1 Introduction

Condom use remains a cornerstone of global sexual health strategies with sales averaging around 60.89 billion units annually from 2015 to 2024. Global condom market reached USD 6.35 billion in 2025, projected to grow to USD 6.98 billion in 2026 and USD 16.80 billion by 2034 at an AGR of 11.60%. Market growth in EU member states are reflective of the global trends. Germany’s condom segment benefits from strong public health campaigns, while France sees steady demand via pharmacy/e-commerce channels; the UK reports robust sales growth (aligned with Europe’s overall 25% regional share), though university student usage remain inconsistent (e.g., 57–61% last intercourse per WHO HBSC ), highlighting opportunities for targeted marketing akin to UCC needs, These are is driven by rising awareness of STIs, family planning, and innovations like eco-friendly and non-latex options. Worldwide, condom promotion programs have stronger effectiveness, as evidenced by a systematic review of 99 peer-reviewed articles from 2000 to 2019, where 85% achieved positive effects on condom use measures like attitudes, norms, and behaviors. These programs, often using social marketing’s four Ps (product, price, place, promotion), targeted HIV/STI prevention and showed high success rates, of up to 85%, for both behavioral outcomes (e.g., consistent use), pre-behavioral changes (e.g., beliefs), and up to 96% for sales/distribution increases [18].

Understanding consumer behaviour of condoms at the global stage is essential because, purchasing decisions are influenced by factors such as perceptions, preferences, and attitudes which are in turn shaped by marketing strategies [8, 12, 31, 35]. This is particularly true among elite communities like university campuses with diverse and highly educated populations where retailers most focus on responding to diverse consumer behaviours to gain a competitive edge by creating strong brand images and adopting holistic approaches to consider the entire purchasing process [11, 13, 15, 25].

In recent years, social marketing programs have expanded condom markets in developing regions through targeted promotion, brand-specific advertising, and subsidized distribution to high-risk groups like youth, though consistent use varies by region and demographics [39, 45]. In Sub-Saharan Africa, condom use among sexually active individuals is reported to remain low with existing meta-analyses highlighting fluctuating trends and the need for stronger interventions to curb transmission if sexually transmitted diseases [17]. The study reports a pooled prevalence of 44.66% (95% CI: 18.49–70.83) for consistent condom use among sexually active HIV-positive individuals in Sub-Saharan Africa, based on 33 studies. Research further express emphasizes on social marketing’s role in improving availability and equity, as seen in countries like Ethiopia, with yet barriers like stigma and access continuing to persist [39].

In Ghana, peer-reviewed published studies with details on marketing strategies for condoms remain scarce in literature, with only scanty evidence available but drawn from earlier studies. Specific studies like that of Tweneboah-koduah and Owusu-frimpong [48] reveal the use of social marketing strategies by organizations such as Ghana Social Marketing Foundation (GSMF) and DKT to promote some brands of condoms like Champion and Fiesta. It is further revealed that such promotion faces cultural constraints. From the 2014 DHSD, Ahinkorah et al., [2, 3] found that, among 971 men who have never married, exposure to family planning media messages significantly increased consistent condom use odds by 51% (aOR = 1.51), alongside factors like higher education and wealth. Among tertiary students, condom use self-efficacy predicts intentions and actual use, but recent data show only 46–52% usage in last encounters, with 93% of sexually active students in some surveys avoiding contraceptives altogether [10].

At the global level are systematic reviews documenting condom promotion effectiveness but mostly with a focus on program outcomes rather than marketing’s causal impact on consumer purchasing or preferences. Although marketing strategy is widely recognized as a key influencer of consumer purchasing behaviour [23, 34, 46, 47], most global studies examined individual elements such as product positioning, pricing and promotion [21] without exploring the collective impact on consumer purchasing behaviour. While there seems to be no studies systematically linking marketing mix elements (4Ps) to buying decisions, cultural moderators remain unexamined despite adolescent use declines. Although research on tools like digital marketing and advertising may further highlights some influence, it often lacks a holistic perspective [36]. In the case of Ghana, national strategies documenting GSMF/DKT promotion for some brands like Champion and Fiesta lack empirical analysis. Moreover, studies like Asante et al., [10] and Ahinkorah et al., [2, 3] examine self-efficacy or media exposure effects on intentions to use and actual use but do not dissect specific marketing strategies and or their direct impact on purchasing behavior preferences among tertiary students.

