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Patient attitudes, beliefs, and practices in environmentally friendly inhaler disposal: a mixed-methods evaluation with behaviourally informed recommendations

Delyth James Orcid Logo, Terence J McElvaney, Thomas Henstock, Hannah Thomas, Aleysha Caffoor, Alys Harrop, Sarah Brown, Catherine Heidi Seage

npj Primary Care Respiratory Medicine

Swansea University Author: Delyth James Orcid Logo

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DOI (Published version): 10.1038/s41533-026-00521-6

Abstract

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, Opportu...

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Published in: npj Primary Care Respiratory Medicine
ISSN: 2055-1010
Published: Springer Nature 2026
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URI: https://cronfa.swan.ac.uk/Record/cronfa72129
first_indexed 2026-06-19T13:10:04Z
last_indexed 2026-06-20T05:03:13Z
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spelling 2026-06-19T14:10:01.7506759 v2 72129 2026-06-19 Patient attitudes, beliefs, and practices in environmentally friendly inhaler disposal: a mixed-methods evaluation with behaviourally informed recommendations dc24cdd4d09d96fa49a0f213d1060cf9 0000-0001-7434-7064 Delyth James Delyth James true false 2026-06-19 MEDS 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. Journal Article npj Primary Care Respiratory Medicine 0 Springer Nature 2055-1010 22 5 2026 2026-05-22 10.1038/s41533-026-00521-6 COLLEGE NANME Medical School COLLEGE CODE MEDS Swansea University Another institution paid the OA fee Public Health Wales Grant: GB542 9157 36 2026-06-19T14:10:01.7506759 2026-06-19T14:06:11.8355477 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Pharmacy Delyth James 0000-0001-7434-7064 1 Terence J McElvaney 2 Thomas Henstock 3 Hannah Thomas 4 Aleysha Caffoor 5 Alys Harrop 6 Sarah Brown 7 Catherine Heidi Seage 8
title Patient attitudes, beliefs, and practices in environmentally friendly inhaler disposal: a mixed-methods evaluation with behaviourally informed recommendations
spellingShingle Patient attitudes, beliefs, and practices in environmentally friendly inhaler disposal: a mixed-methods evaluation with behaviourally informed recommendations
Delyth James
title_short Patient attitudes, beliefs, and practices in environmentally friendly inhaler disposal: a mixed-methods evaluation with behaviourally informed recommendations
title_full Patient attitudes, beliefs, and practices in environmentally friendly inhaler disposal: a mixed-methods evaluation with behaviourally informed recommendations
title_fullStr Patient attitudes, beliefs, and practices in environmentally friendly inhaler disposal: a mixed-methods evaluation with behaviourally informed recommendations
title_full_unstemmed Patient attitudes, beliefs, and practices in environmentally friendly inhaler disposal: a mixed-methods evaluation with behaviourally informed recommendations
title_sort Patient attitudes, beliefs, and practices in environmentally friendly inhaler disposal: a mixed-methods evaluation with behaviourally informed recommendations
author_id_str_mv dc24cdd4d09d96fa49a0f213d1060cf9
author_id_fullname_str_mv dc24cdd4d09d96fa49a0f213d1060cf9_***_Delyth James
author Delyth James
author2 Delyth James
Terence J McElvaney
Thomas Henstock
Hannah Thomas
Aleysha Caffoor
Alys Harrop
Sarah Brown
Catherine Heidi Seage
format Journal article
container_title npj Primary Care Respiratory Medicine
container_volume 0
publishDate 2026
institution Swansea University
issn 2055-1010
doi_str_mv 10.1038/s41533-026-00521-6
publisher Springer Nature
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Pharmacy{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Pharmacy
document_store_str 0
active_str 0
description 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.
published_date 2026-05-22T06:03:13Z
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