Introduction

In today’s digital market, the transition of businesses to Industry 4.0 creates a need for marketing strategies1. Due to dynamic changes on the global business scene with the paradigm shift to Industry 4.0, there is an urgency to meet modern customer expectations, achieve operational efficiency to remain sustainable, and achieve business growth2,3. An example of this can be seen in the Prosthetics and Orthotics (Artificial limbs and Braces) medical device industry, where achieving sustainability and growth presents significant challenges, particularly in developing nations.

The research addresses the challenges and gap for developing effective marketing strategies in the medical device industry, specifically within the prosthetics and orthotics sector. It seeks to explore how the integration of Industry 4.0 technologies can enhance business growth by optimizing marketing efforts and creating competitive advantages in emerging economies. Significance of this research lies in exploring how Industry 4.0 technologies leverage marketing strategies in the medical device sector. It advances understanding of technology-driven marketing and offers practical solutions for driving competitiveness and innovation globally4. Research aims to prioritize Industry 4.0 technologies for marketing strategies in the P&O medical device industry to overcome business growth challenges. By focusing on developing countries such as the case study of Pakistan, opportunities in emerging markets will be explored. Choosing Pakistan is relevant due to its diverse cultural dynamics, healthcare policies influenced by politics, a tech-savvy youth population, and the crucial need for Industry 4.0 solutions to optimize marketing strategies and customer engagement in an emerging economy. Unique contributions include integrating Industry 4.0 into marketing and offering insights that can be adapted to other emerging economies and industries. The goal of the proposed model will be to identify and assess opportunities for marketing leverage.

Our research breaks new ground as it is the first in the P&O field; therefore, medical device marketing decision-making processes is a pioneering concept worthy of meaningful and robust study. The author found no research regarding previous studies specific to P&O businesses using primary criteria and hierarchical processes as potential methodologies. The study has selected emerging economies due to their untapped market potential and unique healthcare challenges, offering opportunities to adopt Industry 4.0 technologies. Pakistan was chosen as a case study because of its significant growth potential in the healthcare, alongside challenges like limited access to advanced technologies. By focusing on Pakistan, the study aims to generate insights that can drive business innovation and growth, with findings applicable to other developing countries facing similar constraints.

The need for this study arises from the lack of research in the Prosthetics and Orthotics (P&O) industry regarding how Industry 4.0 technologies can enhance marketing strategies, as traditional models are insufficient to meet the modern, technology-driven needs of these businesses, particularly in markets with unique healthcare challenges. The innovation in this study comes from introducing novel ideas and applying unique methodologies to improve marketing strategies. The research aims to provide valuable insights and practical applications that enhance real-world marketing practices. The study introduces a combined fuzzy logic model to create robust marketing strategies involving Industry 4.0 technologies capable of handling fuzziness, which are considered optimal choices for designing models. These attributes commonly manifest in the healthcare sector, especially in emerging economies.

Scholars have devised various decision-making models tailored to healthcare using the Analytical Hierarchal Process (AHP) method5. Although there is a growing body of literature on Industry 4.0 and healthcare marketing, there is a noticeable gap regarding business strategic capabilities and technological feasibility related to the P&O medical device industry based on alignment with marketing objectives. The study also, presents an innovative decision-making framework tailored for the healthcare sector, allowing for a thorough evaluation of criteria in the Prosthetics and Orthotics (P&O) industry. It also creates an integrated model that aligns marketing strategies with technological advancements, offering practical guidance for improved strategic planning and operational effectiveness in this sector. The methodologies laid out in the study provide a foundation for future research in emerging economies, encouraging the development of new parameters and criteria. This adaptability highlights the study’s novelty and relevance in addressing the challenges faced by emerging markets.

This innovative approach contributes methodologically by introducing a new framework for aligning marketing strategies with the technological capabilities of the P&O industry, utilizing tools like F-AHP/VIKOR and decision support systems to optimize outcomes in emerging economies. Therefore, the novel and innovative nature of our research causes the need to address such questions as;

  1. 1.

    What industry 4.0 technologies must be prioritized to leverage businesses operation in the P&O medical device industry?

  2. 2.

    Will implementing a marketing strategy that includes a combined F-AHP/VIKOR framework be the solution to help P&O medical device businesses be sustainable and profitable?

This research poses these queries to find the best possible outcomes.

To help better understand this study, Business Scope, Marketing Referral Sources, Marketing Resources, and Customer Experience have been identified in addition to Artificial Intelligence (AI)6, Big Data7, Internet of Things (IoT)8, Machine Learning (ML)9, Virtual Reality (VR) and Augmented Reality (AR)10. The research will employ the F-AHP/VIKOR approach to ascertain weightage values and prioritize identified factors. A weightage value will suggest a greater inclination towards selecting the Industry 4.0 marketing alternative as a primary source than those with lower weightage values11. Prior research findings could prove invaluable for comparative analysis, but as previously mentioned, no previous P&O research studies have been done. However, several studies have been carried out for P&O medical device businesses, but they are within other diverse economic contexts12.

The structure of this research consists of an introduction followed by a review of pertinent literature. Next, the Methodology presents a proposed model with Results discussed regarding findings and Case Study. Finally, the work is concluded with suggestions for the future.