To address these gaps, the current study explores how the core elements of marketing mix, product, price, place and promotion jointly influence consumer behaviour of condom purchases while considering cultural and contextual issues as moderating factors. This offers an integrated understanding of the dynamics between marketing strategies, consumer purchasing behaviour, and broader environmental factors. The focus, condom use, is particularly important because of the central role condom plays in sexual health, with yet consumption often influenced negatively by cultural beliefs. Condom use among university students is important because of the limited research attention despite its public health importance. Building on this foundation, the objectives of the study are clearly outlined, (1) to examine the relationship between marketing strategy and consumer purchasing behaviour of condoms, (2) evaluate the role of promotional strategies in shaping consumer preferences and buying decisions of condoms, (3) analyze the impact of the marketing mix on consumer purchasing behaviour, and (4) investigate how cultural and contextual factors moderate the relationships between marketing strategies and consumer behaviour of condoms.

The significance of the study lies in its potential to provide condom manufacturers and importers with a deeper understanding of how marketing strategies influence consumer behaviour. By uncovering the complex relationships between marketing approaches and consumer decision-making, it provides firms with a strategic advantage in influencing consumer behaviour, driving growth, and maintaining competitiveness. The study can help condom manufacturers and importers refine marketing strategies to better resonate with target audiences, enhance customer satisfaction through tailored experiences, differentiate themselves from competitors, establish a unique market position, and inform data-driven decisions to optimize marketing investments and improve return on investment. Ultimately, it delivers practical recommendations for condom manufacturers and importers while contributing to academic literature and advancing strategic business practice.

2 Literature review

2.1 Theoretical foundations and study linkages

Models such as the Theory of Planned Behaviour emphasizes attitudes, norms, and perceived control [5,6,7]; Maslow’s hierarchy of needs of 1943 links purchasing motives to levels of need [33]; and the Engel-Kollat-Blackwell model frames consumption as a process from need recognition to post-purchase evaluation [51]. Other theoretical perspectives, such as Selective Perception [16] and reference group influence [32], highlight how cultural and social cues guide decisions. While these frameworks collectively suggest that marketing strategies particularly promotion, product positioning, and advertising play a decisive role in shaping purchasing behavior, the current study specifically adopts the theory of planned behavior and Hofstede’s cultural dimensions theory.

Theory of Planned Behaviour was built on the Theory of Reasoned Action [19]. It posits three main constructs influencing intention to perform a behavior. These are attitude toward the behavior, subjective norms, and perceived behavioral control (self-efficacy). While actual behavior is influenced by these intentions, it is moderated by control factors [7]. The Hofstede’s cultural dimensions theory [24], comprises of six dimensions. These are (1) power distance, (2) individualism vs. collectivism, (3) masculinity vs. femininity, (4) uncertainty avoidance, (5) long-term vs. short-term orientation, and (6) indulgence vs. restraint. These six dimensions provide a robust framework for understanding the effects of cultural values in shaping consumer behavior for sensitive product categories like condoms which purchase decisions have the potential to be influenced by stigma. By integrating dimensions of the model, the study test how cultural moderators influence promotional effectiveness and buying intentions, enabling tailored strategies to overcome barriers in restrained Ghanaian contexts.

TPB directly models how marketing strategies influence students’ attitudes (e.g. promotional messaging), norms (e.g., peer-endorsed adds), and control (e.g., accessible distribution). This help to fill gaps in existing Ghanaian research by linking elements of marketing mix to purchasing intentions and behavior in a sensitive product category. In explaining the core variables of the study using the TPB, the authors specifically posit:

  1. i.

    Marketing Strategy/Marketing Mix as the independent variable influencing attitude toward condom purchase (e.g., perceptions of product quality and promotion via advertising/social media shaping positive evaluations) and subjective norms (e.g., place/distribution via peer-accessible channels which reinforce social acceptance).

  2. ii.

    Perceived Behavioral Control is shaped by price (affordability barriers) and place (availability), predict intention to purchase.

  3. iii.

    Consumer Purchasing Behaviour as the dependent variable reflecting actual purchase as the outcome of intention moderated by control factors.

