A Systematic Review of the Application of Health Behavioral Theories in Drug Disposal and Reuse

OBJECTIVES: The hospitals and prescription drugs sectors contribute significantly to degrading climate health in the United States through improper drug disposal. This systematic review explores the application of health behavior theories (HBT) in drug disposal and reuse behavior in the population.

METHODS: Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, experimental and non-experimental studies assessing drug disposal and reuse were searched across databases like PUBMED, SCOPUS, CINHAL, MEDLINE, PsycINFO, and Web of Science from January 1991 to February 2023. Two independent researchers comprehensively reviewed studies on HBT in drug disposal and reuse. The use of HBT in the studies was assessed using the Theory Coding Scheme (TCS) checklist. The risk of bias in randomized control trials (RCT) was evaluated using the revised version of the Cochrane risk of bias tool.

RESULTS: The review identified 267 articles, of which seven were included in the final review. Five studies were conducted in the U.S. and two in the U.K. The sample size of the studies ranged from 19 to 1,003. Five studies utilized the Theory of Planned Behavior (TPB); additionally, one study each employed the Theory of Reasoned Action (TRA) and the Health Belief Model (HBM). The studies employing the TPB focused on control beliefs, behavioral beliefs, normative beliefs, and intentions. In contrast, HBM emphasized constructs like perceived susceptibility, severity, benefits, barriers, and self-efficacy. Meanwhile, TRA primarily utilized normative and behavioral beliefs as its constructs. Only one study has a TCS score >50%, indicating a higher extent of theory used. The risk of bias was rated as unclear for the RCT.

CONCLUSIONS: Our study reveals minimal application of health behavior theories in understanding and guiding drug disposal and reuse interventions, highlighting a significant gap in the literature and the potential for these theories to enhance safe practices in communities.