KNOWLEDGE, ATTITUDE, AND PRACTICES REGARDING ECOPHARMACOLOGY AMONG NURSING STUDENTS IN MANDYA

KNOWLEDGE, ATTITUDE, AND PRACTICES REGARDING ECOPHARMACOLOGY AMONG NURSING STUDENTS IN MANDYA

T. E. Divya *, H. Nagabushan, N. G. Chandan and T. S. Arjun Gowda

Department of Pharmacology, Mandya Institute of Medical Sciences, Mandya, Karnataka, India.

ABSTRACT: Background: Pharmaceuticals released into the environment pose ecological and public health concerns. Ecopharmacology, which addresses the adverse effects of pharmaceuticals on the environment, remains underexplored among healthcare students. This study aimed to assess the knowledge, attitude, and practices regarding ecopharmacology and safe drug disposal among nursing students. Materials and Methods: A cross-sectional study was conducted among 172 nursing students in Mandya city. The responses were collected using a pre-tested structured questionnaire that comprised demographics, knowledge (7 items), attitude (8 items), and practice (7 items). Data were analysed using descriptive statistics. Results: Among the 172 nursing students who participated in the study, awareness of ecopharmacology and existing guidelines for drug disposal was limited. Although attitudes towards environmental protection were largely positive, unsafe disposal practices were commonly reported. Conclusion: The present study showed that nursing students had a positive attitude towards ecopharmacology, but demonstrated limited knowledge and engaged in unsafe drug disposal practices. Enhancing awareness programmes and establishing accessible drug disposal facilities are essential to promote safe drug disposal practices.

Keywords: Ecopharmacology, Nursing students, Drug disposal

INTRODUCTION: The global use of pharmaceutical products is steadily increasing, leading to their continuous release into the environment. Due to their chemical stability and persistence, many pharmaceuticals tend to accumulate in the environment. Even drugs that are easily degradable may still pose environmental risks due to their constant introduction from multiple sources ¹. Ecopharmacology refers to the entry of pharmaceuticals into the environment through various routes and at concentrations that may disrupt ecological balance. Major sources of pharmaceutical entry include industrial activities, as well as human and veterinary use.

Green chemistry focuses on designing chemical products and processes that reduce or eliminate the use and generation of hazardous substances. Green pharmacy is an approach that evaluates and manages the entire lifecycle of pharmaceutical products to minimize environmental impact, from research and manufacturing to their use and final disposal ². Contaminants of emerging concern (CECs) include synthetic or natural chemicals and biological agents that are newly detected in the environment and are known or suspected to pose risks to human health and ecosystems ³.

Pharmaceuticals and personal care products such as analgesics, antibiotics, antidepressants, antiepileptics, hormones, anticancer agents, veterinary medicines, and cosmetic ingredients are regarded as contaminants of emerging concern. Approximately 4,000 pharmaceuticals are currently in use worldwide, of which about 600 have been detected in the environment. The highest environmental risks are associated with hormones, antibiotics, analgesics, antidepressants, anticancer agents, and veterinary antiparasitic drugs ¹. India is one of the major global suppliers of pharmaceuticals. However, the absence of effective CEC management has resulted in the detection of high levels of pharmaceutical residues in wastewater treatment plants ⁴. Pharmaceuticals have also been detected in several major rivers in India such as Cooum, Ganga, and Yamuna ⁵. A landmark study by Larsson et al. reported exceptionally high antibiotic concentrations in industrial effluents from Patancheru, near Hyderabad, India ⁶.

Human and veterinary use of pharmaceuticals results in the release of drug residues into the environment through the excretion of parent compounds and active metabolites in urine and faeces ^{2, 7}. In addition, improper drug disposal practices contribute to environmental contamination ¹. Environmental exposure to pharmaceuticals has been associated with several adverse biological effects, including feminization of male fish due to estrogen exposure, decline of vulture population following exposure to diclofenac, development of resistant bacteria, and aggressive behaviour in lobsters exposed to antidepressants ^{8, 9}.

Recognizing the growing environmental and public health concerns associated with improper drug disposal, the Central Drugs Standard Control Organization (CDSCO) issued official guidelines in May 2025 for the safe disposal of expired and unused drugs. These guidelines recommend various drug disposal methods such as engineered sanitary landfills, encapsulation, inertization, and incineration. Community-level initiatives, such as authorized drug take back programmes and a small flush list for certain high-risk drugs are also recommended. Open dumping and uncontrolled burning are strongly discouraged due to their potential to cause soil, water, and air contamination ¹⁰.