On the other hand, Hofstede’s framework is used to contextualize cultural moderators such as how collectivism shapes subjective norms around condom stigma. Specifically, religion and ethnicity align with collectivism/restraint dimensions. this amplifies or weakens marketing effects. Example, high restraint in Ghanaian Christian/Muslim groups heightens stigma, moderating promotion’s impact on norms whiles uncertainty avoidance affects product trust. Place of residence does not moderate, as urban/rural access equalizes via distribution,

2.2 Marketing strategy and consumer purchasing behavior

Marketing strategy is a comprehensive set of actions and decisions made by a company to achieve its marketing objectives and gain a competitive edge in the market [44]. It includes identifying target markets, positioning, product development, pricing, promotion, and distribution strategies. Effective marketing strategies directly contribute to business success by driving sales, increasing market share, and enhancing brand equity [4]. Companies that align their marketing strategies with customer needs and preferences are better positioned to gain a competitive advantage, foster customer loyalty, and achieve sustainable growth. By continuously adapting to market trends and consumer demands, companies can differentiate themselves from competitors and meet their marketing objectives.

Consumer purchasing behaviour refers to the actions individuals take when deciding to acquire products or services, influenced by personal psychological, social, cultural, and situational factors [40]. Personal factors, such as age, income, and occupation, impact buying patterns, while psychological factors like perceptions and attitudes shape decisions [26, 31]. Social factors, including family and peer influence, and cultural factors, such as shared beliefs and values, also affect purchasing choices [28]. Consumer behaviour is complex and influenced by psychological, social, cultural, and contextual factors [8, 12], making it essential to consider products behavioural theories that explain purchasing processes.

Marketing strategy is widely regarded as a fundamental determinant of consumer purchasing behaviour, shaping how individuals perceive, evaluate, and decide on [23]. A well-designed strategy typically integrates the marketing mix product, price, place, and promotion to influence customer decisions and build loyalty.

Empirical studies provide strong support for the theoretical insights. Some studies found that effective product positioning enhances consumer preference [20, 27], while others showed that persuasive advertising influences attitudes and purchase intent [50]. Pricing remains influential, with Gospi [22] and Li et al., [30] demonstrating the role of price fairness and dynamic pricing. Branding also matters significantly in consumer purchasing behavior. According to Lee et al., [29] and Aaker and Shansby [1], brand equity and personality predict consumer loyalty. In condom use specifically, Nkwei et al., [37, 38] revealed that brand trust and satisfaction drive consistent use among youth, while Olson et al., [39] showed that social marketing improves affordability and accessibility in low and middle income countries. A meta-analysis by Sweat et al., [45] further confirmed that culturally sensitive promotional strategies increase condom uptake across diverse populations. Overall, the literature establishes that the marketing mix (product, price, place, promotion) moderated by factors such as religion, ethnicity, and cultural norms is central to explaining consumer purchasing behaviour, particularly in the case of sensitive health products like condoms. Effective marketing strategies influence consumer perceptions, attitudes, and preferences. Studies reveal that strategies like personalized recommendations, social influence, and promotional activities significantly impact purchase decisions, especially in e-commerce and online shopping contexts [41]. Marketers can strengthen these strategies by creating emotional connections and building trust through marketing campaigns.

2.3 Operationalization of constructs

Marketing Strategy/Marketing Mix is defined as multidimensional construct via the 4Ps (price, place, product and promotion). Product is measured using 3 items, specifically, quality, variety and design. Price is measured using 3 items, specifically, reasonableness, value and variety. Place is measured using 3 items, specifically, retail trust, availability, and online purchasing. Promotion is also measured using 3 items, specifically, ads, social media, endorsements.

Consumer Purchasing Behaviour is opertionalised as a multidimensional construct which is measured using 7 items, capturing ads; price, quality and brands; promotions/discounts; personal preferences/needs; CSR; packaging and branding preferences; and convenience and accessibility. It is measured as Likert-scale intentions/behaviors.

Moderators are measures as categorical variables using Religion (Christians, Muslims and Traditionalists) and Ethnicity (Akan, Ga, Ewe and others.

2.4 Conceptual framework

The conceptual framework for the study illustrates how marketing strategies and consumer purchasing behavior influence each other directly. It further shows that marketing mix (product, price, place, and promotion) affect consumer buying decisions. These relationships justify the use of Pearson’s correlation, Spearman’s rank correlation, and multiple regression analysis. Additionally, the framework incorporates contextual factors such as culture and societal norms as moderators of the relationship between marketing strategy and consumer behavior. This means that the impact of marketing strategies may differ depending on the consumer’s cultural background. The framework explains the importance of aligning marketing strategies with consumer needs and motivations. The framework depicts the multidimensional Marketing Mix (4Ps) directly influencing Consumer Purchasing Behaviour, with specific TPB-mapped paths and Hofstede-based moderators (both in dotted arrows from culture/social norms). It is worthy to note that the feedback path from Consumer Purchasing Behaviour to Marketing Strategies reflects the well-established principle in marketing management that consumer purchasing outcomes provide firms with market intelligence that informs and refines subsequent marketing strategy decisions. Consumer purchasing patterns are routinely used by organisations to recalibrate their marketing mix and promotional focus. This bidirectional conceptualisation is consistent with the interactive marketing systems perspective. The conceptual framework is illustrated in Fig. 1 below.

