The research team evaluated a mobile application called Kelola Obatku, which translates roughly as Manage My Medicines, over a three-month period between August and November 2025. The study recruited 60 adults who managed medicines at home, owned an Android smartphone, and were not healthcare workers or trained in the health sciences. Participants were allocated into two groups of 30 each: an intervention group that used the application for three months, and a control group that received no digital intervention. The setting was Margahusada Pharmacy, a facility owned by the Central Java Provincial Government with ISO-standardized service procedures, and adherence to app use was monitored through door-to-door follow-up every two weeks.

What sets Kelola Obatku apart from a simple health information site is its breadth of functionality. The application bundles eight core features: a drug search tool, stock management for the home medicine supply, documentation of medication use, family member profiles, medication reminders, a locator for the nearest pharmacy, educational content, and direct consultation with a pharmacist. Together, these features cover the full lifecycle of a household medicine, from selection and purchase through use, storage, and eventual disposal. The design reflects a growing consensus in digital health that behavior change requires more than a one-off pamphlet; it needs tools that embed themselves into daily routines.

Before the intervention could be judged on its health outcomes, the researchers tested whether users actually found the app usable. They employed the validated Usefulness, Satisfaction, and Ease of Use questionnaire, which scored an overall eligibility rating of 80.33 percent, comfortably above the 70 percent threshold considered acceptable. The instrument itself showed strong psychometric properties, with an average content validity index of 0.97 across its five domains and a Cronbach’s alpha of 0.973, indicating excellent internal consistency. Users rated the app highly on usefulness, ease of learning, and satisfaction, and most said they would download and continue using it. The weakest signal, tellingly, appeared in a negatively worded item about inconsistencies in the interface, which half of respondents agreed with, suggesting room for polish in future versions.

The core outcome was measured with a validated knowledge, attitude, and practice questionnaire covering 29 knowledge items, 25 attitude items, and 27 practice items related to medication selection, purchasing, use, storage, and disposal. When the researchers compared the change scores between the two groups, the results were striking for two of the three domains. Knowledge improved significantly more in the intervention group, with a between-group difference yielding a p-value of 0.001, and attitudes followed with a p-value of 0.017. Within the intervention group alone, knowledge scores rose from an average of 20.70 to 25.83, and the proportion of respondents classified as having good knowledge climbed from 70 percent to 100 percent. Attitude improvements were similarly pronounced, with the share of good attitudes rising from about a third to nearly two-thirds.

Practice, however, told a more sobering story. Although practice scores trended upward in the intervention group, the between-group difference did not reach statistical significance, with a p-value of 0.688 and a delta score of only 0.9 points. This pattern echoes a well-established finding in health behavior research: knowledge and attitudes are comparatively easy to shift with education, but entrenched habits, such as regularly checking expiration dates, storing medicines away from heat and humidity, and returning unused drugs to pharmacies, take far longer to reform. The authors note that medication management practices are routines woven into everyday life, and that three months may simply be too short an exposure to break and rebuild them. Prior studies of mobile health interventions suggest stronger behavioral effects emerge when tools are sustained over longer periods.

The economic dimension of the study is where the stakes become tangible in rupiah. The researchers calculated the monetary value of leftover, damaged, and expired medicines in each household using the maximum retail price printed on packaging, multiplying remaining quantities by unit price. Within the intervention group, the value of damaged medicines fell significantly, from an average of about 12,293 IDR to 1,300 IDR per household, and the value of expired medicines dropped from roughly 10,330 IDR to 2,667 IDR, with p-values of 0.023 and 0.047 respectively. The control group showed a significant reduction only in damaged medicine value. Intriguingly, the intervention group also showed an increasing trend in the value of remaining medicines, which the authors interpret as a possible sense of confidence and safety in storing and managing a home supply.

Yet when the magnitude of change was compared directly between groups, none of the economic differences reached significance. The between-group p-values for remaining, damaged, and expired medicine values were 0.258, 0.781, and 0.330 respectively. The authors caution that household drug damage often stems from improper storage conditions, such as heat and humidity, and that much of the medicine accumulating in homes has not even expired, pointing instead to problems in purchasing and use patterns. The within-group improvements remain noteworthy as preliminary evidence, but the study’s small sample of 30 participants per group, justified by the Central Limit Theorem, limits statistical power, and the quasi-experimental design restricts causal claims.

One of the more interesting secondary findings concerned who benefited. When the researchers dichotomized demographic variables at their medians and tested associations with outcome changes, almost nothing predicted improvement. Age, gender, education, marital status, employment, and income showed no significant relationship with knowledge, attitude, or practice gains, nor with economic value reductions. The single exception was family size, which was significantly associated with attitude change at a p-value of 0.017. Larger households face more diverse medication needs and more complex decision-making dynamics, a pattern the authors connect to the PRECEDE-PROCEED model of health behavior, in which family characteristics act as predisposing factors shaping health attitudes. The broader implication is encouraging: the app’s benefits did not appear confined to any particular demographic slice.