Literature review

A Systematic Literature Review (SLR) was performed to identify the essential criteria for incorporating Industry 4.0 technologies into healthcare marketing, with a particular focus on the Prosthetics and Orthotics (P&O) sector. Key studies were summarized and organized in Table 1 for quick reference. The review focused on technologies which were found to enhance personalization, real-time marketing, and data-driven decision-making.

This literature review found several studies that demonstrated pioneering advancements in P&O research. For example, research was conducted based on the economics of innovation in the P&O industry13. At the same time, it investigated technological advancements in prosthetics amid the shift from Industry 1.0 to Industry 4.0, and another study identified and described various dimensions of business models 14. The research was also found to involve establishing theoretical structures for marketing based on recommendations for devising strategies to integrate Industry 4.0 for marketing performance, which identified specific contributing factors such as AI/ML, Big Data, IoT, VR, and AR 15.

Industry 4.0, also known as the fourth industrial revolution, is characterized by the integration of advanced digital technologies into various industries. In marketing, Industry 4.0 technologies have transformed how businesses engage with customers, develop strategies, and make data-driven decisions16. Industry 4.0 technologies have significantly impacted marketing by enabling businesses to deliver highly personalized experiences, tailored to individual preferences and behaviors. The integration of AI/ML, IoT, and Big Data allows for data-driven decision-making, helping marketers make accurate predictions about consumer behavior and trends. Automation of marketing tasks through AI/ML and cloud-based tools improves efficiency and reduces costs. These technologies also facilitate real-time marketing, allowing businesses to adjust campaigns instantly based on customer interactions. Immersive tools like AR and VR enhance customer engagement by creating interactive experiences, while blockchain ensures transparency and security, fostering greater trust in marketing transactions17.

Also, Industry 4.0 technologies are reshaping the marketing landscape, driving innovation, and creating new opportunities for customer engagement. The integration of technologies enables businesses to operate more efficiently, create personalized experiences, and respond to the evolving needs of consumers in real-time. As these technologies continue to advance, their influence on marketing strategies will only grow, helping businesses gain a competitive edge in the market18.

The literature review identified that Industry 4.0 is still a relatively new idea in emerging economies19. New disruptive technologies have changed traditional businesses by creating new opportunities and the need for new marketing models20. Employers seek marketing strategies in the current business environment to adequately address customers’ needs21. For example, research on directions and tools of industry marketization identified that more traffic is driven by online advertising; thus, marketing helps businesses reach wider audiences22.

The study focuses on leveraging the industry 4.0 technologies in marketing strategies, examining the effectiveness in enhancing consumer engagement and accessibility. Its purpose is to provide actionable insights for businesses and policymakers, improving marketing efficiency in the healthcare sector. Selected technologies include the AI & ML are used for automating data analysis, optimizing marketing campaigns, AI & ML are used for automating data analysis, optimizing marketing campaigns, and predicting trends. IoT helps collect real-time device usage data, improving customer insights and engagement. VR & AR enhance product demonstrations and training, creating immersive marketing experiences. Big Data drives deeper market segmentation and performance measurement by analyzing vast datasets. These technologies address local challenges in Pakistan’s healthcare market by enabling smarter, personalized, and efficient marketing strategies. The study aims to showcase their transformative potential in promoting prosthetics and orthotics in the country. By leveraging AI/ML, IoT, VR/AR, and Big Data, the research highlights how these tools will enhance customer engagement, optimize marketing efforts, and improve healthcare outcomes. This integration fosters better market penetration and adoption of medical devices. Overall, the study emphasizes the role of Industry 4.0 in driving innovation in the prosthetics and orthotics sector in Pakistan.

Previously studied were AI/ML and Big Data technologies for healthcare purposes that employed surveys from consumers’ perspectives as marketing strategies23,24,25. Additionally, AR and VR were used previously in medical fields26. AR applications in medical practices have helped health experts through innovation awareness27.

Still, other researchers have conducted studies regarding the role of IoT in Healthcare as a means of using Industry 4.0 technology for patient care and monitoring28,29. Regarding trends and prospects, positive outcomes can come from focusing on marketing strategies30.Some literature suggests that modern marketing is replacing traditional marketing with a current trend consisting of a rapidly growing and shifting mindset to Industry 4.031. For example, marketers have been trying to innovate and introduce technology as much as they can to convince consumers to acquire their products or services32.

The literature reviewed regarding Industry 4.0 marketing identified that stakeholders actively engage in various marketing processes, unlike when there were only passive recipients of marketing information. Business models in the new era of Industry 4.0 are considering marketing strategies that are more dynamic with new communication infrastructures and analytics, allowing marketers to collect and figure out vast amounts of information. Businesses will develop more complex market models as Industry 4.0 keeps evolving33.

