Medication disposal knowledge, attitude and practice among undergraduates: Implications for pharmacy education

BACKGROUND: Improper disposal of unused and expired medications contributes to environmental contamination and public health risks. Despite awareness efforts, disposal practices remain inconsistent and public education limited. Undergraduate students represent a key population for shaping long-term behaviors and understanding their knowledge, attitude and practice can inform educational strategies relevant to pharmacy education and public health. METHODS: A cross-sectional survey was conducted using a content-validated questionnaire via Microsoft Forms. A pilot study (n = 39) preceded the main survey (n = 108) among undergraduates from diverse disciplines. Data were analyzed using Chi-square/Fisher's exact tests and Spearman's correlation coefficients in IBM SPSS Statistics. RESULTS: Household waste was the most common disposal method (67.6%) and 56.5% had never used a community pharmacy for safe medication disposal. Higher knowledge scores correlated with confidence in advising others (r = -0.412, p < 0.001) and frequent use of community pharmacies (r = 0.213, p = 0.027). Higher attitude scores correlated with confidence (r = -0.356, p < 0.001) but not disposal frequency (r = 0.090, p = 0.354). Knowledge and attitude scores were positively correlated (r = 0.391, p < 0.001). Knowledge level was associated with academic program, prior disposal education and curriculum content; attitude level with academic program and curriculum content only. CONCLUSION: Undergraduates demonstrate inconsistent medication disposal practices and variable confidence, influenced by knowledge levels and educational exposure. These findings highlight opportunities for pharmacy education to address gaps in medication disposal knowledge and patient counselling skills. A structured, longitudinal pharmacy curriculum, progressing from foundational awareness to applied practice, patient education and community engagement may prepare future pharmacists to promote safe and sustainable medication disposal behaviors.