The study arrives at a moment when Indonesia is grappling with the limits of offline approaches. A national program launched in 2019, Let’s Dispose of Medication Waste Properly, enlisted roughly 1,000 pharmacies to accept returned unused and expired medicines, but its long-term influence on public behavior has remained uncertain, and clear household-level disposal regulations are still lacking. Against that backdrop, the Central Java findings suggest that digital tools can lay the cognitive and attitudinal groundwork that policy alone has struggled to build. The authors are careful about scope: three months is short, the sample is modest, and practice change may demand longer exposure and repeated reinforcement. Still, the combination of strong usability scores, significant knowledge and attitude gains, and meaningful within-group reductions in the value of damaged and expired medicines positions apps like Kelola Obatku as a promising, low-cost complement to pharmacist-led education. Future studies with larger samples, longer follow-up, and more rigorous designs will determine whether a medicine cabinet cleaned up by an algorithm can stay that way.

Subject of Research: A mobile health intervention for improving household medication management, knowledge, attitudes, practices, and economic losses

Article Title: Digital intervention for household drug management: Impacts on knowledge, attitudes, practices, and economic losses

Article References: Fathnin, F. H., Satibi, S., Endarti, D., & Lazuardi, L. (2026). Digital intervention for household drug management: Impacts on knowledge, attitudes, practices, and economic losses. Pharmacia, 73, Article e200091. https://doi.org/10.3897/pharmacia.73.e200091

Image Credits: AI Generated

DOI: 10.3897/pharmacia.73.e200091

Keywords: mHealth, household medication management, Kelola Obatku, digital health intervention, KAP study, Indonesia, medicine disposal, expired medicines, quasi-experimental study, pharmacists, rational drug use, economic losses

The study, led by Sara M. Hanning of the University of Auckland’s School of Pharmacy with colleagues from the university and Middlemore Hospital, set out to answer three practical questions: how unwanted medicines are currently disposed of in community pharmacies, how many metered-dose inhalers are actually returned for disposal, and whether pharmacists would support a dedicated, low-carbon return scheme for inhalers. Between December 2023 and January 2024, an anonymous online questionnaire was emailed to 1,043 community pharmacies across New Zealand, drawn from the Medsafe pharmacy licence register. After reminders and data cleaning, 102 responses were complete enough for analysis, a response rate of roughly ten percent.

The headline finding was encouraging: 98 percent of responding pharmacies already collect unwanted or expired medicines for disposal, and most reported receiving returns at least weekly, with nearly 16 percent receiving them daily. The dominant disposal route was a dedicated pharmaceutical waste bin collected by a third-party contractor. In New Zealand, non-cytotoxic pharmaceutical waste is steam sterilised by autoclave and then sent to a dedicated landfill, because the country no longer operates any high-temperature incinerators for pharmaceuticals or other waste. Cytotoxic medicines are the exception, exported offshore for incineration.

But the survey also uncovered practices that fall short of the official pathway. Some pharmacies reported pouring liquid medicines down the sink, a method that introduces pharmaceutical compounds into wastewater, where they can persist through treatment plants and reach rivers and coastal waters. A handful of respondents said they returned unopened, in-date medicines to stock for re-dispensing, a practice the researchers warn against, since pharmacies cannot verify how medicines were stored once they left the premises. Others mentioned giving sealed, in-date medicines to medical aid charities or destroying controlled drugs by dissolving them into kitty litter. The variety of reported methods, the authors suggest, reflects a deeper problem: most pharmacists simply do not know what happens to waste after it leaves their premises. Only 15.7 percent felt informed or well informed about the fate of pharmaceutical waste, and 67.4 percent said they were not at all informed about the environmental impact of inhaler disposal.

The inhaler numbers were stark. Respondents estimated their pharmacies dispensed an average of 214 metered-dose inhalers per month, but received only about eight back for disposal, a return rate of under four percent. This aligns with earlier research showing that most consumers toss empty inhalers into household rubbish, despite consumer information leaflets instructing them to bring devices back to a pharmacy. Passive information channels, the authors conclude, are clearly not enough to change behaviour.

The climate stakes are considerable. Pressurised metered-dose inhalers accounted for 66 percent of inhalers prescribed in New Zealand in 2020, largely because they are cheaper than dry-powder or soft mist alternatives and better suited to patients who cannot generate the inspiratory force needed for powder devices, including children, older people and those with severe symptoms. The hydrofluorocarbon propellants they contain were introduced to replace ozone-destroying chlorofluorocarbons after the Montreal Protocol, but they are powerful greenhouse gases. A common propellant, HFA134a, has a heat-trapping potential roughly 1,300 times that of carbon dioxide, and a typical 200-puff salbutamol inhaler carries a footprint equivalent to 28 kilograms of carbon dioxide, comparable to driving a petrol car more than 120 kilometres. Because manufacturers fill canisters with excess propellant to guarantee every dose, gas remains even after all the medicine is used, and it lingers in the atmosphere for an average of 15 years.