The literature also indicates that marketing manages customer relationships to benefit the company and its stakeholders. This is mainly because flexible processes and activities are rapidly and frequently modified to accommodate technological changes necessary for value proposition and delivery16. Even with the advent of the new paradigm and the emerging technological developments of IoT, Blockchain, Cloud Computing, and AI, the Economy is influenced, leading to improvements in healthcare34. The role of Industry 4.0 in healthcare is extraordinary, as it has reduced time and costs and led to the implementation of better solutions6. Some of the literature suggests that Industry 4.0 technologies for marketing performance lies in effectively utilizing patient data for marketing strategies35.

Industry 4.0 technologies also offer vast potential for leveraging data. For example, patient data encompasses various types of data generated by patients, including electronic health records (EHRs), health monitoring devices, wearable sensors, and patient-reported outcomes36. Technologies of Industry 4.0, such as Big Data, AI, ML, IoT, VR, and AR, derive actionable insights into data about patients’ behaviors, preferences, and health status in real-time for marketing performance.

Despite the abundance of patient data generated from various sources, there needs to be more literature regarding how Industry 4.0 tools can effectively harness this data for just-in-time marketing performance. Often, the focus is on the technical aspects of data collection and processing rather than exploring the marketing implications and strategies derived from patient data37. Prioritizing research efforts in this area is crucial for unlocking the full potential of Industry 4.0 in real-time marketing performance. Healthcare businesses can gain a competitive edge in a rapidly evolving landscape by addressing this research gap by delivering more value-driven marketing experiences38.

Literature summary:

Table 1 Selective literature for marketing and industry 4.0.
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Literature gaps and contribution

The research highlights several key literature gaps, particularly in the application of Industry 4.0 technologies to enhance marketing strategies within the Prosthetics and Orthotics (P&O) industry in emerging economies. While individual technologies have been explored, their integrated use for healthcare marketing remains largely unaddressed, with most research focusing on developed markets and failing to account for the unique challenges faced by emerging economies. Furthermore, limited attention has been given to how patient data can be effectively leveraged for real-time marketing strategies in the P&O industry. This study’s main contribution is pioneering research at the intersection of Industry 4.0 technologies and marketing strategies, utilizing frameworks such as fuzzy logic models and advanced decision-making tools. It provides context-specific insights for emerging markets like Pakistan, with the aim of emerging dynamic, data-driven marketing models that can adapt to the rapidly evolving healthcare landscape.

Motivation

The motivation for this study arises from several compelling factors. First, there is a significant need to address underexplored gaps in literature, particularly in the specialized medical device market, such as the application of Industry 4.0 technologies within the Prosthetics and Orthotics (P&O) industry. This research seeks to fill those gaps by investigating new opportunities in integrating advanced technologies with marketing strategies. Secondly, the practical relevance of this study is a key driver, as it aims to deliver solutions with immediate real-world applicability, improving both business growth and customer engagement within the healthcare sector. Additionally, the study is motivated by the need to refine existing marketing theories by integrating advanced methodologies, such as fuzzy logic models and decision-making frameworks, offering valuable contributions to the field. The rapid emergence of technological trends, particularly those associated with Industry 4.0, further drives this research, necessitating updated marketing frameworks to keep pace with evolving strategies in healthcare marketing. Finally, the researcher’s passion for innovation and commitment to driving advancements in healthcare marketing underscores the motivation for this study, aiming to deliver meaningful, impactful solutions in this growing field.

Methodology

The methodology presented explores uncharted territory in the P&O medical device industry and the design of related marketing strategies for business performance evaluation and improvement. Its focus is on prioritizing Industry 4.0 for multi-criteria decision-making (MCDM). It involves a combined F-AHP/ VIKOR model, and the procedure details have been reported previously39. Fuzzy sets and judgment matrices composed of triangular fuzzy numbers are utilized to determine ultimate weights, which are essential for our investigation40. The integration of these two methods is chosen as preferred research methodologies for their ability to incorporate fuzziness when determining weightage values for fuzzy criteria and sub-criteria, which has demonstrated effectiveness in hierarchical structure scenarios41 and its valuableness in ranking strategies, particularly when considering sub-criteria42. In practical application, the choices of each decision-maker are usually recorded and frequently combined, which is then presented for performance purposes. The matrix is an initial stage in prioritizing alternatives or identifying the best choice43.

This innovative study is a marketing approach to determine the highest priority of advanced technology within the industry 4.0 framework, specifically concerning P&O medical devices in emerging economies. It consists of obtaining data from survey responses from 16 subject experts with diverse backgrounds. The challenges encountered in this process include efficiently handling all data and criteria to understand performance while showcasing the significance of each criterion. This process is the chosen methodology and is a good choice as it is increasingly utilized across various fields, including information technology and medical diagnostics, to address real-life situations44. It is a valuable tool for establishing the basis for material selection, sorting, prioritization, and meaningful assessment45,46.

More specifically, analyzing the extrapolated data led to the creation of an integrated F-AHP/ VIKOR model for determining weightage values of the main criteria and sub-criteria. This combination serves as an effective MCDM technique validating its use in the context—the research process established objectives by gathering relevant criteria and evaluating the best Industry 4.0 technology alternatives. Cutting-edge Industry 4.0 technologies are applied and assessed according to impact on marketing performance and technological feasibility specific to P&O medical device perspectives. This is beneficial as it offers a systematic and evidence-driven approach for applying a linguistic scale. It provides solutions between criteria/sub-criteria to an alternative, enabling pairwise comparisons among suggested elements. This scale assessed the main criteria and sub-criteria, subjective attributes such as “very low,” “low,” “moderate,” “high,” and “very high” employed grade, assigning weights of 0.0, 0.25, 0.50, 0.75, and 1.00 correspondingly, thereby simplifying the optimal selection process within the framework.