Fig. 1
Fig. 1
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Diagrammatic representation of conceptual framework. (Derived from TPB and Hofstede’s framework with moderators)

3 Research methodology

The study employed a quantitative, cross-sectional survey. This was considered appropriate for examining relationships between marketing strategies and consumer purchasing behaviour. The design enabled the collection of standardized data from a large group of respondents, allowing for statistical analysis of research hypotheses. The population of the study consisted of regular students at the University of Cape Coast (UCC), estimated at approximately 7,000. These are students residing at the University campus. Using Slovin’s formula at a 5% margin of error, a sample size of 413 respondents was determined. To ensure representativeness across the student body, stratified random sampling was applied to divide the population into strata based on faculty. Stratified and random sampling was preferred over just the simple random or the non-probabilistic techniques because UCC student population is heterogeneous across faculties with different disciplinary cultures and demographic compositions. By stratifying on faculty and proportionately allocating sample units, the technique ensures that each sub-group is adequately represented in the final sample, thereby enhancing the external validity of the findings and reducing sampling bias.

Data were collected using a structured questionnaire, designed to capture responses on the four marketing mix elements (product, price, place, promotion) as independent variables and consumer purchasing behaviour as the dependent variable. Moderating variables including religion, ethnicity, and place of residence were also measured. The questionnaire employed a five-point Likert scale, ranging from “strongly disagree” to “strongly agree.” Prior to administration, the instrument was pre-tested to ensure clarity and reliability. Ethical considerations were strictly observed, with respondents assured of confidentiality, anonymity, and voluntary participation.

The data were analyzed using descriptive statistics (frequencies, percentages, means, and standard deviations) to summarize demographic characteristics and responses. The internal consistency of the scales was assessed using Cronbach’s alpha, confirming reliability of the constructs. Pearson correlation analysis was conducted to establish the strength and direction of associations between marketing strategies and consumer purchasing behaviour. To test predictive relationships, multiple regression analysis was performed. Furthermore, moderation was tested within the PLS-SEM framework using the product-indicator approach, whereby interaction terms were constructed by multiplying the standardised scores of the predictor with each moderator variable. This approach is recommended for testing moderation in PLS-SEM because it preserves the reflective nature of the constructs and produces unbiased interaction estimates. The significance of each interaction path was assessed using bootstrapping with 5000 subsamples, which generates biased-corrected confidence intervals for the path coefficients without assuming normality of the sampling distribution. A moderating effect was considered statistically significant when the 95% biased-corrected confidence interval of the interaction path coefficient excluded zero and associated p-value was below 0.50. the standardised path coefficient for each interaction term quantifies the change in the strength of the relationship between marketing strategy and consumer purchasing behaviour for each unit change in the moderator variable. Positive interaction coefficients indicate that higher levels of the moderator amplify the marketing strategy-purchasing behaviour, while non-significant interaction indicate that the moderator does not alter this relationship. The method was selected for its predictive power, compatibility with non-normal data distributions, capacity to handle complex moderation models, and established use in consumer behaviour research. These reasons collectively demonstrate that PLS-SEM is the most appropriate analytical tool for meeting the study’s objectives.

Also, the research hypotheses were developed to address the main research problem and its sub- questions, focusing on the correlation and influence among the study variable. The hypotheses were formulated as follows:

  • H1: There is a significant relationship between marketing strategy and consumer purchasing behaviour of condoms.

  • H2: Promotional strategies have significant effect on consumer preferences and buying decisions of condoms.

  • H3: The marketing mix significantly influences consumer purchasing behaviour.

  • H4: Cultural and contextual factors moderate the relationship between marketing strategies and consumer behaviour of condoms.

The study involved human participants, therefore, all ethical requirements enshrined in the ICMJE guidelines on protection of research participants, the Belmont Report or the Declaration of Helsinki were followed. The requirement for ethical approval was waived by the Institutional Review Board of the University of Cape Coast. However, respondents’ consent to participate was sought. Informed consent to participate in the study was obtained from participants before they were allowed to participate. The study was self-funded because it did not receive any funding from external organizations.

