targeting attitudinal vulnerabilities, coping appraisal capacity, and structural hardening of the digital environment.