MCDM proves particularly beneficial in addressing numerous intricate issues, particularly those centered on selecting the optimal solution. This solution selection involves considering various aspects of a problem; thus, many real-world scenarios require the involvement of multiple decision-makers47. The theoretical framework of MCDM is built upon the concept of employing positive and negative reference points, which function as benchmarks48. In practice, decisions from multiple decision-makers, usually presented in separate matrices, are merged to formulate a collective decision matrix. This is the first step in evaluating alternatives or finding the best-performing choice.

Proposed marketing approach

A proposed marketing approach is vital for positioning, ensuring relevance, and fostering communication with target audiences. It boosts revenue, expands market share, and supports sustainable growth49. Marketing facilitates adaptation to market changes, enhancing long-term sustainability. Through resource optimization and innovation, strategies maximize Return on Investment (ROI) and competitiveness50. This study offers unique insights into marketing performance for P&O medical devices. Advanced technologies like AI-driven customization necessitate clear communication of device benefits to P&O professionals and patients51. Tailored marketing efforts for personalized medical device solutions can enhance patient satisfaction52.

Research has highlighted next-generation marketing technologies from Industry 4.0 that are particularly relevant and transformative for the Prosthetics and Orthotics (P&O) medical device industry. These technologies were selected for their alignment with the objectives of optimizing business strategies, enhancing healthcare performance, and harmonizing marketing goals within the P&O sector. Moreover, they facilitate the use of advanced analytical tools, such as F-AHP and VIKOR models, reinforcing the study’s methodological framework.

The main and sub-criteria in the research paper were derived by conducting a Systematic Literature Review (SLR), beginning with the formulation of research questions centered on next-generation marketing expectations through the integration of Industry 4.0 technologies into the medical device industry to align marketing strategies with business performance. The search strategy was crafted using academic databases and keywords related to Industry 4.0, medical device marketing, and decision-making models such as F-AHP and VIKOR. Inclusion and exclusion criteria were applied to studies focusing on the intersection of these topics. After screening titles, abstracts, and full texts, key data was extracted and categorized based on Industry 4.0 tools, marketing strategies, and business growth as study objectives. The findings were synthesized to identify the main and sub-criteria used in the study. These criteria were incorporated into the research model, supported by evidence from the literature, ensuring the model’s effectiveness in optimizing marketing strategies and enhancing next business efficiency in the P&O sector. Furthermore, showcasing commitment to research and development through marketing builds stakeholder trust53.

Identified in this research study has the following main criteria related to P&O medical devices:

Business Scope (A1)54,55 Marketing Referrals Resources (A2)56, Marketing Resources (A3)57, and Customer Experience (A4)58,59,60 in business marketing strategy making it multi-dimensional. These will be explored in greater length and detail later in our “Results and discussion” section as they pertain to our P&O medical device industry findings.

Industry 4.0 technologies

While Industry 3.0 may lack the capabilities required for modern business marketing performance, such as data-driven insights, personalized experiences, agility, and integration across the entire value chain, Industry 4.0 offers a transformative marketing approach, enabling businesses to thrive in today’s digital landscape. Selective technologies related to Industry 4.0 are discussed as;

Big Data is essential for marketing performance as it offers real-time insights into consumer behavior, preferences, and trends. Marketers use it to personalize campaigns, optimize pricing, and measure success accurately. In prosthetics and orthotics, big data customizes devices, predicts maintenance needs, supports clinical decisions, and optimizes supply chains. By leveraging big data, businesses can enhance customer satisfaction, drive growth, and achieve marketing performance goals effectively. Marketers use big data to make data-driven decisions, personalize campaigns, target specific segments, and optimize ROI. In prosthetics and orthotics, big data improves patient outcomes, streamlines manufacturing, and enhances efficiency throughout the supply chain.

Integrating AI and ML into marketing performance enables more intelligent decision-making, enhanced personalization, and improved efficiency, driving growth and competitive advantage. AI offers advanced analytics, predictive insights, automation, and campaign optimization. In P&O, significant data customization, quality control, clinical support, and R&D advancements are facilitated. Big data analytics collect patient data for personalized devices, ensure manufacturing quality, inform clinical decisions, and drive innovation. Ultimately, big data enhances patient outcomes, operational efficiency, and innovation in prosthetics and orthotics, aligning with broader marketing strategies leveraging AI and ML for growth and customer satisfaction.

Incorporating IoT technology into marketing strategies to collect real-time data offers enhanced customer insights, contextual marketing, and seamless Omni-channel experiences. IoT data enables real-time insights, granular data analysis, and predictive analytics for better decision-making. It enhances customer experience, drives product innovation, and ensures competitive advantage. In P&O, considerable data customization, quality control, clinical support, and R&D advancements are facilitated. Big data accelerates innovation, improves patient outcomes, and enhances operational efficiency in the field. Leveraging IoT data in marketing strategies aligns with broader business goals, driving growth, customer satisfaction, and innovation in today’s digital landscape.

