Ian McGonagle

Objectives We sought to review studies that examine healthcare professionals’ and students’ knowledge, attitudes and practices (KAP) regarding medication disposal. We also explore recommendations and barriers related to appropriate medication disposal. Design A systematic review was conducted that adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Data sources MEDLINE, Embase, CINAHL, Web of Science, PsycINFO and Google Scholar were searched up to 23 February 2024. Study eligibility criteria and setting Qualitative, quantitative and mixed-method primary research studies. There was no limitation on the publication date, geographical locations or the study settings. Participants Pharmacists, doctors, nurses and students from these respective professional groups in any country. Primary outcome measures The levels of healthcare staff and students’ KAPs about disposal of unwanted medications. Date extraction and synthesis Data extraction was conducted by four of the researchers independently. The study details were categorised into three main domains, that is, KAP using the KAP model. Other relevant information was also extracted, and synthesised in overall themes, such as challenges and recommendations. Results Thirty-seven studies from 18 countries (Asia n=21, the USA n=7, Africa n=5, EU n=2, South America n=2) were included. 86.5% (n=32) investigated participants’ knowledge of medication disposal. Although there was a good level of awareness about the environmental impacts, there were significant gaps in knowledge regarding correct disposal methods, available services, guidelines and training. Thirty studies explored participants’ attitudes towards medication disposal. There was a generally positive attitude towards the need for environmentally safe disposal practices. Thirty-five studies evaluated participants’ practices in relation to medication disposal. Although there was generally a positive attitude and some understanding of appropriate disposal methods, the majority of the participants did not follow the practice guidelines, especially outside healthcare settings. Discussions and conclusions Although healthcare staff and students have fair knowledge and positive attitudes towards medicine disposal, their actual practices are lacking. One significant challenge identified is the limited awareness about proper disposal methods coupled with a lack of established services or guidelines. Even in cases where take-back programmes are available, they often face issues with accessibility. To tackle these challenges, it is suggested that governmental bodies should establish and enforce clear policies on medication disposal while also expanding educational initiatives to increase understanding among professionals and students. Furthermore, improving access to take-back programmes is crucial for ensuring safe medication disposal and minimising potential environmental and health hazards. PROSPERO registration number CRD42024503162.

Objectives: We sought to review studies that examine healthcare professionals’ and students’ knowledge, attitudes, and practices (KAP) regarding medication disposal. We also explore recommendations and barriers related to appropriate medication disposal. Design: A systematic review was conducted that adhered to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). Data sources: MEDLINE, Embase, CINAHL, Web of Science, PsycINFO and Google Scholar were searched up to 23 ^rd February 2024. Study eligibility criteria and setting: Qualitative, quantitative, and mixed-method primary research studies. There was no limitation on the publication date, geographical locations, or the study settings. Participants: Pharmacists, doctors, nurses, and students from these respective professional groups in any country. Primary outcome measures: The levels of healthcare staff and students’ knowledge, attitudes, and practices about disposal of unwanted medications. Date extraction and synthesis: Data extraction was conducted by four of the researchers independently. The study details were categorised into three main domains, i.e., knowledge, attitude, and practice using the KAP model. Other relevant information was also extracted, and synthesised in overall themes, such as challenges and recommendations. Results: 37 studies from 18 countries (Asia n=21; USA n=7; Africa n=5; and EU n=2; South America n=2) were included. 86.5% (n=32) investigated participants’ knowledge of medication disposal. Although there was a good level of awareness about the environmental impacts, there were significant gaps in knowledge regarding correct disposal methods, available services, guidelines, and training. 30 studies explored participants’ attitudes toward medication disposal. There was a generally positive attitude towards the need for environmentally safe disposal practices. 35 studies evaluated participants’ practices in relation to medication disposal. Although there was generally a positive attitude and some understanding of appropriate disposal methods, the majority of the participants did not follow the practice guidelines, especially outside healthcare settings. Discussions and Conclusions: While healthcare staff and students have fair knowledge and positive attitudes toward medicine disposal, their actual practices are lacking. One significant challenge identified is the limited awareness about proper disposal methods coupled with a lack of established services or guidelines. Even in cases where take-back programs are available, they often face issues with accessibility. To tackle these challenges, it is suggested that governmental bodies should establish and enforce clear policies on medication disposal while also expanding educational initiatives to increase understanding among professionals and students. Furthermore, improving access to take-back programs is crucial for ensuring safe medication disposal and minimising potential environmental and health hazards. PROSPERO registration number: CRD42024503162. Strengths and limitations of this study: The review used the theoretical framework (KAP model) to effectively structure the literature search and data organisation, ensuring a comprehensive focus on studies and consistent data collection and analysis. This review covered all three components of the KAP model that is knowledge, attitude and practice, resulting in a more robust data synthesis with increased generalisability. The review encompassed a considerable number of studies (n=37) conducted in 18 different countries across five continents. The diverse range of populations and settings enhances the broad relevance of the review’s results. The review only included studies in English language.