4 Findings

4.1 Demographics characteristics of respondents

Analysis of the demographic profile of respondents from the University of Cape Coast, covering age, gender, education, occupation, place of residence, and the cultural and contextual factors of religion and ethnicity, which together provide context for analyzing consumer purchasing behaviour of condoms is presented in Table 1 below.

Table 1 Demographic characteristics of respondents
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From the Table 1 above, majority 212(51.3%) were females. Again, majority 331(80.1%) of the respondents falls within the age group of 18–25, followed by 26–33 76(18.4%), 34–41 6(1.5%). In addition, 397(96.1%) of the respondents were single, while 16(3.9%) were married. With regards to level of education, 326(78.9%) had degree, 36(8.7%) had a diploma, 45(10.9%) had other level of education and 5(1.2%) had master’s degree. Regarding employment status, 300(72.6%) of the respondents were students, 68(16.5%) were employed, 25(6.1%) were entrepreneurs and 20(4.8%) were unemployed. With respect to religion, 382(92.5%) were Christians, 25(6.1%) Muslims, 6(1.5%) Traditionalist. In terms of Ethnicity, 300(72.6%) of the respondents were Akan, 51(12.3%) were others, 28(6.8%) were Ga and 34(8.2%) were Ewe. Lastly, 174(42.1%) respondents were from rural areas, 214(51.8%) urban and 25(6.1%) sub-urban.

4.2 Descriptive analysis of marketing strategy variables

This section highlights the analysis of how marketing strategies influences consumer behaviour towards the purchasing of condoms. It focuses on important aspects such as, the perceived information gotten from advertisements, how effective brand marketing strategies are, the impact social and public relation has in influencing consumer purchasing behaviour. In addition, the key highlights of this section explore how advertisement exposure and overall marketing approach contributes to shaping awareness and purchase decision. Table 2 below provide summary of the descriptive statistics on the influence of marketing strategies on consumer behaviour towards the purchasing of condoms.

Table 2 Marketing strategies
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The table above displays that respondents had a positive perception of the marketing strategy used, with an overall average mean score of 4.182. Among the six indicators, MS4 received highest rating with the mean of 4.41, indicating that it was the most effective strategy according to respondent. MS2 had the lowest mean (3.98), indicating that it was the least impactful.

4.3 Consumer purchasing behaviour of condoms

This section explores the factors that influence consumers buying decisions, i.e. advertisement, promotions, brand reputation, convenience, social and environmental responsibility. It also assesses how personal preference, impulsive buying patterns, perceptions of value and accessibility affect purchases of condoms. Table 3 below provides statistics on the factors influencing consumer buying decisions.

Table 3 Consumer purchasing behaviour
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Table 3 above shows that respondents generally agreed that the factors measured influenced their condom purchasing behaviour, with an overall average mean of 4.069. The highest-rated item was CPB7 with the mean of 4.27. The lowest-rated was CPB3, recording a mean of 3.66.

4.4 Marketing mix

In this section, the factors that shape consumer choices and brand loyalty are examined. It examines how the elements of the marketing mix, that is the 4Ps (price, promotion, place and product) influence respondents’ preferences and purchasing decisions for condoms, in relation to convenience, accessibility and brand’s social and environmental responsibility. Table 4 below provides summary statistics of how price, as an element of marketing mix, shapes consumer choice and brands loyalty.

Table 4 Marketing mix (price)
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From Table 4 above, average mean score for the price-related indicators is 2.92, indicating a neutral to slightly low agreement among respondents regarding the influence of pricing strategies on their purchasing behaviour. Among the three items, MMPrice3 had the highest mean (3.44). On the other hand, MMPrice2 recorded the lowest mean (2.30), showing limited agreement from respondents. The relatively high standard deviations (ranging from 1.466 to 1.629) indicate varied opinions across respondents. Further analysis were made on the effect of promotion, as an element of marketing mix, on consumer choice and brands loyalty. Table 5 below provides the summary statistics.

Table 5 Marketing mix (promotion)
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From Table 5 above, promotion received stronger support from respondents, with an overall average mean of 3.85, showing positive agreement on its influence. MMPromotion1 had the highest mean (4.23), indicating that this promotional strategy was the most impactful. MMPromotion2 had the lowest mean (3.49), though still above average. The standard deviations (around 1.2) show moderate consistency in responses. Table 6 below also provides summary statistics of the effect place, as an element of marketing mix, on consumer choice and brands loyalty.