Incorporating VR and AR into marketing strategies offers immersive experiences, product visualization, and interactive engagement. These technologies differentiate brands, foster loyalty, and provide valuable data insights. Extensive data customization, quality control, clinical support, and R&D advancements are facilitated in prosthetics and orthotics. Big data drives innovation, improves patient outcomes, and enhances operational efficiency in the field. Leveraging VR and AR technologies aligns with broader marketing performance goals, creating memorable experiences, driving engagement, and effectively achieving marketing objectives.

It is essential for each country, based on a healthcare system as a business or social service, to conduct research that presents individual factor ranking based on importance within the industry. At the same time, it looks ahead to the future as either a government organization or a privately run business.

Fig. 1
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Proposed marketing and technology.

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The research methodology commenced with identifying subject matter experts, as shown in Fig. 1, followed by developing a survey questionnaire. The aim of opinion sourcing involved soliciting perspectives from the host country’s technology professionals, healthcare departments, and clinicians to ensure a comprehensive breadth and variability of subjects aligned with the research objective, aiming to achieve robust outcomes while mitigating bias. The study’s reliability depends on the precision of multiple determining factors, alongside research for evaluation that stays aligned with the continuously evolving technological landscape. Figure 2 presents the model and stages for the proposed research.

Fig. 2
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Proposed model’s framework and stages.

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Proposed model

The research study translated the criteria and sub-criteria into F-AHP and VIKOR modelling questionnaires. A fuzzy matrix for criteria was employed in F-AHP to test the framework, where various criteria factors were assigned designated numerical positions, each linked to a priority vector and indicating its relative importance within the parent-level framework component. This approach facilitated the main criteria normalization of values using the matrix’s eigenvector, ensuring consistency in scores across the comparison matrix, as demonstrated in Tables 2 and 3 for the main criteria. Furthermore, a weighting model was proposed to convert the results into ultimate weights, quantifying subjective variables.

In the FAHP model, subject experts evaluated initial comparison matrices of criteria, showcasing the pairwise comparison matrix results for the main criteria. Subsequently, fuzzy survey findings were utilized to weigh the main criteria in the FAHP model, delineating alternative Industry 4.0 technology sources for healthcare marketing. Experts outlined criteria for components of F-AHP, establishing relative to alternative components.

Table 2 Criteria’s fuzzy pairwise comparison matrix.
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The subsequent step involved calculating a normalized principal eigenvector as a priority vector. This vector was employed to determine the significance of each component at its parent level, ensuring consistency of results over time.

Table 3 Main criteria ranking value.
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Moreover, fuzzy logic was employed to compute the AHP pairwise comparison matrix and sub-criteria outcomes. This was done to obtain weightage values for sub-criteria to criteria, e.g. Business Scope (A1), Marketing Referrals Resources (A2), Marketing Resources (A3), and Customer Experience (A4). as presented in Tables 4, 5, 6 and 7.

Table 4 Sub-criteria pairwise comparison matrix results.
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Table 5 Sub-criteria pairwise comparison matrix results.
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Table 6 Sub-criteria pairwise comparison matrix results.
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Table 7 Sub-criteria pairwise comparison matrix results.
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Subsequently, the overall global weightage is discussed, and then Criteria and sub-criteria with assigned weightage values cover all proposed factors as outlined in Table 8.

The results of the comparison matrix indicate a substantial relationship by value among sub-criteria, emphasizing the significance of selective sub-criteria such as Business with private hospitals (0.0451), Patient referrals (0.0394), Public relationship (0.0542), and Customer empowerment (0.0498).

Table 8 Sub-criteria overall weightage.
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The Sensitivity Assessment evaluates how parameter values affect the outcomes. It investigates significant findings concerning variations in values ranging and emerging as optimal choices. However, as the ‘ν’ value increases from 0.5 to 0.8, A2 yield identical results as the best alternatives. Decision-makers strive to choose the most appropriate option from the available choices for marketing performance while minimizing value biases. Table 9 displays all four options for consideration.

Table 9 Sensitivity analysis.
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This presents a higher-ranking value when it exhibits the smallest value among the proposed alternative Industry 4.0 technological tools. In the results of the marketing study, Fig. 3, the ranking of healthcare technology is determined based on the minimum value of “Artificial Intelligence & Machine Learning,” having the lowest index value (Qi) of 0.3295, thus making it the top choice. Subsequently, (A3-0.4325), representing the “Internet of Things,” is ranked second choice. “Virtual Reality & Augmented Reality” (A4-0.5000) occupies the third position, while “Big Data” (A1-0.5704) is considered the least favored choice.

Fig. 3
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Marketing strategies weightage values.

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The VIKOR model currently requires examining expert-selected data to determine the optimal source of tools among alternatives, followed by calculation. The pairwise comparison matrix presents the main criteria alternative in Table 10.