Aim: To compare health-promoting behaviours among rural and urban residents following primary treatment for cancer. Methods: A cross-sectional survey collecting demographic variables and data pertaining to health-promoting behaviours, documented using the 52-item Health Promotion Lifestyle Profile II (HPLP-II) measure, which is categorised into six subscales: (1) health responsibility, (2) spiritual growth, (3) physical activity, (4) interpersonal relations, (5) nutrition, and (6) stress management. Residence was defined using the U.K. Office for National Statistics RUC 2011 Rural Urban Classifications. The Index of Multiple Deprivation (IMD) Decile was used to measure deprivation. Quantitative data were analysed using independent samples t-test and multiple linear regression. Qualitative data from open-ended questions were analysed thematically. Results: In total, 227 participants with a range of cancer types completed the questionnaire. Fifty-three percent were residents in urban areas and forty-five percent in rural areas. Rural participants scored significantly higher on health responsibility (p = 0.001), nutrition (p = 0.001), spiritual growth (p = 0.004), and interpersonal relationships (p = 0.001), as well as on the overall HPLP-II (p = 0.001). When controlling for deprivation, age, marital status, and education, rural–urban residence was a significant predictor of exhibiting health-promoting behaviours. A central theme from the qualitative data was the concept of “moving on” from cancer following treatment, by making adjustments to physical, social, psychological, spiritual, and emotional wellbeing. Conclusions: This research revealed, for the first time, differences in health-promoting behaviours among rural and urban U.K. populations who have completed primary cancer treatment. Rural residence can provide a positive environment for engaging with health-promoting behaviours following a cancer diagnosis and treatment.

Objective: To explore the effect of rural–urban residence on the self-reported health status of UK cancer survivors following primary treatment. Design: A post-positivist approach utilizing a cross-sectional survey that collected data on demographics, postcode and self-reported health status. Methods: An independent samples t test was used to detect differences in health status between rural and urban respondents. Pearson’s χ² was used to control for confounding variables and a multivariate analysis was conducted using Stepwise linear regression. Setting: East Midlands of England. Participants: Adult cancer survivors who had undergone primary treatment in the last five years. Participants were excluded if they had recurrence or metastatic spread, started active oncology treatment in the last twelve months, and/or were in receipt of palliative or end-of-life care. Main outcome: Residence was measured using the UK Office for National Statistics (ONS) RUC2011 Rural–Urban Classifications and Health Status via the UK ONS self-reported health status measure. Ethics: The study was reviewed and approved (Ref: 17/WS/0054) by an NHS Research Ethics Committee and the Health Research Authority (HRA) prior to recruitment and data collection taking place. Results: 227 respondents returned a questionnaire (response rate 27%). Forty-five percent (n = 103) were resident in a rural area and fifty-three percent (n = 120) in an urban area. Rural (4.11 ± 0.85) respondents had significantly (p < 0.001) higher self-reported health statuses compared to urban (3.65 ± 0.93) respondents (MD 0.47; 95% CI 0.23, 0.70). Conclusion: It is hoped that the results will stimulate further work in this area and that researchers will be encouraged to collect data on rural–urban residency where appropriate.

Objective: To explore the effect of rural-urban residence on self-reported health status with UK cancer survivors. Design: A cross-sectional postal questionnaire that collected data on demographics, post-code and self-reported health status. Methods: Independent Samples t test was used to detect differences in health status between rural and urban respondents. Pearson’s χ2 was used to control for confounding variables and multivariate analysis was conducted using Stepwise linear regression. Setting: East Midlands of England. Participants: Adult cancer survivors who had undergone primary treatment in the last five years. Participants were excluded if they had recurrence or metastatic spread, started active oncology treatment in the last twelve months and were in receipt of palliative or end of life care. Main Outcome: Residence was measured using the UK ONS RUC2011 Rural-Urban Classifications and Health Status via the UK ONS self-reported health status measure. Results: 227 respondents returned a questionnaire. Forty-five per cent (N=103) were resident in a rural area and fifty-three per cent (N=120) in an urban area. Rural (4.11±0.85) respondents had significantly (p<0.001) higher self-reported health status compared to urban (3.65±0.93) respondents (MD 0.47; 95% CI 0.23, 0.70). Conclusion: Rural respondents had significantly higher self-reported health status compared to their urban counterparts. It is hoped that the results will stimulate further work in this area and that researchers will be encouraged to collect data on rural-urban residency where appropriate.

Purpose: Despite wide acknowledgement of differences in levels of support and health outcomes between urban and rural areas, there is a lack of research that explicitly examines these differences in relation to self-management in people affected by cancer following treatment. This scoping review aimed to map the existing literature that examines self-management in people affected by cancer who were post-treatment from rural and urban areas. Methods: Arksey and O’Malley’s framework for conducting a scoping review was utilised. Keyword searches were performed in the following: Academic Search Complete, CINAHL, MEDLINE, PsycINFO, Scopus and Web of Science. Supplementary searching activities were also conducted. Results: A total of 438 articles were initially retrieved and 249 duplicates removed leaving 192 articles that were screened by title, abstract and full text. Nine met the eligibility criteria and were included in the review. They were published from 2011 to 2018 and conducted in the USA (n = 6), Australia (n = 2) and Canada (n = 1). None of the studies offered insight into self-managing cancer within a rural-urban context in the UK. Studies used qualitative (n = 4), mixed methods (n = 4) and quantitative designs (n = 1). Conclusion: If rural and urban populations define their health in different ways as some of the extant literature suggests, then efforts to support self-management in both populations will need to be better informed by robust evidence given the increasing focus on patient-centred care. It is important to consider if residency can be a predictor of as well as a barrier or facilitator to self-management.

This chapter provides an overview of an aspect of a large research study conducted on the subject of learning transfer from an education institution to a mental health service in the English National Health Service (NHS). From a population of 64 trained staff, nurses and other workers, managers and supervisors were interviewed to gain a detailed understanding of how they sought to maintain and develop the new skills and knowledge they had acquired from an education programme delivered from an approved university provider. A total of 45 interviews were conducted using 1:1 or focus group approaches as part of a larger longitudinal study using a mixed methods design. This chapter provides an overview of the qualitative element of the study. Results indicated that whilst aspects of new learning and skill were maintained, many services were subject to pressure to change from the external political, economic and social environment that influenced the delivery of services such as that provided by the one within this study. This complex interaction between the ‘external’ and ‘internal’ healthcare environment is an issue that all educators should acknowledge when developing new and innovative education programmes for nurses and other professionals.