The effectiveness of these guidelines depends on public awareness, stakeholder commitment, and the availability of appropriate disposal infrastructure. As frontline healthcare providers, nurses play a key role in patient education, and promotion of safe drug disposal practices.

Hence, this study was designed to assess and describe the knowledge, attitude, and practices related to ecopharmacology among nursing students.

MATERIALS AND METHODS: A cross-sectional study was carried out over a period of two months among nursing students studying in nursing colleges in Mandya city, Karnataka. A total of 172 nursing students participated in the study. The sample size was determined based on a previously published similar study ¹¹. Participants were recruited using convenience sampling.

Inclusion Criteria: Nursing students willing to give written informed consent to participate in the study.

Exclusion Criteria: Students who were on long-term leave or not available during the data collection period.

Ethical Considerations: The study was conducted after obtaining approval from the Institutional Ethics Committee of MIMS, Mandya (IEC No: MIMS/IEC/2025/1137). Written informed consent was obtained from all participants after explaining the purpose and voluntary nature of the study prior to data collection.

Data Collection: Data were collected using a predesigned, structured, self-administered questionnaire. The questionnaire was developed based on relevant literature and adapted from previously published studies on ecopharmacology ^{2, 11, 12}. The questionnaire was reviewed by subject experts to establish content validity and was pilot tested among a small group of nursing students to ensure clarity and ease of understanding. Necessary modifications were made prior to final administration.

The questionnaire comprised four sections: demographic details, knowledge (7 items), attitude (8 items), and practice (7 items) related to ecopharmacology and safe drug disposal. Participants completed the printed questionnaire under the supervision of the researcher. Completed questionnaires were collected immediately after completion and securely stored for further analysis.

Statistical Analysis: The collected data were entered and analyzed using Microsoft Excel. Descriptive statistics like frequencies and percentages were used for categorical data such as demographic characteristics like age, gender, year of study, and responses to knowledge, attitude, and practice questions.

RESULTS: A total of 172 nursing students participated in the study, with a mean age of 20.27 ± 1.37 years. The majority of participants were female (95.3%).

Knowledge about Ecopharmacology: Overall knowledge regarding ecopharmacology and related concepts was limited among the participants. Awareness of the term ecopharmacology, green pharmacy, and drug take back programmes was low, while awareness of official government guidelines for the safe disposal of unused or expired medicines was comparatively better (Table 1).

Most participants were aware that improper disposal of medicines can lead to environmental pollution. However, awareness regarding the role of improper drug disposal in the development of antimicrobial resistance was relatively poor (Table 2).

Regarding the sources of pharmaceutical entry into the environment, improper disposal was considered a major contributor (Fig. 1).

TABLE 1: KNOWLEDGE REGARDING ECOPHARMACOLOGY AND RELATED CONCEPTS

TABLE 2: KNOWLEDGE REGARDING ENVIRONMENTAL IMPACT OF IMPROPER DRUG DISPOSAL

FIG. 1: SOURCES OF PHARMACEUTICAL ENTRY INTO THE ENVIRONMENT

Attitude towards Ecopharmacology: Assessment of attitude revealed an overall positive attitude towards safe drug disposal and environmental protection. Most participants supported the establishment of dedicated collection facilities, and a strong sense of personal responsibility towards environmental protection was also evident (Table 4). Additionally, the majority (76.2%) expressed willingness to participate in awareness programmes related to pharmaceutical waste management. With regard to measures required for stricter implementation of existing disposal guidelines, increased public awareness (45.3%) was the most commonly suggested approach.

TABLE 3: CONCERN REGARDING DISPOSAL OF UNUSED AND EXPIRED DRUGS

TABLE 4: ATTITUDE TOWARDS SAFE DRUG DISPOSAL

Practices Related to Ecopharmacology: Drug disposal practices among the participants were poor. The most common drug disposal method was discarding in household waste. Other unsafe methods of disposal such as burning the medicines were also noted. Environmentally safer practices, including returning medicines to pharmacies or authorized collection facilities were infrequently followed (Fig. 2). Participation in formal training programmes, workshops, or awareness campaigns related to ecopharmacology was also minimal (Table 6).