Table 10 Alternative pairwise comparison matrix.
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Normalizing the decision matrix determines the ideal A (positive) or A* (harmful) solutions to ensure a bias-free selection of technology as alternative ranking options, considering both unity and regret measures to acknowledge performance direction. The procedure is iterated for all attributes concerning all alternatives, with the results computed, and Table 11 presents the “Sij” utility matrix. It presents unity and regret measures for all four options, which are used to priorities the rank of technologies. The index value Qi for these alternatives is subsequently examined to validate the findings. This index value indicates the optimal solution and highest rank, which is signified by having the smallest value among the proposed alternatives.

Table 11 The Sij matrix.
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Results and discussion

The design of the research study includes a series of questions incorporated into a survey to conduct pairwise comparison of factors for the purpose of prioritizing technologies to find impact related to developing marketing strategies for improving the P&O medical device industry in Pakistan. Correlation coefficient between main criteria/ sub-criteria results with numerical values was determined for incorporating Business Scope, Marketing Referral Sources, Marketing Resources and Customer Experience as fundamental competency components in the framework for selected Industry 4.0 technologies.

The survey translated questions into F-AHP, addressing them through a criteria/sub-criterion fuzzy pairwise comparison matrix, assigning numerical positions to each. Alongside, a priority vector was assigned to each, denoting its significance compared to other criteria within the overarching framework. This process facilitated the calculation of normalized values using the matrix’s eigenvector, which served as a priority vector. A weightage model was proposed final pairwise comparison matrix outcomes, converting subjective variables into quantifiable solutions.

Subsequently, a VIKOR model was introduced to provide criteria and sub-criteria ranking technique, while an alternative technology ranking for selection within the framework. Findings of the F-AHP model for four technology alternative ranking sources identified the criteria for comparison matrix elements at each level, as well as compared to components.

Furthermore, fuzzy logic was utilized to compute the AHP pairwise comparison matrix and determine the weightage values for Business Scope, Marketing Referral Sources, Marketing Resources, and Customer Experience, which has been presented in Tables 3, 4, 5, 6 and 7.

Case study

Results of weightage value assigned from this study were assigned to total weights of each factor ranking, encompassing main criteria as “Marketing Resources” (0.274); “Customer Experience” (0.264); “Business Scope” (0.252) and “Marketing Referral Sources” (0.211). Additionally, weightage values for the sub-criteria were designated: Q34 – “Marketing Research Analysis” (0.0769); Q44 – “Customer Experience” (0.0757); Q14 – “Business with Charity Organizations” (0.0748) and Q23 – “Family and Friends Referrals” (0.0630) corresponding in Tables 4, 5, 6, 7, 8.

The case study of Pakistan identified first criteria as “Marketing Resources” as this was the factor with most responses when analyzing P&O medical device market trends, consumer behavior, and competitive landscape related to marketing strategies and business decisions. Many of subject experts surveyed felt that marketing resources should be given top priority because it would enable companies to educate and engage patients, thereby differentiating businesses themselves from competitors. Many believed that by being ranked first for marketing resources would be optimal choice for influencing key stakeholders, understanding local consumer behaviors building trust and leveraging digital platforms effectively.

The paramount subfactor was identified as “Marketing Research Analysis” because the surveyed experts believed it would help to bridge the gap between market dynamics and business strategy, thus ensuring that P&O medical device products and marketing efforts would align with the evolving needs of patients and healthcare providers in Pakistan. The next subfactor was determined to be “Traditional and Digital Marketing Strategies”. Data obtained suggested Pakistan P&O businesses were able to effectively reach and engage with consumers as their unique characteristics and preferences of these markets leverage channels that drive customer engagement. “Digital Tools and Platforms” was the 3rd subfactor as these offered a multitude of benefits making it highly attractive as part of Pakistan P&O marketing strategies. Surveyed experts also stated cost effectiveness and wide reach was crucial for precise targeting and real-time analytics in Pakistan’s P&O medical device sector and the use of digital marketing would empower businesses to connect in meaningful ways and drive business growth. The 4th sub-criteria of “Public Relation Source” were identified because many respondents believed it was a strategic tool for business performance and for managing reputation, building trust with stakeholders, navigating regulatory challenges, and building credibility, especially in Pakistan’s market space.

The significance of “Customer Experience” was selected as 2nd main criteria with associated sub-criteria. “Optimization of Customer Experience” was agreed as being a vital component for P&O businesses in Pakistan as many respondents were in favor of enabling differentiation and sustainable growth through providing exceptional customer service delivery. “Customer Education” was another sub-criterion emerged as a powerful marketing tool. Surveyed experts in Pakistan believed it fostered trust, P&O medical device awareness and consumer empowerment. Additionally, “Customer Value-added Services” was identified as key to enhancing P&O competitive advantage, loyalty, and market penetration in Pakistan as experts believed offering extra benefits beyond core products such as free assessments, P&O accessories and guarantees/warranties was a good marketing initiative. Lastly, “Customer Motivation” was deemed important for understanding consumer behavior, addressing Pakistan’s economic constraints, and fostering emotional connections. The majority of the experts emphasized the need for P&O businesses to adapt strategies to local contexts that took demographics and the Pakistani culture into consideration when tailoring marketing approaches as a means to strengthen consumer preferences for Pakistan’s long-term viability and growth.

