Implementing environmentally sustainable behavior in healthcare: an illustration of why behavioral definitions matter

Abstract Background Implementing more sustainable practices is crucial for reducing the environmental footprint of the healthcare sector. While organizational factors such as availability of sustainable materials are important, healthcare professionals’ adoption of sustainable behavior is also associated with psychological factors. This study examines how associations between psychological factors and such behaviors differ between general and material-specific definitions of the behavior of interest. Methods Secondary analyses on global cross-sectional survey data from 594 surgeons across 75 countries (Age M = 45, SD = 11.2; 70.7% male; 74.2% from European region). A psychological network approach was employed to provide insight into psychological factors’ associations with reusable surgical instrument choice (method EBICglasso). Results General consideration of environmental impact when selecting surgical instruments shows the strongest association with feeling responsible for generally reducing the environmental impact of surgical practice (edge weight 0.30). However, when examining behavioral intentions regarding specific reusable surgical instruments (i.e., trocars, clip applicators) or textiles (i.e., drapes, gowns), associations between responsibility and behavioral intentions are comparable to or even weaker than associations with other psychological factors such as the perceived strain of making surgical practice more sustainable (edge weights varying between 0 and 0.09, depending on the surgical material). Moreover, for specific reusable materials, results show a more diverse pattern in which psychological factors are related to specific materials. Conclusions This study illustrates how the pattern of associations between psychological factors and environmentally sustainable behavior in surgical practice varies depending on how the behavior of interest is defined. This finding emphasizes the importance of behavioral definitions for efforts to reduce the environmental impact of healthcare. Stakeholders who aim to identify levers for behavior change are recommended to carefully define the behavior they aim to change, which may reduce the risk of focusing on psychological factors that are insufficiently related to the behaviors of interest, or overlooking factors that are indeed important.