Barriers and facilitators to recycling waste in hospitals: a mixed methods systematic review

Hospitals generate large amounts of waste, part of which is recyclable. However, research shows that recycling opportunities in hospitals often get missed with human behaviour playing an important role. Following current behavioural science, better understanding the influences on hospital recycling behaviour can support the design of promising behaviour change interventions, which draw on identified facilitators and help overcome identified barriers, to maximise recycling potential. Therefore, this systematic review aimed to investigate the barriers and facilitators to hospital waste recycling. Three databases were searched to identify studies in high-income countries, pertaining to barriers and facilitators to hospital waste recycling. Their findings were thematically analysed and narratively synthesised drawing on a combination of the Capability, Opportunity, Motivation – Behaviour (COM-B) model with a multi-level framework. Twenty-four studies met pre-defined inclusion criteria. Reported influences on hospital waste recycling pertained to factors beyond the hospital environment (e.g. product design preventing recycling), the internal hospital environment (e.g. lack of access to recycling bins) and individuals working within hospitals (e.g. concerns about infection control). Most influences were located in the internal hospital environment. Many related to the physical opportunity of recycling behaviour, with the most dominant barriers being difficulties accessing appropriate recycling bins and lack of information or education on recycling. This overview of barriers and facilitators to hospital waste recycling will aid researchers and practitioners in designing hospital waste recycling interventions addressing key identified influences. Combining the COM-B model with a multi-level framework allowed for identified influences to be organised in a nuanced manner.