The selection of “Business Scope” as a criterion in marketing performance was necessary because it facilitated effective market segmentation, resource allocation, risk management, and sustainable growth amidst dynamic conditions. Integrating collaboration with charity organizations in emerging countries such as Pakistan aligns with corporate social responsibility, community engagement, and long-term sustainability, fostering social impact alongside business success.

In regard to business scope for Pakistan P&O marketing, all experts surveyed strongly agreed it was multifaceted and this was the main reason for creating tailored strategies so as to enable market segmentation. Strategic partnerships with Pakistan’s government, private, charity hospitals, and independent patient population fostered long-term collaborations and opportunities. Partnering with prestigious institutions enhanced brand reputation while broadening patient access ensured inclusivity. In Pakistan, adhering to healthcare compliance and regulations are mandatory and demonstrate commitment via facilitated successful partnerships. For example, in major hubs such as Karachi, Multan, Lahore, Peshawar, Quetta and capital city Islamabad, government hospital partnerships demonstrated P&O, regulatory compliance and cost-effectiveness while collaborations with private hospitals emphasized quality and customization. Engaging with the social welfare department in charity hospitals fulfill social responsibility and promote accessibility in each province of Pakistan. Direct-to-consumer strategies targeting individual patients aimed to raise awareness, educated and fostered trust for long-term relationships. By considering these sub-criteria, the overall survey consensus was Pakistan medical device businesses have strong potential for designing and emerging comprehensive marketing strategies for meeting Pakistan’s diverse P&O market needs and maximizing growth opportunities.

Next, main criterion was “Marketing Referral Sources” in emerging countries as part of performance as marketing strategy. Leveraging social networks, this approach aids in building trust, expanding market reach, and enhancing customer experience, ultimately driving customer acquisition and business growth in competitive markets. According to experts, orthopedic surgeons, prosthetists and other healthcare professionals, along with satisfied patients and trusted acquaintances were determined as leveraged diverse sources of influence that when incorporated into marketing strategies, builds trust, credibility, and relationships, maximizing reach and impact throughout Pakistan, thus driving awareness and adoption of P&O medical device solutions.

Other data collected and analyzed as part of this Pakistan case study revealed that several charities and organizations provide prosthetics and orthotics medical devices for individuals in need. These organizations often provide financial assistance, free devices, and rehabilitation services to those of the Pakistan population, who are unable to afford it. More specifically, survey results identified Pakistan charities and organizations that include the Pakistan Institute of Prosthetic and Orthotic Sciences (PIPOS), Layton Rahmatulla Benevolent Trust, The Indus Hospital, Chughtai Foundation, Al-Khidmat Foundation, Sahara for Life Trust, Ansar Burney Trust and The Pakistan Bait-ul-Mal. These organizations rely on donations, fundraising events, and grants to provide essential services. They often work with hospitals, rehabilitation centers, and international donors to ensure that those who need P&O medical devices in Pakistan have access to them61.

“Family and Friends Referrals” sub-criteria capitalized on social networks and cultural influences to drive patient acquisition in Pakistan and foster community engagement. Physician referral networks streamlined processes and enhanced patient satisfaction, driving patient referrals and thus contributing to business growth. Online testimonials leveraged social proof and user-generated content to enhance brand awareness and drive customer acquisition, especially among the younger Pakistani population.

Patient referrals also focused on trust-building and community engagement, driving patient acquisition and satisfaction in dynamic healthcare markets. It highlighted the importance of strategic referral networks and social engagement in marketing strategies tailored to Pakistan’s diverse and vibrant landscapes and validated needs through data analysis to determine optimal ranking purposes among alternatives.

The selection of Digital Tools and Platforms, Traditional and Digital Marketing, Public Relationship Resources, and Market Research and Analysis within Marketing Resources for P&O marketing in Pakistan was demonstrated as strategic and essential in the context of study. Leveraging digital tools, traditional and digital marketing, public relations, and market analysis optimized market positioning, ensuring value delivery to patients, healthcare professionals, and stakeholders.

Finally, rationale for selecting Customer Education, Empowerment and Motivation, Value-Added Service, and Experience Optimization within Customer Experience for P&O marketing in Pakistan was because it addressed unique challenges of Pakistan’s P&O medical device industry. For example, “Customer Education” ensured informed decisions by clarifying options and functionalities; “Empowerment and Motivation” supported customers through the transition, setting goals, and provided guidance; Value-Added Services, like fittings and support programs, enhanced satisfaction and demonstrated commitment; and Experience Optimization identified pain points, streamlined processes and improved communication for seamless patient continuity of care. According to the case study, prioritized aspects caused P&O businesses in emerging countries such as Pakistan to effectively meet customer needs and thrive in the competitive healthcare market.

Outcomes from the study position Industry 4.0 technology as a pivotal marketing performance tool for strategizing P&O medical device marketing. “Artificial Intelligence & Machine Learning” technology achieved the lowest index value Qi of 0.3295, making it the top ranking. The next technology of choice was “Internet of Things Technology” followed by “Virtual Reality & Augmented Reality technology” and finally “Big Data technology” considered for later stages.

