Multifaceted Approach Is Necessary for Pharmacist-Led Medication Takeback

Through the theory of planned behavior (TPB), researchers uncovered a variety of factors that encourage or deter pharmacists from offering medication takeback services, according to 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 takeback.

“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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Previous surveys and studies have identified that the improper disposal of medications is a significantly prominent issue today. With 95% of survey respondents reporting possession of unused medications, 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 another study previously published in Exploratory Research in Clinical and Social Pharmacy, researchers reported that patient responses highlighted a significant lack of knowledge on disposal practices amongst the general population.³ Aside from patients’ lack of knowledge on medication disposal, there is also an absence of targeted approaches to universally improve medication take-back services around the world.

Rather than exploring the takeback 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.”

Researchers’ primary goal was to identify the attitude, subjective norm, and PBC of community pharmacists’ intentions 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.

When it comes to the TPB, it is made up of 3 core constructs: attitude (ATT), PBC, and subjective norm (SN). While PBC and ATTs may be self-explanatory constructs within this study’s context, it’s worth noting that SN refers to a subject’s perception of social pressures from other stakeholders that are important to the subject in question.

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

“This study 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

Among the 310 survey respondents (71.3% women; 68.7% below 36 years old) included in the analysis, community pharmacists 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. With the hopes of streamlining and developing these services faster than others, researchers hope the current study can inform policymakers’ 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 out 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. https://doi.org/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 Jul 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. https://doi.org/10.1016/j.rcsop.2023.100369