TABLE 5: PRACTICES RELATED TO MEDICINE DISPOSAL

FIG. 2: METHODS OF DISPOSAL OF UNUSED AND EXPIRED MEDICINES

TABLE 6: TRAINING AND AWARENESS RELATED TO ECOPHARMACOLOGY

DISCUSSION: The present study assessed the knowledge, attitudes, and practices related to ecopharmacology among nursing students and identified a clear gap between knowledge, attitudes, and actual drug disposal behaviours. Overall, the findings indicate poor knowledge, largely positive attitudes, and inadequate drug disposal practices.

Awareness of ecopharmacology and related concepts such as green pharmacy and drug take back programmes was low among the participants. This level of awareness was lower than that reported in several studies conducted among nursing students and other healthcare professionals across India ^11-14. These differences likely reflect regional variation in curricular exposure and institutional emphasis on ecopharmacology. Similarly, awareness regarding official government guidelines in India for the safe disposal of unused or expired medicines was limited in the present study. This finding was comparable to that reported by Khanavkar et al.¹² In contrast, Nagarajan et al. reported comparatively higher level of awareness among their study participants ¹⁵. Such variation may be attributed to differences in dissemination of regulatory guidance among healthcare students. Despite limited conceptual knowledge, most participants recognized that improper disposal of medicines could lead to environmental pollution. A similar finding has been reported in previous studies ^{16, 17}. However, awareness regarding the link between improper drug disposal and antimicrobial resistance was lower in the present study compared with reports by Dhapola et al. and Javed et al.^{11, 18} This highlights a significant gap in understanding an important public health concern related to pharmaceutical waste management.

Attitudes toward safe drug disposal were generally positive. Most participants acknowledged their responsibility in protecting the environment from the harmful effects of improper drug disposal. However, this finding was lower than that reported in some earlier studies ^{11, 19}. This suggests the need for additional measures to cultivate a stronger sense of responsibility towards the environment. Support for stakeholder involvement, including pharmaceutical manufacturers and pharmacies in medicine collection programmes, was comparatively lower than that reported in other studies ^{11, 20}. This highlights the importance of educating students about the collaborative roles of various stakeholders in safe medicine disposal. Although a majority of participants expressed willingness to participate in pharmaceutical waste management awareness campaigns, this was lower than that observed in previous studies ^{11, 13}. This underlines the potential gaps in promoting active participation and the need for strategies to increase student involvement.

Regarding medicine purchasing practices, most students avoided bulk purchase of medicines, reflecting cautious medicine purchasing behavior. This finding was higher compared to reports by Javed et al. and Sriman et al.^{18, 21} Only a minority of participants reported receiving instructions on safe medicine disposal, with levels lower than those reported in some studies and higher than in others ^{11, 22}. This suggests that existing educational approaches may be insufficient in promoting adequate knowledge regarding proper medication disposal among healthcare students. Disposal practices were largely inappropriate, with most participants discarding unused or expired medicines in household trash. Similar disposal patterns have been consistently reported among healthcare students ^{11, 14}. Studies by Menon et al. and Narasimhaiah et al. also identified household trash as the predominant method of drug disposal ^{23, 24}.

Limitations: The cross-sectional design restricts the ability to determine the relationship between knowledge, attitudes, and practices. The use of convenience sampling and small sample size limits the representativeness and generalizability of the findings. Additionally, the sample was confined to nursing students in a particular city, which may not reflect the perspectives of students in other regions or healthcare disciplines. Furthermore, the study relied on self-reported responses, which may be subject to recall bias and social desirability bias. The analysis was limited to descriptive statistics, and the absence of inferential analysis restricts the ability to identify statistically significant associations between variables.

CONCLUSION: The present study identified notable gaps in knowledge and practices related to ecopharmacology and safe drug disposal among nursing students, despite generally positive attitudes. Awareness of core concepts such as ecopharmacology, green pharmacy, and official disposal guidelines was limited. Unsafe disposal methods, particularly disposal in household trash, were commonly practiced. Integrating ecopharmacology into the nursing curriculum, strengthening institutional awareness programmes, and establishing accessible drug disposal facilities are essential to translate positive attitudes into appropriate practices.

ACKNOWLEDGEMENT: Nil

CONFLICTS OF INTEREST: Nil

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    How to cite this article:

    Divya TE, Nagabushan H, Chandan NG and Gowda TSA: Knowledge, attitude, and practices regarding ecopharmacology among nursing students in Mandya. Int J Pharm Sci & Res 2026; 17(5): 1573-79. doi: 10.13040/IJPSR.0975-8232.17(5).1573-79.

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