Assessing the knowledge, attitudes and practices of healthcare staff and students regarding disposal of unwantead medications: a systematic review

Objectives: We sought to review studies that examine healthcare professionals' and students' knowledge, attitudes and practices (KAP) regarding medication disposal. We also explore recommendations and barriers related to appropriate medication disposal.

Design: A systematic review was conducted that adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

Data sources: MEDLINE, Embase, CINAHL, Web of Science, PsycINFO and Google Scholar were searched up to 23 February 2024.

Study eligibility criteria and setting: Qualitative, quantitative and mixed-method primary research studies. There was no limitation on the publication date, geographical locations or the study settings.

Participants: Pharmacists, doctors, nurses and students from these respective professional groups in any country.

Primary outcome measures: The levels of healthcare staff and students' KAPs about disposal of unwanted medications.

Date extraction and synthesis: Data extraction was conducted by four of the researchers independently. The study details were categorised into three main domains, that is, KAP using the KAP model. Other relevant information was also extracted, and synthesised in overall themes, such as challenges and recommendations.

Results: Thirty-seven studies from 18 countries (Asia n=21, the USA n=7, Africa n=5, EU n=2, South America n=2) were included. 86.5% (n=32) investigated participants' knowledge of medication disposal. Although there was a good level of awareness about the environmental impacts, there were significant gaps in knowledge regarding correct disposal methods, available services, guidelines and training. Thirty studies explored participants' attitudes towards medication disposal. There was a generally positive attitude towards the need for environmentally safe disposal practices. Thirty-five studies evaluated participants' practices in relation to medication disposal. Although there was generally a positive attitude and some understanding of appropriate disposal methods, the majority of the participants did not follow the practice guidelines, especially outside healthcare settings.

Discussions and conclusions: Although healthcare staff and students have fair knowledge and positive attitudes towards medicine disposal, their actual practices are lacking. One significant challenge identified is the limited awareness about proper disposal methods coupled with a lack of established services or guidelines. Even in cases where take-back programmes are available, they often face issues with accessibility. To tackle these challenges, it is suggested that governmental bodies should establish and enforce clear policies on medication disposal while also expanding educational initiatives to increase understanding among professionals and students. Furthermore, improving access to take-back programmes is crucial for ensuring safe medication disposal and minimising potential environmental and health hazards.

Prospero registration number: CRD42024503162.