Patient attitudes, beliefs, and practices in environmentally friendly inhaler disposal: a mixed-methods evaluation...

The National Health Service (NHS) aims to reduce emissions from inhalers, a major contributor to its carbon footprint. Despite willingness, patient awareness and engagement with appropriate inhaler disposal and recycling remains low. This paper combines two studies both using the Capability, Opportunity, Motivation-Behaviour (COM-B) model with contrasting methodological approaches to explore inhaler disposal behaviours, and barriers and facilitators to recycling uptake. Synthesis of two datasets from quantitative (Study 1) and qualitative (Study 2) studies was undertaken, using deductive analysis (i.e. categorisation of barriers/facilitators from both studies and comparison to each COM-B component) to identify patterns across both studies inhaler users were unaware of the need to return inhalers to pharmacies for disposal and often discarded them in domestic waste. Inhaler users viewed community pharmacies as convenient locations for recycling schemes due to their proximity to the local pharmacy. However, they were unlikely to engage with initiatives that require significant additional effort such as traveling out of their way to return inhalers. Although awareness of environmental impacts can motivate intentions to recycle, users reported struggling to develop and maintain consistent recycling habits. Barriers to appropriate inhaler disposal were therefore evident across psychological capability (limited knowledge), physical opportunity (access and convenience), and automatic motivation (habitual disposal practices). These findings highlight persistent gaps between positive environmental intentions and actual disposal behaviours among inhaler users and the complexity of behaviour change, requiring interventions that address psychological, physical, motivational, environmental and social barriers. Future research should focus on implementing behaviourally informed approaches and evaluating these interventions to identify the most effective methods for improving inhaler disposal and reducing the environmental impact of inhaler use.