Table 6 Marketing mix (place)
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The statistics on the Place component of the marketing mix, as illustrated in Table 6 above, shows a moderate overall perception, with an average mean score of 3.60. Among the three indicators, MMPlace1 had the highest mean score of 4.31, indicating that respondents viewed this aspect of the distribution strategy favorably. In contrast, MMPlace2 and MMPlace3 had lower mean scores of 3.30 and 3.20, respectively, suggesting weaker performance in those areas. The overall standard deviation of 1.250 indicates a relatively high level of variation in responses, which points to inconsistencies in customer experiences with the distribution channels. Again Table 7 below provides summary statistics on the influence of product, as an element of marketing mix, consumer choice and brands loyalty.

Table 7 Marketing mix (product)
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From Table 7 above, the product component of the marketing mix received generally positive feedback, with an overall average mean score of 4.13. MMProduct1 scored the highest at 4.27, with the lowest standard deviation of 0.910, indicating that this aspect of the product offering is not only well-regarded but also consistently experienced across respondents. MMProduct2 and MMProduct3 also received favorable ratings with mean scores of 3.97 and 4.14, respectively, though MMProduct2 showed slightly more variability in responses. The overall standard deviation for the product indicators is 1.037, which is lower than that of the Place component, suggesting more consistent perceptions among respondents.

4.5 Reliability analysis of research instruments

To ensure the consistency of the measurement instruments, Cronbach’s Alpha reliability tests was performed. The results are presented in Table 8 below.

Table 8 Reliability coefficients of key constructs
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From the Table, 8 above the Marketing Strategy construct, measured with 6 items, has a Cronbach’s Alpha of 0.716, which is interpreted as acceptable. The Promotional Strategy construct, with 3 items, has an alpha of 0.778, interpreted as acceptable to good. The consumer purchasing behaviour construct, measured with 7 items, has an alpha of 0.819, interpreted as good. Finally, the Marketing Mix construct, measured with 12 items, has an alpha of 0.827, also interpreted as Good.

4.6 Marketing strategy and consumer purchasing behaviour

Hypothesis 1

states that, there is a significant relationship between marketing strategy and consumer purchasing behaviour of condoms. To evaluate this, Pearson Correlation analysis was conducted. The results are presented in Table 9 below.

Table 9 Effect of marketing strategy on consumer purchasing behaviour
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Table 9 above reports the results of a statistically significant and positive correlation between the two variables, r = .565, n = 413, p < .001. There is a statistically significant, positive relationship between marketing strategy and consumer purchasing behaviour. This finding implies that improvements in marketing strategies such as pricing, advertising, and branding are associated with increased consumer willingness to purchase condoms. The correlation is moderate to strong, indicating a meaningful relationship between the constructs.

4.7 Promotion strategy and consumer purchasing behaviour

Hypothesis 2

states that, promotional strategies have significant effect on consumer preferences and buying decisions of condoms. To test this hypothesis, a multiple regression analysis was used to test how three promotional variables, advertising, social media, and celebrity endorsement predict consumer purchasing behaviour. Tables 10 and 11 below illustrate the regression results on the influence of promotional strategies on consumer preferences and buying decisions of condoms.

Table 10 Effect of marketing strategy on consumer purchasing behaviour
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From Table 10 above, the model was statistically significant, F(3, 409) = 126.19, p < .001, and explained 47.8% of the variance in consumer purchasing behaviour (R² = 0.478). Promotional strategy had a significant positive effect on consumer purchasing behaviour, B = 548, p < .001, indicating that stronger promotional strategies are associated with higher levels of condom purchase behaviour.

Table 11 Regression coefficients of elements of Promotional on Consumer Behaviour
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The analysis in Table 11 above revealed that both advertising (β = 0.503, p < .001) and social media promotions (β = 0.255, p < .001) had significant positive association on consumer purchasing behaviour. However, celebrity endorsement was not a significant predictor (p = .918).

4.8 Marketing mix and consumer purchasing behaviour

Hypothesis 3

states that, marketing mix significantly influences consumer purchasing behaviour. To test this hypothesis, a multiple regression analysis was conducted to assess the influence of the entire four elements of the marketing mix, i.e., product, price, place, and promotion on consumer purchasing behaviour. The results are summarized in Table 12 below.