When asked whether they would be interested in a dedicated recycling scheme for metered-dose inhalers, 42.7 percent of pharmacists said yes and 39.3 percent said maybe, with only 18 percent declining. The two biggest barriers, ranked by a weighted scoring method, were the administrative load on pharmacy staff and the financial cost to the pharmacy. The small number of inhalers returned by consumers ranked lowest among the barriers. Free-text comments captured the tension: one pharmacist wrote that they would want to know the procedure and full rationale first, since delivering medication was the priority and environmental concerns secondary; another noted that pharmacies spend significant staff time on returned medicines with no financial reimbursement, calling it yet another service community pharmacies provide for free.

Pharmacists also had clear views on what would motivate patients. Media advertisements promoting the scheme and financial incentives for returning inhalers ranked highest, while reminders at the point of dispensing ranked lowest, echoing the finding that passive advice has little effect. International evidence suggests such schemes can work. A 12-month postal pilot in one English region collected more than 20,000 inhalers, 77 percent of them pressurised devices, and recycled the propellant gases for refrigeration, the aluminium canisters into smelting bricks and the plastic casings into pellets, preventing an estimated minimum of 119 tonnes of carbon dioxide equivalent from entering the atmosphere. Yet scale matters: the UK’s Complete the Cycle scheme, which recycled two million inhalers over nine years, closed in 2020 because its creator concluded that a standalone scheme could not achieve adequate scale without industry-wide cooperation. In New Zealand, a six-month inhaler recycling trial began in the Bay of Plenty in June 2025, and a refrigerant destruction facility using plasma arc technology is under construction in the North Island, potentially offering a domestic route for capturing and destroying propellant gases.

The researchers argue that a product stewardship model, in which responsibility is shared across manufacturers, importers, distributors, pharmacies and consumers, may be the fairest path forward, with pharmacies forming one link in a larger technological chain. New Zealand already has precedent for such schemes with synthetic refrigerants, and the regulatory and administrative infrastructure exists. To ease the burden on pharmacies, the authors propose a scheme that integrates seamlessly with existing medicine return systems, supported by centralised automated administration, government funding, space-conscious collection containers and regular scheduled pick-ups. Consumer-side measures could range from money-back incentives on prescription costs, as trialled in Sweden, to low-cost local prize draws like one running at a general practice on Vancouver Island, Canada.

The study has limitations the authors acknowledge candidly. The ten percent response rate, likely worsened by staffing shortages, pharmacist burnout and the timing of invitations over the Christmas and New Year holiday period, means the sample may over-represent pharmacists already interested in sustainability, potentially inflating estimates of willingness to participate. Still, the direction of the findings is clear: pharmacies overwhelmingly accept returned medicines, most feel responsible for safe disposal, and most are open to an inhaler scheme if cost and paperwork are addressed. The next phase of the research will use semi-structured interviews with pharmacists and inhaler users to map barriers and encouragers in more detail, alongside work to establish cost-effective pathways for emptying and decontaminating canisters so that aluminium and plastic components can re-enter the circular economy. With New Zealand committed to cutting net carbon dioxide emissions to 50 percent below 2005 levels by 2030 and reaching net zero for most greenhouse gases by 2050, capturing the greenhouse gases hiding in medicine cabinets and rubbish bins may prove one of the quieter but more achievable wins in healthcare’s climate transition.

Subject of Research: Pharmaceutical waste disposal practices in community pharmacies and the feasibility of a low-carbon return scheme for metered-dose inhalers in New Zealand

Article Title: Disposal practices for unwanted medicines in New Zealand community pharmacies and their willingness to support a low-carbon return scheme for metered-dose inhalers

Article References: Hanning, S. M., Barnes, M., Burrell, R., & Aspden, T. J. (2026). Disposal practices for unwanted medicines in New Zealand community pharmacies and their willingness to support a low-carbon return scheme for metered-dose inhalers. Clean Technologies and Environmental Policy, 28(10), Article 262. https://doi.org/10.1007/s10098-026-03622-5

Image Credits: AI Generated

DOI: 10.1007/s10098-026-03622-5

Keywords: community pharmacy, pharmaceutical waste, metered-dose inhalers, hydrofluorocarbons, greenhouse gas emissions, inhaler recycling, New Zealand, planetary health, medicine disposal, product stewardship, environmental sustainability, asthma