Pharmacy students’ and pharmacy professionals’ knowledge, perception, and attitude regarding environmental sustainability in pharmacy practice: a systematic review

Abstract Objectives The environmental impact of healthcare systems represents a significant global challenge. Evaluating how pharmacy students and pharmacy professionals understand and perceive environmentally sustainable practices is crucial for reducing the healthcare industry’s ecological footprint. This systematic review aimed to critically assess and synthesize the existing evidence on the knowledge, attitudes, and perceptions of pharmacy students and pharmacy professionals regarding environmental sustainability (ES) in pharmacy practice, identifying facilitators and barriers that influence their engagement. Methods A systematic review was conducted following Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. Seven databases were searched using a prespecified search string for studies published in English between 2011 and 2024. Quality assessment was performed using the National Heart, Lung, and Blood Institute tool for cross-sectional studies, Consolidated Criteria for Reporting Qualitative Research checklist for qualitative research, and Mixed Methods Appraisal Tool for mixed-methods studies. Data were synthesized narratively due to methodological heterogeneity. Key findings Fifteen studies from 11 countries were included. While most pharmacy students and pharmacy professionals recognized environmental risks associated with pharmaceutical waste, significant knowledge gaps existed regarding proper disposal practices, ecopharmacovigilance, and broader ES concepts. Despite positive attitudes toward ES, participants often struggled to translate awareness into action, citing barriers such as a lack of formal training, unclear guidelines, and limited systemic support. Both students and pharmacy professionals expressed a strong interest in enhancing ES education and training. Conclusions This review highlighted the need for comprehensive integration of ES principles in pharmacy education and practice using a structured approach. Additionally, future efforts should focus on developing clear guidelines, enhancing professional training, and establishing supportive infrastructure for ES in pharmacy practices.