Table 12 Effect of market mix on consumer purchasing behaviour
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The results in Table 12 above shows that, the model was statistically significant, F(4, 408) = 83.61, p < .001, and accounted for approximately 48.7% of the variance in consumer purchasing behaviour (R² = 0.487). Price strategy had a statistically significant positive influence on consumer purchasing behaviour, β = 0.521, p < .001, indicating that favorable pricing enhances the likelihood of condom purchases. The regression coefficients for the individual elements are shown in Table 13 below.

Table 13 Regression coefficients for marketing mix predicting consumer behaviour
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The results in Table 13 shows that promotion (β = 0.453, p < .001) and product (β = 0.311, p < .001) had significant positive effects on consumer behaviour of condoms. In contrast, price and place were not statistically significant.

4.9 Moderating effect of contextual factors

Hypothesis 3

states that, Cultural and contextual factors moderate the relationship between marketing strategies and consumer behaviour of condoms. To test this hypothesis PLM-SEM was employed, as illustrated in Fig. 2 below. The fourth objective was to examine the moderating effects of contextual factors, specifically, religion, ethnicity and place of residence on the relationship between marketing strategy and consumer purchasing behaviour of condoms. Given the sociocultural sensitivity of the product, it was hypothesized that individuals’ responses to marketing may vary based on their religious beliefs, cultural background, or residential setting.

Fig. 2
Fig. 2
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Moderating effect of contextual factors

Figure 2 above illustrates the conceptual model for Objective Four, which aimed to examine how contextual and cultural factors moderate the relationship between marketing strategy and consumer purchasing behaviour. The solid path from Marketing Strategy to Consumer Purchasing Behaviour represents the direct influence of marketing efforts (such as product, price, place, and promotion) on consumers’ decisions. The path from Cultural and Contextual Factors to the interaction point implies a moderating effect suggesting that the strength or direction of the marketing strategy’s impact on consumer behaviour depends on individuals’ backgrounds, including their religion, ethnicity, place of residence, education level, and income. This indicates that the effectiveness of marketing strategies varie across different consumer groups, reinforcing the importance of tailoring marketing approaches to align with the socio-cultural context of the target audience. Table 14 below provides the path estimates for the model.

Table 14 Path estimates for moderation model
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As presented in Table 14, the moderating effects results depicts that, Religion significantly moderated the marketing strategy, consumer purchasing behaviour relationship (β = 0.174, p = .012), indicating that the influence of marketing strategies on purchasing behaviour differs meaningfully across religious groups. Ethnicity similarly emerged as a significant moderator (β = 0.142, p = .038), suggesting that consumers from different ethnic backgrounds respond differentially to the same marketing approaches. Place of Residence, however, did not significantly moderate the relationship (β = 0.054, p = .210), implying that urban-rural differences do not meaningfully alter how marketing strategies shape condom purchasing decisions in this context.

This result posits that moderating roles of religion and ethnicity indicate that a one-size-fits-all marketing approach is insufficient when promoting sensitive health products like condoms. Marketers must therefore develop culturally tailored messaging that resonates with the values and norms of different religious and ethnic groups, ensuring that campaigns are framed in ways that align with the moral and social sensibilities of their target audiences. The non-significant effect of place of residence is equally informative, redirecting attention away from geography toward cultural identity as the more decisive contextual factor in shaping consumer responses to marketing. From a public health perspective, these findings reinforce the argument that sexual health communication is not merely a marketing challenge but a deeply sociocultural one. Health organisations and NGOs should therefore collaborate with religious leaders and ethnic community representatives to co-design campaigns that are both credible and culturally acceptable, as doing so not only improves the reach and effectiveness of health promotion efforts but also helps reduce the stigma and cultural barriers that often inhibit condom purchasing behaviour.

4.10 Discussion of findings

The results showed a strong and statistically significant positive correlation between marketing strategy and consumer purchasing behaviour (r = .565, p < .001). This means that when marketing strategies are well thought out addressing the product’s quality, fair pricing, effective promotional messages, and ease of access, people are more likely to purchase condoms. This is in line with the argument that an integrated marketing mix increases the likelihood of purchase because it addresses multiple consumer needs simultaneously. Similarly, Biesty et al. [14] highlighted that effective marketing strategies build trust and relevance, which are particularly important in sensitive product categories like sexual health [14].

