Multifaceted Approach Is Necessary for Pharmacist-Led Medication Take-back

Through the theory of planned behavior (TPB), researchers uncovered a variety of factors that encourage or deter pharmacists from offering medication take-back services, according to data from a study published in Research in Social and Administrative Pharmacy.¹ Perceived behavioral control (PBC), external factors, and pharmacists’ perceptions of social pressure were all predictors of pharmacists offering medication take-back.

“Pharmaceuticals are essential for human health, but their residues form a serious source of environmental pollution,” wrote the authors of the study. “Active pharmaceutical residues enter the environment through excretion post consumption and through improper disposal of unused medications, such as discarding them in household trash or flushing them down the toilet/sink.”

Researchers used the Theory of Planned Behavior to determine the attitudes and predictors of pharmacists’ intentions to provide medication take-back services. | image credit: Towfiqu Barbhuiya / stock.adobe.com

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Findings from previous surveys and studies have identified that the improper disposal of medications is a significant issue today. In one survey, 95% of respondents reported possessing unused medications, and 82.1% said they throw medications away in their household garbage, which was the most popular route of improper disposal. Furthermore, 79.5% of these respondents said they never received proper education on how to dispose of medications.²

In other data published in Exploratory Research in Clinical and Social Pharmacy, researchers reported that patient responses highlighted a significant lack of knowledge on disposal practices among the general population.³ Aside from patients’ lack of knowledge on medication disposal, targeted approaches to universally improve medication take-back services around the world are also absent.

Rather than exploring the take-back services already offered at community pharmacies, researchers investigated what factors may lead to the pharmacist’s willingness to adopt these services.

“Given these considerations, this study aims to bridge the knowledge gap by investigating the factors influencing behavioral intention to provide medication take-back service in the absence of a legislative mandate,” they continued.¹ “While numerous studies on household pharmaceutical waste disposal have assessed pharmacists’ knowledge and attitude, revealing deficiencies in their practice, no known research has investigated the underlying factors and perceptions that shape their intention to engage in safe medication disposal service provision.”

The researchers’ primary goal was to identify the attitude (ATT), subjective norm (SN), and PBC of community pharmacists to provide a medication take-back service. Utilizing the TPB as a theoretical framework, they conducted a cross-sectional survey for full-time community pharmacists in Malaysia with at least 1 year of experience, collecting data between December 2023 and April 2024.

The TPB comprises 3 core constructs: ATT, PBC, and SN. Although PBC and ATTs may be self-explanatory constructs within this study’s context, it is worth noting that SN refers to a person’s perception of social pressures from other stakeholders that are important to the person in question.

The survey consisted of questions regarding the 3 TPB constructs, participants’ demographics, and a fourth TPB construct, serving as an independent variable, which was external factors (EFs).

“This study['s data] revealed that while community pharmacists generally have the correct attitudes towards household pharmaceutical waste disposal, their willingness to provide medication take-back service is shaped by consumer demand, business dynamics, and professional practice factors, noticeable from the rejection of [the] hypothesis that ATT is insignificant in predicting pharmacists' intention to provide medication take-back service,” they wrote.¹

The 310 survey respondents (71.3% women; 68.7% below age 36) included in the analysis provided positive responses to the ATT and SN statements associated with the high value of providing take-back services. Respondents also agreed that a variety of EFs could influence their intention to provide said services.

Overall, professional practice-based EFs were the most prominent predictors of pharmacists’ willingness to provide the take-back service, with SN and PBC following shortly behind as the 3 most common factors.

Using the 3 constructs positively associated with pharmacists’ intentions, researchers believe a targeted and theoretically grounded approach with multiple facets is necessary in further developing medication takeback services. To streamline and develop these services faster than others, researchers hope the current study can inform policy makers’ decisions on state- and federal-level take-back services.

“Guided by the TPB, the analysis identified 3 constructs, namely SN, PBC, and EF, as significant predictors of pharmacists’ intention to provide medication take-back service, thereby supporting 3...of the 4 proposed hypotheses,” concluded the authors.¹ “To enhance community pharmacists' commitment to safe medication disposal and environmental protection, a multifaceted approach is required.”

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References

1. Hiew SY, Low BY, Liew KW, et al. Insights into community pharmacists’ behavioural intention towards providing safe medication disposal service using the theory of planned behaviour. Res Social Adm Pharm. Published online July 5, 2025. doi:10.1016/j.sapharm.2025.06.111

2. Insani WN, Qonita NA, Jannah SS, et al. Improper disposal practice of unused and expired pharmaceutical products in Indonesian households. Heliyon. 2020;29;6(7):e04551. doi:10.1016/j.heliyon.2020.e04551

3. Toe J, Orok E, Erah PO. Assessment of knowledge and disposal practices of unused and expired household medicines in a community in Liberia. Explor Res Clin Soc Pharm. 2023;12:100369. doi:10.1016/j.rcsop.2023.100369