Patient Attitudes, Beliefs, and Practices in Environmentally Friendly Inhaler Disposal: A Mixed-Methods Evaluation with Behaviourally Informed Recommendations

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 behavioural frameworks with different 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, and deductive analysis was conducted, based on the COM-B (Capability, Opportunity, Motivation) model of behaviour. Findings were mapped to the Behaviour Change Wheel (BCW) to provide recommendations for improving disposal practices. 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 to the inhaler. Although awareness of environmental impacts can motivate intentions to recycle, users often struggle to develop and maintain consistent recycling habits. This highlights the complexity of behaviour change, requiring interventions that address psychological, physical, and social barriers. By applying behaviour change frameworks such as COM-B and the BCW, targeted strategies can be designed to enhance inhaler recycling. These include national educational campaigns to raise awareness, better signposting and prompts in healthcare settings, providing feedback on environmental benefits, persuasive messaging linking disposal to carbon reduction, and incentivization to encourage participation. A whole-system approach, engaging all healthcare professionals, is critical for sustained behaviour change and broader reach. Future research should focus on implementing and evaluating these interventions to identify the most effective methods for improving inhaler disposal/recycling and reducing the environmental impact of inhaler use.