Again, promotion as a component of marketing mix had a strong and significant positive effect on purchasing behaviour (β = 0.548, p < .001), explaining 47.8% of the variance. This supports works of Biesty et al., and other, who found that targeted promotions especially those that inform, educate, and emotionally engage consumers are effective in shaping positive attitudes toward health-related products. In our context, this finding suggests that campaigns using relatable, culturally appropriate language and channels can have a measurable impact on behaviour. It also reflects the point made that promotional strategies not only increase awareness but can also reduce stigma and misconceptions surrounding product use [9, 14].

Also, pricing was found it to be a significant driver of consumer purchasing behaviour (β = 0.521, p < .001), accounting for 48.7% of the variance. This confirms that consumers weigh perceived value against cost, and that competitive pricing can tip the balance toward purchase [42, 49]. Biesty et al. [14], similarly emphasized that affordability is critical in low- and middle-income contexts, where disposable income is limited [14]. The implication here is straightforward, even the best promotional strategy may fall flat if the product is priced out of reach for its intended users.

Finally, the findings indicated, religion (β = 0.174, p = .041) and ethnicity (β = 0.142, p = .012) significantly shape the strength of the relationship between marketing strategy and consumer purchasing behavior, while place of residence did not (β = 0.054, p = .210). This resonates strongly with Hofstede’s (2001) cultural dimensions theory, explaining that, culture influences not only what people buy, but also how they interpret marketing messages. Similarly, existing studies indicate that, cultural alignment in marketing increases message acceptance and behavioural follow-through [28, 43, 46, 47]. The moderating roles of religion and ethnicity indicate that a one-size-fits-all marketing approach is insufficient when promoting sensitive health products like condoms. Marketers must therefore develop culturally tailored messaging that resonates with the values and norms of different religious and ethnic groups, ensuring that campaigns are framed in ways that align with the moral and social sensibilities of their target audiences. The lack of a significant effect for place of residence suggests that urban–rural differences in Ghana may not be as pronounced in condom purchasing as previously thought, possibly due to improved nationwide distribution and access. The non-significant effect of place of residence is equally informative, redirecting attention away from geography toward cultural identity as the more decisive contextual factor in shaping consumer responses to marketing.

Taken together, these findings reinforce a central theme in the literature: while a well-designed marketing strategy is powerful, its impact is magnified when it is culturally relevant and supported by fair pricing and effective promotion. In practical terms, this means that marketers and public health actors should focus on the fundamentals clear and engaging promotional messages, accessible and affordable products while also paying attention to the cultural and religious identities of their audiences. Doing so not only aligns with established marketing theory but also reflects the realities uncovered in this study.

5 Conclusions

The study aimed to examine how marketing strategies influence consumer purchasing behaviour, with a specific focus on condom usage. Based on the findings, the following conclusions are drawn and recommendations proposed for different stakeholders. From a public health perspective, the findings that religion and ethnicity moderate the relationship between marketing strategy and consumer behavior of condoms reinforce the argument that sexual health communication is not merely a marketing challenge but a deeply sociocultural one. There is therefore a strong need for health organisations and NGOs to collaborate with religious leaders and ethnic community representatives to co-design campaigns that are both credible and culturally acceptable. Doing so not only improves the reach and effectiveness of health promotion efforts but also helps reduce the stigma and cultural barriers that often inhibit condom purchasing behaviour.

For marketers and condom brands, we propose advertising and social media campaigns to be culturally sensitive, emotionally engaging, and tailored to diverse consumer backgrounds, while innovation in product design such as texture, packaging, scent, and usability should be prioritized to enhance satisfaction. To improve patronage in university campuses, celebrity endorsements should be used cautiously, ensuring endorsers appeal to the religious and ethnic needs of target audience, while partnerships with trusted community and faith leaders can strengthen message credibility given the moderating role of religion and ethnicity.

For public health organizations and NGOs, collaborations with universities, clinics, and student bodies through peer education and digital campaigns can drive awareness, while integrating public health goals with commercial marketing strategies and ensuring discreet yet convenient condom distribution points can encourage consistent use. Product developers and policymakers should involve consumers in the design process to meet user preferences, support culturally tailored sexual health education, and foster public-private collaborations to ensure quality and accessibility religions, while focusing on cultural and contextual factors rather than just residence. Finally, future research should explore the moderating effects of religion and ethnicity in greater depth, adopt qualitative or mixed-methods for richer insights, expand samples beyond a single institution, assess real-life usage patterns rather than only purchase intent, and employ longitudinal approaches to capture the long-term impact of marketing strategies on consumer behaviour.