A sensitivity assessment examined how variations in parameters impacted the outcomes of the decision-making process commonly known as sensitivity analysis. It explored significant findings regarding changes in values ranging from 0.5 to 0.8. At a “v” value of 0.5, A2 and A3 emerge as the optimal alternatives compared to the reduced “v” value of 0.1. Similarly, A4 and A1 yield identical results as the preferred alternatives when the “v” value transitions from 0.5 to 0.8. Decision-makers aim to determine the best option among the available alternatives while minimizing biases in the values.

Final thoughts from the study results suggest Industry 4.0-based marketing strategies should be implemented in emerging countries to understand performance; an effective method for leveraging business growth is to focus on customer satisfaction and retention2,62. This will help gain repeat buyers, who will recommend P&O businesses to others, leading to organic growth. Additionally, investing in marketing strategies tailored to a target audience can help attract new customers and expand reach63. The study also proves that businesses in emerging countries can benefit from Industry 4.0 technologies, if they are cost-effective, scalable, and adaptable to local conditions64,65. Lastly, this study proves that the implementation of a hybrid decision-making system can significantly contribute to business growth by enabling more informed and effective decision-making processes and explains how marketing is linked with business performance66,67.

The study is essential for demonstrating the practical application for Pakistan case. It provides a context to evaluate how technologies to address unique challenges in prosthetics and orthotics. This case study makes the research more relevant by showing how theoretical strategies translate into real-world outcomes, offering insights into localized market dynamics. Overall, the case scenario strengthens the study’s conclusions by providing concrete evidence of the effectiveness of these technologies in emerging market.

Conclusion

The objective of this research is to provide contributions to the P&O medical device industry considering Industry 4.0 as marketing strategy for the purpose of establishing a model that leveraging of industry 4.0 can impact business performance. Based on the identified current state of literature and developed tentative theoretical framework, a combined F-AHP/VIKOR approach is proposed as a marketing strategy for a successful outcome. As previously mentioned, this study is the first of its kind for examining prioritized technologies as a marketing strategy in P&O medical devices industry emerging economies such as Pakistan which was used as a case study. A combined F-AHP/VIKOR model analyzed Industry 4.0-based marketing performance for P&O medical devices and involved collecting and evaluating data provided by subject experts along with the presentation of a case study. Limitations included sample size, data collection, model complexity, and time constraints. The results of the research showed that the prioritization of Industry 4.0 technologies in Pakistan’s P&O medical device businesses identified from highest to least priority was AI & ML, IoT, VR & AR and Big Data. F-AHP model’s main criteria included “Business Scope,” “Marketing Referral Sources,” “Marketing Resources,” and “Customer Experience.” Finally, a sensitivity analysis highlighted the impact of parameter variations on P&O marketing decision-making outcomes.

Results from this study successfully answered the previously mentioned questions posed earlier in the research, thereby confirming the necessity of a model framework inclusion for prioritizing industry 4.0 technologies to leverage impact for P&O medical device industry. It proves that implementation of a combined F-AHP/VIKOR framework is an optimal solution for creating marketing strategies that will help P&O medical device businesses in emerging economies be sustainable and profitable.

Further considerations suggest engaging a larger and more diverse range of individuals with expertise in technology, healthcare economics, and business professions could yield even more comprehensive results. Therefore, scholars must take this into account when conducting subsequent research. This study serves as a model for future research by investigating technology integration, next generation marketing and business growth challenges faced by P&O medical device businesses devices in other emerging economies. This can lead to other valuable studies and further contributions both on the local and global scene.

The Pakistan case study conducted as part of this research highlights the critical role of technological advancements in next-generation marketing. It recommends that advanced marketing strategies should undergo a technological transformation enabled by the Fourth Industrial Revolution, potentially through a comprehensive technology-healthcare marriage package. From both short-term and long-term perspectives, next-generation marketing driven by Industry 4.0 such as tools AI and big data, will enhance market penetration by effectively targeting specific demographics. Additionally, digital marketing strategies that leverage advanced technologies will foster stronger customer relationships, leading to increased trust and brand loyalty.

Next-generation marketing tools also, will offer real-time feedback on campaign performance, allowing businesses to quickly adapt their strategies to changing consumer preferences in Pakistan. The emphasis on personalization and customer experience is particularly significant in a culturally diverse market, where tailored marketing messages can boost satisfaction and loyalty. Data-driven decision-making enables businesses to utilize analytics for strategic planning, helping them identify market trends and customer needs effectively. Moreover, next-generation marketing strategies that incorporate social responsibility and ethical practices will enhance brand reputation and appeal to socially conscious consumers.

By integrating emerging technologies like augmented reality (AR) and virtual reality (VR), businesses can create immersive customer experiences that drive engagement. Ultimately, focusing on customer loyalty and engagement fosters long-term relationships essential for sustained growth in the Pakistani market. This research represents a milestone in improving healthcare access for disabled individuals in low-income countries and underscores the potential for similar methodologies to be adapted in other emerging economies using AHP/VIKOR models.